The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom: executive summary

Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology

“…Details on the pathophysiology, epidemiology and treatment of hydroxychloroquine retinopathy have been reviewed extensively elsewhere 133 . Notably, advances in diagnostic procedures in the past few years, and the resulting realization that hydroxychloroquine related retinopathy is more common that previously realized, have led to the development of new ophthalmology guidelines 134,135 . Various factors are thought to increase the risk of developing retinopathy during treatment with hydrochloroquine: a drug dose of >5 mg/kg actual body weight per day, prolonged use of the drug (10-25 years), a high cumulative dose (above 600-1,000 g), stage 3-5 chronic kidney disease and comedication with tamoxifen (>6 months) 133 .…”

Keeping an Eye on Hydroxychloroquine Retinopathy

“…Despite immediate cessation of HCQ, she remained severely symptomatic in her daily life activities. Both the American Academy of Ophthalmology (AAO) and the Royal College of Ophthalmologists (RCOphth) proceeded to revised screening guidelines in 2016 [2] and 2018 [3], respectively, targeting safe doses of HCQ and proposing screening tools. Pre-existing renal disease or use of tamoxifen have been recognized as risk factors for developing HCQ toxic maculopathy.…”

Recomendaciones para la atención oftalmológica durante el estado de alarma por la pandemia de enfermedad por coronavirus COVID-19

“…Se ha demostrado toxicidad macular entre los pacientes que consumen estos medicamentos de forma prolongada, siendo el uso diario el determinante más crítico de este riesgo y estando correlacionado con el peso corporal real. Además, presentan mayor riesgo aquellos pacientes en tratamiento con tamoxifeno y los que presentan insuficiencia renal 25 . De esta manera tratamientos con dosis ≤ 5 mg/Kg de peso, presentan menos de 1% de riesgo de maculopatía tras 5 años de tratamiento y menos de 2% tras 10 años de tratamiento 26 .…”