Hyperreflective material as a biomarker in neovascular age-related macular degeneration

Abstract

Introduction: Anti-vascular endothelial growth factor (anti-VEGF) therapy has dramatically improved the visual outcome of patients with neovascular age-related macular degeneration (nAMD). However, despite this treatment, atrophy, and fibrosis of the macula are two important factors contributing to the continuing vision loss over time. Hyperreflective material (HRM) is now considered an optical coherence tomography (OCT) biomarker of fibrosis in nAMD. The aim of this article is to provide a narrative review of the current knowledge about the role of HRM as a relevant biomarker in the management of nAMD. Areas covered: This is a narrative review based on a PubMed search which was used to identify relevant literature regarding the role of HRM in nAMD. Reference lists were checked to identify additional relevant studies. Expert opinion: HRM can be considered an established tomographic biomarker in nAMD. A detailed analysis of HRM on OCT may guide the clinicians about the prediction of prognosis and response to anti-VEGF treatment. An integrated multimodal imaging analysis including the newest techniques such as OCT angiography and polarization OCT shows promise in helping to elucidate the pathophysiology of nAMD and in particular can elucidate the relationship between HRM and the onset of fibrosis.