High-Risk Medication Monitoring
Screening that protects your vision while you stay on treatment
Hydroxychloroquine, often known as Plaquenil, is an effective treatment for lupus, rheumatoid arthritis, and other autoimmune conditions. In a small percentage of long term users it accumulates in the retina and causes irreversible damage to the photoreceptors and retinal pigment epithelium.
The key point is that this toxicity is detectable well before it affects vision. Structural changes appear on OCT and functional changes on visual field testing at a stage where discontinuing or adjusting the drug prevents any noticeable loss. Once vision is affected, the damage does not reverse and may continue progressing even after the medication stops.
Other medications including certain ethambutol, tamoxifen, and pentosan polysulfate regimens carry their own ocular risks and follow their own screening protocols.
How screening works
Current ophthalmology guidance recommends a baseline examination within the first year of starting hydroxychloroquine, then annual screening after five years of use, with earlier and more frequent testing for patients on higher doses, with kidney impairment, or with pre existing retinal disease.
Screening combines OCT of the macula, automated visual field testing, and fundus autofluorescence imaging. These are painless, take relatively little time, and together are highly sensitive for early toxicity.
Results go directly to your rheumatologist or prescribing physician. The decision to continue, adjust, or change your medication is theirs to make, and our role is to ensure it is made with accurate ocular information.
Guideline based screening detects medication related retinal toxicity before vision is affected, while stopping the drug still prevents loss.
