Tomographic Biomarkers Predicting Progression to Fibrosis in Treated Neovascular Age-Related Macular Degeneration: A Multimodal Imaging Study

Hyperreflective material as a biomarker in neovascular age-related macular degeneration

“…An interesting feature of HRM is the layered appearance reported by Kumar et al [37] which has been associated with poor visual acuity outcome. This layered appearance had been previously reported under different terminologies including hyperreflective line over HRM and splitting of RPE [23]. These [23,39].…”

“…This layered appearance had been previously reported under different terminologies including hyperreflective line over HRM and splitting of RPE [23]. These [23,39].…”

“…Several studies corroborated these findings and showed that the clinical course of HRM influences visual outcome of anti-VEGF therapy. We and others have shown that eyes with undefined HRM or no HRM prior to treatment are less likely to progress to fibrosis and have better visual outcomes as compared to eyes with defined HRM or extensive HRM at baseline [23,[35][36][37]. Moreover, a decrease in HRM thickness and volume after treatment correlates with an improvement in visual acuity 12 months after initiation of treatment [38].…”

“…The appearance of HRM changes considerably with treatment and it has been recenlty showed that HRM before initiation of treatment is usually subretinal, has undefined boundaries and is highly associated with the presence of fibrin [15]. Conversely, after initiation of treatment HRM becomes well defined in a high proportion of eyes and therefore may represent the development of mature vascular complexes and conversion to a more fibrotic phenotype [23].…”

“…Indeed eyes presenting with well-defined HRM have the highest risk of scarring, whereas those with undefined HRM have a lower risk [15]. Other features of HRM such as well-defined borders prior to initiation of therapy, high reflectivity, a zone of separation between HRM and the outer retina, a layered appearance, subretinal hyperreflective spots, thicker and wider HRM have been shown to correlate with poor visual outcome [23,[35][36][37].…”