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Screening and Management of Hydroxychloroquine Retinopathy
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This executive summary provides key recommendations regarding screening and management of retinopathy due to long-term use of hydroxychloroquine and chloroquine.
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The highlights of this article are the screening criteria and an algorithm for deciding the baseline tests to identify hydroxychloroquine retinopathy, the prevalence of which may be increasing due to its ubiquitous use.
– Raza Shah, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe Royal College of Ophthalmologists recently published recommendations for retinal screening in users of hydroxychloroquine and chloroquine in the United Kingdom. This article forms a summary of the key components of the guideline. These recommendations involve a range of stakeholders including patients, Ophthalmologists and the hospital eye service, Rheumatologists, Dermatologists, General Practitioners, community optometry services, healthcare commissioners, and patient groups/ voluntary organisations who have had input into the development of the guideline.
Additional Info
The Royal College of Ophthalmologists Recommendations on Screening for Hydroxychloroquine and Chloroquine Users in the United Kingdom: Executive Summary
Eye (Lond) 2018 Jun 11;32(xx)1168-1173, IH Yusuf, B Foot, J Galloway, MR Ardern-Jones, SL Watson, C Yelf, MA Burdon, PN Bishop, AJ LoteryFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The following quote identifies the need for the review, "Moreover, new data using modern retinal imaging techniques identify the prevalence of hydroxychloroquine retinopathy at around 7.5% in patients taking the drug for more than 5 years, increasing to 20–50% after 20 years." This information is sobering. The recommendations, therefore, should prove helpful to those practitioners evaluating patients on chronic hydroxychloroquine treatment.
Hydroxychloroquine is a drug increasingly used in the treatment of systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune disorders. The use of hydroxychloroquine is increasing, with an estimated 11,000 new treatment initiations per year in England and Wales. Modern retinal imaging techniques identify the prevalence of hydroxychloroquine retinopathy at around 7.5% in patients taking the drug for more than 5 years, increasing to 20% to 50% after 20 years. These data suggest a large patient cohort with detectable pre-symptomatic hydroxychloroquine retinopathy in the United Kingdom who continue to take the medication. The Royal College of Ophthalmologists now recommends annual assessment for patients who are taking hydroxychloroquine for more than 5 years. They also recommend a safe dose as 5 mg/kg per day. A key point is that the doctor prescribing this medication is responsible in ensuring the patient can be adequately screened to avoid complications of the therapy. As such, the onus is on those who prescribe hydroxychloroquine (including general practitioners who re-prescribe it on behalf of consultants) to ensure that the ophthalmic resources are available for screening for long-term complications in their locality.