Visual Field Examinations in Asian Patients with Hydroxychloroquine Retinopathy

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.