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Scotoma analysis of 10-2 visual field testing with a red target in screening for hydroxychloroquine retinopathy.

Browning DJ, Lee C - Clin Ophthalmol (2015)

Bottom Line: The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.A median of 86%, IQR (77, 100), of these resolved on the subsequent field.The annular zone 2°-8° from fixation was useful for distinguishing the significance of scotoma points.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, USA.

ABSTRACT

Objective: To quantify the variability of scotomas detected by 10-2 visual field (VF) testing with a red target in patients taking hydroxychloroquine without and with retinopathy.

Design: Retrospective review of clinical charts and VFs.

Methods: Twenty-four patients taking hydroxychloroquine without retinopathy, and eight patients taking hydroxychloroquine with retinopathy were tested in this study. Retinopathy was defined by annular scotomas on 10-2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10-2 VF testing were recorded and their fates followed in serial, reliable 10-2 VFs performed with a red target over time. The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.

Results: A median of 3, interquartile range (IQR) (2, 5), scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR (77, 100), of these resolved on the subsequent field. For patients with retinopathy, a median of 50%, IQR (46, 79), resolved, a difference compared to patients without retinopathy that was significant (P=0.0158). The median percentage of scotoma points in the zone from 2° to 8° from fixation in eyes with retinopathy was 72%, IQR (54, 100), compared to 49%, IQR (40, 54), in eyes without retinopathy (P=0.0069). The number of persistent scotoma locations at the last visit was higher in eyes with retinopathy: 3, IQR (1, 3), versus 0, IQR (0, 1), in patients without retinopathy, P=0.0156.

Conclusion: Point scotomas are common and variable in 10-2 VF testing with a red target for hydroxychloroquine retinopathy in subjects without retinopathy. Scotoma points in eyes with retinopathy are less variable. The annular zone 2°-8° from fixation was useful for distinguishing the significance of scotoma points. Discriminating eyes with retinopathy from eyes without retinopathy is probably easier using the 10-2 VF with a white target than a red target.

No MeSH data available.


Related in: MedlinePlus

mfERG of a patient taking hydroxychloroquine without retinopathy.Note: The mfERG is normal.Abbreviations: FFT, fast fourier transform; LE, left eye; T, temporal; N, nasal; TN, temporal-nasal; N1, implicit time of the initial negative wave trough; P1, implicit time of the initial positive wave peak; R1, ring 1; Rn, ring n; RMS, root mean square.
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f2-opth-9-1499: mfERG of a patient taking hydroxychloroquine without retinopathy.Note: The mfERG is normal.Abbreviations: FFT, fast fourier transform; LE, left eye; T, temporal; N, nasal; TN, temporal-nasal; N1, implicit time of the initial negative wave trough; P1, implicit time of the initial positive wave peak; R1, ring 1; Rn, ring n; RMS, root mean square.

Mentions: A 40-year-old woman with undifferentiated connective tissue disease had been taking hydroxychloroquine for 7.7 years. She was originally on 400 mg/day but more recently was taking 300 mg/day. Her height was 162.6 cm, her ideal body weight was 63.5 kg, her actual body weight was 65.8 kg, and her cumulative dose was 1,124 g. Her adjusted daily dose was 6.29 mg/kg/d based on her ideal body weight, which is in a range recognized as nontoxic. She had no renal or liver disease and no preexisting maculopathy. Figure 1 shows four consecutive 10–2 VFs performed with a red target. The first VF (January 25, 2007) had a single scotoma point on the defect depth display (circled in red) that resolved on the second field (February 12, 2008), which in turn had four new scotoma points (circled in green). Three of the four green-circled scotoma points occurred in the low-risk zone outside the 2°–8° annulus encircling the fixation point. In the third field (February 17, 2009), all four scotoma points circled in green had resolved, and remained so in the fourth field (March 22, 2010). As the patient had a low pretest probability of retinopathy (nontoxic daily dosing, no renal disease, and no liver disease), no intensified testing was done. Figure 2 shows that in 2014, she had normal mfERG ancillary testing, corroborating the lack of evidence of retinopathy seen in all of the VFs.


