What is observed in the underlying choroid at the area of absent RPE in the case of an RPE tear?

In the case of an RPE (retinal pigment epithelium) tear, the underlying choroid typically exhibits hyperreflectivity. This is due to the exposure of the choroidal vascular structures or stroma that is normally masked by the RPE layer. When the RPE is absent or has a tear, there can be a significant change in the normal reflectivity seen on imaging modalities such as optical coherence tomography (OCT). This hyperreflectivity indicates that light is being reflected from the denser tissues of the choroid that would usually be shielded by the overlying RPE.

The presence of hyperreflectivity is a critical indicator for ophthalmologists in diagnosing and assessing the severity and progression of retinal conditions associated with RPE damage. Recognizing this change is essential for understanding the implications of RPE tears in diseases such as age-related macular degeneration (AMD) and for determining the best management strategies for patients affected by these conditions.