7,8 That being said, a detailed anterior and posterior segment examination to assess for corneal verticillata as well as concurrent macular disease (i.e., age-related macular degeneration), remains important in monitoring these patients long term.įigure 1. Thus, ophthalmoscopy alone is not sufficient to screen for HCQ toxicity. On the other hand, visible bull’s-eye retinopathy, characterized by a ring of retinal pigment epithelium degeneration often sparing the foveal center, is a late finding indicative of advanced damage (See Figure 1). While recognition of subtle foveal depigmentation has been described in some cases of early toxicity, this was only after corroboration with ancillary imaging studies. 4-6 The scotoma typically becomes apparent to the patient well before changes are seen on examination. However, perceptive individuals may report difficulty with night vision, glare or paracentral scotomas that interfere with reading. In the earliest stages of HCQ toxicity, patients are often asymptomatic with preservation of visual acuity. This review summarizes the clinical presentation of HCQ retinopathy, current American Academy of Ophthalmology recommended screening guidelines and contribution of ancillary imaging studies in establishing a timely diagnosis. Accordingly, in recent years there has been an increased emphasis on more effective screening measures utilizing multimodal imaging techniques to elicit early signs of toxicity before the characteristic advanced changes manifest clinically. 3 However, the retinopathy, described as a bull’s-eye, is untreatable and tends to progress even after cessation of the drug. 2 Retinal toxicity associated with HCQ use is relatively rare, estimated at 1 percent after five years and rising with continued therapy. 1 By some estimates, more than 150,000 patients are on long-term therapy with this medication in America alone. Hydroxychloroquine, sold under the brand name Plaquenil (Sanofi-Aventis), is an antimalarial drug that has gained widespread use in treating various autoimmune diseases, including systemic lupus erythematosus and rheumatoid arthritis.
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