Unclear Whether Hyperreflective Dots on OCT Predict Outcomes in DME Treatment

Hyperreflective dot (HRD) numbers on optical coherence tomography (OCT) decrease with treatment in patients with diabetic macular edema (DME), according to a systematic review of available literature.

However, it remains unclear whether HRDs predict the treatment outcome in this patient population.

“Future investigations with more uniform approaches are needed to confirm the nature of the biomarker and its effect on DME treatment outcome,” wrote study investigator Leonoor I. Los, MD, PhD, Department of Ophthalmology, University Medical Center Groningen

Aiming to evaluate the role of HRDs using OCT to predict the role of the treatment outcome in patients with DME stemmed from the often unsatisfactory results of DME treatment, despite its potential.

Investigators thus noted the importance of developing biomarkers that can help to predict the treatment response to optimize the treatment effect for an individual patient. They searched databases including PubMed, Embase, Web of Science, and Cochrane library, with the final search date in May 2021.

The included individuals were patients diagnosed with DME and provided with treatment. The predictor was HRDs detected using OCT before treatment. Study outcomes were best-corrected visual acuity (BCVA) and central macular thickness (CMT) detected using OCT following treatment.

Two independent reviewers screened the database titles and abstracts as well as full text. To assess the risk of bias for each included study, investigators used the refined Quality in Prognosis Studies tool. They noted that due to the clinical heterogeneity of the studies, no meta-analysis was performed.

Overall, a total of 36 studies were included by investigators. Based on The Quality in Prognosis Studies assessment, most studies were found to have a low or moderate risk of bias in 6 domains.

Data show six studies did not find a correlation between baseline HRDs (either presence or absence of HRDS [n = 1] or baseline HRD number [n = 5]) and outcome (BCVA or CMT). Meanwhile, a total of 12 studies found a significant correlation between the variables.

Moreover, eight studies indicated that baseline HRDs could predict a poor visual outcome (n = 4 on presence or absence of HRD and n = 4 on HRD number) and 4 studies (n = 1 on presence or absence or HRD and n = 3 on HRD number) observed that HRDs were predictive of visual improvement.

“Fifteen out of 17 studies found that the HRD number decreased after treatment,” Los added.

The study, “Hyperreflective Dots on OCT as a Predictor of Treatment Outcome in Diabetic Macular Edema: A Systematic Review,” was published in Ophthalmology Retina.