Hyperreflective Focuses as a Biomarker of Optical Coherence Tomography in Retinal Diseases: Pathogenesis, Visualization, and Clinical Significance

The presented literature review is devoted to an important OCT biomarker of retinal diseases; hyperreflective foci (GRF); which are considered as a promising indicator of inflammatory processes and vascular disorders of the retina. The purpose is to clarify modern ideas about the nature and classification of hyperreflective foci as an important diagnostic marker. This is necessary to improve the accuracy of diagnosis and monitoring of the most common retinal diseases; as well as to develop personalized treatment approaches; including using artificial intelligence technologies in ophthalmology. GRFs are defined as discrete point or rounded structures with increased optical density; ranging in size from 20 to 100 microns; localized within the retinal layers or in the subretinal space. GRF is not a specific morphological feature; but a universal phenotype reflecting a wide range of pathophysiological processes. The article describes in detail the morphology of foci; the pathogenetic mechanisms of their formation; the prognostic role and differences in age-related macular degeneration; diabetic retinopathy; diabetic macular edema. The correct differential interpretation of GRF requires an integrated approach; including an analysis of medical history and risk factors; a detailed assessment of their localization and morphological characteristics; as well as consideration of concomitant OCT signs and multimodal imaging data. The integration of these parameters makes it possible to accurately determine the nature of hyperreflective foci; choose the optimal patient management tactics; and reasonably predict the course of the disease.

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