title: Spectral-domain optical coherence tomography and adaptive optics may detect hydroxychloroquine retinal toxicity before symptomatic vision loss.
abstract: OBJECTIVE
  To describe spectral-domain optical coherence tomography (SD-OCT) and adaptive optics (AO) imaging in hydroxychloroquine retinal toxicity.
  
  
  METHODS
  Two patients with long-term hydroxychloroquine use, subtle perifoveal ophthalmoscopic pigmentary changes, and bilateral perifoveal defects on automated Humphrey visual field (HVF) 10-2 perimetry were imaged using SD-OCT and AO.
  
  
  RESULTS
  SD-OCT images demonstrated loss of photoreceptor inner segment/outer segment (IS/OS) junction and a downward "sink-hole" displacement of inner retinal structures in areas of hydroxychloroquine toxicity corresponding to HVF 10-2 defects and ophthalmoscopic clinical examination findings. SD-OCT irregularities in the IS/OS junction were also seen in areas not detected on HVF 10-2. AO images showed disruption of the cone photoreceptor mosaic in areas corresponding to HVF 10-2 defects and SD-OCT IS/OS junction abnormalities. Additionally, irregularities in the cone photoreceptor density and mosaic were seen in areas with normal HVF 10-2 and SD-OCT findings.
  
  
  CONCLUSIONS
  SD-OCT and AO detected abnormalities that correlate topographically with visual field loss from hydroxychloroquine toxicity as demonstrated by HVF 10-2 and may be useful in the detection of subclinical abnormalities that precede symptoms or objective visual field loss.
authors.affiliation: Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Stepien
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Han
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schell
authors.forename: Pooja
authors.initials: P
authors.lastname: Godara
authors.forename: Jungtae
authors.initials: J
authors.lastname: Rha
authors.forename: Joseph
authors.initials: J
authors.lastname: Carroll
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008875:Middle Aged; D009887:Ophthalmoscopy; D055095:Optics and Photonics / Q000379:methods*; D012160:Retina / Q000187:drug effects / Q000473:pathology; D017949:Retinal Cone Photoreceptor Cells / Q000473:pathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D012168:Retinal Pigments / Q000378:metabolism; D012859:Sjogren's Syndrome / Q000188:drug therapy; D041623:Tomography, Optical Coherence / Q000379:methods*; D014786:Vision Disorders / Q000209:etiology*; D058609:Visual Field Tests; D014794:Visual Fields
chemical_list: D018501:Antirheumatic Agents; D012168:Retinal Pigments; D006886:Hydroxychloroquine