Abstract
Purpose To evaluate early effects of hydroxychloroquine (HCQ) on the retina using adaptive optics (AO). Methods This was a prospective observational single-center study of 29 eyes of 29 patients who had been treated with HCQ for the first time and followed with AO for a minimum of two years. Cone counting was performed in 4 quadrants, nasal, temporal, superior, and inferior, at 0.75 mm from the foveal center. The changes of cone density on AO, visual acuity, and foveal thickness within two years of use were analyzed. The changes of mean cone density of patients whose cumulative dose was over 200 g in 2 years were also assessed. We evaluated the correlation between cone density and cumulative dose of HCQ. Results There was no significant decrease in cone density in the first 2 years of HCQ use. VA and foveal thickness did not show obvious change, either. Among 9 patients whose cumulative dose was over 200 g in 2 years, the mean cone density showed no significant change at 6, 12, 18, and 24 months compared with baseline (P=0.381, P=0.380, P=0.281, and P=0.534, respectively). There was no correlation between cone density and cumulative dose of HCQ at two years (Spearman's correlation coefficient, r = −0.0553, P=0.780; n = 29). Conclusion AO showed no change in cone density in the first two years of HCQ use.
Highlights
Effects of hydroxychloroquine (HCQ) on the retina remain largely unexplored
HCQ retinopathy (HCQR) is progressive and irreversible, and there is no present therapy. erefore, patients taking HCQ are recommended to be informed about toxicity risk and proper dose levels and appropriately screened for early detection [13]. e American Academy of Ophthalmology (AAO) guidelines recommend the use of both automated visual field and spectral-domain optical coherence tomography (SD-OCT) as the primary tests [13]
Considering that the primary detectable change is in photoreceptors, the assessment of cone density using adaptive optics (AO) retinal imaging could help detect the definitive signs of toxicity at an early enough stage of HCQR
Summary
Effects of hydroxychloroquine (HCQ) on the retina remain largely unexplored. Erefore, patients taking HCQ are recommended to be informed about toxicity risk and proper dose levels and appropriately screened for early detection [13]. Considering that the primary detectable change is in photoreceptors, the assessment of cone density using adaptive optics (AO) retinal imaging could help detect the definitive signs of toxicity at an early enough stage of HCQR. Debellemaniere et al reported moderate cone loss in patients with no clinical evidence of maculopathy as HCQ cumulative doses increased [14]. E changes of cone density within a few years of use are still unclear In this prospective observational single-center study, we examined the cone structure in patients who had been treated with HCQ for the first time and followed for at least 2 years
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