Screening for hydroxychloroquine retinal toxicity: Current recommendations

Hydroxychloroquine (HCQ) is a commonly used drug for the treatment of various autoimmune diseases including systemic lupus erythematosus and rheumatoid arthritis. Though HCQ may be associated infrequently with systemic side effects, its long-term use is associated with retinal toxicity in some patients. Most patients with HCQ associated retinal toxicity are asymptomatic initially. Retinal toxicity if allowed to persist is usually associated with irreversible damage. Therefore, screening is needed to detect retinal toxicity at an early stage to prevent visual loss. Various methods have been utilized for the screening of HCQ associated retinal toxicity, but until recently, no test(s) had been established as the gold standard. Current recommendation is to screen for HCQ associated retinal toxicity with both automated visual field and spectral domain optical coherence tomography after 5 years of use, provided baseline ocular examination is normal and there are no associated high risk factors.