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

Authors Browning D, Lee C

Received 8 February 2015

Accepted for publication 27 March 2015

Published 27 May 2015 Volume 2015:9 Pages 943—952


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

David J Browning, Chong Lee

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

Objective: To quantify the variability of scotomas detected by 10-2 visual field (VF) testing in patients taking hydroxychloroquine without and with retinopathy.
Design: Retrospective review of clinical charts and visual fields.
Subjects: Twenty-one patients taking hydroxychloroquine without retinopathy, and nine patients taking hydroxychloroquine and one patient taking chloroquine with retinopathy.
Methods: 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 white target over time.
Main outcome measures: 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 five, interquartile range (IQR) 3–8 scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR 63%–100% of these points resolve on the subsequent field. For patients with retinopathy, a median of 22%, IQR 10%–59% resolve. The median percentage of scotoma points in the zone 2–8 degrees from fixation in eyes with retinopathy was 79%, IQR 68%–85% compared to 60%, IQR 54%–75% in eyes without retinopathy (P=0.0094). Single-point scotomas were more common in eyes without than with retinopathy. Scotomas consisting of more than four contiguous scotoma points were generally indicative of retinopathy.
Conclusion: Point scotomas are common and variable in 10-2 VF testing with a white target for hydroxychloroquine retinopathy in subjects without retinopathy. The annular zone 2 to 8 degrees from fixation was useful for distinguishing the significance of scotoma points. Scotomas with more contiguous scotoma points were more often associated with retinopathy.

Keywords: hydroxychloroquine, chloroquine, 10-2 visual field, ideal body weight, toxicity, retinopathy

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