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Objectives:To observe the long-term effects of hydroxy-chloroquine sulfate on retinal electrical activity by multi-focal electroretinography(mfERG)and to evaluate the re-gional variation of retinal dysfunction in subjects with hy-droxychloroquine retinopathy.Methods:Multifocal ERG with 103-hexagon stimulation was performed on 19patients(36eyes)treated with hydroxychloroquine fo r systemic lupus erythematosus,rheumatoid arthritis,or localized atypical scleroderma.Visual acuity testing,Amsler grid testing,and Ishihara color vision t esting were also per-formed.In 2of the patients,hydroxy chloroquine was dis-continued due to concerns about toxicity.Both of these patients had additional mfERG perfo rmed after discontinu-ation of medication.Results:Twelv e patients(19eyes)had a normal response density in one o r both eyes,including 6patients(12eyes)with a low lifetime dose(≤438g )of hydroxychloroquine who had norma l response densities in both eyes.Eleven patie nts(17eyes)had ab-normal response densities in one or b oth eyes,and 2of these patients(4eyes)had significant attenuation of re-sponse densities in almost the whole tested field;4patients had a normal mfERG result for one eye b ut had a slight decrease of response densities for t he other eye.There were4patterns of abnormal mfERG amplitu de change observed:(1)paracentral loss,(2)foveal loss,(3)peripheral loss,and(4)generalized loss.Implicit times we re abnormal for pericentral responses in 3patients.The results of color vision and Amsler grid testing were n ormal,except for one patient with a generalized loss patt ern.In 2subjects in whom hydroxychloroquine toxicity was suspected,response densities improved after terminati on of hydroxychloroquine.Conclusions:Long-term hydroxychl oroquine use may be associated with mfERG abnormalitie s.The mfERG appears to detect retinal physiological change earlier than visual acuity testing,color vision testin g,or Amsler grid testing can.The greatest value of the mfERG i s in differentiating a retinal cause and,hence,providing important evidence for hydroxychloroquine toxicity,for whatever visual field loss is apparent on perimetry.
Objectives: To observe the long-term effects of hydroxy-chloroquine sulfate on retinal electrical activity by multi-focal electroretinography (mfERG) and to evaluate the re-gional variation of retinal dysfunction in subjects with hy-droxychloroquine retinopathy. Methods: Multifocal ERG with 103-hexagon stimulation was performed on 19patients (36eyes) treated with hydroxychloroquine fo r systemic lupus erythematosus, rheumatoid arthritis, or localized atypical scleroderma. Visual acuity testing, Amsler grid testing, and Ishihara color vision t esting were also per- formed. In 2 the patients, hydroxychloroquine was dis-continued due to concerns about toxicity.Both of these patients had additional mfERG perfo rmed after discontinu- tion of services. Results: Twelv e patients (19eyes) had a normal response density in one or both eyes, including 6 low-dose (≤438g) of hydroxychloroquine who had norma l response densities in both eyes. Eleven patie nts (17eyes) had ab-normal re sponse densities in one or b oth eyes, and 2 of these patients (4eyes) had significant attenuation of re-sponse densities in almost the entire tested field; 4patients had a normal mfERG result for one eye b ut had a slight decrease of response densities for (2) foveal loss, (3) peripheral loss, and (4) generalized loss. Implicit times we re abnormal for pericentral responses in 3patients . The results of color vision and Amsler grid testing were n ormal, except for one patient with a generalized loss patt ern. 2subjects in whom hydroxychloroquine toxicity was suspected, response densities improved after terminati on of hydroxychloroquine. Conclusions: Long-term hydroxychl oroquine use may be associated with mfERG abnormalitie s. mfERG appears to detect retinal physiological change earlier than visual acuity testing, color vision testin g, or Amsler grid testing can. greatest of value of the mfERG is in ddifferentiating a retinal cause and, hence, providing important evidence for hydroxychloroquine toxicity, for whatever visual field loss is apparent on perimetry.