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The incidence of subretinal hyper-reflective material in patients with newly diagnosed neovascular age-related macular degeneration requiring anti-VEGF therapy

Session Details

Session Title: AMD I

Session Date/Time: Thursday 17/09/2015 | 08:30-10:30

Paper Time: 09:02

Venue: Athena

First Author: : M.Longmore UNITED KINGDOM

Co Author(s): :    M. Khan   S. Downes   V. Chong        

Abstract Details

PURPOSE:Subretinal hyper-reflective material (SHRM) is considered a prognostic factor for visual outcome after anti-vascular endothelial growth factor (VEGF) in Age Related Macular Degeneration (AMD). SHRM is thought to correspond to fibrovascular tissue, thick haemorrhage or photoreceptor debris in the subretinal space. Reduction in SHRM correlates with improved visual acuity after anti-platelet derived growth factor (PDGF) therapy, and the Phase III pivotal study of anti-PDGF recently included SHRM as part of its inclusion criteria. In this study, we report the incidence of SHRM in newly diagnosed treatment naïve patients with neovascular AMD using spectral-domain (SD)-OCT.


University Teaching Hospital


Retrospective imaging analysis was performed in all treatment naïve neovascular AMD patients requiring anti-VEGF therapy in a single centre between November 2013 and February 2015. All consecutive patients were included in the analysis. All patients had protocol fluorescein angiography and SD-OCT (Heidelberg HRA Spectralis, Germany). Images were analysed by 2 trained observers independently to identify isolated SHRM in the subretinal space and SHRM as part of the retinal pigment epithelium (RPE) complex. If the two graders disagreed, a senior retinal specialist made the final grading decision.


In total, 307 patients were included in the study, 2 patients were excluded due to poor image quality. The mean age of the remaining 305 patients was 81.2 years, with a female to male ratio of 1.6 to 1.0. There were 38 (12.6%) cases of disagreement. The incidence of SHRM was 29.1%, with 13.6% as isolated SHRM and 15.7% as part of the RPE complex.


Previous estimates of the incidence of SHRM are based on time-domain (TD)-OCT. Newer spectral-domain (SD)-OCT, however, identifies the subretinal space, RPE and sub-RPE space more clearly. The Comparison of AMD treatments trials (CATT) found over 70% of patients had SHRM. These estimates may have resulted from including hyper-reflective material present in the sub-RPE space. Present-day earlier AMD diagnosis may also mean our cohort had better visual acuity and reduced SHRM at presentation than in the CATT study, as SHRM correlates with baseline visual acuity. If similar incidences of SHRM are reproduced in further studies, it might have significant implications for anti-PDGF therapy in wet AMD.

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