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. Hydroxychloroquine sulfate for ra Hydroxychloroquine retinopathy after short-term therapy Plaquenil total dose How to treat plaquenil toxicity Advanced cases may demonstrate widespread retinal pigment epithelium atrophy, with a reduced visual field and decreased night vision. 3. Visual field. Parafoveal sensitivity loss is an early sign that may precede fundus changes. A computerized white-on-white 10-2 visual field test enables good resolution to test for macular sensitivity. May 16, 2011 It is important to know the facts. Retinal complications from HCQ are actually rare at proper dosage and, with good screening, the risk for visual loss is very low. Nevertheless, retinopathy begins to appear with long-term use, and retinopathy is serious insofar as there is no known treatment. When allowed to advance, hydroxychloroquine retinal toxicity leads to loss of up to three visual functions acuity, peripheral vision and night vision. Signs. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. 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). Visual field loss in plaquenil retinopathy How to Succeed in Plaquenil Screenings, Hydroxychloroquine Retinopathy Still Alive and Well - The. Does plaquenil help with sex drive Nov 05, 2016 B Nonreproducible central scotoma red arrow in her 10-2 visual field test isn’t typical of hydroxychloroquine retinopathy. C Blue fundus autofluorescence imaging is normal. D Near infrared reflectance imaging shows a hyperreflective annulus yellow arrow which has low sensitivity and specificity for hydroxychloroquine retinopathy. Avoiding the Traps of Hydroxychloroquine Use. HCQ Retinopathy Update 2019 - Acuity Eye Center. Hydroxychloroquine toxicity - EyeWiki. When allowed to advance, hydroxychloroquine retinal toxicity leads to loss of up to three visual functions acuity, peripheral vision and night vision. Signs. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull. The main outcomes were toxicity as determined by characteristic visual field loss or retinal thinning and photoreceptor damage. They also examined risk factors and prevalence. The study findings revealed that when hydroxychloroquine was used at doses 5mg /kg, the risk of retinopathy was 1% in the first 5 yrs. 2% in 10 yrs. 20 % after 20 yrs. Unfortunately the pigmentary "bulls eye" changes that occur in plaquenil toxicity are a late stage finding, meaning that typically there has been structural damage and vision loss by the time these changes are observed on your eye exam.