Advantages of Optical Coherence Tomography as a High Dynamic Range Imaging Modality in Subretinal Hyperreflective Material

Abstract

Purpose: To describe the utility of high dynamic range optical coherence tomography imaging to study subretinal hyperreflective material (SHRM) in patients with age-related macular degeneration.Methods: Clinical information including visual acuity and optical coherence tomography images (Heidelberg Engineering GmbH, Heidelberg, Germany) of patients undergoing antiangiogenic treatment for neovascular age-related macular degeneration and showing SHRM at baseline were retrospectively reviewed. Contrast between strong signal structures (high dynamic range image) reclassifying SHRM as hyperreflective (HyperR), isoreflective, and hyporeflective was increased. The patients at baseline, 3, 6, and 12-months follow-up were evaluated.Results: Forty-four eyes were classified as 15 HyperR (34.1%), 21 as isoreflective (47.7%), and eight as hyporeflective (18.2%). During follow-up, hyporeflective SHRM disappeared in all cases, isoreflective SHRM faded in 16 cases (76.2%); HyperR SHRM remained in all cases. Hyporreflective SHRM showed a greater visual acuity improvement than HyperR SHRM group (P = 0.033). After 12-month follow-up, only the hyporeflective and isoreflective groups significantly reduced the presence of fluid in 37.5% (P = 0.250) and 46.62% (P = 0.006) of the patients, respectively; outer retinal layers were disrupted more frequently in the presence of HyperR SHRM (ellipsoid zone, P = 0.16; external limiting membrane, P = 0.007).Conclusion: Contrast-enhanced optical coherence tomography images enabled us to classify SHRM according to its reflectivity, showing groups with different disappearance rates, visual acuity improvement, and outer retinal layer disruption. This easy-to-access tool may be helpful as a prognostic factor in neovascular age-related macular degeneration cases.

Retinal neurodegeneration in age-related macular degeneration

“…Of note, the presence of macular complications associated with neovascular AMD (i.e., submacular hemorrhage) may be associated with a greater neurodegeneration in these eyes. 33 Using structural OCT to quantify the EZ reflectivity in exudative neovascular AMD eyes, Riedl et al 34 investigated 185 patients undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy. At baseline, EZ integrity was predominantly impaired in the fovea, showing progressive recovery during anti-VEGF therapy.…”

“…Of note, the presence of macular complications associated with neovascular AMD (i.e., submacular hemorrhage) may be associated with a greater neurodegeneration in these eyes. 33…”