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  • Hyperreflective Foci and Hyperreflective Specks Linked to Impaired Dark Adaptation

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, November 2020

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    In longitudinal studies of age-related macular degeneration (AMD), the presence of hyperreflective foci (HRF) at baseline signals risk for progression to advanced disease. Echols et al. as­sessed the impact of HRF on rod- and cone-mediated function in the macula. They also explored the association of hyperreflective specks (HRS) with visual dysfunction. They found that both HRF and HRS are strongly asso­ciated with delayed rod-mediated dark adaptation, which has been found to be accentuated as AMD progresses.

    For this cross-sectional study, the researchers evaluated 101 eyes of 101 patients with healthy maculae (n = 34), early AMD (n = 26), and intermediate AMD (n = 41). Vision tests were used to assess cones, mixed cones and rods, and rods. HRF and HRS were counted manually in optical coherence tomog­raphy (OCT) scans.

    All told, HRF and HRS were found in 25 and 95 eyes, respectively. HRF were present but sparse in healthy eyes, infrequent in eyes with early AMD, and frequent but highly variable in eyes with intermediate AMD—the mean ± standard deviation (SD) number per eye for these three groups was 0.1 ± 0.2, 0.2 ± 0.5, and 1.9 ± 3.4, respectively. HRS were present in all eyes, increasing from a mean SD of 4.5 ± 3.2 in healthy eyes to that of 19.4 ± 22.4 in eyes with intermediate AMD.

    With regard to impact on vision, HRF were associated with worse low-luminance visual acuity (VA), and HRS were associated with worse contrast sensitivity, low-luminance VA, low-luminance deficit, and mesopic and scotopic sensitivity. Delayed rod-medi­ated dark adaptation was more likely to occur in eyes with more HRF and HRS.

    In their discussion of the findings, the researchers said that HRS may rep­resent lipofuscin translocating inwardly within cone photoreceptors. They also noted that because HRF and HRS are visible and quantifiable on OCT, they may be useful structural end points in clinical trials targeting the early stages of AMD.

    The original article can be found here.