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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Pharmacology

Background:

  • Hydroxychloroquine (HCQ) is increasingly used for autoimmune disorders, showing survival benefits in systemic lupus erythematosus.
  • However, HCQ and chloroquine (CQ) carry a risk of irreversible retinal toxicity, with prevalence increasing significantly after prolonged use.
  • Retinal toxicity is more common than previously thought, affecting up to 20% of patients after 20 years of treatment.

Purpose of the Study:

  • To provide an update on hydroxychloroquine/chloroquine retinopathy.
  • To summarize emerging indications, efficacy, risk factors, prevalence, diagnostic tests, and management strategies for HCQ retinopathy.
  • To highlight updated guidance on safe dosing and screening protocols.

Main Methods:

  • Review of current literature on HCQ/CQ retinopathy.
  • Analysis of prevalence data and risk factors associated with HCQ use.
  • Summary of diagnostic methods and management approaches for HCQ retinopathy.

Main Results:

  • Hydroxychloroquine retinal toxicity prevalence is higher than previously estimated, especially with long-term use (>5-20 years).
  • Emerging risk factors include tamoxifen use; updated guidance recommends using ideal body weight for dosing, not actual body weight.
  • Asian patients may exhibit unique retinopathy patterns requiring wider screening fields.

Conclusions:

  • Hydroxychloroquine is generally safe and effective for systemic diseases, but retinal toxicity risk necessitates adherence to modern screening and ideal dosing.
  • Dissemination of updated guidelines on optimal dosing and screening for HCQ is crucial.
  • Implementing updated screening methods and ideal dosing can help prevent HCQ-related visual loss.