Macular thickness mapping detects hydroxychloroquine toxicity early, with specificity
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KOLOA, Hawaii — Sequential macular thickness mapping can be used to detect retinal toxicity from hydroxychloroquine early and with specificity, according to a speaker here.
A fundus or clinical exam, on the other hand, is not ideal, Robin A. Vora, MD, said in a presentation at Retina 2023.
“It is not sensitive, and it will detect disease way too late,” he said.
Advantages of using sequential macular thickness plots to diagnose hydroxychloroquine toxicity are that it uses OCT data, is objective and quantitative, has fairly consistent retinal full-thickness data from test to test, and offers graph interpretation that is straightforward, he said.
Disadvantages are that OCT vendors have yet to enable thickness and trend reports, and they require three or more studies to confirm a trend, he said.
Hydroxychloroquine toxicity matters because approximately 500,000 patients in the U.S. take the drug long-term as a mainstay of treatment for lupus, as well as other anti-inflammatory diseases, including rheumatoid arthritis, he said.
“As ophthalmologists, we really want to save the patient from a blinding outcome,” Vora said.
It is key to recognize toxicity early so that dose reduction and more frequent monitoring can be implemented.
“If you start to see things, you can begin the discussion both with the patient and rheumatologist or dermatologist,” Vora said.
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Vora RA. Diagnosing hydroxychloroquine toxicity: Are you sure, you are sure? Presented at: Retina 2023; Jan. 15-20, 2023; Koloa, Hawaii.
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