Screening for Hydroxychloroquine Retinal Toxicity in Indian Patients

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Hydroxychloroquine (HCQ) is widely used for autoimmune rheumatic diseases.
• Previous studies on HCQ retinal toxicity primarily focused on East Asian populations.
• Limited data exist on HCQ retinal toxicity in Indian patients.

Purpose of the Study:

• To determine the prevalence and pattern of HCQ retinal toxicity in Indian patients.
• To assess if current screening protocols for HCQ retinal toxicity need modification for Indian patients.

Main Methods:

• A cross-sectional study was conducted on adult patients with autoimmune rheumatic diseases.
• Patients had used HCQ for at least 5 years or a cumulative dose of 500 g.
• Retinal toxicity was evaluated using fundus examination, visual fields (10-2 and 30-2 protocols), and spectral domain optical coherence tomography.

Main Results:

• Retinal toxicity was identified in 7 out of 110 screened patients (6.36%).
• The observed patterns were parafoveal (4 patients) or mixed parafoveal and perifoveal (3 patients).
• Toxicity was associated with prolonged HCQ use (mean 13 years) and high cumulative doses (mean 1573.7 g).

Conclusions:

• Hydroxychloroquine retinal toxicity is more prevalent than previously thought in patients with long-term use.
• In Indian patients, HCQ retinal toxicity typically presents with parafoveal or mixed parafoveal and perifoveal patterns.
• Findings suggest the need for continued vigilance and potentially tailored screening for HCQ retinal toxicity in Indian populations.