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An objective method of diagnosing hydroxychloroquine maculopathy.

Hani Hasan1, Andrew Lotery2, Elizabeth J Price3

  • 1Ophthalmology Department, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, SN3 6BB, UK. hani.dirar@gmail.com.

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Summary

Regular monitoring prevents irreversible hydroxychloroquine (HCQ) maculopathy. This study quantifies HCQ toxicity using visual field (VF) and optical coherence tomography (OCT) tests for early detection.

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Medical Imaging

Background:

  • Hydroxychloroquine (HCQ) maculopathy is irreversible and necessitates regular monitoring for prevention.
  • Current guidelines define toxicity based on abnormal screening tests; a quantitative interpretation method is presented.
  • The study addresses the need for objective diagnostic criteria in managing HCQ toxicity.

Purpose of the Study:

  • To develop and validate a quantitative method for interpreting screening tests for hydroxychloroquine (HCQ) maculopathy.
  • To establish objective criteria for diagnosing HCQ toxicity based on visual field (VF) and optical coherence tomography (OCT) data.
  • To aid in the early and accurate detection of HCQ maculopathy in patients undergoing long-term treatment.

Main Methods:

  • Ocular coherence tomography (OCT) scans and 10-2 visual field (VF) tests were performed on 100 patients on HCQ and 70 controls.
  • Linear regression determined cut-off points for VF and OCT in eight Early Treatment of Diabetic Retinopathy Study (ETDRS) macular sectors.
  • Logistic regression calculated the probability of developing maculopathy, correlating outer nuclear layer (ONL) volume with toxicity.

Main Results:

  • The study included 100 patients (mean age 59.9 years, 85% female) on HCQ for a mean of 6.3 years.
  • Logistic regression revealed a strong negative correlation between outer nuclear layer (ONL) volume and the probability of HCQ toxicity.
  • The Hosmer and Lemeshow test indicated high significance (P=1) for the model's goodness of fit.

Conclusions:

  • Combining ONL volume reduction and VF retinal sensitivity reduction in ETDRS macular sectors offers an accurate, objective diagnosis of HCQ maculopathy.
  • This quantitative approach supports optometrist-led or virtual services, reducing reliance on individual assessor experience.
  • The findings facilitate timely intervention and primary prevention of HCQ-induced retinal damage.