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Consider ancillary testing in addition to OCT for hydroxychloroquine toxicity
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BALTIMORE — Ancillary testing may provide essential information in determining hydroxychloroquine toxicity, according to a study presented here.
When screening for hydroxychloroquine (HCQ) retinopathy, the 2016 American Academy of Ophthalmology guidelines recommend the use of ancillary testing such as fundus autofluorescence (FAF) and multifocal electroretinography (mfERG), as well as the standards of clinical exam, visual fields and OCT.
“We were interested in doing this study because there has not been a cohort of patients who have had all of these tests done to see the comparative efficacy of each test,” Mustafa Iftikhar, MD, of Wilmer Eye Institute, said in an interview with Healio.com/OSN at the Association for Research in Vision and Ophthalmology annual meeting.
An ophthalmic exam, microperimetry (MP), OCT, FAF and mfERG were performed on 443 eyes of 222 patients who met the criteria for diagnosis of systemic lupus erythematosus and were using HCQ. HCQ treatment averaged 12.5 years.
One hundred three eyes (23%) had abnormal findings on OCT, with 47 (11%) related to HCQ. With MP, 121 eyes (27%) had abnormal findings, with 30 (7%) related to HCQ. FAF testing yielded abnormal findings in 106 eyes (24%), with 26 (6%) related to HCQ. With mfERG, 129 eyes (29%) had abnormal findings, with 24 (5%) related to HCQ.
Thirty-two eyes (7%) showed changes consistent with HCQ retinopathy in two or more tests and 11 eyes (2%) in all four tests, according to the study.
“We found that OCT was the most sensitive test in detecting definite HCQ toxicity followed by microperimetry,” Iftikhar said. “However, at least 20% of patients who were OCT-negative did show definitive toxicity in other tests.”
While OCT has been one of the best tests to use, “objectively, it is not the only test to implement. Inclusion of visual fields, particularly microperimetry, is going to improve HCQ toxicity detection,” he said. – by Abigail Sutton
Reference:
Iftikhar M, et al. Detection of hydroxychloroquine toxicity based on AAO 2016 guidelines. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 7-11, 2017; Baltimore.
Disclosure: Iftikhar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.