Hydroxychloroquine retinopathy

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.