Comparison of Fundus-Guided Microperimetry and Multifocal Electroretinography for Evaluating Hydroxychloroquine Maculopathy

Alghanem, Husam; Padhi, Tapas Ranjan; Chen, Adrienne; Niziol, Leslie M.; Abalem, Maria Fernanda; Dakki, Natalie; Steffens, Timothy; Andrews, Chris; Musch, David C.; Jayasundera, Thiran; Khan, Naheed W.

doi:10.1167/tvst.8.5.19

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…Furthermore, previous studies with standard automatic perimetry had already shown a reduction in differential light sensitivity in patients with Parkinson's disease even in presence of a normal retinal structure detected by OCT. 42,43 Some electrophysiological studies in the literature on patients with Parkinson's disease demonstrated delayed implicit times and decreased amplitude responses in the visual evoked potentials and pattern electroretinogram in PD subjects 44 as well as multifocal electroretinography (mfERG) changes in patients with PD without visual loss. 45 Husman et al compared the FP to the mfERG in hydroxychlororoquine maculopathy 46 concluding that the detection frequency of hydroxychloroquine toxicity with FP was greater than with mfERG. FP showed good sensitivity and moderate specificity in detecting functional deficits induced by hydroxychlororoquine.…”

Section: Discussionmentioning

confidence: 99%

The Retinal Posterior Pole in Early Parkinson’s Disease: A Fundus Perimetry and SD-OCT Study

Cesareo

Marco

Giannini

et al. 2021

OPTH

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To assess the structure and function of the retinal posterior pole in patients with early Parkinson's disease (PD) and to identify possible biomarkers correlated with clinical features. Patients and Methods: A cross-sectional case-control study of 21 patients with PD and 22 age-matched healthy controls (HC) was conducted. All subjects underwent full ophthalmological examinations, fundus perimetry (FP) and spectral domain-OCT (SD-OCT) of the entire retinal posterior pole and peripapillary retinal nerve fiber layer (pRNFL). Results: We analyzed 41 eyes from 21 patients (14 males and 7 females) with early PD (Hoehn and Yahr scale (H&Y) equal to or less than stage 2) and 41 eyes from 22 HC (12 males and 10 females). We found no significant difference in the pRNFL thickness between patients with PD and HC. The statistical analysis of the SD-OCT posterior pole area, consisting of 64 values for each retinal layer, revealed a decrease in the outer nuclear layer (ONL) thickness in patients with PD (p < 0.0001). On the contrary, a significant increase in the thickness of the outer plexiform layer (OPL) (p < 0.0001) and of the retinal pigmented epithelium (RPE) (p= 0.002) compared to healthy controls was detected. Other retinal layers showed no significant statistical differences. The differential light sensitivity (DLS) values measured by FP were significantly lower in patients than the healthy controls (15 [13-16.2] vs 17.95 [16.08-18.96] p<0.0001). Conclusion:Our results showed that DLS and retinal structure differed in the posterior pole between patients with early PD and controls. Thickening of the OPL may represent accumulation of α-synuclein in the OPL of patients with PD.

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Section: Discussionmentioning

confidence: 99%

The Retinal Posterior Pole in Early Parkinson’s Disease: A Fundus Perimetry and SD-OCT Study

Cesareo

Marco

Giannini

et al. 2021

OPTH

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“…Visual campimetry should also be part of the screening, especially the evaluation of the central 10°, but it is more subject to individual variations and can be a challenging test for many patients [2,10] . Other exams can help in the screening of retinotoxicity by HCQ, such as multifocal electroretinogram (mfERG) [25] and microperimetry (MP) [28] . PM would be the most sensitive test between the two, but more evidence is still needed to corroborate its routine use in the screening of these patients [28] .…”

Section: Discussionmentioning

confidence: 99%

Early and progressive hydroxychloroquin retinal toxicity: 9-year follow-up with multimodal retinal imaging

Pereira¹,

Miguel²,

Miguel³

et al. 2022

Int. J. Med. Ophthalmol.

