This OCT-A Marker May Help Assess Treatment Response in Patients with MNV

Recognizing the foveal vertical hyperreflective line on OCT-A could help identify MNV eyes undergoing structural recovery, particularly in conjunction with improvements in BCVA and IZ/EZ integrity. Photo: Rein AP, et al. Graefe's Arch Clin Experimental Ophthalmol. October 15, 2024. Click image to enlarge. Researchers recently identified a previously underreported optical coherence tomography angiography (OCT-A) finding in patients with macular neovascularization (MNV): the foveal vertical hyperreflective line (FVHL). This retinal imaging marker was detected in 8.7% of patients with MNV in a recent study. Eyes with FVHLs that were maintained throughout follow-up showed better interdigitation zone/ellipsoid zone (IZ/EZ) restoration than eyes whose FVHLs became reflex-weakened, suggesting FVHLs may serve as a marker of photoreceptor and Müller cell recovery.The retrospective study, published over the weekend in the journal Eye, reviewed 322 eyes from 161 patients with MNV seen at a single hospital between January 2024 and October 2025. Eligible eyes had OCT-A image quality sufficient for analysis, were followed for at least three months and had no major confounding ocular disease or recent retinal surgery. FVHL was defined as a vertical hyperreflective line on OCT-A B-scan images extending from the ellipsoid zone or lower retinal layers through the outer nuclear layer to the internal limiting membrane in the fovea. Two retina specialists independently reviewed the images, and a senior physician resolved any disagreements.Among the 161 patients, 14 had FVHLs in 15 eyes. Most FVHLs were seen in eyes with age-related macular degeneration-related MNV (13 eyes), while two were in pathological myopia-related MNV. The mean patient age was 69.29 years, and all FVHLs were detected early in the disease course; the average time from FVHL onset to the initial visit was 1.60 months.All FVHLs were maintained throughout follow-up. Among eyes with FVHLs, 80% remained unchanged and 20% became less reflective. The researchers observed that all eyes with persistent FVHLs had a higher IZ/EZ repair rate (91.7%) than eyes with weakened FVHL reflectivity (0%). Additionally, four cases showed enhanced reflection of the Müller cell cone, which the authors note supports the idea that FVHLs may reflect interactions between photoreceptors and Müller cells in a damaged fovea.The team concluded that FVHLs may be a useful OCT-A biomarker when monitoring patients with MNV, especially early in the disease course. Specifically, they wrote, “FVHLs in patients with MNV may represent photoreceptor cell damage, persistent activation of Müller cells and the interaction between these two types of cells in the macula,” which may help clinicians assess treatment response in patients on anti-VEGF therapy.There are a few noteworthy limitations of this study, including its retrospective design, small cohort drawn from a single medical center and short follow-up period. In the future, the researchers suggested that “additional histological evidence will help clarify the detailed pathological characteristics of FVHLs as well as the specific involvement of Müller and photoreceptor cells.”Click here for the journal source. Zhang Y, Gao J, Zhou A, Wang J. Optical coherence tomography angiography imaging characteristics and clinical significance of the foveal vertical hyperreflective line in patients with macular neovascularisation. Eye. June 20, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.