From the Guidelines
Hydroxychloroquine can affect vision, particularly with long-term use, and regular eye examinations are crucial to minimize the risk of retinal toxicity. The medication, commonly used to treat autoimmune conditions like rheumatoid arthritis and lupus, can cause retinal toxicity, with the risk increasing with higher doses (over 5 mg/kg of actual body weight per day) and longer duration of treatment (especially beyond 5 years) 1. Key factors to consider include:
- The risk of retinal toxicity from hydroxychloroquine is less than 2% for usage up to 10 years at a daily dosage of ≤5 mg/kg/day actual body weight 1
- Baseline testing is advised to rule out confounding disease when a patient is started on hydroxychloroquine, and annual screening with sensitive tests should begin no more than 5 years after treatment initiation 1
- Early symptoms of retinal toxicity may include difficulty reading, decreased color vision, light flashes, or blind spots, though many patients remain asymptomatic until significant damage occurs
- Regular eye examinations, including visual field testing and retinal imaging, are essential for patients taking hydroxychloroquine to detect early toxicity and preserve visual function 1. The most recent guidelines recommend annual screenings after 5 years of use, or sooner in the presence of major risk factors, to optimize the utility and safety of hydroxychloroquine 1.
From the FDA Drug Label
Retinal Toxicity Inform the patient that irreversible retinal damage has been observed in some patients with the use of hydroxychloroquine sulfate. Advise patients of the importance of the ophthalmology visits for monitoring their eyes. Instruct patients to seek medical attention promptly if they experience decreased vision or decreased dark adaptation [see Warnings and Precautions (5. 2)].
Hydroxychloroquine can affect vision, as it has been associated with irreversible retinal damage in some patients. Patients should be advised to seek medical attention if they experience decreased vision or decreased dark adaptation. Regular ophthalmology visits are recommended for monitoring eyes while taking hydroxychloroquine sulfate 2.
From the Research
Hydroxychloroquine and Vision
- Hydroxychloroquine can cause irreversible toxic retinopathy, especially with long-term use and high dosages 3, 4, 5, 6, 7
- The risk of retinal toxicity increases with daily consumption of more than 5.0 mg/kg of real body weight and duration of use longer than 10 years 3
- Other major risk factors for hydroxychloroquine retinopathy include kidney disease and concurrent tamoxifen citrate therapy 3
- Early detection of presymptomatic retinal changes through screening and monitoring is crucial to limit the extent of irreversible visual loss due to hydroxychloroquine retinal toxicity 5, 7
- The pathophysiology of hydroxychloroquine retinopathy is not fully understood, but significant advances have been made in understanding the disease from clinical imaging studies 7
Screening and Diagnosis
- Various diagnostic tests, including visual field testing, optical coherence tomography, and electroretinogram, can be used to detect hydroxychloroquine retinopathy 4, 6
- The utility and limitations of each diagnostic test should be considered when screening for hydroxychloroquine retinopathy 7
- A consensus on the definition of hydroxychloroquine retinopathy is necessary to guide screening recommendations and management of proven cases of toxicity 7
Management and Prevention
- Cessation of hydroxychloroquine therapy may not prevent progression of retinal toxicity, and sustained visual improvement is not typically observed 6
- Lean body weight should be used when calculating daily dosage to minimize the risk of retinal toxicity 6
- Retinopathy screening programs should be implemented for patients at risk of hydroxychloroquine retinopathy 7