Abstract
Purpose :
To report the outcome and findings from hydroxychloroquine (HCQ) retinopathy screening utilising spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) as a primary imaging modality at Moorfields Eye Hospital, London.
Methods :
Patients who were treated with HCQ were screened annually using SD-OCT and FAF. If both imaging modalities were positive, a patient was confirmed to have HCQ toxicity but if only one modality was positive, further examinations were performed. The patient records from the HCQ screening clinics from November 2019 to November 2021 were reviewed. Data collected included age, sex, indication for usage of HCQ, number of years of treatment, dosage, risk factors such as kidney disease, and use of tamoxifen. Further qualitative and quantitative data from FAF and OCT were evaluated.
Results :
Nine hundred forty-six patients were included in our study.
Eight hundred and one were female (84.67%) and 145 (15.33%) were male. The age was 56.631±4.14 (range 16-97). Medical indications for HCQ included rheumatoid arthritis in 317 cases (33.51%), undifferentiated connective tissue disease in 261 cases (27.59%), systemic lupus erythematosus in 220 cases (23.26%), and other indications in 148 cases (15.64%). The subjects were treated for 7.58±5.89 years (range 0-40).
One hundred fifty-one (15.96%) patients were referred to further examination: seventy-eight (8.25%) to electrophysiology tests, seventy-two (7.61%) to visual fields, and one (0.11%) to genetic blood tests.
Thirty-seven (3.91%) patients were diagnosed with HCQ retinopathy. The rates of retinopathy based on duration were 1.72% (6/348) with treatment up to 5 years, 3.87% (12/ 310) with use of HCQ between 5-10 years, 5.38% (5/93) between 10-15 years, 15.38% (8/52) between 15-20 years, and 19.23% (5/26) with more than 20 years of HCQ use. One of the positive patients had kidney disease, and was positive after the shortest treatment period of 3 months. None of the positive cases was treated with tamoxifen. Of the 37 patients with confirmed toxicity, 19 (51.35%) had a vision of LogMAR 0.
Conclusions :
Findings from HCQ retinopathy screening monitored using SD-OCT and FAF results in a similar incidence of HCQ retinopathy as programmes utilising visual fields as a routine thus proving to be a safe and effective method to screen HCQ retinopathy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.