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Ancillary Testing in Screening for Hydroxychloroquine and Chloroquine Retinopathy

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Hydroxychloroquine and Chloroquine Retinopathy

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Abstract

The most important purpose of 4-aminoquinoline retinopathy (4AQR) screening, detecting overdosing, requires no ancillary testing. However, a subsidiary purpose, detecting the rare occurrence of 4AQR among properly dosed patients, requires ancillary testing, because clinical examination is insensitive. In Bayesian reasoning, the sensitivity and specificity of an ancillary test interact with the estimated prior probability of disease to determine the estimated posterior probability of the disease. For a condition of low prior probability a single test is rarely dispositive for management. Instead, the common role for each test is to adjust the clinician’s estimate of the probability of 4AQR before applying another test, until a level of certainty is achieved indicating that the 4-aminoquinoline (4AQ) will be stopped or continued. Testing with 10-2 visual fields, multifocal electroretinography, spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence is useful for this purpose when applied selectively rather than universally. SD-OCT is especially helpful because it has the lowest test variability, the highest specificity, and similar sensitivity to the other tests.

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Abbreviations

4AQs:

4-Aminoquinolines (chloroquine and hydroxychloroquine)

4AQR:

4-Aminoquinoline retinopathy

asb:

Apostilb

C:

Chloroquine

COR:

Coefficient of repeatability

COV:

Coefficient of variation

dB:

Decibel

DTL:

Dawson–Trick–Litzkow electrodes

ERG:

Electroretinogram

FA:

Fluorescein angiography

FDP:

Frequency doubling perimetry

HC:

Hydroxychloroquine

ICC:

Intraclass correlation coefficient

ISCEV:

International Society for Clinical Electrophysiology and Vision

MD:

Mean defect

mfERG:

Multifocal electroretinography

nm:

Nanometer

RNFL:

Retinal nerve fiber layer

SAP:

Standard automated perimetry

S :

Standard deviation of a sample of a normally distributed variable

SD-OCT:

Spectral domain optical coherence tomography

SITA:

Swedish Interactive Treatment Algorithm

TD-OCT:

Time domain optical coherence tomography

X :

Mean of a sample of a normally distributed variable

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Browning, D.J. (2014). Ancillary Testing in Screening for Hydroxychloroquine and Chloroquine Retinopathy. In: Hydroxychloroquine and Chloroquine Retinopathy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0597-3_8

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