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Subjective and objective screening tests for hydroxychloroquine toxicity.

Catherine Cukras1, Nancy Huynh2, Susan Vitale1

  • 1Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland.

Ophthalmology
|December 3, 2014
PubMed
Summary
This summary is machine-generated.

Objective clinical tests, including optical coherence tomography (OCT) and visual field mean deviation (VFMD), effectively screen for hydroxychloroquine retinal toxicity. These tests show high sensitivity and specificity, serving as reliable surrogates for multifocal electroretinography (mfERG) testing.

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Area of Science:

  • Ophthalmology
  • Retinal Imaging
  • Pharmacological Toxicity

Background:

  • Hydroxychloroquine (HCQ) is widely used for autoimmune conditions.
  • HCQ retinopathy is a serious complication that can lead to vision loss.
  • Early detection of HCQ retinopathy is crucial for preserving vision.

Purpose of the Study:

  • To compare the efficacy of various subjective and objective clinical tests in screening for HCQ retinal toxicity.
  • To evaluate these tests against multifocal electroretinography (mfERG) as a reference standard.

Main Methods:

  • A prospective, single-center, case-control study involving 57 patients with long-term HCQ treatment.
  • Evaluations included medical history, ophthalmologic exams, fundus photography, fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), 10-2 visual field mean deviation (VFMD), and mfERG.
  • Participants were classified into HCQ retinopathy-affected and unaffected groups based on mfERG findings.

Main Results:

  • Nineteen patients were affected and 38 were unaffected by HCQ retinopathy based on mfERG.
  • Affected patients showed significantly reduced OCT retinal thickness in all macular subfields and a lower mean VFMD.
  • Color fundus photography, FAF, and SD-OCT detected toxicity in 68.4%, 73.3%, and 84.2% of affected patients, respectively.
  • OCT inner ring retinal thickness and Humphrey 10-2 VFMD were most strongly associated with HCQ toxicity.

Conclusions:

  • Optical coherence tomography (OCT) retinal thickness and 10-2 visual field mean deviation (VFMD) are objective measures with high sensitivity and specificity for detecting HCQ toxicity.
  • These tests can serve as effective surrogate markers for multifocal electroretinography (mfERG) in screening for HCQ retinopathy.