To the right of the image the retina is normal. Here a normal orderly progression is seen. In the deeper layers, the outer nuclear layer (ONL), external limiting membrane (ELM) and ellipsoid zone (EZ) are clearly visible, as is the retinal pigment epithelium (RPE). The choroid is also of normal intensity in this area.

In the middle and to the left of the image, there is a deep zone of hyperreflectivity as there is loss of RPE and light is able to penetrate the deeper tissues (hyperreflectivity #1). This results in a hyperreflective choroid; this is called ”reverse“ shadowing. Anterior to the RPE, located in the deep retina, there are a series of hyperreflective rings (hyperreflectivity #2). These are consistent with outer retinal tabulation.

These lesions are typically suggestive of advanced age-related macular degeneration and may be confused with deep retinal fluid/cysts.