Hydroxychloroquine retinopathy: A review of imaging

Abstract

Hydroxychloroquine (HCQ) retinopathy can result in permanent vision loss. In early stages of HCQ retinopathy, patients are usually asymptomatic with preservation of visual acuity. We aspire that our review, in conjunction with the American Academy of Ophthalmology screening guidelines, shall shed light on effective screening measures utilizing multimodal imaging techniques to detect early signs of HCQ retinopathy before advanced changes manifest clinically.

Figure 1

10-2 visual fields: Bilateral paracentral scotoma

Figure 2

Color fundus photography: Bilateral parafoveal retinal pigment atrophy (“Bull's eye maculopathy”)

Figure 3

Color Fundus photography: No clinically evident retinopathy, despite corresponding changes in spectral-domain optical coherence tomography [Figure 5]

Figure 4

Spectral-domain optical coherence tomography: Bilateral parafoveal outer retinal and retinal pigment epithelium atrophy with central sparing (“flying saucer sign”)

Figure 5

Spectral-domain optical coherence tomography: Selective inner retinal layer thinning with sparing of the outer retinal or retinal pigment epithelium layers

Figure 6

Fundus autofluorescence: Bilateral parafoveal hypoautofluorescence

Figure 7

Multifocal electroretinogram: Paracentral and generalized signal attenuation