June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Characterization of outer retinal changes in patients with long-term hydroxychloroquine use with visible light optical coherence tomography (vis-OCT)
Author Affiliations & Notes
  • Anupam K Garg
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Jingyu Wang
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Ana Collazo Martinez
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Bailee Alonzo
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Ji Yi
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
    Department of Bioengineering, Johns Hopkins University, Baltimore, Maryland, United States
  • Amir H. Kashani
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Anupam Garg None; Jingyu Wang None; Ana Collazo Martinez None; Bailee Alonzo None; Ji Yi None; Amir Kashani Carl Zeiss Meditec, Code F (Financial Support), Carl Zeiss Meditec, Code R (Recipient)
  • Footnotes
    Support  NIH Grant R01EY030564, NIH Grant R01NS108464, NIH Grant R01EY032163
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3381. doi:
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    • Get Citation

      Anupam K Garg, Jingyu Wang, Ana Collazo Martinez, Bailee Alonzo, Ji Yi, Amir H. Kashani; Characterization of outer retinal changes in patients with long-term hydroxychloroquine use with visible light optical coherence tomography (vis-OCT). Invest. Ophthalmol. Vis. Sci. 2023;64(8):3381.

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

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Abstract

Purpose : To evaluate the outer retinal changes associated with hydroxychloroquine (HCQ) toxicity using a novel ultrahigh resolution visible light optical coherence tomography (vis-OCT) system with 1.3μm axial resolution.

Methods : Both eyes of adult subjects with history of HCQ use were prospectively recruited from a tertiary care retina practice for retinal imaging with a custom-built vis-OCT device. Control subjects with no history of retinal disease were also recruited. Subjects with significant media opacity, poor signal quality, or inability to fixate sufficiently to obtain at least one high quality foveal line scan were excluded. Subjects were scanned using a high-definition protocol using a 4-line radial scanning pattern (A-scan [2048*32] * B-scan [4]). 32 modulated A-lines over ~0.1 mm orthogonal to the B-scan direction were averaged to produce high-quality images with reduced speckle noise. The line rate was 100kHz with a total acquisition time of 2.62 seconds.

Results : 13 eyes of 8 subjects (2 controls and 6 HCQ; mean age 51.9 +/- 6.4 years) met inclusion and exclusion criteria. The most common reason for exclusion was inability to fixate. Mean duration of HCQ use was 14.5 +/- 5.6 years. Three subjects had clinically diagnosed toxicity resulting in cessation of HCN and 3 subjects had clinically suspicious changes warranting further investigation. Figures 1 & 2 illustrate the spectrum of findings. Figure 1 demonstrates an image from a 53-year-old subject with 4 years of HCQ use and known toxicity who had graded parafoveal attenuation of outer retinal bands including putative external limiting membrane (ELM), ellipsoid zone (EZ) and photoreceptor outer segment tips (POS) and retinal pigment epithelium (RPE). Figure 2 demonstrates an image from a subject with 31 years of HCQ use and suspected toxicity showing subtle parafoveal attenuation in the EZ, POS, and RPE.

Conclusions : Ultrahigh resolution vis-OCT imaging demonstrates graded attenuation of outer retinal features in subjects with HCQ use and known or suspected toxicity. In regions where RPE is most severely affected, the overlying retinal features are also most severely damaged supporting the hypothesis that RPE damage occurs earlier than or in parallel with outer retinal changes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

 

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