Hydroxychloroquine (Plaquenil) is a medication used to treat various autoimmune conditions, including rheumatoid arthritis and lupus. However, high-dose or long-term use of this medication can cause retinal toxicity, which can lead to irreversible vision loss.
Hydroxychloroquine works by reducing inflammation in the body, but it can also accumulate in the retina, leading to retinal toxicity. The risk of retinal toxicity increases with higher doses, the duration of use, and the cumulative dose of the medication. Early signs of retinal toxicity include changes in color vision, difficulty reading, and blurred vision. As the condition progresses, it can lead to a loss of visual acuity and even blindness.
To prevent retinal toxicity, regular examinations of the retina are recommended for patients taking hydroxychloroquine. During the examination, we will perform a dilated retinal exam, looking for signs of retinal toxicity. These will include specialized imaging tests, such as optical coherence tomography (OCT), retinal photography, and visual field testing, to detect early changes in the retina. If retinal toxicity is detected, the medication may need to be discontinued or the dose reduced to prevent further damage.
The current recommendations for dosing hydroxychloroquine are based on the patient's weight and not to exceed 5 mg/kg/day. However, recent studies have shown that even patients who receive less than the recommended dose can develop retinal toxicity. Therefore, it is important for us to monitor patients regularly, regardless of the dose they are taking.
In conclusion, hydroxychloroquine is a medication used to treat autoimmune conditions, but it can cause retinal toxicity and irreversible vision loss. Regular examinations of the retina are recommended for patients taking hydroxychloroquine to detect early signs of toxicity and prevent further damage. The current recommendations for dosing are based on the patient's weight, but even patients who receive less than the recommended dose can develop retinal toxicity. Therefore, it is important to monitor patients regularly and adjust the medication dose as needed to prevent vision loss.