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Validation of the colour difference plot scoring system analysis of the 103 hexagon multifocal electroretinogram in the evaluation of hydroxychloroquine retinal toxicity
Author(s) -
Graves Gabrielle S.,
Adam Murtaza K.,
Stepien Kimberly E.,
Han Dennis P.
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12353
Subject(s) - hydroxychloroquine , retinal , ophthalmology , medicine , optometry , toxicity , covid-19 , disease , infectious disease (medical specialty)
Purpose To evaluate sensitivity, specificity and reproducibility of colour difference plot analysis ( CDPA ) of 103 hexagon multifocal electroretinogram (mf ERG ) 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 mf ERG responses in the central ring ( R c ; 0–5.5 degrees from fixation) and paracentral ring ( R p ; 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 R c had 83% sensitivity and 93% specificity. R p had 89% sensitivity and 82% specificity. Requiring abnormal hexagons in both R c and R p 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 R p with ring ratio analysis using R5/R4 P 1 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 R p 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 P 1 responses. Ease of implementation and reproducibility are notable advantages of CDPA .