Case 59

Marko Tien (University of British Columbia Medical Student)

Patient Presentation: 68-year-old male was referred to ophthalmology for a macular assessment. He endorsed a 2-month history of metamorphopsia his right eye. VA was 20/30 OD and 20/25 OS. Fundus exam and OCT of the macula are shown below:


Question: Given the fundus photo and OCT in the right eye, what abnormality is seen?

Question: You examine another patient with AMD in clinic and obtain the following OCT scan. What are the hyper-reflective foci (yellow arrows)?


Question: What does the presence of hyper-reflective foci mean for the prognosis in this patient?


  1. Ouyang, Y., Heussen, F. M., Hariri, A., Keane, P. A., & Sadda, S. R. (2013). Optical coherence tomography-based observation of the natural history of drusenoid lesion in eyes with dry age-related macular degeneration. Ophthalmology, 120(12), 2656–2665.

  2. Schuman, S. G., Koreishi, A. F., Farsiu, S., Jung, S. H., Izatt, J. A., & Toth, C. A. (2009). Photoreceptor layer thinning over drusen in eyes with age-related macular degeneration imaged in vivo with spectral-domain optical coherence tomography. Ophthalmology, 116(3), 488–496.e2.

  3. Roquet, W., Roudot-Thoraval, F., Coscas, G., & Soubrane, G. (2004). Clinical features of drusenoid pigment epithelial detachment in age related macular degeneration. The British journal of ophthalmology, 88(5), 638–642.

  4. Balaratnasingam, C., Yannuzzi, L. A., Curcio, C. A., Morgan, W. H., Querques, G., Capuano, V., Souied, E., Jung, J., & Freund, K. B. (2016). Associations Between Retinal Pigment Epithelium and Drusen Volume Changes During the Lifecycle of Large Drusenoid Pigment Epithelial Detachments. Investigative ophthalmology & visual science, 57(13), 5479–5489.

Learning Objectives:
1.    To identify intraretinal hyper-reflective foci on OCT
2.    To understand the significance of intraretinal hyper-reflective foci for patients with AMD