Novel ERG for Detection of Hydroxychloroquine Retinopathy
NCT ID: NCT06035887
Last Updated: 2025-08-06
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
140 participants
OBSERVATIONAL
2024-05-31
2026-05-31
Brief Summary
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Detailed Description
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Electroretinography is a non-invasive method of testing for eye retinal problems, which works by flashing light (in certain patterns and brightness) into eyes and measuring the electrical response through fine wires placed on the eye surface or behind the eyelid, and is considered by many authors to be a gold-standard test to detect HCQ retinopathy. Their use has been limited due to the high expertise required to undertake and interpret tests, limited availability of testing, and high test burden, however newer electroretinography devices have been developed by a company called LKC Technologies, which are faster to perform, use leads placed on the skin (rather than the eye surface) which are more comfortable, easier to use by healthcare technicians, and can be done without the need for dilating eyedrops. The two devices being tested in this study are:
* The RETEval = a handheld electroretinography testing device
* The UTAS multifocal ERG = a trolley-mounted electroretinography testing device
These innovations may make testing far easier to develop in both hospital eye service, and potentially even general settings such as outpatient clinics, general practices, and optometrists. This study aims to evaluate the performance of devices to detect and classify participants in 4 main groups:
* Normative control participants (n=35)
* Patients taking HCQ but without retinopathy (n=35)
* Patients taking HCQ with indeterminate features of retinopathy (also known as POSSIBLE retinopathy) (n=35)
* Patients taking HCQ with definite retinopathy
Device outputs will be analysed and compared with masked graded screening results (incorporating spectral-domain macular optical coherence tomography and autofluorescence as standard, taken on the same visit) to generate device- and device-output-specific sensitivities and specificities. If a signal is found, the feasibility outcomes from this study will inform the study methodology and timelines for a larger trial if necessary.
Conditions
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Study Design
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OTHER
PROSPECTIVE
Study Groups
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Normative Controls
Age- and sex- matched normal controls
Hand-Held Full-Field Skin-Electrode Electroretinography (Device to be evaluated)
RETEval Complete hand-held electroretinogram
Trolley-Mounted Multifocal Skin-Electrode Electroretinography (Device to be evaluated)
UTAS multifocal electroretinogram
Spectral-Domain Optical Coherence Tomography (Standard of Care test)
Heidelberg Engineering Spectralis Spectral-Domain Optical Coherence Tomography (macular structural scan)
Macular Autofluorescence (Standard of Care test)
Heidelberg Engineering Spectralis Autofluorescence imaging (macular structural image)
On Hydroxychloroquine, NO retinopathy
Participants over 18 years on hydroxychloroquine without hydroxychloroquine-related retinopathy
Hand-Held Full-Field Skin-Electrode Electroretinography (Device to be evaluated)
RETEval Complete hand-held electroretinogram
Trolley-Mounted Multifocal Skin-Electrode Electroretinography (Device to be evaluated)
UTAS multifocal electroretinogram
Spectral-Domain Optical Coherence Tomography (Standard of Care test)
Heidelberg Engineering Spectralis Spectral-Domain Optical Coherence Tomography (macular structural scan)
Macular Autofluorescence (Standard of Care test)
Heidelberg Engineering Spectralis Autofluorescence imaging (macular structural image)
On Hydroxychloroquine, POSSIBLE retinopathy
Participants over 18 years on hydroxychloroquine with possible (indeterminate) hydroxychloroquine-related retinopathy
Hand-Held Full-Field Skin-Electrode Electroretinography (Device to be evaluated)
RETEval Complete hand-held electroretinogram
Trolley-Mounted Multifocal Skin-Electrode Electroretinography (Device to be evaluated)
UTAS multifocal electroretinogram
Spectral-Domain Optical Coherence Tomography (Standard of Care test)
Heidelberg Engineering Spectralis Spectral-Domain Optical Coherence Tomography (macular structural scan)
Macular Autofluorescence (Standard of Care test)
Heidelberg Engineering Spectralis Autofluorescence imaging (macular structural image)
On Hydroxychloroquine, DEFINITE retinopathy
