Original articleDetection of Early Hydroxychloroquine Retinal Toxicity Enhanced by Ring Ratio Analysis of Multifocal Electroretinography
Section snippets
Methods
All data were collected in the course of routine clinical practice. Institutional Review Board approval was obtained and the study is in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations.
Normal Data
Linear regression was used to determine the change of each parameter value with age. The R1 and the other raw ring amplitudes (R2–R5) all change significantly with age (P < .007 for all rings, t test), in agreement with reports by other investigators.17, 18 This change with age was greatest in the central ring (R1) and least in the peripheral ring (R5). In contrast, R1/R2, R1/R3, and R1/R4 did not change significantly with age (P > .14 for all ratios, t test). The R1/R5 values changed with age (
Discussion
Because there were few early reports of loss of retinal function in patients taking hydroxychloroquine, it was assumed that the drug would not present a serious danger even after many years of use.1 Because of the years-long delay in onset and the subtlety of early symptoms, hydroxychloroquine retinotoxicity is still considered by many practitioners to be a relatively rare event.5 Readily available tests such as funduscopy, fluorescein angiography, perimetry, Amsler grid evaluation, and color
Jonathan S. Lyons, MD is a specialist in Medical Retina (Retinal Electrophysiology) in private practice in Silver Spring, Maryland. Dr Lyons is a lecturer and consultant in retinal electrophysiology at the Georgetown University/Washington Hospital Center Program in Ophthalmology and a Senior Attending Surgeon at the Washington National Eye Center.
References (22)
- et al.
The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal
Ophthalmology
(2003) The dilemma of hydroxychloroquine screening: new information from the multifocal ERG
Am J Ophthalmol
(2005)- et al.
Ocular changes induced by long-term hydroxychloroquine (Plaquenil) therapy
Am J Ophthalmol
(1967) - et al.
Occult macular dystrophy
Am J Ophthalmol
(1996) - et al.
The field topography of ERG components in man—IThe photopic luminance response
Vision Res
(1992) - et al.
Hydroxychloroquine therapy in massive total doses without retinal toxicity
Am J Ophthalmol
(1987) - et al.
Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity
J Rheumatol
(1985) Ocular safety of hydroxychloroquine
Ann Ophthalmol
(1991)- et al.
Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice
Arthritis Rheum
(1997) Detection and prevention of maculopathy associated with antimalarial agents
Int Ophthalmol Clin
(1999)
Multifocal electroretinographic evaluation of long-term hydroxychloroquine users
Arch Ophthalmol
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Screening for Plaquenil
2022, Advances in Ophthalmology and OptometryCitation Excerpt :Although specificity of 98.1% has been reported for sdOCT, its sensitivity to detect retinopathy is significantly less compared with AVF and mfERG (78.6% sdOCT vs 85.7% AVF vs 92.9% mfERG) [17]. As such, many studies have demonstrated that functional deficits occur before structural alterations [7,9,18–20]. By using mfERG as a sensitive measure for early retinopathy, a few studies have characterized early structural changes on sdOCT that precede clinically visible retinopathy or visual field loss [21–23].
Effect of stopping hydroxychloroquine therapy on the multifocal electroretinogram in patients with rheumatic disorders
2020, Canadian Journal of OphthalmologyThe Diagnostic Utility of Multifocal Electroretinography in Detecting Chloroquine and Hydroxychloroquine Retinal Toxicity
2019, American Journal of OphthalmologyCitation Excerpt :The number of false-positives and poor specificity performance of mfERG against the 2016 AAO guidelines emphasizes the importance of distinguishing between hydroxychloroquine-induced acute electrophysiologic changes and clinically relevant toxicity. Historically, the introduction of the age-corrected R1:R2 ring ratio analysis significantly reduced interindividual variations and increased confidence in the interpretation of mfERG for chloroquine and hydroxychloroquine retinal toxicity.11 Further studies showed that normalization to Ring 5, which is made up of multiple hexagons as opposed to a single central hexagon (Ring 1), could increase the sensitivity of mfERG and reduce reliance on age correction.12
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Jonathan S. Lyons, MD is a specialist in Medical Retina (Retinal Electrophysiology) in private practice in Silver Spring, Maryland. Dr Lyons is a lecturer and consultant in retinal electrophysiology at the Georgetown University/Washington Hospital Center Program in Ophthalmology and a Senior Attending Surgeon at the Washington National Eye Center.
Matthew L. Severns, PhD is a Biomedical Engineer who develops methods to diagnose retinal disorders. Currently with LKC Technologies, Inc (a manufacturer of visual diagnostic systems), he was on the faculties of the Wilmer Eye Institute, Johns Hopkins University Medical School from 1986 to 1997 and George Washington University Medical School from 1980 to 1982.