It is generally well tolerated, but retinopathy is a concern. Retinopathy is rare, but is sight threatening, generally irreversible and may progress even after cessation of therapy. Although a number of risk factors have been proposed (such as duration of therapy and cumulative dose), the many exceptions (e.g. Plaquenil guidelines for eye monitoring 2016 Plaquenil and prednisone for lupus Evaluation with electroretinogram ERG 5. Determine the frequency of surveillance examinations. For example, if a patient has taken 250 milligrams of plaquenil per day for three years, the cumualtive dose is 273,750 milligrams. This equals 273.75 grams of plaquenil and is below the 1,000 gram threshold for developing toxic maculopathy. Another. Cein angiography, full-field ERG, and electro-oculogram are not considered to be helpful.1-3 mfERG is a sensitive, objective, and reproducible test for detecting hydroxy-chloroquine toxicity. Several drugs taken in high doses or for long periods of time can cause retinal degeneration with pigmentary changes. The electroretinogram ERG. The global or full-field electroretinogram ERG is a mass electrical response of the retina to photic stimulation. The ERG is a test used worldwide to assess the status of the retina in eye diseases in human patients and in laboratory animals used as models of retinal disease. Novel technologies such as optical coherence tomography (OCT), fundus autofluorescence (FAF) and multifocal electroretinogram (mf ERG) may provide the earliest structural and functional evidence of toxicity in these stages. Retinopathy on low-dose HCQ, or no retinopathy after a very large cumulative dose of HCQ) highlight our limited understanding of the disease process. Plaquenil fullfield erg severe ERG findings in patients using hydroxychloroquine SpringerLink, Evaluating Hydroxychloroquine Toxicity With Multifocal Electroretinography Hydroxychloroquine and coldsHydroxychloroquine mechanism The better substitute for chloroquine, Plaquenil, can also have macular effects noticeable by multifocal electroretinograms. Hydroxychloroquine Plaquenil is usually less disruptive to the retina than chloroquine, but ERG changes can still occur. Vigabatrin, a pediatric seizure medication, can be toxic to the retina. Attenuation of full-field. Erg eog - SlideShare. The Electroretinogram and Electro-oculogram Clinical Applications by.. Electroretinogram - EyeWiki. Plaquenil toxicity isn’t even in the top 10, or the top 100” if you’re looking at incidence, he said. “It’s a pretty rare thing.” Nevertheless, he urged doctors to master the Academy’s new guidelines, because the effects from chloroquine and hydroxychloroquine, when they do occur, are severe and often irreversible. The primary value of fundoscopy is not for screening for toxicity but for documentation of other retinal pathology. Tests which are no longer recommended are the Amsler grid test, colour vision tests, fundus photograph, time-domain OCT, fluorescein angiography and full-field ERG as they are not sensitive enough to detect early signs of toxicity. The full-field ERG parameters including OPs showed little relationship to the duration of HCQ usage or the cumulative dose. CONCLUSIONS A substantial subgroup of patients showed varying degrees of diffuse ERG abnormality despite having no clinical signs visual or fundus changes of toxicity, and despite a range of cumulative doses.