• 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

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    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.