Hydroxychloroquine retinopathy: an emerging problem

Area of Science:

• Ophthalmology
• Rheumatology
• Toxicology

Background:

• Hydroxychloroquine (HCQ) is a widely prescribed medication for autoimmune conditions like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
• While beneficial for survival in SLE, prolonged HCQ use carries a risk of serious, irreversible retinal toxicity.
• Current monitoring guidelines may not adequately address the risk of HCQ-induced retinopathy.

Observation:

• This case series details 3 patients with long-term HCQ treatment (over 15 years) who developed symptomatic retinal toxicity.
• Macular involvement was confirmed using advanced imaging (Optical Coherence Tomography, Autofluorescence) and functional testing (Humphrey visual fields).
• The observed retinal damage varied in severity but was characteristic of HCQ toxicity.

Findings:

• All patients on long-term HCQ exhibited signs of retinal toxicity, specifically affecting the macula.
• Imaging and functional tests confirmed the diagnosis and severity of the visual impairment.
• The cases underscore the potential for HCQ to cause significant, irreversible vision loss.

Implications:

• There is an emerging issue of serious retinal damage associated with prolonged hydroxychloroquine use.
• Early detection of presymptomatic retinal changes through appropriate screening and monitoring is mandatory.
• Ophthalmologists and rheumatologists must collaborate to implement effective monitoring strategies to prevent irreversible visual loss in patients treated with HCQ.