Hyper-reflective foci in diabetic macular edema are closely associated with disease severity and progression, according to findings published in Investigative Ophthalmology & Visual Science. Esther L. von Schulthess, MD, and colleagues examined the baseline distribution of hyper-reflective foci (HRF) and their relationship with disease parameters using automated spectral-domain OCT (SD-OCT) segmentation with data from 1,527 SD-OCT volume scans. HRF were prevalent in almost all patients included in the study (99.7%). Median HRF volume within the 3-mm Early Treatment Diabetic Retinopathy Study ring was 1,964.3 picolitres, with a median count of 64.0. According to Dr. von Schulthess and colleagues, HRF volumes correlated significantly with worse best-corrected visual acuity (BCVA), increased central subfield thickness (CST), and greater cystoid intraretinal fluid (IRF) volume (all nominal P<0.0001). HRF were found to co-localize with IRF in the en face projection. The results highlight the potential of automated HRF analysis using SD-OCT to assess disease severity and progression in DME, providing valuable insights for clinical management and therapeutic monitoring, according to von Schulthess and colleagues.