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We thank Dr. Flach for his comments that bring up good points, including the use of handouts to remind patients of the importance of follow-up testing. We hasten to note that the new Academy Recommendation does not prevent any physician from using Amsler grids in conjunction with other tests.1Marmor M.F. Kellner U. Lai T.Y.Y. et al.Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.Ophthalmology. 2011; 118: 416-423Abstract Full Text Full Text PDF Scopus (1) Google Scholar In Dr. Flach's hands they are undoubtedly a very useful adjunct procedure for all of the reasons he presents.However, even in the absence of controlled studies, our experience as retina specialists is that we see many patients who use the test incorrectly, or don't understand quite what they are looking for; and not all physicians are as diligent as Dr. Flach with instructions and follow-up. Amsler grid testing simply has too many variables, including patient understanding, lighting, test distance, grid contrast, uncertainty about what changes to anticipate, and the subjective sensitivity of both patient and physician. It should not be a “gold standard” for screening a serious retinal toxicity in an era when objective tests, such as spectral domain-optical coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG), can be performed in standardized fashion with high sensitivity that has been verified in the literature.Automated 10-2 visual fields also have problems with respect to patient compliance and physician sensitivity to subtle changes, but at least the procedure is done under controlled stimulus conditions that make it more likely to be comparable worldwide than Amsler grid testing. We advise that fields also be supplemented with objective tests if at all possible. We thank Dr. Flach for his comments that bring up good points, including the use of handouts to remind patients of the importance of follow-up testing. We hasten to note that the new Academy Recommendation does not prevent any physician from using Amsler grids in conjunction with other tests.1Marmor M.F. Kellner U. Lai T.Y.Y. et al.Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.Ophthalmology. 2011; 118: 416-423Abstract Full Text Full Text PDF Scopus (1) Google Scholar In Dr. Flach's hands they are undoubtedly a very useful adjunct procedure for all of the reasons he presents. However, even in the absence of controlled studies, our experience as retina specialists is that we see many patients who use the test incorrectly, or don't understand quite what they are looking for; and not all physicians are as diligent as Dr. Flach with instructions and follow-up. Amsler grid testing simply has too many variables, including patient understanding, lighting, test distance, grid contrast, uncertainty about what changes to anticipate, and the subjective sensitivity of both patient and physician. It should not be a “gold standard” for screening a serious retinal toxicity in an era when objective tests, such as spectral domain-optical coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG), can be performed in standardized fashion with high sensitivity that has been verified in the literature. Automated 10-2 visual fields also have problems with respect to patient compliance and physician sensitivity to subtle changes, but at least the procedure is done under controlled stimulus conditions that make it more likely to be comparable worldwide than Amsler grid testing. We advise that fields also be supplemented with objective tests if at all possible. Amsler Grids for Chloroquine ToxicityOphthalmologyVol. 118Issue 10Preview“Amsler grid testing is no longer recommended,” concludes the American Academy of Ophthalmology Update report in the “Revised Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy” published in the February 2011 issue.1 Although the initial American Academy of Ophthalmology Guidelines, proposed during 2002, recommended the use of the Amsler grid as an alternative to automated 10-2 testing,2 the present Update states, “Amsler grid testing is not consistent enough in general use for reliable screening.” Are there references one can cite to support the comment that Amsler grid testing is not consistent in these patients? Full-Text PDF