J Rheum Dis.  2018 Jul;25(3):153-157. 10.4078/jrd.2018.25.3.153.

Hydroxychloroquine Retinopathy Update

• Ahn SJ
• Lee BR

• KMID: 2415603
• DOI: http://doi.org/10.4078/jrd.2018.25.3.153

Abstract

Hydroxychloroquine (HCQ) has been used widely for the treatment of several rheumatologic and dermatologic conditions, including systemic lupus erythematosus and rheumatoid arthritis. Its toxic effects on the retina, HCQ retinopathy, is not uncommon among long-term users, and produces characteristic irreversible and progressive outer retinal damage. Recent studies of Asian populations showed different patterns of retinopathy according to ethnicity; for example, a pericentral pattern is more common in Asian populations, whereas the parafoveal type is more prevalent in Caucasian patients. The pericentral pattern, which is common in Asian patients, is likely to lead to a late diagnosis with conventional imaging modalities, thereby necessitating increased attention to the screening of Asian patients. The most recent American Academy of Ophthalmology guidelines suggest optical coherence tomography and a visual field examination as the primary screening tests, and multifocal electroretinogram and fundus autofluorescence as other recommended objective screening tests. The optimal timing and frequency of annual screening depend on the systemic and ocular risk factors. Annual screening should begin from 5 years of drug use in cases without any known risk factors, but patients with major risk factors require earlier regular screening. After a diagnosis of HCQ retinopathy, a decision regarding whether to stop the drug should be made in consultation with the prescribing physician, and the progression of retinopathy should be monitored carefully because the retinopathy can progress even after drug cessation.

Keyword

Hydroxychloroquine; Retinal diseases; Diagnosis

MeSH Terms

Arthritis, Rheumatoid
Asian Continental Ancestry Group
Delayed Diagnosis
Diagnosis
Humans
Hydroxychloroquine*
Lupus Erythematosus, Systemic
Mass Screening
Ophthalmology
Retina
Retinal Diseases
Retinaldehyde
Risk Factors
Tomography, Optical Coherence
Visual Fields
Hydroxychloroquine
Retinaldehyde

Figure

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  Figure 1. Fundus photograph (Fd), optical coherence tomography (OCT), fundus autofluorescence (FAF), and visual field (VF) examination of the right eye in a 54-year-old female systemic lupus erythematosus patient with hydroxychloroquine retinopathy. Retinal pig-mentary changes observable in the fundus photograph corre-spond to outer retinal damage visible on the OCT image, hy-po-autofluorescence on FAF, and complete visual field loss in visual field examination. The visual acuities in both eyes were “hand motion.”

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