Correlation of hyperreflective foci, status of photoreceptor layer, and visual acuity in diabetic macular edema

Purpose To investigate the correlation ofhyperreflective foci, photoreceptor integrity and visual acuity ( VA ) in patients with diabetic macular edema ( DME ). Methods Seventy‐eight patients (114 eyes) with DME were analyzed retrospectively with Spectral‐domain optical coherence tomography ( SD ‐ OCT ). Results SD ‐ OCT showed that 28 eyes (24.5%) had hyperreflective foci in the inner retinal layers, and 66 eyes (57.9%) had hyperreflective foci in the outer retinal layers. The log MAR VA was significantly (P < .0001) worse in eyes with hyperreflective foci in the outer retinal layers than in eyes without them (0.478 ± 0.241 vs 0.133 ± 0.233, respectively). Disruption of the ellipsoid zone and ELM line on OCT were significantly (respectively P < .0001 and P < .0001) associated with both hyperreflective foci in the outer retinal layers and poor log MAR VA . Conclusions The presence of hyperreflective foci in the outer retina is closely associated with a disrupted ELM and ellipsoid zone on SD ‐ OCT images and decreased VA in DME .