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A. Parikh, K. Oh, C.D. Vallar, M. Dooley, P. Stewart; An Evaluation of Risk Factor Stratification for Hydroxychloroquine Retinal Toxicity Utilizing mfERG and HVF . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5147.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: (1) To evaluate the validity of risk factors identified by the American Academy of Ophthalmology for hydroxychloroquine toxicity. We intend to investigate six specific ocular toxicity risk factors established by the American Academy of Ophthalmology that stratify patients into high and low risk groups. These risk factors include dosage and duration of hydroxychloroquine use, age, presence of hepatic or renal dysfunction, presence of other retinal disease, and body mass index. (2) To validate a new diagnostic technique known as multifocal electroretinography (mfERG) as a primary technology for identifying an ocular toxicity phenotype. Methods: At least 30 patients on hydroxychloroquine therapy for systemic lupus erythematosus or rheumatoid arthritis will be studied. They were stratified into high and low risk groups based on AAO recommendations. Patients will be evaluated using a case control series for the validity of the risk factors identified as well as the cumulative risk conferred by the presence of multiple factors. All patients underwent HVF 10–2 SITA Fast (white target) and 10–2 FastPac (red target), dilated fundoscopic examination, and mfERG testing. Toxicity is defined as having two of four of the following: 1) paracentral scotomas on HVF testing, 2) mfERG parafoveal depression, 3) fundus changes and 4) symptoms of vision loss. Each ancillary study will be graded as normal, abnormal or unable to assess. Patients with pre–existing ocular disease will be excluded from the study. Correlation between HVF testing and mfERG testing will also be analyzed. This study will allow us to determine validity of high/low risk stratification as well as if mfERG provides improved diagnostic sensitivity compared to the HVF. Results: Based on a preliminary analysis of 24 patients (n=18 in high risk and n=6 low risk), a 0% prevalence of toxicity was found in the low risk group and 50% in the high risk group. Further analyses to be submitted. Good correlation was noted between HVF 10–2 SITA Fast (white target) and mfERG for evidence of toxicity, though 2 patients had abnormal mfERG with normal HVF 10–2 white and red target testing. Conclusion: At this point, the results corroborate the AAO recommendations of stratifying patients based on high and low risk factors as our study has shown a marked difference in prevalence of toxicity between the two groups (final data analyses and conclusions to be reported in poster presentation).
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