title: Near-infrared reflectance bull's eye maculopathy as an early indication of hydroxychloroquine toxicity.
abstract: OBJECTIVE
  In some patients, hydroxychloroquine ocular toxicity may progress even following cessation of therapy. Any leverage the clinician may use to allow earlier detection may avert significant vision loss.
  
  
  METHODS
  We report three cases suggesting that bull's eye maculopathy seen on near-infrared reflectance with a confocal scanning laser ophthalmoscope could be an early, objective manifestation of hydroxychloroquine ocular toxicity, and with progression of the disease this near-infrared "bull's eye" change may disappear.
  
  
  CONCLUSIONS
  Alerting clinicians to this observation may allow a larger case series to corroborate the hypothesis that bull's eye maculopathy detected by near-infrared reflectance may represent an early sign of hydroxychloroquine toxicity.
authors.affiliation: Retina Associates of Sarasota, Sarasota, FL, USA.
authors.forename: Keye L
authors.initials: KL
authors.lastname: Wong
authors.affiliation: Retina Vitreous Associates of Florida, Tampa, FL, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Pautler
authors.affiliation: Charlotte Eye Ear Nose and Throat Associates, Charlotte, NC, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Browning
keywords: confocal; multifocal ERG; scanning laser ophthalmoscope
references.citation: Am J Ophthalmol. 2014 Dec;158(6):1247-1252.e2
references.pmid: 25174897
references.citation: Clin Exp Optom. 2011 May;94(3):276-83
references.pmid: 20533929
references.citation: Ophthalmology. 2014 Jun;121(6):1257-62
references.pmid: 24439759
references.citation: J Ocul Pharmacol Ther. 2009 Jun;25(3):249-58
references.pmid: 19348599
references.citation: Ophthalmology. 2011 Feb;118(2):415-22
references.pmid: 21292109
references.citation: Vision Res. 1996 Jan;36(1):191-205
references.pmid: 8746253