Retinopathy and antimalarial drugs--the British experience

A study at St. Thomas' Hospital and review of the literature show that retinopathy associated with antimalarial treatment is now much less common. This is probably due to the prescription of lower dosages and shorter durations of treatment and possibly due to the tendency to prescribe hydroxychloroquine rather than chloroquine. The dosage parameters associated with retinopathy are still uncertain as well as the best way to screen for it but the dosage/kg body weight appears to be important. We suggest that if hydroxychloroquine is prescribed in doses of less than 6.5 mg/kg the incidence of retinopathy is minimal. Ophthalmic screening can then be restricted to a baseline examination at the onset of treatment with a yearly examination of visual acuity and fundoscopy if treatment carries on after three years. Patients who have had over ten years of treatment need more careful and detailed follow up.