Additionally, another exception occurred while executing the custom error page for the first exception. : September 14, 2016 Chief complaint: Whirling and flashing lights A 57-year-old female presented to the Ophthalmology clinic at UIHC complaining bilateral central photopsias for the past two years. Hydroxychloroquine retinopathy an emerging problem Hydroxychloroquine exam Lichen sclerosus plaquenil Multifocal ERG has a consistent topographic distribution in the normal population. However, the summed amplitude of multifocal ERG can vary significantly among normal subjects. Therefore, topographic abnormalities via a three-dimensional distribution map are useful for the interpretation of multifocal ERG in diseased patients. Twenty patients on Plaquenil treatment were evaluated for retinal toxicity using the EOG and the mfERG. Group 1 comprises 15 patients 30 eyes with normal EOG. From these patients 11 22 eyes showed normal RRD of mfERG in area 1 and area 2. The rest four patients 8 eyes the RRD were reduced. Six months after interruption of HC, the mfERG improved in three cases. Group 2 comprises 5. Multifocal ERGs better quantify retinal toxicity than full-field ERGs. Below are mfERGs of several patients with Plaquenil toxicity. Plaquenil first affects small areas between 5-15 degrees from fovea eventually progressing to produce a ring scotoma. Figs. 47 and 48. Fig. 47. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. Multifocal erg plaquenil Advanced Multifocal ERG mfERG Diopsys, Assessing hydroxychloroquine toxicity by the multifocal ERG. Hydroxychloroquine dose based on weight and renal functionNormal plaquenil doseNatural version of plaquenilChloroquine malarone Multifocal electroretinography mfERG is highly sensitive for detecting hydroxychloroquine retinal toxicity. • Ring 2 P1 amplitude is the most sensitive mfERG parameter to detect hydroxychloroquine retinal toxicity. • Ring 2 P1 amplitude is inversely related to cumulative and daily doses of hydroxychloroquine. • The Diagnostic Utility of Multifocal Electroretinography in.. The Electroretinogram and Electro-oculogram Clinical.. How Do Ophthalmologists Look for Plaquenil Damage.. Eye Exam and Testing for Plaquenil. For the first 5 years annual screening is appropriate. In addition to the previous discussion of a thorough complete eye exam with best corrected vision, central visual field, color vision, and dilated retinal exam, other tests include multifocal ERG, spectral domain OCT, and autofluoresence of the macula. Multifocal ERG ring ratios provide a sensitive and objective method to detect ocular toxicity in patients taking hydroxychloroquine Plaquenil. In order to measure ring ratios, the average mfERG amplitude was calculated for each of five concentric rings of a 61-hexagon mfERG. The abnormalities on multifocal ERG corresponded with the patients’ subjective descriptions and the visual field depiction of their pericentral scotomas. All affected patients had been taking hydroxychloroquine for at least 7 years. One patient with generalized depression on multifocal ERG had possible hydroxychloroquine retinopathy.