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Hydroxychloroquine-related retinal toxicity.

Hui Jen Ding1, Alastair K Denniston2, Vijay K Rao3

  • 1Department of Medicine, Putrajaya Hospital, Putrajaya, Malaysia, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The Medical School, University of Birmingham.

Rheumatology (Oxford, England)
|October 3, 2015
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Summary
This summary is machine-generated.

Hydroxychloroquine (HCQ) is vital for rheumatic diseases, but can cause sight-threatening retinopathy. Early detection through novel screening methods is crucial, though an ideal test remains elusive.

Keywords:
hydroxychloroquineocular safetyretinal toxicityrisksscreening modalitiessystemic lupus erythematosus

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Pharmacology

Background:

  • Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).
  • While generally safe, HCQ can induce potentially irreversible retinopathy, posing a significant risk to vision.
  • Current understanding of HCQ retinopathy pathogenesis and risk factors is incomplete, with many exceptions to established guidelines.

Purpose of the Study:

  • To review the current understanding of HCQ retinopathy, including risk factors and diagnostic challenges.
  • To highlight the role of emerging imaging and functional testing technologies in early toxicity detection.
  • To discuss ongoing debates in screening strategies for HCQ retinopathy.

Main Methods:

  • Review of existing literature on HCQ retinopathy and its management.
  • Discussion of established and novel diagnostic modalities: visual field testing, optical coherence tomography (OCT), fundus autofluorescence (FAF), and multifocal electroretinogram (mfERG).
  • Analysis of commonly accepted risk factors and limitations in predicting toxicity.

Main Results:

  • HCQ retinopathy, though rare, is sight-threatening and may progress silently or after treatment cessation.
  • Novel technologies (OCT, FAF, mfERG) show promise for detecting early, subclinical structural and functional damage.
  • No single screening test currently offers high sensitivity and specificity for HCQ retinopathy.

Conclusions:

  • HCQ remains a valuable therapeutic agent for rheumatic diseases.
  • Early detection of HCQ retinopathy is critical, necessitating awareness of risk factors and implementation of appropriate screening protocols.
  • Ongoing research and technological advancements are essential to refine screening strategies and improve patient outcomes.