How often should I be examined by an ophthalmologist if I take Plaquenil?

The American Academy of Ophthalmology recommendations for screening of chloroquine and hydroxychloroquine (Plaquenil) retinal damage were recently updated in 2011. Plaquenil is more commonly used and the risk for damage increases after a total cumulative dose of 1000 gm or 5 or more years of use. The current recommendations are that a baseline examination be obtained when starting therapy to rule out preexisting retinal disease. Then yearly screenings should begin after 5 years of use. Of course more frequent exams may be necessary if a patient has symptoms such as blurry, wavy or decreased vision. The annual testing must include a specific visual field test that looks at the central 10 degrees of your peripheral visual field. Also, fundus autofluorescence or ocular coherence tomography should be done. These tests look at anatomical changes in the retina. In lieu of that multifocal electroretinogaphy (mERG) can be performed, however, this is not readily available and patients would normally have to go to a tertiary care setting(university or medical school ophthalmology department) for this. I order this test to confirm or rule out toxicity if I suspect it may be present as a result of the other tests. Lastly, once the ophthalmologist can see retinopathy on clinical examination it would imply relatively late stage disease so an examination without testing as above is not adequate to pick up early manifestations and hopefully stop the progression by stopping the medication.

Plaquenil (hydroxychloroquine) is a very important medication in the prevention and treatment of malaria and in the treatment of rheumatoid arthritis and lupus. It can do great things for you and can do serious things to you, including permanently reducing the clearness of your vision. Your prescribing doctor will likely advise you to see an ophthalmologist (eye doctor) as you begin taking Plaquenil to try to protect you from any eye complications. The damage that Plaquenil causes to your eyes cannot be reversed, so it is most important to catch any eye problems early, but stopping the medication will almost always stop any progression of blurred vision.

The amount of Plaquenil required to cause these problems is somewhat dose-related, and therefore the frequency of problems goes up with the number of years and daily dosage taken. Your eye doctor will want to get photographs of your retinas, perform side-vision testing and color-vision testing, and measure your best vision level as you begin your Palquenil treatment. Your doctor will want to repeat these tests at various intervals, often every six months.

All this being said, Plaquenil damage to the eyes is very rare. You should carefully discuss the risks and benefits of this medication with your prescribing physician and eye doctor.

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