FRI0639 A NOVEL SCREENING METHOD FOR HYDROXYCHLOROQUINE MACULOPATHY

Background Hydroxychloroquine maculopathy is irreversible, primary prevention is done by early screening. Published data show that thinning of the retinal outer nuclear layer (ONL) is an early feature which has been described as “The flying saucer sign”. Objectives To determine the effect of retinal outer nuclear layer thinning on the progression of hydroxychloroquine retinopathy. Methods We used a Heidelberg Spectralis(R) Spectral Domain Ocular Coherence Tomography (SD OCT) scanner to record the volume of the ONL in 194 eyes of 100 patients who have been on Hydroxychloroquine for 5 years or more. Volume data was analysed using the Statistical Package for Social Sciences (SPSS), we used logistic regression method to determine the probability of developing maculopathy based of the degree of reduction of the ONL volume. We correlated the loss of ONL to changes in visual fields. Results Mean age: 62.2 years, 20% males and 80% females. Diagnosis: 68% rheumatoid arthritis, 14% Sjogren’s syndrome, 16% Systemic Lupus and 2% others. Mean duration of use was 6.3 years. Logistic regression results show strong negative correlation between the ONL volume and probability of toxicity, a reduction of 0.5 mm3 of the ONL volume carries a 51% chance of developing maculopathy (P=0.001), the Hosmer-Lemeshow test indicates a high significance with a high P value of 0.61. Onset and progression of visual field defects strongly correlate to loss of ONL volume of 50% or more (P=0.000) and age above 35 years (P=0.0001). Conclusion Outer nuclear layer volume reduction provides an accurate and objective way of predicting the development of hydroxychloroquine retinopathy, this method also helps building a cooperative relationship between ophthalmologists and rheumatologists to establish an effective screening service. References [1] I. H. Yusuf, S. Sharma, R. Luqmani and S. M. Downes, Hydroxychloroquine retinopathy, 2017. [2] M. Wiacek, D. Bobrowska-Snarska, W. Lubinski, M. Brzosko and M. Modrzejewska, What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review, 2017. [3] G. P. Smith, High-risk category for early annual ophthalmology screening of patients receiving hydroxychloroquine, 2017. [4] G. Ruberto, C. Bruttini, C. Tinelli, L. Cavagna, A. Bianchi and G. Milano, “Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study”. [5] J. A. Rodriguez-Padilla, T. R. Hedges, B. Monson, V. Srinivasan, M. Wojtkowski, E. Reichel, J. S. Duker, J. S. Schuman and J. G. Fujimoto, “High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy,” Archives of Ophthalmology, 2007. [6] K. C. Iselin, P. Marti and M. Pless, “Hydroxychloroquine-Induced Retinal Toxicity,” Klinische Monatsblatter fur Augenheilkunde, 2016. [7] F. Babeau, T. Busetto, C. Hamel, M. Villain and V. Daien, Adaptive optics: a tool for screening hydroxychloroquine-induced maculopathy?, 2017. [8] “Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Screening,” 2018. Disclosure of Interests Hani Hasan Grant/research support from: Bayer, Heidelberg Engineering, Speakers bureau: Bayer, Khin Yein: None declared, Tareg Mudawi: None declared, Elizabeth Price: None declared, Guy Smith: None declared