Hydroxychloroquine Maculopathy Early Detection Relies on Multimodal Screening Approach

Hydroxychloroquine Medicine Isolated on Black
Investigators explain an imaging protocol effective at capturing the ocular complication early.

The following article is a part of conference coverage from the American Academy of Ophthalmology 2020, being held virtually from November 13 to 15, 2020. The team at Ophthalmology Advisor will be reporting on the latest news and research conducted by leading experts in ophthalmology. Check back for more from the AAO 2020.

Reliable early detection of hydroxychloroquine maculopathy relies on a multimodal screening approach, according to research results presented at the American Academy of Ophthalmology 2020 annual meeting, held virtually November 13 to 15, 2020.

Although hydroxychloroquine maculopathy must be detected early, the commonly utilized screening technology can potentially miss this diagnosis before visual sequelae develop. To evaluate the efficacy of spectral domain optical coherence tomography (SD-OCT), researchers evaluated 207 patients on hydroxychloroquine therapy who were referred to a retina practice for evaluation in a retrospective case series. All patients underwent screening via SD-OCT, multifocal electroretinography (mfERG), fundus autofluorescence, and completed a standardized visual symptom questionnaire. 

Overall, 25.6% of patients were diagnosed with hydroxychloroquine toxicity via mfERG ring ratio analysis. Of these, 41.5% had normal optical coherence tomography, and 45.3% had subjective visual changes. 

Researchers further stratified patients diagnosed with hydroxychloroquine toxicity into 1 of 2 groups — early or advanced toxicity — based on ring ratio. Within the advanced toxicity group, 83% of patients demonstrated changes in optical coherence tomography, while only 55% of the early toxicity group demonstrated these same abnormalities. 

“SD-OCT may be less reliable in detecting earlier stages of [hydroxychloroquine] maculopathy compared with mfERG, suggesting that functional deterioration occurs prior to what can be determined structurally on [optical coherence tomography],” the researchers concluded. 

“A multimodal screening approach is key to reliable early detection,” they added. 

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Broderick KM, Katira R. Evaluation of SD-OCT results in screening patients in early and later stages of HCQ maculopathy. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO382.