Purpose:

To define, characterize and classify hyper-reflectivity on optical coherence tomography (OCT) and report its prevalence in macular telangiectasia type 2 (MacTel).

Methods:

In a primary cross-sectional analysis, multimodal imaging data were retrospectively analyzed. The definition of hyper-reflectivity and neovascularization on OCT followed OCT-angiography-based criteria. Eyes were graded for the presence of hyper-reflectivity and neovascularization and further categorized into three classes based on position and extent of hyper-reflectivity. In a secondary analysis, eyes were reviewed for≥ 24 months using OCT-imaging.

Results:

322 eyes from 161 patients were analyzed as part of the cross-sectional analysis. Hyper-reflectivity was found in 177 (55%), and neovascularizations in 49 (15%) eyes. Hyper-reflectivity correlated significantly with parameters indicative of disease progression. In the longitudinal analysis, 206 eyes from 103 patients were reviewed over a mean of 35.6 months. 17/86 eyes (20%) showed a de novo-development of hyper-reflectivity. 8/29 eyes (28%) with preexistent intraretinal hyper-reflectivity developed outer retinal hyper-reflectivity. A high proportion of eyes with outer retinal hyper-reflectivity (17/52 [33%]) developed neovascularizations.

Conclusion:

Hyper-reflectivity represents a common finding in MacTel but lacks a uniform definition. We propose a hyper-reflectivity grading scale that may help to estimate disease progression and identify eyes at risk for developing neovascularization.