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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: 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).Discriminating eyes with retinopathy from eyes without retinopathy is probably easier using the 10-2 VF with a white target than a red target.

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 at toxic doses who developed retinopathy.Note: The mfERG shows reduced amplitudes in rings R1 and R2 (red-circled values) and flattened waveforms in the green-circled locations.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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f4-opth-9-1499: mfERG of a patient taking hydroxychloroquine at toxic doses who developed retinopathy.Note: The mfERG shows reduced amplitudes in rings R1 and R2 (red-circled values) and flattened waveforms in the green-circled locations.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 69-year-old woman had been taking hydroxychloroquine for rheumatoid arthritis for 17 years. She had been taking 400 mg/day the entire time. She was 160.0 cm, had an ideal body weight of 61.2 kg, but an actual body weight of 64.9 kg. Therefore, her adjusted daily dose was in a toxic range of 6.52 mg/kg/d for the duration of therapy. Her cumulative dose was 2,450 g. She had no renal or liver disease, nor any preexisting maculopathy. Figure 3 shows three consecutive 10–2 VFs with a red target. The first field on January 28, 2009 shows an annular ring scotoma on the gray scale display. The defect depth display shows a single scotoma point (green circle). The red-circled point was not scotomatous in this display. The second VF on February 1, 2010 shows that the green-circled scotoma point persisted and the adjacent red-circled point had now become scotomatous (ie, the scotoma was reproducible and has enlarged). By the third VF of March 28, 2011, the red-circled scotoma point had deepened by 4 dB, the scotoma had enlarged to include the adjacent blue-circled scotoma point, and a separate scotoma (purple-circled) in the high-risk zone from 2° to 8° from fixation had developed. At this point, the patient’s ophthalmologist recognized retinopathy and her hydroxychloroquine was stopped. Scotoma points associated with hydroxychloroquine retinopathy do not resolve, unlike the situation with patients taking hydroxychloroquine who do not have retinopathy. Moreover, the scotomas tend to broaden over time. Figure 4 shows that on October 25, 2012, there was marked diminution of the mfERG amplitudes in rings R1–R2.


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 at toxic doses who developed retinopathy.Note: The mfERG shows reduced amplitudes in rings R1 and R2 (red-circled values) and flattened waveforms in the green-circled locations.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

f4-opth-9-1499: mfERG of a patient taking hydroxychloroquine at toxic doses who developed retinopathy.Note: The mfERG shows reduced amplitudes in rings R1 and R2 (red-circled values) and flattened waveforms in the green-circled locations.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 69-year-old woman had been taking hydroxychloroquine for rheumatoid arthritis for 17 years. She had been taking 400 mg/day the entire time. She was 160.0 cm, had an ideal body weight of 61.2 kg, but an actual body weight of 64.9 kg. Therefore, her adjusted daily dose was in a toxic range of 6.52 mg/kg/d for the duration of therapy. Her cumulative dose was 2,450 g. She had no renal or liver disease, nor any preexisting maculopathy. Figure 3 shows three consecutive 10–2 VFs with a red target. The first field on January 28, 2009 shows an annular ring scotoma on the gray scale display. The defect depth display shows a single scotoma point (green circle). The red-circled point was not scotomatous in this display. The second VF on February 1, 2010 shows that the green-circled scotoma point persisted and the adjacent red-circled point had now become scotomatous (ie, the scotoma was reproducible and has enlarged). By the third VF of March 28, 2011, the red-circled scotoma point had deepened by 4 dB, the scotoma had enlarged to include the adjacent blue-circled scotoma point, and a separate scotoma (purple-circled) in the high-risk zone from 2° to 8° from fixation had developed. At this point, the patient’s ophthalmologist recognized retinopathy and her hydroxychloroquine was stopped. Scotoma points associated with hydroxychloroquine retinopathy do not resolve, unlike the situation with patients taking hydroxychloroquine who do not have retinopathy. Moreover, the scotomas tend to broaden over time. Figure 4 shows that on October 25, 2012, there was marked diminution of the mfERG amplitudes in rings R1–R2.

Bottom Line: 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).Discriminating eyes with retinopathy from eyes without retinopathy is probably easier using the 10-2 VF with a white target than a red target.

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