Hydroxychloroquine Retinopathy in Systemic Lupus Erythematosus: Risk Factors, Screening, and Emerging Biomarkers.

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Hydroxychloroquine (HCQ) is essential for managing systemic lupus erythematosus (SLE) due to its anti-inflammatory properties.
• Long-term HCQ use can lead to hydroxychloroquine-induced retinopathy, a potentially irreversible condition requiring early detection.
• Current screening adherence for HCQ retinopathy in SLE patients is often insufficient.

Purpose of the Study:

• To review the prevalence of HCQ-related retinal toxicity in SLE patients.
• To identify key risk factors associated with HCQ retinopathy.
• To synthesize current and emerging screening strategies for early detection.

Main Methods:

• Literature review summarizing reported prevalence of HCQ retinopathy in SLE.
• Analysis of risk modifiers such as dosage, duration of exposure, and renal function.
• Synthesis of multimodal ophthalmic testing strategies including SD-OCT, FAF, visual field testing, and mfERG.

Main Results:

• Higher HCQ dosage, longer duration/cumulative exposure, and renal impairment are consistent risk factors for retinopathy.
• Multimodal imaging (SD-OCT, FAF) and functional tests (visual perimetry, mfERG) aid early detection.
• Emerging methods like OCT angiography and pharmacokinetic measures require further investigation.

Conclusions:

• Optimal screening requires aligning HCQ dosing, risk stratification, and regular ophthalmic monitoring.
• Standardizing diagnostic criteria and screening intervals is necessary.
• Prospective validation of novel biomarkers and automated screening workflows is needed for improved patient outcomes.