|
Color
vision loss in patients treated with chloroquine
Dora F. Ventura
Luiz Carlos L. Silveira
Mauro Nishi
Marcelo F. Costa
Mirella Gualtieri
Ruth M. A. dos Santos
Carolina T. Pinto
Ana Laura A. de Moura
Anderson R. Rodrigues
Claudio Sakurada
Maria de Fátima L. C. Sauma
John M. de Souza
Patients that make use of chloroquine or hydroxychloroquine, drugs which are
frequently administered for treatment of rheumatoid arthritis, lupus
erithromatosus or malaria, may suffer alterations in color vision and in
contrast sensitivity. The present work evaluates the visual function of
these patients in a joint study of the University of São Paulo (USP), in São
Paulo, and of the Federal University of Pará (UFPA), in Belém. Thirty two
chloroquine user patients without alterations in the eye fundus exam were
evaluated in São Paulo (n=10; aged 38 to 71 years; mean=55,8 years) and in
Belém (n=22; aged 20 to 67; mean=40 years). The prescribed accumulated
chloroquine dose was 45 to 430 g (mean=213 g; sd = 152 g) for the São Paulo
group, and 36 to 540 g (mean=174 g; sd=183 g) for the Belém group. Tests
were performed monocularly with corrected eye refractive state. Color
discrimination was evaluated using the Cambridge Colour Test (CCT): the
color discrimination threshold was measured first in the protan, deutan and
tritan axes and, in succession, three MacAdam’s ellipses were determined.
The patient’s color vision was also evaluated with color arrangement tests:
the Farnsworth-Munsell 100 Hue (FM100), the Farnsworth-Munsell D15, and the
Lanthony Desaturated (D15d) tests. We also measured the contrast sensitivity
for black-and-white sine wave grating of twenty two patients. The results
were compared with controls without ophthalmologic or neuro-ophthalmologic
pathologies. Twenty four patients presented acquired dyschromatopsia. There
were cases of selective loss (11 patients) and of diffuse loss (13 patients).
Although losses were present in the FM100 there was no correlation between
the FM100 error score and the ellipse area measured by the CCT. Moreover,
three patients that scored normal in the FM100, failed to reach normal
threshold in the CCT. The Lanthony test was less sensitive than the other
two tests, since it failed to indicate loss in about half the patients, and
the D15 was the least sensitive test, having failed to indicate loss in 9
out of 10 patients.
Contrast sensitivity was within normal values for patients submitted to this
test. The extent of losses in color discrimination was positively correlated
with the accumulated dose. The CCT is recommended for follow up since it
provides quantitative data that can be directly interpreted in CIE (Commission
Internationalle d’Éclairage) color space. |