Early Detection of HCQ Retinopathy With OCT
By Lynda Seminara
Selected By: Deepak P. Edward, MD
Journal Highlights
British Journal of Ophthalmology
Published online Feb. 28, 2019
Download PDF
Early detection of hydroxychloroquine (HCQ) retinopathy is crucial because the drug may cause severe irreversible vision loss, even after discontinuation. Garrity et al. evaluated optical coherence tomography (OCT) findings of patients who had taken HCQ for many years and had also undergone Humphrey visual field (VF) testing. They found that OCT was able to detect HCQ-related abnormalities before they were picked up by VF testing.
For this retrospective, observational study, the researchers identified 10 patients (17 eyes) with HCQ-related abnormalities detected on spectral-domain OCT (SD-OCT) and normal VF results. The researchers conducted several ancillary tests—including color fundus photography, fundus autofluorescence, and microperimetry—as part of a comprehensive examination.
The mean duration of treatment with HCQ was 11 years (range, 3-26 years), and the mean dose of HCQ was 1,611 g (range, 730-3,796 g). (Of note, the recommended dosage is 5 mg/kg of actual—not ideal—body weight.) At baseline, all 10 patients had visual acuity between 20/20 and 20/30 in the eye(s) with HCQ retinopathy. Three of the patients reported no visual symptoms; the remainder reported blurry vision, floaters, or photopsia.
All 10 patients presented with normal 10-2 perimetry testing. However, features of early HCQ macular toxicity were evident on SD-OCT, including attenuation of the parafoveal ellipsoid zone (relative to the central ellipsoid band) and loss of a clearly identifiable continuous parafoveal interdigitation zone. These observations were bilateral in seven patients and unilateral in three. Six eyes eventually developed advanced HCQ retinopathy with characteristic paracentral VF defects and/or advanced outer retinal disruption.
The original article can be found here.