Visual field examinations using different strategies in Asian patients taking hydroxychloroquine

In this study, we investigated the patterns of visual field (VF) defects and the diagnostic abilities of VF tests using different strategies in Asian patients with hydroxychloroquine retinopathy. Patients screened for hydroxychloroquine retinopathy using optical coherence tomography, fundus autofluorescence, VF, and/or multifocal electroretinography were included. The VF was performed using the Humphrey 30-2 and/or 10-2 strategy, and 2,107 eyes of 1,078 patients with reliable results, including 136 eyes of 68 patients with hydroxychloroquine retinopathy, were analyzed. The characteristics of VF findings were evaluated and the sensitivity and specificity were compared between the 30-2 and 10-2 tests in subgroups of retinopathy severity and pattern. The most common VF defect pattern was partial- or full-ring scotoma in both the 10-2 and 30-2 tests. Among the eyes with hydroxychloroquine retinopathy that underwent both tests, 14.2% showed a disparity between the two tests, almost all at the early stage. In overall and early pericentral retinopathy, the sensitivity of the 30-2 test was significantly higher than that of the 10-2 test (95.7% vs. 77.1% and 90.6% vs. 53.1%, respectively; P < 0.05). However, the specificity of the 10-2 test was significantly higher than that of the 30-2 test (89.6% vs. 84.8%, P < 0.001). Therefore, the pattern of retinopathy should be carefully considered when choosing a VF strategy for better detection of hydroxychloroquine retinopathy.