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

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA.
Transactions of the American Ophthalmological Society 12/2009; 107:28-33.
Source: PubMed


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.

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Available from: Joseph Carroll, Jan 14, 2014
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    • "SD-OCT is an objective, quick, and reproducible technique to examine the anatomy of the retina and optic nerve, which makes it a useful screening tool. Recent studies have shown that changes in retinal thickness and loss of outer retinal layers can be detected by SD-OCT in patients with early Chloroquine toxicity, even in areas that appeared normal on fundoscopy and perimetry [15] [16]. Detection of these changes in preclinical stages can be invaluable in screening for Chloroquine maculopathy. "
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    ABSTRACT: Purpose . To evaluate the role of spectral-domain optical coherence tomography (SD-OCT) in early detection of Chloroquine maculopathy in rheumatoid arthritis (RA) patients. Methods . 40 left eyes of 40 female rheumatoid arthritis patients who received treatment chloroquine for more than one year were recruited in the study. All patients had no symptoms or signs of Chloroquine retinopathy. They were evaluated using SD-OCT, where the Central Foveal Thickness (CFT), parafoveal thickness and perifoveal thickness, average Retinal Nerve Fiber Layer (RNFL) thickness, and Ganglion Cell Complex (GCC) measurements were measured and compared to 40 left eyes of 40 normal females. Results . The mean CFT was found to be thinner in the Chloroquine group (238.15 µ m ± 22.49) than the normal controls (248.2 µ m ± 19.04), which was statistically significant ( p value = 0.034). The mean parafoveal thickness was lesser in the Chloroquine group than the control group in all quadrants ( p value < 0.05 ). The perifoveal thickness in both groups showed no statistically significant difference ( p value > 0.05 ) in all quadrants. No significant difference was detected between the two groups regarding RNFL, GCC, or IS/OS junction. Conclusions . Preclinical Chloroquine toxicity can lead to early thinning in the central fovea as well as the parafoveal regions that is detected by SD-OCT.
    Full-text · Article · Aug 2015 · Journal of Ophthalmology
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    • "Although similar abnormal images of cones have been obtained using their AO system, they were not as high quality as the images obtained in the present study. Specifically, we were able to achieve improved image quality and contrast because our AO-SLO utilized a dual liquid crystal on LCOS-SLMs to correct for wavefront aberrations, while the system used by Stepien et al. [16] relied upon a deformable mirror. Moreover, creating a montage of AO-SLO images made it possible to compare each AO-SLO image to visual field test results. "
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    ABSTRACT: A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.
    Full-text · Article · Feb 2014 · Korean Journal of Ophthalmology
    • "However, relative sensitivity and specificity of these tests has not been established yet.[12] Recently, SD-OCT imaging exhibited abnormalities in areas that appeared unaffected on VF 10-2 and clinical fundoscopic examination.[10] These changes may represent potential early retinal HCQ toxicity. "
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    ABSTRACT: Objective: To determine whether early toxic effects from hydroxychloroquine (HCQ) could be detected by spectral-domain optical coherence tomography (SD-OCT) before symtomatic visual loss occured. Materials and Methods: Fifteen subjects with a history of the chronic use of hydroxychloroquine monotherapy for less than five years without fundus changes (group 1) and 15 visually normal healthy subjects (group 2) were enrolled in this study. All participants underwent systemic and ocular examination, visual field testing, and macular scan imaging using SD-OCT. Results: There were no significant differences in sex and ages between the groups (P > 0.05). Mean duration of HCQ usage in group 1 was 2.5 ± 1.34 (range:1-5) years. Visual field testing with central 10-2 threshold program was normal in all subjects. Inner retinal thickness in parafoveal and perifoveal area were found to be significantly lower in group 1 compared to group 2 (P < 0.01 for perifoveal, P < 0.05 for parafoveal retinal measurements). However, significant thinning was demonstrated only in full retinal thickness of perifoveal area in group 1 compared to group 2 (P: 0.013). Parafoveal and perifoveal inner retinal thickness measurements of inferior quadrants were significantly reduced in group 1 compared to group 2 (P < 0.01). Conclusion: Significant thinning of inner retinal layer especially in parafoveal and perifoveal areas in the absence of clinical fundus changes was observed in our study. We consider that SD-OCT may determine when inner retinal thinning starts in these patients and may contribute a quantitative approach to the early diagnosis and progression of retinal changes.
    No preview · Article · Apr 2013 · Indian Journal of Ophthalmology
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