Choroidal Hyperreflective Foci Represent a Common Finding Across Different Types of Macular Atrophy

PURPOSE. To evaluate the presence, distribution, and potential implications of choroidal hyperreflective foci (HRFs) across different types of macular atrophy and their relationship with the size of atrophic regions. METHODS. This retrospective case series analyzed 95 eyes from 87 patients with macular atrophy caused by various conditions, including geographic atrophy due to age-related macular degeneration, pachychoroid disease, punctate inner choroidopathy, angioid streaks, and Stargardt disease. Structural optical coherence tomography (OCT) images were evaluated to identify HRFs in different choroidal layers. HRF counts were correlated with the size of macular atrophy and underlying conditions using multiple regression analysis. RESULTS. HRFs were observed in all cases, with their number significantly associated with the size of macular atrophy (P < 0.001). The highest HRF counts were found in Stargardt disease, while the lowest were in pachychoroid disease. However, no association was identified between HRF quantity and specific disease type (P = 0.2). HRFs were primarily located in the choriocapillaris, Sattler’s layer, and near Bruch’s membrane but were absent within choroidal vessels. CONCLUSIONS. HRFs represent a common OCT finding in various disorders associated with macular atrophy. Their quantity correlates with atrophy size rather than disease type, suggesting they are likely normal choroidal components rendered visible by RPE loss. Future studies are warranted to elucidate their origin and potential implications for disease progression.