Scotoma analysis of 10-2 visual field testing with a red target in screening for hydroxychloroquine retinopathy.

Browning DJ, Lee C - Clin Ophthalmol (2015)

mfERG of a patient taking hydroxychloroquine without retinopathy.Note: The mfERG is normal.Abbreviations: FFT, fast fourier transform; LE, left eye; T, temporal; N, nasal; TN, temporal-nasal; N1, implicit time of the initial negative wave trough; P1, implicit time of the initial positive wave peak; R1, ring 1; Rn, ring n; RMS, root mean square.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548756&req=5

f2-opth-9-1499: mfERG of a patient taking hydroxychloroquine without retinopathy.Note: The mfERG is normal.Abbreviations: FFT, fast fourier transform; LE, left eye; T, temporal; N, nasal; TN, temporal-nasal; N1, implicit time of the initial negative wave trough; P1, implicit time of the initial positive wave peak; R1, ring 1; Rn, ring n; RMS, root mean square.
Mentions: A 40-year-old woman with undifferentiated connective tissue disease had been taking hydroxychloroquine for 7.7 years. She was originally on 400 mg/day but more recently was taking 300 mg/day. Her height was 162.6 cm, her ideal body weight was 63.5 kg, her actual body weight was 65.8 kg, and her cumulative dose was 1,124 g. Her adjusted daily dose was 6.29 mg/kg/d based on her ideal body weight, which is in a range recognized as nontoxic. She had no renal or liver disease and no preexisting maculopathy. Figure 1 shows four consecutive 10–2 VFs performed with a red target. The first VF (January 25, 2007) had a single scotoma point on the defect depth display (circled in red) that resolved on the second field (February 12, 2008), which in turn had four new scotoma points (circled in green). Three of the four green-circled scotoma points occurred in the low-risk zone outside the 2°–8° annulus encircling the fixation point. In the third field (February 17, 2009), all four scotoma points circled in green had resolved, and remained so in the fourth field (March 22, 2010). As the patient had a low pretest probability of retinopathy (nontoxic daily dosing, no renal disease, and no liver disease), no intensified testing was done. Figure 2 shows that in 2014, she had normal mfERG ancillary testing, corroborating the lack of evidence of retinopathy seen in all of the VFs.

Bottom Line: The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.A median of 86%, IQR (77, 100), of these resolved on the subsequent field.The annular zone 2°-8° from fixation was useful for distinguishing the significance of scotoma points.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, USA.

ABSTRACT

Objective: To quantify the variability of scotomas detected by 10-2 visual field (VF) testing with a red target in patients taking hydroxychloroquine without and with retinopathy.

Design: Retrospective review of clinical charts and VFs.

Methods: Twenty-four patients taking hydroxychloroquine without retinopathy, and eight patients taking hydroxychloroquine with retinopathy were tested in this study. Retinopathy was defined by annular scotomas on 10-2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10-2 VF testing were recorded and their fates followed in serial, reliable 10-2 VFs performed with a red target over time. The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.

Results: A median of 3, interquartile range (IQR) (2, 5), scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR (77, 100), of these resolved on the subsequent field. For patients with retinopathy, a median of 50%, IQR (46, 79), resolved, a difference compared to patients without retinopathy that was significant (P=0.0158). The median percentage of scotoma points in the zone from 2° to 8° from fixation in eyes with retinopathy was 72%, IQR (54, 100), compared to 49%, IQR (40, 54), in eyes without retinopathy (P=0.0069). The number of persistent scotoma locations at the last visit was higher in eyes with retinopathy: 3, IQR (1, 3), versus 0, IQR (0, 1), in patients without retinopathy, P=0.0156.

Conclusion: Point scotomas are common and variable in 10-2 VF testing with a red target for hydroxychloroquine retinopathy in subjects without retinopathy. Scotoma points in eyes with retinopathy are less variable. The annular zone 2°-8° from fixation was useful for distinguishing the significance of scotoma points. Discriminating eyes with retinopathy from eyes without retinopathy is probably easier using the 10-2 VF with a white target than a red target.

No MeSH data available.


Related in: MedlinePlus