Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field...

Area of Science:

• Ophthalmology
• Medical Imaging
• Toxicology

Background:

• Hydroxychloroquine (HCQ) retinopathy can cause irreversible vision loss, necessitating early detection.
• Screening for HCQ toxicity is vital, especially in patients with chronic exposure.
• This study investigates early signs of HCQ toxicity using advanced imaging techniques.

Observation:

• Optical coherence tomography (OCT) revealed abnormalities in patients with HCQ exposure and normal Humphrey visual field (HVF) testing.
• Specific OCT findings included parafoveal ellipsoid zone attenuation and interdigitation zone loss.
• Ancillary tests like fundus photography and multifocal electroretinography were utilized for comprehensive analysis.

Findings:

• Ten patients (17 eyes) demonstrated characteristic OCT abnormalities despite normal HVF results.
• Early structural changes on OCT may precede functional visual field deficits in HCQ toxicity.
• Progression to outer retinal disruption and paracentral visual field defects was observed in some cases.

Implications:

• OCT is a valuable tool for identifying early-stage HCQ retinopathy, even with normal visual fields.
• Integrating OCT into screening protocols can aid in the timely diagnosis of HCQ toxicity.
• Ancillary testing may be beneficial for patients with suspicious OCT findings and normal HVFs, guiding further management.