Hydroxychloroquine Retinopathy with Advanced Visual Field Changes but Minimal Fundus Changes

The visual fields shown here refer to the same case as that illustrated in "Hydroxychloroquine Retinopathy with Minimal Fundus Changes". This 68 year old woman with systemic lupus erythematosus had been on hydroxychloroquine at a dosage of 400 mg/d (6.52 mg/kg/d) for eight years. Her optometrist had checked her yearly during that time until in the eighth year he became suspicious of hydroxychloroquine toxicity because of visual field changes noted. C - 10-2 visual field testing showed bilateral paracentral scotomata. The 10-2 visual field test is the gold standard screening test for hydroxychloroquine retinopathy. In 2013, other tests, such as multifocal electroretinography and spectral domain-OCT, have become more commonly used, but 10-2 visual field testing remains the foundation, because hundreds of thousands of patients have historical data that can be compared to current tests and because the test is sensitive to toxicity when interpreted carefully.