She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Hydroxychloroquine sulfate and sun exposure Methotrexate and plaquenil Multifocal ERG ring ratios reveal retinal toxicity in a surprisingly large fraction of patients taking hydroxychloroquine who are referred for evaluation and have no previous history of eye disease. We find the use of ring ratios to be a sensitive measure of dysfunction in ocular hydroxychloroquine toxicity. 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. • Multimodal Imaging in Plaquenil Toxicity. Conversely, multifocal ERG, with its ability to record localized central retinal defects, has gained acceptance as an excellent candidate for detecting subtle changes in the early stages of toxicity. 20 Raj Maturi, MD. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Multifocal erg plaquenil toxicity Multifocal ERG in Practice -, The Diagnostic Utility of Multifocal Electroretinography. Plaquenil anti-aging Purpose To evaluate the utility of ring ratios in detecting hydroxychloroquine HCQ related retinal toxicity using the 103-hexagon multifocal electroretinogram mfERG. Design Retrospective cross-sectional study. Methods 23 patients taking HCQ were consecutively evaluated for retinal toxicity and divided into those without HCQ-non-toxic group and with documented visual field loss HCQ-toxic. Quantitative assessment of the 103-hexagon multifocal.. Multimodal Imaging in Plaquenil Toxicity. Evaluating Hydroxychloroquine Toxicity With. Multi-focal Electroretinography mfERG may be considered medically necessary for detecting chloroquine Aralen and hydroxychloroquine Plaquenil toxicity. mfERG is considered experimental, investigational and/or unproven for all other indications, including but not limited to the diagnosis and evaluation of glaucoma and the prediction of. A 57-year-old female presented to the Ophthalmology clinic at UIHC complaining bilateral central photopsias for the past two years. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine Plaquenil 200mg bid 6.5mg/kg for 10 years, which was stopped one year prior Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity a review. Abstract. Multifocal ERG ring ratios provide a sensitive and objective method to detect ocular toxicity in patients taking hydroxychloroquine Plaquenil.