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Longitudinal Ellipsoid Zone Dynamics During Hydroxychloroquine Use.

Karen Matar1,2, Katherine E Talcott1,2, Obinna Ugwuegbu1,2

  • 1The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

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|September 26, 2025
PubMed
Summary
This summary is machine-generated.

Early detection of hydroxychloroquine (HCQ) retinopathy is crucial. Longitudinal OCT analysis using ellipsoid zone (EZ) mapping identified subtle changes in some patients, indicating potential early toxicity.

Keywords:
automated feature segmentationellipsoid zone integrityhydroxychloroquine retinopathyoptical coherence tomography

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Pharmacology

Background:

  • Hydroxychloroquine (HCQ) retinopathy can be subtle and underrecognized.
  • Early detection of HCQ retinopathy is vital to prevent irreversible vision loss.
  • Optical Coherence Tomography (OCT) structural changes may precede symptoms.

Purpose of the Study:

  • To evaluate longitudinal OCT changes preceding overt HCQ toxicity.
  • To assess the utility of ellipsoid zone (EZ) mapping for early toxicity detection.
  • To identify factors associated with the progression of HCQ-induced retinal changes.

Main Methods:

  • Longitudinal macular cube OCT scans were obtained from patients on long-term HCQ.
  • Scans were analyzed using an EZ-mapping platform and manually validated.
  • Patients with baseline toxicity signs or co-existing macular disease were excluded.

Main Results:

  • Outer retinal metrics were generally stable, but 9.1% of eyes showed increased EZ attenuation.
  • Increased EZ attenuation correlated significantly with age at HCQ initiation and baseline visual acuity.
  • Quantitative OCT metrics detected toxicity more sensitively than clinician review in a subset of patients.

Conclusions:

  • Longitudinal OCT with EZ mapping reveals subtle outer retinal changes in a subset of HCQ users.
  • These EZ attenuation changes may serve as potential biomarkers for early HCQ toxicity.
  • Further validation is needed to establish these changes as reliable screening biomarkers.