Chloroquine: ophthalmological safety, and clinical assessment in rheumatoid arthritis

272 patients on long-term chloroquine therapy were assessed with respect to ocular toxicity and clinical benefit. A simple scheme for rendering patients ophthalmologically safe is presented, employing the recording of central fields to red targets. Under this it was possible to diagnose a state of premaculopathy, which was reversible on stopping treatment. The incidence of premaculopathy was 41% in 143 patients who otherwise displayed no abnormality of the fundus oculi and who had received a mean total dose of 410 g. of chloroquine phosphate or the hydroxychloroquine sulphate equivalent. Under this joint ophthalmological and rheumatological supervision it was considered that the minor side-effects that may be caused by chloroquine are outweighed by its therapeutic value.