Date: Monday, November 9, 2015
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The risk of end-stage retinopathy (bull’s eye maculopathy) from hydroxychloroquine (HCQ) is low (0.65%, Wolfe and Marmor, 2010). With recent advances in retinal structure and function testing, early changes on optical coherence tomography (OCT), fundus autoflourescence (FAF), multifocal electroretinography (mfERG), and microperimetry (MP) are being used to detect early signs of hydroxychloroquine retinopathy. Risk of retinopathy as defined by combinations of these tests ranges from 7.5-12% in those on HCQ for at least 5 years or longer. The American Academy of Ophthalmology (AAO) revised its guidelines in 2011 advocating the use of OCT, FAF and mfERG as ancillary tests to ophthalmic exam and visual fields.
Methods: Ophthalmic exam, OCT, FAF, mfERG and MP by experienced retina specialists were performed in 72 eyes of 36 consecutive SLE patients meeting SLICC criteria and on hydroxychloroquine.
Results: Eleven of 72 eyes (15%) had abnormal OCT findings with 2 eyes (2%) deemed possibly related to HCQ, 26 eyes had abnormal mfERG (36%) with 3 eyes (4%) deemed possibly related to HCQ, 19 eyes had abnormal MP (26%) and 10 abnormal FAF (13%). No patient showed changes in all 4 tests suggestive of HCQ retinopathy.
Conclusion: Our series demonstrates that, in the absence of baseline pre-HCQ data for the AAO recommended ancillary tests, it may be difficult to interpret changes seen on these tests. Most of the screenings are done by regular ophthalmologists who may lack the equipment and experience with specialized testing such as mfERG, FAF and OCT. Nonspecific abnormalities are common with these tests, which need careful interpretation by retina specialists. We recommend repeat testing in those with abnormal tests and additional testing in patients in whom all four modalities were not used to determine early toxicity. We do not recommend discontinuing hydroxychloroquine based on nonspecific abnormalities alone and/or abnormalities that are not supported by the respective other modalities.
To cite this abstract in AMA style:Shah SM, Petri M, Scholl H. Hydroxychloroquine Retinopathy: Application of the 2011 Screening Guidelines in an Academic Practice [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/hydroxychloroquine-retinopathy-application-of-the-2011-screening-guidelines-in-an-academic-practice/. Accessed February 24, 2021.
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