10-2 Visual Field for Detecting Early Hydroxychloroquine Retinopathy

Maculopathy is an irreversible adverse effect of Hydroxychloroquine (HCQ). The earlier the diagnosis and discontinuation of HCQ, the less severe maculopathy and the less likely of is to progress. The work aims to compare between 10-2 Visual field (VF) test as a subjective functional test and optical coherence tomography (OCT) as an objective structural imaging in diagnosing the HCQ retinopathy and to evaluate its severity. A prospective, case-control study, conducted at Al-Zahraa University Hospital (May 2021 - April 2022), included 30 patients (60 eyes) on HCQ for ≥ 5 years or on doses > 5mg/Kg (Group I) and 20 healthy subjects (40 eyes, Group II). All participants underwent a comprehensive ophthalmic examination, as well as 10-2 VF testing, and OCT. Mean patient age: 47.4 years, duration of HCQ treatment: 9.3 years. No statistically significant difference between both groups in macular thickness. PSD was significantly worse in group I (p = 0.045), while the difference in MD was not statistically significant (P = 0.066). In group I, there was a statistically significant decreased macular thickness (ETDRS 9 sectors) except the foveal area in eyes with outer nuclear layer thinning (10 eyes) when compared to eyes with normal OCT (50 eyes) and a statistically significant difference between eyes with VF changes (20 eyes) and eyes with normal VF (40 eyes) in MD, PSD (p = <0.001). The area under the curve (AUC) for OCT parameters ranged from 0.92 for the inner nasal area to 0.68 for the outer superior area, parafoveal thickness (except inferior) had the highest sensitivity at 90%. The AUC for VF parameters was 0.95 for PSD & 0.83 for MD with higher sensitivity for MD. The 10–2 VF is more sensitive than OCT in identifying retinal toxicity. Although we recommend the 10–2 VF test plus OCT for the initial screening of HCQ maculopathy.