Background: This study aimed to know the association of visual status and hyperreflective foci in patients with diabetic macular edema (DME).

Material and methods: This observational cross-sectional study included patients with diabetes mellitus type 2 (DM2) with DME or non-proliferative diabetic retinopathy (NPDR). Baseline assessment included: ophthalmic examinations such as best-corrected visual acuity (LogMAR), color vision, contrast sensitivity, intraocular pressure (IOP), fundus examination by direct, indirect ophthalmoscopy, slit-lamp biomicroscopy with 90D, and spectraldomain — optical coherence tomography (SD-OCT) [counting of hyperreflective foci (HF) were done manually]. Retina specialists performed counting and classification of HF. The correlation was calculated to establish the association between HF with visual status. p-value < 0.05 was considered statistically significant.

Results: In majority of the patients (46.67%), HF was < 50 followed by 51–100 (30.83%) and > 100 (17.50%). With increasing HF, there was a significantly decreasing trend of best-corrected visual acuity (BCVA) (0.2 in no HF to 0.5 in HF > 100, p = 0.001) and contrast (1.58 in no HF to 1.35 in HF > 100, p = 0.0004). HF were found to significantly increase with increasing duration of the disease (4 in no HF to 17 in HF > 100, p = 0.0001). The lab parameters such as glycated haemoglobin (HbA1c), serum urea, serum creatinine, triglycerides, very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL) showed significant derangement with increasing HF (p < 0.05).

Conclusion: The presence of HF in patients with DME negatively affects BCVA and contrast sensitivity. The severity of HF may increase with the increasing duration of DME and altered glycemic index.