Disparity between visual fields and optical coherence tomography in hydroxychloroquine retinopathy

Area of Science:

• Ophthalmology
• Medical Imaging
• Pharmacology

Background:

• Hydroxychloroquine (HCQ) is used for autoimmune conditions.
• HCQ retinopathy is a serious ocular toxicity.
• Current screening guidelines recommend objective measures like SD-OCT and visual fields.

Purpose of the Study:

• To evaluate the relative sensitivity and specificity of screening tests for HCQ retinopathy.
• To characterize patients with HCQ toxicity showing disparities between visual fields and SD-OCT.
• To inform HCQ retinopathy screening practices.

Main Methods:

• Retrospective chart review of patients with HCQ use and toxicity.
• Evaluation included visual fields, SD-OCT, and sometimes mfERG or fundus autofluorescence.
• Comparison of findings between visual fields and SD-OCT.

Main Results:

• 11 patients with HCQ toxicity had parafoveal ring scotomas on visual fields but normal SD-OCT.
• No other cause for bull's-eye maculopathy was identified in these patients.
• Patients with SD-OCT parafoveal damage also showed parafoveal field loss.

Conclusions:

• Approximately 10% of early HCQ toxicity cases present with ring scotomas on visual fields without clear SD-OCT abnormalities.
• Visual fields are crucial for screening, complementing SD-OCT.
• Combining visual fields and SD-OCT enhances sensitivity and specificity for HCQ retinopathy detection.