Hyperreflective Foci May Reveal Age-Related Macular Degeneration Severity

Hyperreflective foci (HRF) may serve as a biomarker for intermediate age-related macular degeneration (AMD) due to their high correlation with other AMD biomarkers, according to research published in Ophthalmology Retina. The study shows that the presence of HRF is associated with higher severity levels of AMD and worse dark adaptation function.

Researchers included 281 eyes from 158 participants older than 50 years (median age, 73.1 years) with different AMD severities, including patients without AMD, between May 2011 to March 2022 in analysis. Participants underwent color fundus imaging and optical coherence tomography (OCT) assessment to identify AMD severity and subretinal drusenoid deposits. Dark adaptation assessment was performed in 1 eye per patient designated as the study eye (drusen ≥125 µm, non-advanced AMD, visual acuity ≥20/63) to determine rod intercept time. An investigator chose 1 eye as the study eye if both eyes met the criteria.

The presence of HRF was detected more frequently in patients with higher AMD severities and was significantly associated with the presence of hyperpigmentation  (odds ratio [OR], 832.9; P <.001) and subretinal drusenoid deposits (OR, 9.42; P =.017). 

Eyes with HRF showed significantly longer dark adaptation, compared with eyes without HRF (median, 27.1 vs 13.5 minutes), but a shorter adaptation period compared with eyes with subretinal drusenoid deposits and no other structural or functional AMD features (40 [IQR=28-40] minutes). The longest rod intercept times were observed in eyes with both HRF and subretinal drusenoid deposits (40.0 [IQR=40-40] minutes). 

“The design of this study population allowed us to investigate the presence of HRF across all levels of AMD severity, as well as aged eyes without AMD,” the study authors note. “The longitudinal analysis demonstrated that, once an eye has HRF, it is very likely to continue to demonstrate HRF presence over years of follow-up; this shows that the finding is generally not a transient feature but rather one that persists into advanced disease.”

This study was limited by the subjective nature of the grading and single center design.