Revised Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy

Humphrey visual field findings in hydroxychloroquine toxicity

“…The 10-2 white strategy is also recommended in a recent American Academy of Ophthalmology publication regarding HCQ screening recommendations. 2 The exception to our use of 10-2 white strategy would be for a patient with concurrent glaucoma. When there are other clinical reasons to perform 24-2 or 30-2 tests, the clinician can use that test for HCQ screening but must be aware of how HCQ toxicity manifests on the larger-scale HVF testing strategies as elucidated above.…”

“…On 10-2 white HVF even mildly decreased thresholds (4-8 dB) could be recognizable as positive when there was a contiguous pattern of a paracentral ring or partial ring (Figure 2). One also needs to be certain to review the deviation plots, 2 as this may make subtle defects more obvious. Previous literature has reported that the superior Figure 5 HVF Findings in HCQ Toxicity using 24-2 Test Strategy.…”

“…1 Reports have shown that the visual loss from HCQ toxicity is less likely to be reversible once fundus changes are present. [1][2][3] Although newer testing modalities, such as spectral domain-optical coherence tomography, fundus autofluorescenece, and multifocal electroretinogram, are now recommended as part of screening when available, 2 automated perimetry remains the most readily available screening test in the majority of practices. Additionally, eye care providers are familiar with interpretation of HVF for glaucoma and other conditions.…”

Presumed entecavir-induced ocular toxicity

“…5 On the basis of our imaging results, the RPE thickening and photoreceptor degeneration suggest that the drug may bind melanin in the RPE. 6 The autofluorescence imaging suggest that the function of the lysosomal RPE at the macula is disrupted with increased levels of lipofuscin observed within the RPE and outer retina. Photoreceptor degeneration would follow the RPE dysfunction and lipofuscin accumulation in the outer retina, leading to reductions in autofluorescence signals.…”

Microperimetric sensitivity in patients on hydroxychloroquine (Plaquenil) therapy

“…1 This medication is known to have a high affinity for binding to melanin granules and can therefore accumulate in the iris, choroid, ciliary body, and retinal pigment epithelium (RPE) on prolonged usage. [1][2][3] Although not entirely understood, retinal toxicity often begins with loss of rods and cones and degenerative changes of the RPE. Given the concern for retinal toxicity from Plaquenil use, early detection is an important responsibility faced by ophthalmologists.…”