title: Pericentral retinopathy and racial differences in hydroxychloroquine toxicity.
abstract: OBJECTIVE
  To describe patterns of hydroxychloroquine retinopathy distinct from the classic parafoveal (bull's eye) maculopathy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Patients from a large multi-provider group practice and a smaller university referral practice diagnosed with hydroxychloroquine retinopathy. Patients with widespread or "end-stage" retinopathy were excluded.
  
  
  METHODS
  Review of ophthalmic studies (fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, visual fields) and classification of retinopathy into 1 of 3 patterns: parafoveal (retinal changes 2°-6° from the fovea), pericentral (retinal changes ≥ 8° from the fovea), or mixed (retinal changes in both parafoveal and pericentral areas).
  
  
  METHODS
  Relative frequency of different patterns of hydroxychloroquine retinopathy and comparison of risk factors.
  
  
  RESULTS
  Of 201 total patients (18% Asian) with hydroxychloroquine retinopathy, 153 (76%) had typical parafoveal changes, 24 (12%) also had a zone of pericentral damage, and 24 (12%) had pericentral retinopathy without any parafoveal damage. Pericentral retinopathy alone was seen in 50% of Asian patients but only in 2% of white patients. Patients with the pericentral pattern were taking hydroxychloroquine for a somewhat longer duration (19.5 vs. 15.0 years, P < 0.01) and took a larger cumulative dose (2186 vs. 1813 g, P = 0.02) than patients with the parafoveal pattern, but they were diagnosed at a more severe stage of toxicity.
  
  
  CONCLUSIONS
  Hydroxychloroquine retinopathy does not always develop in a parafoveal (bull's eye) pattern, and a pericentral pattern of damage is especially prevalent among Asian patients. Screening practices may need to be adjusted to recognize pericentral and parafoveal hydroxychloroquine retinopathy.
authors.affiliation: Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California. Electronic address: Ronald.Melles@kp.org.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Melles
authors.affiliation: Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Marmor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000633:toxicity*; D044466:Asian People / Q000208:ethnology*; D016208:Databases, Factual; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis; D005654:Fundus Oculi; D006801:Humans; D006886:Hydroxychloroquine / Q000633:toxicity*; D008875:Middle Aged; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000208:ethnology*; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields; D044465:White People / Q000208:ethnology*
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine