Hydroxychloroquine / Plaquenil Retinal Toxicity Screening Guidelines

Hydroxychloroquine (Plaquenil) is an antimalarial drug that is used to treat various autoimmune disease including lupus and rheumatoid arthritis.  This drug can cause irreversible damage to the retina.  The risk factors of retinopathy include high daily dose, long duration of therapy, decreased kidney function, decreased liver function, and advanced patient age.

The following are the recommendations guidelines for screening patients on hydroxychloroquine:

  • baseline eye exam within first year of therapy including one or more of the following
    • automated visual field assessment
    • spectral domain OCT scanning to evaluate early retinal thinning
    • multifocal ERG
    • fundus autofluorescence
  • patients are deemed high risk if they have the following characteristics
    • daily dose > 6.5 mg/kg
    • duration of therapy > 5 years
    • age > 60 years
    • obesity
    • kidney disease
    • liver disease
    • concurrent retinal disease
  • annual exams are recommended for all patients, and more frequent exams are recommended if abnormalities are noted on baseline exam and for those at higher risk for toxicity
  • after five years of treatment, annual exams with one of the objective tests listed above are recommended