Michael F Marmor1, Ronald B Melles2. 1. Department of Ophthalmology and Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California. Electronic address: marmor@stanford.edu. 2. Department of Ophthalmology, Kaiser Permanente Northern California, Redwood City Medical Center, Redwood City, California.
Abstract
PURPOSE: American Academy of Ophthalmology recommendations for screening for hydroxychloroquine (HCQ) retinopathy advise objective measures, such as spectral-domain optical coherence tomography (SD-OCT) and multifocal electroretinography (mfERG) along with visual fields. However, the relative sensitivity and specificity of screening tests have not been fully resolved. We characterize a subset of patients with toxicity who show unusual disparity between fields and SD-OCT and thus have implications for screening practice. DESIGN: Review of charts and clinical data. PARTICIPANTS: Patients at Stanford and Kaiser Permanente who had used HCQ with greater than 1000 g cumulative exposure. There were more than 2000 such individuals, among whom 150 had clear evidence of toxicity. METHODS: Patients were evaluated by visual fields (10-2 white Swedish Interactive Threshold Algorithm pattern deviation plots), SD-OCT, and sometimes mfERG or fundus autofluorescence. MAIN OUTCOME MEASURES: Relative findings on visual fields in comparison with SD-OCT. RESULTS: There were 11 patients among those with HCQ toxicity who had parafoveal ring scotomas but a normal-appearing SD-OCT. None had a history of macular disease or evidence for any other cause of bull's eye maculopathy. Conversely, all cases with a clear degree of parafoveal damage on SD-OCT showed at least some focal spots of parafoveal field loss. CONCLUSIONS: Approximately 10% of patients with early HCQ toxicity showed prominent ring scotomas on field testing without obvious SD-OCT abnormality. This should encourage the inclusion of visual fields as a key screening tool, even when SD-OCT (a more specific and objective test) also is performed. The combination of visual fields and SD-OCT gives both sensitivity and specificity while avoiding unnecessary stoppage of the drug.
PURPOSE: American Academy of Ophthalmology recommendations for screening for hydroxychloroquine (HCQ) retinopathy advise objective measures, such as spectral-domain optical coherence tomography (SD-OCT) and multifocal electroretinography (mfERG) along with visual fields. However, the relative sensitivity and specificity of screening tests have not been fully resolved. We characterize a subset of patients with toxicity who show unusual disparity between fields and SD-OCT and thus have implications for screening practice. DESIGN: Review of charts and clinical data. PARTICIPANTS: Patients at Stanford and Kaiser Permanente who had used HCQ with greater than 1000 g cumulative exposure. There were more than 2000 such individuals, among whom 150 had clear evidence of toxicity. METHODS:Patients were evaluated by visual fields (10-2 white Swedish Interactive Threshold Algorithm pattern deviation plots), SD-OCT, and sometimes mfERG or fundus autofluorescence. MAIN OUTCOME MEASURES: Relative findings on visual fields in comparison with SD-OCT. RESULTS: There were 11 patients among those with HCQ toxicity who had parafoveal ring scotomas but a normal-appearing SD-OCT. None had a history of macular disease or evidence for any other cause of bull's eye maculopathy. Conversely, all cases with a clear degree of parafoveal damage on SD-OCT showed at least some focal spots of parafoveal field loss. CONCLUSIONS: Approximately 10% of patients with early HCQ toxicity showed prominent ring scotomas on field testing without obvious SD-OCT abnormality. This should encourage the inclusion of visual fields as a key screening tool, even when SD-OCT (a more specific and objective test) also is performed. The combination of visual fields and SD-OCT gives both sensitivity and specificity while avoiding unnecessary stoppage of the drug.
Authors: Mustafa Iftikhar; Ramandeep Kaur; April Nefalar; Bushra Usmani; Saleema Kherani; Isra Rashid; Etienne Schönbach; Michelle Petri; Hendrik P N Scholl; Syed M Shah Journal: Retina Date: 2019-03 Impact factor: 4.256
Authors: Mehmet Bulut; Melih Akıdan; Onursal Gözkaya; Muhammet Kazım Erol; Ayşe Cengiz; Hasan Fatih Çay Journal: Graefes Arch Clin Exp Ophthalmol Date: 2018-08-29 Impact factor: 3.117
Authors: Vivienne C Greenstein; Luz Amaro-Quireza; Evelyn S Abraham; Rithambara Ramachandran; Stephen H Tsang; Donald C Hood Journal: Doc Ophthalmol Date: 2014-12-12 Impact factor: 2.379
Authors: Nathalie Costedoat-Chalumeau; Bertrand Dunogué; Gaëlle Leroux; Nathalie Morel; Moez Jallouli; Véronique Le Guern; Jean-Charles Piette; Antoine P Brézin; Ronald B Melles; Michael F Marmor Journal: Clin Rev Allergy Immunol Date: 2015-12 Impact factor: 8.667
Authors: Riham S H M Allam; Mai N Abd-Elmohsen; Mohamed M Khafagy; Karim A Raafat; Sherif M Sheta Journal: J Ophthalmol Date: 2015-08-02 Impact factor: 1.909