What question did this study set out to answer?

To assess hyperreflective foci detected by optical coherence tomography as a marker for microglial pathology in multiple sclerosis.

April 10, 2026Open Access

Hyperreflective Foci in the Inner Nuclear Layer: Proof‐of‐Concept for an Optical Coherence Tomography Derived Microglia‐Related Marker in Multiple Sclerosis

Key Points

To assess hyperreflective foci detected by optical coherence tomography as a marker for microglial pathology in multiple sclerosis.
Examined hyperreflective foci in the inner nuclear layer of the retina using optical coherence tomography.
Analyzed differences in foci counts between individuals with relapsing and progressive MS.
Correlated foci counts with imaging metrics of global white and gray matter, and deep gray matter uptake.
Hyperreflective foci counts are significantly higher in individuals with relapsing and progressive MS.
There is a correlation between hyperreflective foci counts and uptake of [<sup>18</sup>F]GE-180.
Findings suggest a link between retinal changes and microglial activity in MS.

Abstract

The role of microglia has emerged as a critical driver of disease progression in multiple sclerosis (MS), but we lack broadly applicable monitoring tools. Here, we investigated whether hyperreflective foci (HRF), as detected by optical coherence tomography (OCT) within the inner nuclear layer (INL) of the retina, can be used as a marker for microglial pathology. We demonstrate that HRF counts are increased in persons with relapsing and progressive MS and correlate with global white and gray matter, as well as deep gray matter 18FGE-180 uptake. ANN NEUROL 2026.

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Authors

Jonathan A. Gernert

Laura M. Bartos

Tara Christmann

Journals

Annals of Neurology

Actions

Institutions

Ludwig-Maximilians-Universität München

German Center for Neurodegenerative Diseases

LMU Klinikum

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Hyperreflective Foci in the Inner Nuclear Layer: Proof‐of‐Concept for an Optical Coherence Tomography Derived Microglia‐Related Marker in Multiple Sclerosis

Key Points

Abstract

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