Hydroxychloroquine Retinopathy with SD-OCT Changes and Minimal Fundus Changes

The images shown here refer to the same case as "Hydroxychloroquine Retinopathy with Minimal Fundus Changes". This 68 year old woman with systemic lupus erythematosus had been on hydroxychloroquine at a dosage of 400 mg/d (6.52 mg/kg/d) for eight years. Her optometrist had checked her yearly during that time until in the eighth year he became suspicious of hydroxychloroquine toxicity because of visual field changes noted. E - Spectral domain optical coherence tomography shows loss of the inner segment/ outer segment junction (orange arrow) compared to the more normal structure retained at the yellow arrow, and reduction in thickness of the outer nuclear layer (blue arrow). SD-OCT is an objective test for toxicity that complements 10-2 visual field testing. 10-2 visual testing is probably more sensitive, but is heir to interpretational difficulties and variability not so much a problem with SD-OCT.