Hyperreflective foci in predicting the treatment outcome of antivascular endothelial growth factor in neovascular age-related macular degeneration

Purpose To describe the optical coherence tomographic findings of hyperreflective foci (HF) in neovascular age-related macular degeneration and evaluate the use of HF to predict visual outcome after antivascular endothelium growth factor (anti-VEGF) therapy. Methods This was a post-hoc analysis of a retrospective cohort study. Hyperreflective foci were localized in the inner retina, outer retina, or subretinal fluid (SRF) layer. The treatment response of HF was recorded. The association between HF and visual outcome was analyzed. Results We enrolled 126 eyes. Hyperreflective foci involving more than one layer were associated with poor initial visual acuity (P < 0.001). Hyperreflective foci in each layer at baseline were negatively correlated with baseline visual acuity. At 3 months posttreatment, HF in the SRF layer had decreased significantly (P = 0.003), which was faster compared with HF in other layers. Baseline HF status at each layer was not associated with final visual outcome. The eyes with reduced HF in the SRF at 3 months had better visual improvement at 12 months (P = 0.038). Conclusion Hyperreflective foci involving multiple layers were associated with poor initial visual acuity but not with final visual outcome. With anti-VEGF treatment, HF in the SRF layer resolved faster, which may predict better visual outcome.