Abstract
Purpose :
To report findings on visual field (VF) examinations using different protocols in Asian patients with hydroxychloroquine (HCQ) retinopathy and to compare the diagnostic capabilities among the VF protocols
Methods :
Nine-hundred six patients with rheumatologic conditions were screened for HCQ retinopathy, using optical coherence tomography, fundus autofluorescence, and automated VF examinations. By excluding eyes with glaucoma or combined macular diseases, a total of 1651 eyes in 860 patients taking HCQ with reliable VF results were analyzed for this study. Results from Humphrey VF obtained using 10-2 and 30-2 protocols and those using full-field 120 (FF-120) protocol in selected patients for screening tests were reviewed. Visual field abnormality and patterns were evaluated for each protocol of VF tests (Figure 1). In the patients with reliable 30-2 and 10-2 results, sensitivities and specificities based on the abnormal VF findings were compared between the protocols. Visual field progression was evaluated by comparing VF results between visits.
Results :
Sensitivity and specificity of 10-2 protocol were 75% and 76.5%, respectively, whereas 30-2 showed 92.5% sensitivity and 76.0% specificity. Most common pattern in Asian patients with HCQ retinopathy was constricted VF and paracentral ring scotoma on 10-2 and 30-2 tests, respectively. Atypical VF patterns included bitemporal hemianopsia and nasal step. FF-120 showed 89.3% sensitivity and 63.5% specificity; however, 2 patients with early retinopathy were diagnosed with HCQ reitnopathy by VF abnormality identified only on FF-120. Comparison between 10-2 and 30-2 resulted in significant difference in sensitivity (P=0.010). Particularly, there was significant difference in the sensitivities between the two protocols in eyes with pericentral pattern (P=0.003) and those with early retinopathy (P=0.011). Eyes with severe retinopathy showed progression after drug cessation and 10-2 protocol was useful for evaluation of visual field progression as structural progression correlated with field constriction in the eyes.
Conclusions :
VF 30-2 can be performed for the primary VF test for HCQ retinopathy screening in Asian patients. Additional protocols such as 10-2 and FF120 can be performed according to the location of photoreceptor defects. Visual field progression is important for evaluation of retinopathy progression, particularly in eyes with severe retinopathy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.