Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Lorazepam and hydroxychloroquine How long is plaquenil in your system In the remaining 15 patients, diagnosis was based upon reproducible paracentral or central scotoma on automated visual field testing or a single abnormal HVF test combined with typical fundus changes, as per diagnostic criteria of Bernstein. 7 Patients with significant age-related macular degeneration or severe glaucoma were excluded from the study. Patients with mild glaucoma or drusen without atrophy were not excluded from this study but the co-morbid conditions are noted in the analysis. Misinterpretation of Humphrey visual field HVF findings in patients utilizing hydroxychloroquine HCQ can lead to delay in diagnosis of retinal toxicity. Early retinopathy has been defined as an acquired, persistent paracentral scotoma visualized on automated visual field testing without any observable fundus changes. Here, we’ll only talk about the Humphrey visual field perimeter, which is used for 99% of visual field tests. It’s an automated, static perimeter unlike Goldmann kinetic perimetry which requires a human operator, and uses a moving target. The Humphrey uses fixed points of light which are shown at different intensity levels. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Hydroxychloroquine visual field test Plaquenil Hydroxychloroquine Uses, Dosage, Side Effects., Humphrey visual field findings in hydroxychloroquine toxicity. Hydroxychloroquine aps Screening for hydroxychloroquine retinopathy is dependent on ancillary testing as the clinical examination is insensitive and nonspecific for retinopathy.1 Since the early 1990s, the 10–2 visual field VF has been the most commonly used ancillary test.2–4 Multifocal electroretinography mfERG, spectral domain optical coherence tomography SD-OCT, and fundus autofluorescence FAF have been introduced more recently, and gained wider acceptance when advocated in the revised guidelines. Scotoma analysis of 10–2 visual field testing with a red.. How to interpret visual fields 5 most common patterns.. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Methods of visual field testing Confrontation Visual Fields Estimates the patient’s visual field limits as compared to the clinician’s field Helpful in picking up gross defects such as hemianopsia, quadrantanopsia, or altitudinal loss Typically part of the basic patient workup 17 Amsler Grid Used by the patient to self-monitor changes in the central 10° of the visual field Due to the disagreement of specificity and sensitivity of these two tests, both may be considered as adjunctive to the examinations, but are no longer recommended for screening. The 10-2 visual field test continues to be recommended as a functional assessment of macular damage. I was told from the start by my rheumatologist I would have to have eye exams including visual field exams every six months due to the plaquenil therapy. My first two exams did include these tests. But my next six month appointment is coming up, and they told me I didn't need the visual field test this time so the appointment would be shorter.