June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Diagnostic disparities in testing for hydroxychloroquine (HCQ)-related ocular toxicity
Author Affiliations & Notes
  • Victor Chen
    Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, Los Angeles, CA
  • Maria Carolina Ortube
    Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, Los Angeles, CA
  • Steven Nusinowitz
    Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, Los Angeles, CA
  • Michael Gorin
    Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, Los Angeles, CA
  • Footnotes
    Commercial Relationships Victor Chen, None; Maria Carolina Ortube, None; Steven Nusinowitz, None; Michael Gorin, University of Pittsburgh (P)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1564. doi:
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    • Get Citation

      Victor Chen, Maria Carolina Ortube, Steven Nusinowitz, Michael Gorin; Diagnostic disparities in testing for hydroxychloroquine (HCQ)-related ocular toxicity. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1564.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

The early detection of drug induced HCQ toxicity is paramount in preventing permanent blindness. The recent AAO guidelines describe several tests, including multifocal electroretinogram (mfERG), central automated perimetry (eg Humphrey 10-2 fields (HVF), or macular optical coherence tomography (OCT) as screening tools for HCQ induced toxicity. The purpose of this study was to determine the extent to which the different tests agree in their identification of those patients with toxicity due to HCQ.

 
Methods
 

Retrospective review of records and diagnostic studies of HCQ patients undergoing surveillance for drug-related retinal toxicity. Exclusion criteria included patients with glaucoma, retinal dystrophy, or diabetic retinopathy.

 
Results
 

Sixty-nine patients with prior or current use of HCQ use were evaluated. Of the 19 patients who had at least mfERG and HVF studies, 9 cases (all with < 6 years (yrs) of exposure) did not show abnormalities on HVF and mfERG testing. Four patients had abnormal HVF and mfERG studies after > 10 years of exposure with presumed toxicity. Six individuals demonstrated disparities between their mfERG and HVF test results. (see table below)

 
Conclusions
 

These cases with disparate findings between mfERG and HVF testing for HCQ-related toxicity raise the possibility that a single testing modality may not be sufficient for screening of drug-related retinal toxicity. These unique cases also suggest that HCQ-toxicity may involve a more complex mechanism of action, not simply affecting the RPE, but might include retinal and optic nerve dysfunction.

  
Keywords: 503 drug toxicity/drug effects • 758 visual fields • 509 electroretinography: clinical  
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