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Sina Ahmadi Pirshahid, Chloe C Gottlieb, Stuart G Coupland, Adrian Tsang, Brian C Leonard, Bernard Hurley; Detecting Early Signs of Hydroxychloroquine and Chloroquine Retinopathy: A Meta-analysis Evaluating Multifocal Electroretinogram as a Screening Test under the 2011 Revised American Academy of Ophthalmology Guidelines. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5116.
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To determine a measure of sensitivity and specificity for multifocal electroretinography (mfERG) as a screening tool for detecting Chloroquine and Hydroxychloroquine toxicity. To evaluate and compare mfERG to automated visual fields (AVF), fundus auto fluorescence (FAF) and spectral domain optical coherence tomography (sd-OCT).
Following PRISMA statement guidelines a literature search was conducted in EMBASE and EMBASE Classic (1947 to July 2013), Ovid MEDLINE (1946- July 2013) and PubMed (July 2013) with the assistance of a research librarian. After amalgamating the individual data for each eye, the sensitivity and specificity of mfERG was estimated using AVF and a combination of two of three of AVF, FAF and sdOCT as the reference test. The percent agreement between tests was calculated. An ANOVA was performed to determine if there was a difference in the rate of positive test results between the testing modalities at different cumulative dose ranges.
Using AVF as the reference test , the sensitivity and specificity of mfERG was estimated to be 84.97% and 63.38% respectively .When agreement between at least two of AVF, sdOCT or FAF was used as the reference test the sensitivity and specificity of mfERG was estimated at 96.55% and 91.30% respectively. mfERG had the greatest test agreement with sdOCT (94.34%) and the combined reference test (92.45%) followed by FAF (88%) and AVF(74.58%).mfERG had the highest rate of positive test results. The rate of positive test results differed significantly between the four screening modalities in both the group of subject eyes exposed to a cumulative dose of less than 1000g of HCQ (F (3, 327) = 2.901, p = 0.035 ) and the group with a cumulative dose of greater than 1000g of HCQ ( F (3, 570) = 5.683, p = .0008)
mfERG has an important role in screening for CQ/HCQ toxicity before a cumulative dose of 1000g and annually after this critical cumulative dose. Further prospective studies are warranted to determine a safe cumulative dose and to guide CQ/HCQ therapy
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