Effect of Cataracts on Hydroxychloroquine Retinopathy Screening

Area of Science:

• Ophthalmology
• Retinal Imaging
• Drug Toxicity Monitoring

Background:

• Hydroxychloroquine (HCQ) retinopathy poses a risk to patients using the medication.
• Cataracts can potentially interfere with the detection of HCQ retinopathy using various screening methods.
• Evaluating the impact of cataract severity on HCQ retinopathy detection is crucial for accurate patient monitoring.

Purpose of the Study:

• To assess how different cataract severities affect the detection of HCQ retinopathy using swept source optical coherence tomography (OCT), ultrawide field fundus autofluorescence (FAF), and Humphrey visual field (HVF).
• To compare the diagnostic performance of OCT, FAF, and HVF in eyes with varying degrees of lens opacities.

Main Methods:

• Retrospective cohort study of 202 eyes with confirmed HCQ retinopathy, focusing on 141 cataractous eyes.
• Cataract severity graded using Lens Opacities Classification System III (LOCS III); clinically significant cataracts defined as LOCS III grade ≥ 3.
• Comparison of abnormality detection rates across OCT, FAF, and HVF between minimal and maximal cataract severity, and between clinically significant and mild cataracts.

Main Results:

• OCT detected ellipsoid zone disruptions in 100% of cataractous eyes, unaffected by cataract severity.
• HVF showed comparable sensitivity for paracentral scotomas regardless of cataract severity.
• FAF sensitivity was significantly reduced in eyes with clinically significant cataracts (61.5%) versus mild cataracts (92.1%), and further decreased with higher cortical opacity and nuclear opalescence.

Conclusions:

• Cataracts significantly impair FAF's ability to detect HCQ retinopathy.
• OCT and HVF maintain reliable detection of HCQ retinopathy even in the presence of significant cataracts.
• Clinicians should consider cataract severity when interpreting FAF results and prioritize OCT and HVF for patients with significant cataracts.