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Detecting chloroquine retinopathy: electro-oculogram versus colour vision.
A S Neubauer1, K Samari-Kermani, U Schaller
1Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany. aneubaue@ak-i.med.uni-muenchen.de
The British Journal of Ophthalmology
|June 19, 2003
Summary
Computerised colour vision testing is a sensitive screening tool for antimalarial retinopathy. A normal colour vision test virtually excludes retinopathy, while the electro-oculogram (EOG) has limited diagnostic value.
Area of Science:
- Ophthalmology
- Rheumatology
- Pharmacology
Background:
- Long-term use of chloroquine and hydroxychloroquine can cause ocular toxicity, specifically retinopathy.
- Early detection of chloroquine retinopathy is crucial to prevent vision loss.
Purpose of the Study:
- To compare the sensitivity and specificity of the electro-oculogram (EOG) and a computerised colour vision test for screening chloroquine/hydroxychloroquine retinopathy.
- To identify the earliest signs of antimalarial-induced ocular toxicity.
Main Methods:
- 93 patients on long-term chloroquine/hydroxychloroquine therapy were monitored for 2.6 years.
- Regular clinical examinations, EOG, and quantitative colour vision tests (tritan and protan axes) were performed every six months.
Main Results:
- Colour vision testing showed higher sensitivity and specificity than EOG for detecting retinopathy.
- Disturbances in the tritan axis of colour vision were observed first in patients with early retinopathy.
- Four patients developed bull's eye maculopathy, all with significant colour vision defects; EOG was not a reliable indicator.
Conclusions:
- Computerised colour vision testing, particularly assessing the tritan axis, is a valuable and sensitive method for screening antimalarial retinopathy.
- A normal colour vision test result effectively rules out retinopathy.
- The EOG is of limited value in diagnosing early or advanced chloroquine retinopathy.