Hydroxychloroquine and Chloroquine are medicines used to help treat inflammatory conditions, it is commonly prescribed, but does carry a risk of Eye problems.

The Royal College of Ophthalmologists (RCOphth) published updated clinical guidelines in December 2020, the key summary is highlighted below :

Recent data have highlighted that hydroxychloroquine retinopathy is more common than previously reported.
The prevalence following long-term use appears to be around 7.5% and depending on dose and duration of
therapy can increase to 20-50% after 20 years of therapy. Risk increases for patients taking more than 5mg/
kg/day.

The retinopathy is manifest as damage to the photoreceptors and subsequent degeneration of the
retinal pigment epithelium (RPE). This may produce a “Bull’s eye maculopathy” and central visual loss. This is
important as the only intervention to prevent further damage is stopping the drug. The risk is increased for
patients taking more than 5mg/kg/day, those also taking Tamoxifen, and those with renal impairment.

 

The recommendation from the Royal College of Ophthalmologists is as follows :

After careful review of the existing peer reviewed literature, we recommend that all patients be referred for annual monitoring after five years of therapy and be reviewed annually thereafter whilst on therapy. At each monitoring visit, patients should undergo imaging with both spectral-domain optical coherence tomography (SD-OCT) and widefield fundus autofluorescence imaging (FAF). If widefield FAF is not available, FAF can be acquired in several photographic fields to encompass the macula and extra-macular areas.

 

The full NHS publication and advice can be found here.

 

We are able to provide Hydroxychloroquine and Chloroquine Monitoring in our High Wycombe practice, in order to book this, please select “Eye Examination + OCT Scan” on the online booking system, or quote this on the phone on 01494 258690.

 

 

Ahmed Hilmi
Author : Ahmed Hilmi

Ahmed is an Optometrist with over 15 years experience. He is the senior Optometrist at Redgate Opticians in High Wycombe and is also currently working for the John Radcliffe Eye Clinic.

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