Autoimmune Disease and Treatment-related Eye Toxicity Screening

Chloroquine and Hydroxychloroquine

What are chloroquine and hydroxychloroquine used for?

Chloroquine and hydroxychloroquine can used to treat arthritis and other autoimmune conditions. Although it is a very good drug, long-term use can have significant adverse effects. One such side effect is damage to the retina-specifically the macula (the central area of the retina that is responsible for our best vision) and it can potentially cause irreversible damage to this area known as a maculopathy.

 Symptoms of eye toxicity

Initially there will be no eye complaints. With more extensive damage one might notice a subtle decrease in vision or visual disturbances for instance where straight lines appear wavy (metamorphopsia).  As symptoms can be absent and as the damage is permanent, it is very important that all patients on chloroquine and hydroxychloroquine be under the care of an ophthalmologist.

Risk factors for eye toxicity

High dose and long duration are the most significant risk factors. Patients with kidney diseases are also at higher risk. The damage caused by chloroquine and hydroxychloroquine is irreversible so it is important for patients to know about this potential damage and to undergo screening by their ophthalmologist.

Eye toxicity screening and treatment

A baseline eye examination should be performed to rule out any pre-existing conditions affecting the macula.  Yearly screening should then be performed after 5 years for patients on acceptable doses and without any major risk factors.

Your ophthalmologist will make use of various screening tests to pick up any subtle damage.  These include visual field testing and other retinal scanning devices such as optical coherence tomography.  These modern screening tests should detect early damage before it is seen clinically.

If early damage is detected, your ophthalmologist will advise your rheumatologist to stop the chloroquine/hydroxychloroquine in favor of an alternative treatment option.  With appropriate screening one can avoid the irreversible damage to vision that can happen with these drugs

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