Intraretinal Hyper-Reflective Foci Are Almost Universally Present and Co-Localize With Intraretinal Fluid in Diabetic...

Area of Science:

• Ophthalmology
• Medical Imaging
• Diabetic Retinopathy Research

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Hyper-reflective foci (HRF) on spectral-domain optical coherence tomography (SD-OCT) are associated with DME severity and progression.

Purpose of the Study:

• To investigate the baseline distribution of HRF in DME using an automated approach.
• To assess the co-localization of HRF with cystoid intraretinal fluid (IRF) in DME patients.

Main Methods:

• Automated segmentation of HRF using a deep-learning algorithm on SD-OCT volume scans (N=1527) from YOSEMITE and RHINE trials.
• Analysis of HRF count and volume in relation to best-corrected visual acuity (BCVA), central subfield thickness (CST), IRF volume, and Diabetic Retinopathy Severity Scores (DRSS).
• Calculation of HRF and IRF co-localization using en face projection within the central 3-mm diameter.

Main Results:

• HRF were present in nearly all patients (up to 99.7%).
• Increased HRF volume correlated with decreased BCVA, increased CST, increased IRF volume, and higher DRSS.
• HRF were found to co-localize spatially with IRF.

Conclusions:

• Automated HRF segmentation in SD-OCT volumes confirms HRF as a ubiquitous feature in DME.
• HRF demonstrate significant relationships with key clinical markers (BCVA, CST, IRF, DRSS), supporting their role in DME severity.
• The spatial distribution of HRF closely mirrors that of IRF, indicating a potential shared pathophysiological mechanism.