Participants over 18 years on hydroxychloroquine with definite hydroxychloroquine-related retinopathy
Hand-Held Full-Field Skin-Electrode Electroretinography (Device to be evaluated)
RETEval Complete hand-held electroretinogram
Trolley-Mounted Multifocal Skin-Electrode Electroretinography (Device to be evaluated)
UTAS multifocal electroretinogram
Spectral-Domain Optical Coherence Tomography (Standard of Care test)
Heidelberg Engineering Spectralis Spectral-Domain Optical Coherence Tomography (macular structural scan)
Macular Autofluorescence (Standard of Care test)
Heidelberg Engineering Spectralis Autofluorescence imaging (macular structural image)
Interventions
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Hand-Held Full-Field Skin-Electrode Electroretinography (Device to be evaluated)
RETEval Complete hand-held electroretinogram
Trolley-Mounted Multifocal Skin-Electrode Electroretinography (Device to be evaluated)
UTAS multifocal electroretinogram
Spectral-Domain Optical Coherence Tomography (Standard of Care test)
Heidelberg Engineering Spectralis Spectral-Domain Optical Coherence Tomography (macular structural scan)
Macular Autofluorescence (Standard of Care test)
Heidelberg Engineering Spectralis Autofluorescence imaging (macular structural image)
Eligibility Criteria
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Inclusion Criteria
2. HCQ groups:
a. HCQ use \>5 years for patients without any high-risk factors, or \>1 year in patients with one or more high-risk factors for HCQ retinopathy, namely: i. Dose \>5mg/kg per day actual body weight (ABW) ii. Estimated glomerular filtration rate (eGFR) of \<60mls/min/1.73m2 iii. Concomitant tamoxifen use
3. Control group:
1. No prior HCQ exposure
Exclusion Criteria
2. Recent cataract surgery within 4 weeks of recruitment
3. Significant media opacity or corneal disease including, but not limited to, corneal oedema, corneal scarring, keratoconus, previous corneal transplants, severe keratoconjunctivitis sicca (requiring the use of topical serum, immunosuppressive or analogous therapy, or procedural treatment).
4. Significant macular co-pathology including, but not limited to, macular degeneration, macular scarring, cystic macular oedema (for any reason), staphyloma.
5. Inherited retinal and/or macular dystrophies including colour vision deficiencies
6. Active or previous posterior uveitis or pan-uveitis
7. Aphakia
8. High refractive error \>6.00 dioptres
9. Amblyopia
10. Diabetes
11. Retinal angiopathies including, but no limited to, retinal vein occlusion, retinal artery occlusion, ocular ischaemic syndrome, HIV retinopathy, Sickle cell disease, radiation retinopathy
12. Visually significant surgical retinal disease including epiretinal membrane, macular hole, retinal detachment, retinal tear
13. Previous retinal laser or intravitreal treatment
14. Moderate or worse glaucoma
15. Optic atrophy
16. Photosensitive epilepsy
17. Ungradable HCQ retinopathy screening images
18. Periocular infection or rash (recruitment can be deferred until acute pathology has resolved)
19. Unable or unwilling to undertake study activities
20. Any active use or history of the following medications:
Amiodarone Canthaxanthin Deferoxamine Digoxin Ethambutol Interferon-alpha Melatonin Nefazodone Sildenafil Vigabatrin Chloroquine Quinine
18 Years
ALL
No
Sponsors
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LUPUS UK
UNKNOWN
King's College Hospital Charity
UNKNOWN
King's College Hospital NHS Trust
OTHER
Responsible Party
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Principal Investigators
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Professor Timothy L Jackson
Role: STUDY_CHAIR
King's College Hospital NHS Trust
Locations
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King's College Hospital
London, London, United Kingdom
Countries
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Central Contacts
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Facility Contacts
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References
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Lee CN, Wafa HA, Murphy G, Galloway J, Mahroo OA, Jackson TL. Novel electroretinography devices to detect hydroxychloroquine retinopathy: study protocol for a diagnostic accuracy and feasibility study. BMJ Open Ophthalmol. 2024 Dec 24;9(1):e001898. doi: 10.1136/bmjophth-2024-001898.
Other Identifiers
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IRAS 317611
Identifier Type: -
Identifier Source: org_study_id
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