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The following is a summary of “Hyperreflective Foci Along the Retinal Pigment Epithelium Predict the Onset of Large Choroidal Hypertransmission Defects in AMD,” published in the February 2025 issue of American Journal of Ophthalmology by Berni et al. 

Researchers conducted a retrospective study to analyze whether the location of hyperreflective foci (HRF) along the retinal pigment epithelium (rpeHRF) or intraretinal HRF (iHRF) predicted progression from intermediate age-related macular degeneration (iAMD) to large persistent choroidal hypertransmission defects (hyperTDs).  

They analyzed a natural history database of eyes with AMD imaged with swept-source optical coherence tomography (SS-OCT). En face images from choroidal slabs positioned 64 µm to 400 µm beneath Bruch’s membrane were analyzed with a semi-automated algorithm to quantify hypotransmission defects (hypoTDs) within a 5 mm fovea-centered circle, iHRF were identified on B-scans as hyperreflective lesions within the neurosensory retina, while HRF along the rpeHRF were noted as areas of RPE thickening. Multivariable survival analysis assessed whether iHRF or rpeHRF area measurements predicted the onset of the first large persistent choroidal hyperTD.  

The results showed that among 171 eyes with iAMD, 82 (48%) developed at least 1 large persistent choroidal hyperTD over a median follow-up of 59.1 months. Univariable Cox regression analyses indicated significant associations between hyperTD onset and rpeHRF area (P <0.001), iHRF area (P =0.003), and drusen volume (P <0.001). However, the multivariable Cox regression model identified only the rpeHRF area as a significant predictor of disease progression (P <0.001).  

Investigators concluded that in iAMD eyes, rpeHRF area was a stronger predictor of disease progression than drusen volume or iHRF, indicating rpeHRF as a potential indicator of focal atrophy and hyperTD formation. 

Source: ajo.com/article/S0002-9394(25)00080-7/abstract