ABSTRACT NUMBER: ESOC2026A78 HYPERREFLECTIVE FOCI: BIOMARKER OF IDIOPATHIC INTRACRANIAL HYPERTENSION SEVERITY AND VISION FUNCTION

Abstract Background and aims Hyperreflective foci (HRF) on optical coherence tomography (OCT) may serve as biomarkers of retinal structural damage in idiopathic intracranial hypertension (IIH), but their clinical relevance remains underexplored. We aimed to characterize HRF in IIH and evaluate their associations with disease severity, visual function, and retinal structural/microvascular changes. Methods This multicenter, cross-sectional, and longitudinal study included patients with IIH from three tertiary hospitals in Chengdu, China, between December 2020 and March 2024. HRF metrics (number and volume), intracranial pressure (ICP), Frisén score, visual acuity (VA), visual field mean deviation (MD), and OCT/OCTA-derived retinal layer thicknesses and microvascular densities were collected. HRF metrics were automatically analyzed using a validated artificial intelligence algorithm. Results 113 IIH patients (225 eyes) and 248 healthy controls (496 eyes) were included in final analysis. Compared with controls, IIH patients exhibited significantly higher HRF burden (all P < 0.01). HRF metrics correlated positively with ICP (P < 0.01) and Frisén score (P < 0.001) and negatively with VA (P < 0.001) and MD (P < 0.001). Baseline HRF predicted longitudinal retinal thinning (P < 0.001) and visual impairment at follow-up (AUC = 0.94, 95% CI: 0.88–0.99). Conclusions HRF are robust biomarkers of disease severity and visual dysfunction in IIH, offering a non-invasive tool for monitoring progression and guiding treatment. Conflict of interest Tianxiang Lan. nothing to disclose.