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Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity
1Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina 28210, USA. djbrowning@carolina.rr.com
Purpose:
To report hydroxychloroquine and chloroquine retinopathy and consider screening for drug toxicity.
Design:
Retrospective observational case series.
Methods:
Review of clinical records, visual fields, fundus photographs, and fluorescein angiography of six patients from a retina referral practice.
Results:
All cases arose because of failure by physicians to avoid dosing above published safe levels. Five cases developed despite accepted ophthalmologic patterns of screening for toxicity. All cases developed parafoveal retinal pigment epithelial atrophic changes and paracentral scotomas to threshold visual field testing.
Conclusions:
New cases of hydroxychloroquine and chloroquine toxicity continue to develop in a screening environment. Increased ophthalmologic attention to dosing, awareness of location and nature of early visual field defects, and traditional attention to presence or absence of maculopathy can reduce the incidence of this avoidable condition.
Insights
New cases of hydroxychloroquine and chloroquine retinopathy are still occurring, even with screening. Physicians must pay closer attention to dosing and early visual field defects to prevent this avoidable toxicity.
Area of Science:
- Ophthalmology
- Pharmacology
Background:
- Hydroxychloroquine and chloroquine are commonly prescribed for autoimmune conditions.
- Retinopathy is a known potential side effect of these medications.
Observation:
- A retrospective observational case series reviewed six patients with retinopathy.
- Data included clinical records, visual fields, fundus photography, and fluorescein angiography.
Findings:
- All six cases resulted from physicians exceeding recommended safe dosing levels.
- Five cases developed despite adherence to established ophthalmologic screening protocols.
- Patients exhibited parafoveal retinal pigment epithelial atrophy and paracentral visual field defects.
Implications:
- Hydroxychloroquine and chloroquine toxicity remains a concern despite current screening practices.
- Increased physician awareness of safe dosing and early visual field abnormalities is crucial.
- Proactive ophthalmologic monitoring can help mitigate the incidence of this preventable condition.