The Diagnostic Utility of Multifocal Electroretinography in Detecting Chloroquine and Hydroxychloroquine Retinal Toxicity

Adrian C. Tsang*, Sina Ahmadi, John Hamilton, Jennifer Gao, Gianni Virgili, Stuart G. Coupland, Chloe C. Gottlieb

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


Purpose: To evaluate multifocal electroretinography (mfERG) as a screening test for detecting hydroxychloroquine and chloroquine toxicity. Design: Diagnostic accuracy study. Methods: Patients referred to the University of Ottawa for hydroxychloroquine or chloroquine retinopathy screening during 2011–2014 underwent 10-2 automated visual field, spectral domain optical coherence tomography, and mfERG testing. Patients with amblyopia, high myopia or hyperopia, coexisting retinal disease, or prior surgery were excluded. Abnormalities in parafoveal ring amplitudes or ring ratios were considered a positive mfERG result. We used the definition for hydroxychloroquine and chloroquine toxicity provided by the 2016 American Academy of Ophthalmology recommendations. Area under the curve (AUC) for each mfERG parameter and the sensitivity and specificity of mfERG were calculated. Logistic regression was used to model the effect of covariates in receiver operating characteristic (ROC) analyses. Results: In total, 63 patients (47 female, 16 male) were included. Of 120 eyes, 16 (13.3%) had toxicity according to the American Academy of Ophthalmology guidelines, and 39 (32.5%) had positive mfERG findings. mfERG was found to have a sensitivity of 1.00 (95% CI 0.79–1.00) and a specificity of 0.78 (95% CI 0.69–0.85). Ring 2 amplitude had the best performance among all parameters (AUC 0.97, 95% CI 0.94–1.00). Ring 2 amplitude decreased linearly with increasing cumulative dose and daily dose. Conclusions: The high sensitivity of parafoveal depression on mfERG and its relationship to cumulative and daily dose illustrates an important role for objective functional testing. The high false-positive rate suggests a potential period where physiologic dysfunction is detected objectively on mfERG before structural change on spectral domain optical coherence tomography.

Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalAmerican Journal of Ophthalmology
Early online date10 May 2019
Publication statusPublished - Oct 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Elsevier Inc.

Copyright 2019 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Ophthalmology


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