Plaquenil Screening

• Copyright 2013, Retinal Diagnostic Center
• Year 2013

The quinine family of drugs has been used for a variety of conditions, and Hydroxychloroquine Sulphate (Plaquenil) is a valuable drug for the treatment of certain auto-immune collagen-vascular disease processes. Rheumatoid Arthritis (RA) and Systemic Lupus Erithematosus (SLE) are conditions for which Hydroxychloroquine has been found to be of help. Toxicities may be found in many forms; however it is the macular toxicity, which constitutes the major threat to a patient’s vision.The accumulated amount of these drugs appears to be the factor precipitating damage in the central retina of the eye. Retinal checks are vital for the early detection of the toxic maculopathy. The classic lesion is described as a “bull’s eye” with relative hypo pigmentation surrounding a central area of hyper pigmentation, but this is a late finding and many time patients suffer from irreversible vision loss.

The goal for Plaquenil Screening to detect toxicity early and stop the medication as soon as possible if present. Functional test that focus on central field sensitivity may pick up early toxicity. Early structural changes may be difficult to detect and high resolution optical coherence tomography (OCT) and fundus autofluorescence are very useful in detecting subtle changes. Fluorescein angiography may be a useful adjunct test. Usually, toxicity develops in patients who have taken the drug for many years (more than 5 years).

If signs of early toxicity are detected, your doctor may suggest to your rheumatologist to stop Plaquenil and switch to a different medication for your systemic illness. Sometimes the toxicity is not reversible. Patients taking the drug should have an early baseline assessment of visual acuity, macular appearance and central field sensitivity. The most recent American Academy of Ophthalmology recommendations for routine check up is at baseline and yearly after 5 years of medication use. However, factors such as renal or liver impairment must be considered in the determination of the dosages in the prescription of these drugs.