Screening for hydroxychloroquine retinopathy
Reviewed by Brian Ang

The American Academy of Ophthalmology has updated the recommendations for screening for hydroxychloroquine retinopathy based on new scientific evidence that toxicity is not rare when hydroxychloroquine is used long-term, and that risk is dependent on the daily dose by weight. The daily dosage recommendation is <5.0mg/kg real weight. A retinal and macular examination should be performed within the first year of use, and then annual screening to commence after five years of use or earlier if there are risk factors (such as long duration of use, renal disease, concomitant tamoxifen use). Screening should be conducted with both automated perimetry and spectral domain OCT. Fundus autofluorescence and multifocal electroretinography may also provide useful information during screening. Note that fundus examination, amsler grid testing and colour vision are considered insufficient for screening. Once retinopathy has developed, the hydroxychloroquine should be discontinued upon discussion with the rheumatologist.

Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision).
Marmor MF, Kellner U, Lai TYY, et al.
OPHTHALMOLOGY
2016;123:1386-94.