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. Plaquenil uses arthritis Aralen malaria 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. Early signs visual field defects on 10-2 HVF usually paracentral, perifoveal and parafoveal thinning of the retina with loss of the inner/outer segment junction on SD-OCT, increased or decreased signal on autofluorescence, central/paracentral ERG depression on mfERG, +/- changes on Amsler grid, +/- subtle RPE changes, +/- decreased color vision 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 Retinal Physician - Hydroxychloroquine Maculopathy An., Hydroxychloroquine Plaquenil Toxicity and. Hydroxychloroquine tablets usesWhat is the difference between chloroquine and chloroquine phosphate Visual fields. In early cases of Plaquenil toxicity, an early indicator of damage is the appearance of a paracentral scotoma seen on automated visual field testing in the absence of fundus changes. 18 Each of the testing strategies can be used to detect early toxicity changes, but the presentation of the visual field effects will vary. Due to. How to Succeed in Plaquenil Screenings. HCQ Retinopathy Update 2019 - Acuity Eye Center. Value of Red Targets and Pattern Deviation Plots in Visual.. 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. Eye damage due to Plaquenil is not common,” he says. “Rarely will anybody who has good vision and minimal symptoms develop loss of central vision or ability to read if annual screening is done and visual are symptoms reported as soon as they occur so the medication can be stopped if toxicity occurs. Apr 20, 2011 Vision loss typically is permanent, with little significant improvement, and may continue to progress even years after drug cessation. Previous Plaquenil Testing Guidelines In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy.