Related Experiment Video
Updated: Jan 12, 2026
Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
Diagnostic Accuracy of a Humphrey 24-2C Protocol for Simultaneous Parafoveal and Pericentral Hydroxychloroquine
Ko Eun Kim1, Hyeon Yoon Kwon2, Seong Joon Ahn2
1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Purpose:
To evaluate the diagnostic performance of the Humphrey 24-2C visual field (VF) protocol compared with the standard 10-2 and 30-2 strategies for detecting parafoveal and pericentral hydroxychloroquine (HCQ) retinopathy.
Design:
Retrospective cross-sectional diagnostic validity assessment.
Participants:
In total, 1081 patients (2104 eyes) receiving HCQ therapy without confounding ocular pathology were screened for retinopathy at a tertiary center between January 2021 and April 2025. The cohort included 1011 patients without retinopathy and 70 with confirmed retinopathy.
Methods:
Participants underwent swept-source OCT, fundus autofluorescence, and Humphrey VF testing using the 10-2 Swedish Interactive Thresholding Algorithm (SITA) Fast, 24-2C SITA Faster, and/or 30-2 SITA Fast protocols. Retinopathy was defined according to the American Academy of Ophthalmology guidelines as the presence of at least 2 abnormalities on structural and/or functional tests. Sensitivity and specificity of each VF protocol were evaluated against OCT as the gold standard.
Main Outcome Measures:
Sensitivity and specificity of the 10-2, 24-2C, and 30-2 protocols.
Results:
In early cases without definitive OCT changes (ellipsoid zone loss), parafoveal retinopathy was detected in 71.4% with the 10-2, 57.1% with the 24-2C, and 28.6% with the 30-2. Early pericentral defects were detected on the 24-2C and 30-2 in 57.1% versus 9.5% on the 10-2. The 24-2C's sensitivity matched that of the 10-2 for parafoveal disease (94.7%) and was comparable with the 30-2 for pericentral disease (90.8% vs 85.5%). Receiver operating characteristic analysis using the 24-2C yielded areas under the curve of 0.844 for mean deviation, 0.881 for pattern standard deviation, and 0.887 for VF index in detecting retinopathy. The mean test duration for 24-2C was 164.8 ± 40.2 seconds, significantly shorter than for 30-2 (253.2 ± 79.1 seconds; P < 0.001) among eyes that underwent both tests; among those tested with both 10-2 and 24-2C, 24-2C was also faster than 10-2 (237.4 ± 64.8 seconds; P = 0.001).
Conclusions:
The Humphrey 24-2C protocol offers a reliable, time-efficient, and single-test solution for screening both parafoveal and pericentral HCQ retinopathy, with diagnostic performance comparable with that of the 10-2 protocol for parafoveal retinopathy and 30-2 protocol for pericentral one.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
