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Quantitative analysis of optical coherence tomography imaging in patients with different severities of hydroxychloroquine toxicity
  1. Raul F Membreno1,
  2. Tharindu De Silva1,
  3. Elvira Agrón2,
  4. Tiarnan DL Keenan2,
  5. Catherine A Cukras1
  1. 1Unit on Clinical Investigation of Retinal Disease, National Eye Institute, NIH, Bethesda, MD, USA
  2. 2Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
  1. Correspondence to Dr Catherine A Cukras, National Institutes of Health, Bethesda, USA; cukrasc{at}nei.nih.gov

Abstract

Purpose To determine the diagnostic validity of quantitative measures derived from optical coherence tomography (OCT) images in their ability to discriminate between cohorts of eyes unaffected by hydroxychloroquine (HCQ) and those with a range of toxicity severities, including mild toxicity.

Methods Prospective, single-centre, case–control study conducted between August 2010 and May 2017. Participants were exposed to HCQ for at least 5 years (mean±SD =14±7.2 years) and classified into affected and unaffected cohorts based on the American Academy of Ophthalmology’s 2016 recommendations. For affected eyes, severity (groups 1–4) was assigned based on the extent of ellipsoid zone loss. For all eyes, spectral domain-OCT scans were analysed quantitatively to compute inner retinal thickness (IRT), outer retinal thickness (ORT), and minimum signal intensity (MI) and compared across toxicity groups.

Results Of the 85 participants (mean age 59±12 years, 93% female), 30 had retinal toxicity. Significant differences in ORT and MI were observed between each affected severity group and unaffected eyes. Significant differences in IRT were observed for groups 3–4 but not groups 1–2. ORT and MI were each able to discriminate between unaffected and group 1 eyes with the highest discrimination at the inner subfields (areas under the curve, AUC=0.96 for ORT and AUC=0.93 for MI).

Conclusions Quantitative analysis of OCT scans revealed significant differences between eyes with and without toxicity in two different measures. Each individual metric could discriminate between the unaffected and the lowest severity category, suggesting their potential utility in screening for HCQ toxicity in patients at risk.

  • retina
  • imaging
  • drugs
  • degeneration

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Deidentified participant data that support the findings of this study are available from the corresponding author, CC at cukrasc@nei.nih.gov, on reasonable request and abiding by institutional sharing guidelines.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Deidentified participant data that support the findings of this study are available from the corresponding author, CC at cukrasc@nei.nih.gov, on reasonable request and abiding by institutional sharing guidelines.

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Footnotes

  • RFM and TDS are joint first authors.

  • RFM and TDS contributed equally.

  • Contributors CC thought of the concept and design of the study and is the guarantor. She wrote the clinical protocol and was the physician evaluating and recruiting patients and collecting data. She reviewed the data analysis and provided interpretation. She critically revised the article and gave final approval of the published version. RM contributed to the data analysis and interpretation. He provided critical revision of the article and gave his final approval to the final version. TDS contributed to the data analysis and interpretation. He provided critical revision of the article and gave his final approval to the final version. EA contributed to data analysis and interpretation. She provided critical revision of the article and gave her final approval to the final version. TK contributed to data collection, data analysis and interpretation. He also provided critical revision of the article and gave his final approval to the final version.

  • Funding NIH/NEI Intramural Research Programme EY000498 and with support of the NIH Medical Research Scholars Programme, a public–private partnership supported jointly by the NIH and contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, the American Association for Dental Research, the Colgate-Palmolive Company and other private donors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.