title: Screening for chloroquine maculopathy in populations with uncertain reliability in outcomes of automatic visual field testing.
abstract: OBJECTIVE
  The purpose of this study was to compare screening methods for the early detection of maculopathy in patients treated with chloroquine (CQ) or hydroxychloroquine (HCQ) and to identify the risk factors for the development of toxic maculopathy.
  
  
  METHODS
  We performed a prospective study of all 217 patients taking CQ and/or HCQ and seen in our center between July 2011 and December 2013. All subjects underwent a complete ocular examination, as well as spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), and 10-2 Humphrey visual field (10-2 HVF).
  
  
  RESULTS
  The median age of patients was 51 years, median CQ/HCQ duration was 40 months, and median cumulative dose was 180 g. The prevalence of at least two abnormal tests was 7.4% (16/217). SD-OCT had the highest sensitivity, specificity, predictive values and accuracy while 10-2 HVF showed in 30% of nonreliable results and had the lowest specificity and positive predictive value. In multivariate analysis, an age of older than 60 years (P = 0.002), CQ duration of more than 5 years (P < 0.001), and CQ dose more than 3 mg/kg/day (P = 0.005) were associated with toxicity.
  
  
  CONCLUSIONS
  In patients with unreliable outcomes of 10-2 HVF testing, SD-OCT in combination with FAF might represent a suitable alternative screening tool for toxic maculopathy.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Paradee
authors.initials: P
authors.lastname: Kunavisarut
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Pimploy
authors.initials: P
authors.lastname: Chavengsaksongkram
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothova
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kessara
authors.initials: K
authors.lastname: Pathanapitoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects; D002648:Child; D002738:Chloroquine / Q000009:adverse effects*; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008268:Macular Degeneration / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D002738:Chloroquine