Visual Field Sensitivity Prediction Using Optical Coherence Tomography Analysis in Hydroxychloroquine Toxicity.

This study investigates the association between local retina structure and visual function in a cohort with long-term hydroxychloroquine (HCQ) use. The study included 84 participants (54 participants without toxicity and 30 participants with toxicity) with history of chronic HCQ use (14.5 ± 7.4 years) who had testing with spectral-domain optical coherence tomography (SD-OCT) imaging and Humphrey 10-2 visual fields. Optical coherence tomography (OCT) metrics (total and outer retina thickness [TRT and ORT], minimum intensity [MinI], and ellipsoid zone [EZ] loss) were sampled in regions corresponding to visual field test locations. Univariate linear correlations were investigated and a multivariate random forest regression using a combination of OCT metrics was used to predict visual field sensitivity by locus using a leave-one-out cross-validation strategy. In univariate linear regression, EZ loss demonstrated the strongest relationship with visual field sensitivities in the parafoveal ring with R2 = 0.58. TRT and ORT revealed positive correlations with visual field sensitivity (R2 = 0.57 and 0.40, respectively), whereas total and outer retinal MinI yielded negative correlations (R2 = 0.10 and 0.22). The multivariate model improved correlations (R2 = 0.66) yielding a root mean squared error of 3.8 decibel (dB). Feature importance analysis identified EZ loss as the most relevant predictor of function. Multiple OCT-derived quantitative metrics used in combination can provide information to predict local sensitivities. The results indicate a strong relationship between retinal function and OCT measures, which contribute to the understanding of the retinal toxicity caused by HCQ as well as being applicable to outcome development for other degenerative diseases of the outer retina.

本研究在一组长期使用羟氯喹（HCQ）的队列中探究局部视网膜结构与视觉功能之间的关联。 该研究纳入了84名参与者（54名无毒性参与者和30名有毒性参与者），他们都有长期使用HCQ的病史（14.5 ± 7.4年），并接受了频域光学相干断层扫描（SD - OCT）成像和汉弗莱10 - 2视野检查。光学相干断层扫描（OCT）指标（视网膜全层和外层厚度[TRT和ORT]、最小强度[MinI]以及椭圆体带[EZ]缺失）在与视野测试位置相对应的区域进行采样。研究了单变量线性相关性，并使用一种结合OCT指标的多元随机森林回归，通过留一法交叉验证策略按位点预测视野敏感度。 在单变量线性回归中，EZ缺失在旁中心凹环与视野敏感度的关系最强，R² = 0.58。TRT和ORT与视野敏感度呈正相关（R²分别为0.57和0.40），而视网膜全层和外层的MinI呈负相关（R²分别为0.10和0.22）。多元模型提高了相关性（R² = 0.66），产生的均方根误差为3.8分贝（dB）。特征重要性分析确定EZ缺失是功能最相关的预测因子。 多种OCT衍生的定量指标结合使用可以提供信息来预测局部敏感度。研究结果表明视网膜功能与OCT测量值之间有很强的关系，这有助于理解HCQ导致的视网膜毒性，并且适用于外层视网膜其他退行性疾病的预后发展。