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Evaluation of macular pigment optical density in patients treated with hydroxychloroquine

Session Details

Session Title: New Drug Treatment

Session Date/Time: Saturday 13/09/2014 | 14:30-16:30

Paper Time: 15:26

Venue: Boulevard F

First Author: : A.F.Miranda PORTUGAL

Co Author(s): :    N. Marques   J. Cardoso   A. Cardoso   S. Barros   P. Telles   N. Campos

Abstract Details


Retinal toxicity caused by hydroxychloroquine (HCQ) is rare but potencially irreversible, therefore early detection is important. The macular pigment (lutein and zeaxanthin) attenuates short wavelengths of visible light and neutralizes reactive oxygen species that could damage photoreceptors. There are various methods to measure macular pigment optical density (MPOD) and heterochromatic flicker photometry (HFP) is one of them. MPOD is reduced in some ocular diseases but it has never been measured in patients treated with HCQ. The purpuse of this study is to evaluate MPOD in these patients and to determine a correlation with risk factors associated with retinal toxicity.


This study was performed by the Medical Retina Department at Hospital Garcia de Orta, Portugal.


Cross-sectional study, with a sample of 45 eyes from 23 patients, receiving HCQ. Visual symptoms, treatment duration, cumulative dose, total daily dose, weight adjusted daily dose, best corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundoscopy, MPOD quantification using HFP with QuantifEye®, perimetry using the macular program of Octopus 900®, fundus autofluorescence (FAF) and macular optical coherence tomography (OCT) using Cirrus Photo 600® were evaluated. MPOD results were compared with those obtained in an age-adjusted control group.


45 eyes from 23 patients, 22 were women, with a mean age of 54,6 ± 12,8 years, were evaluated. None had visual symptoms, slit-lamp or fundoscopic changes, and all had a BCVA ≥0,80. Perimetry, FAF and macular OCT results were normal in all patients. We determined a mean MPOD of 0,40 ± 0,10 in the treatment group and of 0,49 ± 0,12 in the control group (p<0,001). We found a correlation between MPOD and HCQ cumulative dose (r = -0,31; p < 0,05) and treatment duration (r= -0,29; p<0,05).


We concluded that MPOD in patients receiving HCQ is statistically different from controls, previously to visual symptoms, fundoscopic changes and signs of toxicity in perimetry, FAF and macular OCT. The MPOD correlates with cumulative dose of the drug and treatment duration. The reduced MPOD is an additional data on the physiopathology of HCQ retinal toxicity and may be important in identifying patients at major risk of developing it.

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