Elsevier

Ophthalmology

Volume 106, Issue 9, 1 September 1999, Pages 1799-1804
Ophthalmology

Detection of color vision defects in chloroquine retinopathy1

https://doi.org/10.1016/S0161-6420(99)90338-XGet rights and content

Abstract

Objective

The effect of chloroquine toxicity on color vision is unclear. The authors identified the color defects seen in chloroquine retinopathy and determined the sensitivity and specificity of clinical color vision tests for detecting the presence of previously diagnosed chloroquine retinopathy.

Design

Case-control study.

Participants

Chloroquine retinopathy was defined using previously published criteria. Data from 30 patients with retinopathy and 25 patients using chloroquine but with no evidence of retinal toxicity were collected.

Methods

All patients were tested with the following six clinical color vision tests: Ishihara, Farnsworth D-15, and Adams Desaturated-15 (Dsat-15), City University 2nd Edition (CU), Standard Pseudoisochromatic Plates Part 2 (SPP-2), and American Optical Hardy Rand Rittler (AO HRR).

Main outcome measures

The number of failures was determined for each test. The types of color vision defects were classified as blue-yellow (BY), red-green (RG), or mixed RG and BY (mixed).

Results

Of the 30 patients with retinopathy, 28 (93.3%) of 30 patients failed at least 1 color vision test, demonstrating predominantly mixed defects. Five (25%) of 25 of the control subjects failed at least 1 test, and these defects were predominantly BY. The sensitivity and specificity of the tests are as follows: SPP-2 (93.3%, 88%), AO HRR (76.7%, 88%), Ishihara (43.3%, 96%), Dsat-15 (33.3%, 84%), D-15 (16.7%, 96%), and CU (20%, 92%).

Conclusions

Color vision can be affected by chloroquine and should be tested routinely with a color vision test designed to detect both mild BY and protan RG defects to maximize sensitivity for toxicity. The SPP-2 and AO HRR are two tests that meet these criteria. The Ishihara has a low sensitivity, as do the D-15 tests and CU. All of the tests have similar specificity for chloroquine toxicity. If color vision defects are detected in patients at risk of developing chloroquine retinopathy, additional testing is indicated to rule out toxicity.

Section snippets

Patients

Patients were recruited consecutively during routine ophthalmologic screening visits in a single practice. All eligible patients were required to have at least 20/80 best-corrected visual acuity (BCVA) to see the color plates. In addition, patients were excluded if they had any conditions that may contribute to possible color vision defects. These conditions included systemic and local retinopathy such as diabetic retinopathy, sickle cell retinopathy, central serous retinopathy, retinitis

Detection of color vision defects

Figure 1 shows the distribution of patients in both groups failing each color vision test. Two patients in the retinopathy group passed all the tests. Of the 28 patients who showed a color defect, 2 failed only 1 test, which was the SPP-2 in both cases. The other 26 patients failed more than 1 test, which included the SPP-2 in all cases and at least 1 other color vision test. In contrast, only 5 of 25 patients in the control group failed at least 1 test. Two patients failed only the Dsat-15,

Discussion

Color vision is often not a standard part of routine screening of patients at risk of developing chloroquine retinopathy because of conflicting reports in the literature. Earlier studies have suggested color vision may be abnormal, but none have determined the sensitivity or specificity of the color vision tests for detection of toxicity. This study identified the common color vision defects seen in chloroquine retinopathy and compared the sensitivity and specificity of six clinical color

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    1

    The authors have no financial interests in the color vision tests reported in this article.

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