Example of Useless 10-2 Visual Field Testing in Hydroxychloroquine Retinopathy Screening

This 69 year old woman taking hydroxychloroquine 400 mg/d for systemic lupus erythematosus had serial 10-2 visual fields since beginning the drug in 2010. She was 5 feet 5 inches tall and weighed 101 pounds. She had no renal or liver disease. She complained of blurred vision bilaterally that had been slowly progressive. The fundus examination was normal bilaterally. The visual fields show low reliability at three consecutive screening examinations. This is manifested in locations where new scotomas appear that were not present on previous examinations (e.g., the red circled area) and scotomas present on previous examinations that disappear subsequently (e.g., the green circled area). In such a setting, it is not possible to test for early hydroxychloroquine retinopathy. A better option would be to test the patient with multifocal electroretinography or spectral domain OCT.