Bibliographic record
Abstract
SIGNIFICANCE: Hydroxychloroquine retinopathy causes irreversible central visual loss and can progress despite medication discontinuation. Appropriate dosing and recognition of early disease are important to minimize adverse visual sequelae. In 2016, the American Academy of Ophthalmology updated its 2011 recommendations for dosing, screening, and monitoring of hydroxychloroquine retinopathy. PURPOSE: The aim of this study was to report a case of hydroxychloroquine retinopathy in a patient who developed toxicity on a dose meeting safety thresholds from the 2011 guidelines (i.e., 6.5 mg/kg ideal body weight and cumulative dose <1000 g), but exceeding that from the 2016 revised recommendations (i.e., 5.0 mg/kg real body weight). CASE REPORT: A 61-year-old woman with rheumatoid arthritis treated with 400 mg/kg hydroxychloroquine daily for 6 years (daily dose, 5.72 mg/real body weight or 6.5 mg/kg ideal body weight; cumulative dose, 876 g) experienced progressive central vision loss and a scotoma affecting her reading ability and was referred to the Retina service. Prior yearly examination with only Ishihara color vision and Amsler grid testing was normal. On examination, visual acuity was 20/40 in the right eye and 20/30 in the left eye. A fundus examination showed bilateral bull's-eye maculopathy, a classic finding of hydroxychloroquine retinal toxicity. Fundus autofluorescence showed a parafoveal ring of speckled hypoautofluorescence and an external ring of increased signal. There were characteristic structural changes on spectral domain-optical coherence tomography, including parafoveal loss of the ellipsoid zone and outer nuclear layer. Humphrey visual field testing of the central 10-2 revealed incomplete paracentral annular scotoma. Subsequently, hydroxychloroquine was switched to sulfasalazine. CONCLUSIONS: The 2016 American Academy of Ophthalmology guidelines for hydroxychloroquine retinopathy were revised to reflect new dosing and care guidelines for early detection of retinal toxicity and to minimize the extent of irreversible vision loss.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.012 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".