Abstract
Purpose :
Hydroxychloroquine (HCQ) is commonly prescribed for treatment of autoimmune diseases. Long term use is associated with retinal toxicity; thus, early detection is paramount in limiting irreversible vision loss. We performed a retrospective chart review characterizing the demographics and analyzing optical coherence tomography (OCT) parameters of patients with high risk HCQ use.
Methods :
Retrospective analysis of 80 patients referred for evaluation at Penn State Eye Center for high risk HCQ use was conducted. For patients diagnosed with retinal toxicity, retinal layer mean thickness was recorded for the nine subfields of the Early Treatment of Diabetic Retinopathy Study (ETDRS) macular grid at time of diagnosis and compared to baseline to calculate the change in OCT thickness. For patients not diagnosed with retinal toxicity, retinal layer mean thickness was recorded as described previously at baseline and patients’ most recent visit.
Results :
Of 80 patients, 75% were female, 26% were non-white, and the most commonly treated diseases were systemic lupus erythematosus (35%), rheumatoid arthritis (20%), and Sjogren’s syndrome (8%). Retinal toxicity was diagnosed in 49% of patients. The mean cumulative dose and duration of plaquenil use were 16,265 g and 11 years respectively. There was no statistically significant difference in age, sex, race, or rheumatologic medical condition between patients with or without retinal toxicity. The mean OCT thickness of the foveal center was 271μm and 267μm (p=0.596), inner ring was 307μm and 322μm (p=0.002), and outer ring was 275μm and 267μm (p=0.112) in patients diagnosed with and without toxicity respectively. The mean change in OCT thickness of the foveal center was -7.7μm and -5.7μm (p=0.617), inner ring was -11.4μm and -4.4μm (p=0.061), outer ring was -9.3μm and -0.5μm (p=0.098) in patients diagnosed with and without toxicity respectively.
Conclusions :
There was no identifiable significant demographic factor that was associated with increased incidence of HCQ retinal toxicity. The mean OCT thickness of the inner ring of the ETDRS grid was most predictive of HCQ toxicity and the net change in OCT thickness at the time of HCQ toxicity diagnosis was unremarkable at the foveal center, inner ring, and outer ring. Monitoring absolute mean OCT thickness of the inner ring may provide early signs of HCQ retinal toxicity and guide additional testing.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.