Multimodal imaging characteristics of hydroxychloroquine retinopathy

Hydroxychloroquine (HCQ) is known to cause retinal toxicity. Early detection of the toxicity is necessary to stop the drug in time. Multicolor imaging (MC) is a new noninvasive retinal imaging modality that simultaneously acquires three reflectance images of the retina using three individual lasers producing a composite image, thereby allowing analysis of changes at various levels within the retina. It is a new and promising addition to the retinal imaging armory. MC characteristics of HCQ toxicity are hitherto unreported. A 61-year-old female presented with history of HCQ intake (400 mg/day) for the last 6 years. She had retinopathy in both eyes. Multicolor composite image showed circumscribed perifoveal arcuate area of darkening, and infrared reflectance showed speckled hyperreflecetance in both eyes. MC imaging shows definite changes in HCQ toxicity, and it might emerge as a possible screening tool in future.