Retinal toxicity in long term hydroxychloroquine treatment

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Hydroxychloroquine is widely prescribed for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
• Long-term safety monitoring for hydroxychloroquine retinopathy is essential, particularly with increasing usage.
• Previous reports of retinopathy often involved patients receiving supratherapeutic doses.

Purpose of the Study:

• To evaluate clinical experience and retinal toxicity in patients with RA and SLE on long-term hydroxychloroquine therapy.
• To monitor for hydroxychloroquine-related retinopathy with regular, six-monthly examinations in patients exceeding six years of treatment.

Main Methods:

• Prospective evaluation of 360 Greek patients with RA and SLE.
• Detailed ophthalmological examinations every six months for 58 patients on treatment for over six years.
• Utilized fundoscopy, color vision tests, dark adaptation, visual fields, automated perimetry, and electroretinography.

Main Results:

• Two patients (3.5%), one with RA and one with SLE, developed characteristic hydroxychloroquine retinopathy after 6.5 and 8 years of treatment, respectively.
• Despite early diagnosis and treatment cessation, both patients experienced permanent paracentral visual field defects.
• The patient with SLE showed persistent retinal lesions on fluorescein angiography even after 3 years of follow-up.

Conclusions:

• This study reports irreversible hydroxychloroquine retinopathy in patients treated with recommended doses, challenging previous assumptions.
• The findings highlight the need for heightened vigilance and concern regarding long-term hydroxychloroquine use in rheumatology.
• Early detection and intervention are critical, but may not fully prevent vision impairment from hydroxychloroquine toxicity.