Spectral-domain optical coherence tomography and adaptive optics may detect hydroxychloroquine retinal toxicity before symptomatic vision loss

• Published in: Transactions of the American Ophthalmological Society 2009-12, Vol.107, p.28-33
• Main Authors: Stepien, Kimberly E, Han, Dennis P, Schell, Jonathan, Godara, Pooja, Rha, Jungtae, Carroll, Joseph
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Female; Fluorescein Angiography; Humans; Hydroxychloroquine - adverse effects; Hydroxychloroquine - therapeutic use; Lupus Erythematosus, Systemic - drug therapy; Middle Aged; Ophthalmoscopy; Optics and Photonics - methods; Retina - drug effects; Retina - pathology; Retinal Cone Photoreceptor Cells - pathology; Retinal Diseases - chemically induced; Retinal Diseases - complications; Retinal Diseases - diagnosis; Retinal Diseases - metabolism; Retinal Pigments - metabolism; Sjogren's Syndrome - drug therapy; Tomography, Optical Coherence - methods; Vision Disorders - etiology; Visual Field Tests; Visual Fields
• ISSN: 0065-9533; 1545-6110

To describe spectral-domain optical coherence tomography (SD-OCT) and adaptive optics (AO) imaging in hydroxychloroquine retinal toxicity. Two patients with long-term hydroxychloroquine use, subtle perifoveal ophthalmoscopic pigmentary changes, and bilateral perifoveal defects on automated Humphrey visual field (HVF) 10-2 perimetry were imaged using SD-OCT and AO. SD-OCT images demonstrated loss of photoreceptor inner segment/outer segment (IS/OS) junction and a downward "sink-hole" displacement of inner retinal structures in areas of hydroxychloroquine toxicity corresponding to HVF 10-2 defects and ophthalmoscopic clinical examination findings. SD-OCT irregularities in the IS/OS junction were also seen in areas not detected on HVF 10-2. AO images showed disruption of the cone photoreceptor mosaic in areas corresponding to HVF 10-2 defects and SD-OCT IS/OS junction abnormalities. Additionally, irregularities in the cone photoreceptor density and mosaic were seen in areas with normal HVF 10-2 and SD-OCT findings. SD-OCT and AO detected abnormalities that correlate topographically with visual field loss from hydroxychloroquine toxicity as demonstrated by HVF 10-2 and may be useful in the detection of subclinical abnormalities that precede symptoms or objective visual field loss.