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Retinopathy secondary to the use of hydroxychloroquine sulfate can cause irreversible central visual loss and progress even after stopping the drug. The pathophysiological mechanism by which this phenomenon occurs is unclear. Periodic eye exams associated with multimodal imaging exams help in the early recognition of this pathology, being essential for the realization of an early diagnosis in order to minimize adverse visual sequelae. Patients must be aware of the risk of toxicity and its possible consequences, so the use of this medication must be well-founded. Detecting early and subtle changes in visual perception can minimize damage, but not necessarily to prevent it. Medications should be discontinued, if possible, when toxicity is recognized or strongly suspected, but this is a decision to be made together with patients and their physicians, as it is indicated by an underlying pathological condition that can also lead to irreversible sequelae for patients.

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“…[31] Hidroksiklorokin makulapatisinin saptanmasında multifokal ERG ve MP'yi karşılaştıran bir çalışmada ise; MP'nin duyarlılığı yüksek olsa da spesifitesi düşük olduğu için yalancı pozitiflik oranının yüksek olabileceği (mfERG'ye kıyasla daha fazla anormal test oranı) ancak toksisite varlığının erken dönem bulgularını saptamada; mf ERG ve SD-OKT' den daha iyi olduğu bildirilmiştir. [33] Bu testlerin kullanımı ile retinopati tanısı konularak, retinopati düzeyi evrelendirilebilir. Literatürdeki çalışmalarda OCT bulgularına [34] göre veya tüm tanı testlerinin birlikte değerlendirilmesi [27,34,35] ile evreleme şablonları oluşturulmuştur (Tablo1).…”

Section: Retinopati Gelişimiunclassified

Medications Damaging Retinal Pigment Epithelium and Photoreceptor Complex-1: Pathogenesis, Diagnosis, and Treatment (Chloroquine/hydroxychloroquine)

2023

Güncel Retina (Current Retina)

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Hydroxychloroquine and chloroquine are frequently used in the treatment of rheumatic and parasitic diseases as a result of their immunomodulatory effects. Due to their high plasma distribution volumes, they cause irreversible side effects by accumulating in the tissues containing melanin following long-term use. Currently, these side effects can be detected before they reach advanced stages (bull’s eye maculopathy) thanks to new developments in diagnosis and imaging methods. Patients with concomitant tamoxifen use, impaired renal function, a dose of hydroxychloroquine greater than 5mg per kg per day or the dose of chloroquine greater than 2,3 mg per kg per day, older age, long-term use (10-25 years) have increased risk of retinopathy. Patients should be reviewed annually thereafter whilst on therapy and they should undergo imaging with optical coherence tomography (OCT), widefield fundus autofluorescence imaging (FAF), and 10-2 visual field testing at each monitoring visit. If the evidence of toxicity cannot be completely excluded patients should undergo multifocal electroretinography (mfERG). Of the tests used in the diagnosis of hydroxychloroquine/chloroquine retinopathy, mfERG has the highest sensitivity and specificity, followed by SD-OCT and 10-2 visual field tests, respectively. Once the precise signs of early retinopathy are detected, the decision to stop the medication should be taken in conjunction with prescribing physician. It should not be forgotten that retinopathy findings will progress even if the treatment is ceased. Following the screening, guidelines allow early detection of retinopathy before leading to irreversible retinal damage.

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Comparison of Fundus-Guided Microperimetry and Multifocal Electroretinography for Evaluating Hydroxychloroquine Maculopathy

Abstract: ison of fundus-guided microperimetry and multifocal electroretinography for evaluating hydroxychloroquine maculopathy.

Cited by 7 publications

References 31 publications

The Retinal Posterior Pole in Early Parkinson’s Disease: A Fundus Perimetry and SD-OCT Study

The Retinal Posterior Pole in Early Parkinson’s Disease: A Fundus Perimetry and SD-OCT Study

Early and progressive hydroxychloroquin retinal toxicity: 9-year follow-up with multimodal retinal imaging

Medications Damaging Retinal Pigment Epithelium and Photoreceptor Complex-1: Pathogenesis, Diagnosis, and Treatment (Chloroquine/hydroxychloroquine)

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