Validation of the colour difference plot scoring system analysis of the 103 hexagon multifocal electroretinogram in the evaluation of hydroxychloroquine retinal toxicity

Purpose To evaluate sensitivity, specificity and reproducibility of colour difference plot analysis (CDPA) of 103 hexagon multifocal electroretinogram (mfERG) in detecting established hydroxychloroquine (HCQ) retinal toxicity. Methods Twenty‐three patients taking HCQ were divided into those with and...

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Bibliographic Details
Published in:Acta ophthalmologica (Oxford, England) England), 2014-08, Vol.92 (5), p.e377-e381
Main Authors: Graves, Gabrielle S., Adam, Murtaza K., Stepien, Kimberly E., Han, Dennis P.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antirheumatic Agents - adverse effects
Arthritis, Rheumatoid - drug therapy
Electroretinography - drug effects
Electroretinography - methods
False Positive Reactions
Female
Humans
Hydroxychloroquine - adverse effects
hydroxychloroquine toxicity
Lupus Erythematosus, Systemic - drug therapy
Male
Middle Aged
multifocal electroretinography
Ophthalmology
Predictive Value of Tests
Ratio analysis
Reproducibility of Results
retinal
Retinal Diseases - chemically induced
Retinal Diseases - diagnosis
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Sjogren's Syndrome - drug therapy
Toxicity
toxicology
Young Adult
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Summary:Purpose To evaluate sensitivity, specificity and reproducibility of colour difference plot analysis (CDPA) of 103 hexagon multifocal electroretinogram (mfERG) in detecting established hydroxychloroquine (HCQ) retinal toxicity. Methods Twenty‐three patients taking HCQ were divided into those with and without retinal toxicity and were compared with a control group without retinal disease and not taking HCQ. CDPA with two masked examiners was performed using age‐corrected mfERG responses in the central ring (Rc; 0–5.5 degrees from fixation) and paracentral ring (Rp; 5.5–11 degrees from fixation). An abnormal ring was defined as containing any hexagons with a difference in two or more standard deviations from normal (colour blue or black). Results Categorical analysis (ring involvement or not) showed Rc had 83% sensitivity and 93% specificity. Rp had 89% sensitivity and 82% specificity. Requiring abnormal hexagons in both Rc and Rp yielded sensitivity and specificity of 83% and 95%, respectively. If required in only one ring, they were 89% and 80%, respectively. In this population, there was complete agreement in identifying toxicity when comparing CDPA using Rp with ring ratio analysis using R5/R4 P1 ring responses (89% sensitivity and 95% specificity). Continuous analysis of CDPA with receiver operating characteristic analysis showed optimized detection (83% sensitivity and 96% specificity) when ≥4 abnormal hexagons were present anywhere within the Rp ring outline. Intergrader agreement and reproducibility were good. Conclusions Colour difference plot analysis had sensitivity and specificity that approached that of ring ratio analysis of R5/R4 P1 responses. Ease of implementation and reproducibility are notable advantages of CDPA.
ISSN:1755-375X
1755-3768
DOI:10.1111/aos.12353