Long-term course of antimalarial maculopathy after cessation of treatment

Since 1980 I have examined some 1650 patients for the presence or absence of antimalarial maculopathy. Bilateral, irreversible visual field defects have been diagnosed is 62 patients, 37 of whom have been followed for at least 4 years. The 22 patients who presented with relative scotomas did not lose central visual acuity; over a median follow-up period of 6.0 years 33 (75%) of the eyes maintained their visual field, 5 (11%) showed some improvement in visual field, 4 (9%) lost some visual field, and 2 (4%) manifested small absolute scotomas. Nine (60%) of the 15 patients who presented with absolute scotomas were symptomatic. Over a median follow-up period of 8.8 years 19 (63%) of the eyes in this group lost one or more lines of visual acuity, including 4 (13%) that became legally blind; 19 (63%) lost field owing to an increase in the size of the absolute scotomas (13 eyes) or the development of new absolute scotomas (6 eyes). The results suggest that the visual prognosis is excellent if antimalarial therapy is stopped at an early stage of the disease.