Relative sensitivity and specificity of 10-2 visual fields, multifocal electroretinography, and spectral domain optical coherence tomography in detecting hydroxychloroquine and chloroquine retinopathy

摘要

Background: The purpose of this study was to determine the relative sensitivity and specificity of 10-2?visual fields (10-2?VFs), multifocal electroretinography (mfERG), and spectral domain optical coherence tomography (SD-OCT) in detecting hydroxychloroquine retinopathy.Methods: A total of 121?patients taking hydroxychloroquine (n=119) or chloroquine (n=2) with 10-2?VF, mfERG, and SD-OCT tests were retrospectively reviewed. Rates of test abnormality were determined.Results: Retinopathy was present in 14?and absent in 107. Eleven of 14?(78.6%) patients with retinopathy were overdosed. Twelve (85.7%) had cumulative dosing greater than 1,000?g. The sensitivities of 10-2?VF, mfERG, and SD-OCT in detecting retinopathy were 85.7%, 92.9%, and 78.6%, respectively. The specificities of 10-2?VF, mfERG, and SD-OCT in detecting retinopathy were 92.5%, 86.9%, and 98.1%, respectively. Positive predictive values of 10-2?VF, mfERG, and SD-OCT in detecting retinopathy were less than 30% for all estimates of hydroxychloroquine retinopathy prevalence. Negative predictive values were >99% for all tests.Conclusion: Based on published estimates of hydroxychloroquine retinopathy prevalence, all three tests are most reliable when negative, allowing confident exclusion of retinopathy in patients taking ≤6.5?mg/kg/day. Each test is less useful in allowing a confident diagnosis of retinopathy when positive, especially in patients taking ≤6.5?mg/kg/day.