Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Metoprolol and plaquenil Plaquenil help calcium Treatment malaria chloroquine Thereafter, the AAO states annual screening can be deferred until year 5 on the medication but should start sooner if the patient is at a higher risk for toxicity. The guidelines recommend 1 an automated visual field as well as a 2 spectral-domain optical coherence tomography SD OCT. Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these patients. 9 Because spectral-domain optical coherence tomography SD-OCT is readily accessible and able to detect early structural damage prior to clinical funduscopic findings. Ahn SJ, Joung J, Lim HW, Lee BR. Optical Coherence Tomography Protocols for Screening of Hydroxychloroquine Retinopathy in Asian Patients. Am J Ophthalmol. 2017 Sep 27. Guideline AAO Quality of Care Secretariat, Hoskins Center for Quality Eye Care. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy - 2016. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Plaquenil screening guidelines asian Hydroxychloroquine retinopathy Eye, How to Succeed in Plaquenil Screenings Aralen canadaPlaquenil and difficulty breathingHow much is to much plaquenilChloroquine dose for malaria prophylaxisDoes chloroquine interact with vitamins Visual screening tests can be performed. If you are pregnant, considering becoming pregnant, or lactating, please discuss this with your doctor before taking this medication. However, hydroxychloroquine has been shown to be safe during pregnancy and breast feeding. Hydroxychloroquine typically is very well tolerated. Serious side effects are rare. PATIENT FACT SHEET Hydroxychloroquine Plaquenil. Chloroquine and Hydroxychloroquine Toxicity Workup Approach.. Hydroxychloroquine And Chloroquine Screening 2016 AAO.. Abstract. Background The American Academy of Ophthalmology recommendations on screening for chloroquine CQ and hydroxychloroquine HCQ retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. Pattern of Retinopathy Although the locus of toxic damage is parafoveal in many eyes, Asian. Contrary to the 2011 recommendations, age, liver disease, and obesity are not well correlated with the risk of retinopathy. 5 The major risk factors are dose and duration, underlying maculopathy, renal disease, and tamoxifen use. 3 The new recommendations reinforce advice in the Invited Commentary by Kim to look beyond the macula when screening. Since the initial screening and monitoring recommendations were published in 2002, there have been reports of retinal toxicity associated with the use of Plaquenil. Furthermore, the advent of novice sensitive diagnostic modalities has led to a revision of the recommended guidelines for patients using Plaquenil see “2011 Plaquenil Screening.