JOURNAL OF RETINA

CORRELATION OF SUBRETINAL HYPERREFLECTIVE MATERIAL MORPHOLOGY AND VISUAL ACUITY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Kumar, Jaya B. MD; Stinnett, Sandra DrPH; Han, Jung I. L. MD; Jaffe, Glenn J. MD

Abstract

Purpose: 

To evaluate the association of subretinal hyperreflective material (SHRM) morphological features with visual acuity in eyes with neovascular age-related macular degeneration.

Methods: 

Retrospective analysis of treatment-naïve patients with neovascular age-related macular degeneration enrolled in randomized anti–vascular endothelial growth factor (VEGF) and anti–platelet-derived growth factor clinical trials. Standardized spectral domain optical coherence tomography images were graded at baseline, 12-week, and 24-week follow-up visits. Masked readers evaluated the morphology of SHRM (reflectivity, shape, anterior, and posterior boundaries) and measured SHRM height, width, and area at the fovea, within the center 1 mm2, and outside the center 1 mm2.

Results: 

Baseline SHRM characteristics that correlated with worse visual acuity at 12 and 24 weeks included layered appearance (P = ۰.۰۰۶, ۰.۰۰۱), hyperreflective spots in SHRM (P = ۰.۰۰۱, ۰.۰۱۱), and separation between SHRM and outer retina (P = ۰.۰۳, ۰.۰۱۹). The disappearance of SHRM correlated with better visual acuity at Weeks 12 and 24 (P < 0.001). Layered appearance of SHRM at baseline was significantly associated with increased reflectivity at Weeks 12 and 24 (P = ۰.۰۰۹, ۰.۰۰۳). Decreasing reflectivity of SHRM lesion at Weeks 12 and 24 correlated with better visual acuity (P < 0.01, 0.01). Increased width and area of baseline SHRM at the foveal center correlated with worse visual acuity at 12 (P < 0.001, <0.001) and 24 weeks (<0.001, <0.001).

Conclusion: 

Several attributes of SHRM including, layered appearance, increased reflectivity, larger size, and hyperreflective spots correlated with worse visual acuity at 12- and 24-week follow-ups. Baseline SHRM characteristics can help practitioners predict visual and morphological prognosis and guide therapy.