Quantification of Hyperreflective Foci in Age-related Macular Degeneration by Polarization-Sensitive OCT

To quantify hyperreflective foci (HRF) using polarization-sensitive OCT (PS-OCT) and evaluate the effect of anti-VEGF therapy on HRF reduction.

Retrospective study.

Twelve eyes from 12 patients with neovascular age-related macular degeneration (nAMD) who underwent PS-OCT imaging before and after 4 intravitreal injections of faricimab, administered every 4 weeks.

Retinal layers between the inner border of the inner nuclear layer and the outer border of the outer segment of photoreceptors were analyzed. Regions with entropy values exceeding the mean + 2 standard deviations from healthy controls (entropy: 0.0896 ± 0.0270) were isolated to quantify hyperentropic foci (HEF), representing HRF.

The sum and area of HEF were calculated as total HEF and area aggregate to compare before and after the treatment.

The mean patient age was 77.4 ± 8.6 years, with an equal distribution of males and females (6 each). Total HEF was significantly associated with worse baseline visual acuity (coefficient: 0.0015297, P = 0.0004). Faricimab treatment significantly reduced both total HEF (P = 0.0049) and area aggregate (P = 0.0068). However, conventional OCT did not detect significant improvements in total reflectivity nor area aggregate.

Polarization-sensitive OCT is a valuable imaging modality for extracting and quantifying HRF in the neurosensory retina. Faricimab significantly reduces HEF in nAMD eyes, highlighting its potential therapeutic effect beyond conventional OCT-detected changes.

Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.