Catherine Cukras1, Nancy Huynh2, Susan Vitale3, Wai T Wong4, Fredrick L Ferris3, Paul A Sieving5. 1. Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: cukrasc@nei.nih.gov. 2. Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland. 3. Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland. 4. Office of the Scientific Director, National Eye Institute, National Institutes of Health, Bethesda, Maryland. 5. Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Section for Translational Research in Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland.
Abstract
OBJECTIVE: To compare subjective and objective clinical tests used in the screening for hydroxychloroquine retinal toxicity to multifocal electroretinography (mfERG) reference testing. DESIGN: Prospective, single-center, case control study. PARTICIPANTS: Fifty-seven patients with a previous or current history of hydroxychloroquine treatment of more than 5 years' duration. METHODS: Participants were evaluated with a detailed medical history, dilated ophthalmologic examination, color fundus photography, fundus autofluorescence (FAF) imaging, spectral-domain (SD) optical coherence tomography (OCT), automated visual field testing (10-2 visual field mean deviation [VFMD]), and mfERG testing. We used mfERG test parameters as a gold standard to divide participants into 2 groups: those affected by hydroxychloroquine-induced retinal toxicity and those unaffected. MAIN OUTCOME MEASURES: We assessed the association of various imaging and psychophysical variables in the affected versus the unaffected group. RESULTS: Fifty-seven study participants (91.2% female; mean age, 55.7±10.4 years; mean duration of hydroxychloroquine treatment, 15.0±7.5 years) were divided into affected (n = 19) and unaffected (n = 38) groups based on mfERG criteria. Mean age and duration of hydroxychloroquine treatment did not differ statistically between groups. Mean OCT retinal thickness measurements in all 9 macular subfields were significantly lower (<40 μm) in the affected group (P < 0.01 for all comparisons) compared with those in the unaffected group. Mean VFMD was 11 dB lower in the affected group (P < 0.0001). Clinical features indicative of retinal toxicity were scored for the 2 groups and were detected in 68.4% versus 0.0% using color fundus photographs, 73.3% versus 9.1% using FAF images, and 84.2% versus 0.0% on the scoring for the perifoveal loss of the photoreceptor ellipsoid zone on SD-OCT for affected and unaffected participants, respectively. Using a polynomial modeling approach, OCT inner ring retinal thickness measurements and Humphrey 10-2 VFMD were identified as the variables associated most strongly with the presence of hydroxychloroquine as defined by mfERG testing. CONCLUSIONS: Optical coherence tomography retinal thickness and 10-2 VFMD are objective measures demonstrating clinically useful sensitivity and specificity for the detection of hydroxychloroquine toxicity as identified by mfERG, and thus may be suitable surrogate tests. Published by Elsevier Inc.
OBJECTIVE: To compare subjective and objective clinical tests used in the screening for hydroxychloroquineretinal toxicity to multifocal electroretinography (mfERG) reference testing. DESIGN: Prospective, single-center, case control study. PARTICIPANTS: Fifty-seven patients with a previous or current history of hydroxychloroquine treatment of more than 5 years' duration. METHODS:Participants were evaluated with a detailed medical history, dilated ophthalmologic examination, color fundus photography, fundus autofluorescence (FAF) imaging, spectral-domain (SD) optical coherence tomography (OCT), automated visual field testing (10-2 visual field mean deviation [VFMD]), and mfERG testing. We used mfERG test parameters as a gold standard to divide participants into 2 groups: those affected by hydroxychloroquine-induced retinal toxicity and those unaffected. MAIN OUTCOME MEASURES: We assessed the association of various imaging and psychophysical variables in the affected versus the unaffected group. RESULTS: Fifty-seven study participants (91.2% female; mean age, 55.7±10.4 years; mean duration of hydroxychloroquine treatment, 15.0±7.5 years) were divided into affected (n = 19) and unaffected (n = 38) groups based on mfERG criteria. Mean age and duration of hydroxychloroquine treatment did not differ statistically between groups. Mean OCT retinal thickness measurements in all 9 macular subfields were significantly lower (<40 μm) in the affected group (P < 0.01 for all comparisons) compared with those in the unaffected group. Mean VFMD was 11 dB lower in the affected group (P < 0.0001). Clinical features indicative of retinal toxicity were scored for the 2 groups and were detected in 68.4% versus 0.0% using color fundus photographs, 73.3% versus 9.1% using FAF images, and 84.2% versus 0.0% on the scoring for the perifoveal loss of the photoreceptor ellipsoid zone on SD-OCT for affected and unaffected participants, respectively. Using a polynomial modeling approach, OCT inner ring retinal thickness measurements and Humphrey 10-2 VFMD were identified as the variables associated most strongly with the presence of hydroxychloroquine as defined by mfERG testing. CONCLUSIONS: Optical coherence tomography retinal thickness and 10-2 VFMD are objective measures demonstrating clinically useful sensitivity and specificity for the detection of hydroxychloroquinetoxicity as identified by mfERG, and thus may be suitable surrogate tests. Published by Elsevier Inc.
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: Ali M Allahdina; Paul F Stetson; Susan Vitale; Wai T Wong; Emily Y Chew; Fredrick L Ferris; Paul A Sieving; Catherine Cukras Journal: Invest Ophthalmol Vis Sci Date: 2018-04-01 Impact factor: 4.799
Authors: Milena A Gianfrancesco; Gabriela Schmajuk; Sarah Haserodt; Laura Trupin; Zara Izadi; Kashif Jafri; Stephen Shiboski; Marina Sirota; Jinoos Yazdany Journal: Rheumatol Int Date: 2017-07-26 Impact factor: 2.631
Authors: Mohammed Salah Eldin Abdelbaky; Tarek Ahmad El Mamoun; Fatma Ibrahim Mabrouk; Rasha Mohamad Hassan Journal: Egypt J Intern Med Date: 2021-06-08