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  • OCT Retinal Thickness Map Detects HCQ Retinopathy

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, January 2021

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    Kim et al. used a retinal thickness deviation map, generated from swept-source optical coherence tomography (SS-OCT) images, to screen for hy­droxychloroquine (HCQ) retinopathy. In their retrospective study of more than 2,300 eyes, the deviation map was highly sensitive and specific for detect­ing retinopathy.

    This study included 1,192 Korean patients with a history of HCQ treat­ment. There were 881 patients (1,723 eyes) in the discovery set and 311 patients (591 eyes) in the validationset. Participants were screened for retinal toxicity using SS-OCT, fundus autofluorescence, and standard auto­mated perimetry. The authors’ scan was a 12- × 9-mm2 macular volume SS-OCT; built-in software generated the retinal thickness deviation map. Abnormality was indicated by yellow or red pixels on the map that correspond­ed to <5% and <1% of the normative level, respectively. All abnormal find­ings were evaluated. Diagnostic criteria were derived from the discovery set and verified by the validation set. Outcome measures were the rate and pattern of abnormalities and the sensitivity and specificity of diagnostic criteria.

    The map for eyes with HCQ reti­nopathy displayed abnormal patterns in the pericentral ring (36%), the para-foveal ring (6.1%), or in both rings (34.2%). Other observed patterns were a central island (13.2%) and whole macular thinning (10.5%). The diag­nostic criterion of “≥5 contiguous red pixels showing one of these five char­acteristic patterns in both eyes” had the best sensitivity and specificity in both datasets (range, 87.5% to 100%). In eyes with HCQ retinopathy, the area of abnormality on the map correlated strongly with mean deviation (p < .001) and pattern standard deviation (p < .001) on the Humphrey 30-2 test.

    This type of map could hasten objective assessment of HCQ retinop­athy, as it doesn’t require morphologic evaluation of the outer retina. It also may aid screening for other conditions that involve retinal thinning.

    The original article can be found here.