Analysis of Hyperreflective Dots Within the Central Fovea in Healthy Eyes Using En Face Optical Coherence Tomography

The purpose of this retrospective study was to describe and quantify superficial hyperreflective dots within the central fovea and correlate them with age, using en face and cross-sectional B-scan optical coherence tomography (OCT).

Healthy eyes, evaluated with a spectral domain instrument (primary cohort) at the Stein Eye Institute (UCLA) and with a swept source instrument (secondary cohort) at the Vitreous Retina Macula Consultants of New York, were included in this study. En face OCT images (3 × 3 mm) segmented at the level of the superior vascular plexus were acquired, and hyperreflective dots in the foveal avascular zone were quantified by two different methodologies. The threshold reflectivity methodology quantified these dots on a cropped en face OCT image using ellipsoid zone mean reflectivity as the threshold cutoff. The OCT B-scan methodology consisted of a manual count of elevated hyperreflective signals on B-scans that colocalized with the dots by en face OCT. Primary outcome was to quantify these dots and correlate them with age.

A total of 44 healthy eyes were evaluated in the primary cohort, and 16 healthy eyes were evaluated in the secondary cohort. The hyperreflective dots steadily increased in number, especially in patients older than 50 years of age, with a strongly positive statistical significant correlation, using both quantitative strategies.

Remarkable superficial hyperreflective dots in the central fovea of healthy subjects are novel anatomical findings that may be readily identified with both en face and cross-sectional OCT and steadily increase in number with age. We propose that these dots may represent a normal anatomical landmark, such as Müller cell end feet or inner limiting membrane basal lamina.