Therapeutic Drug MonitoringHydroxychloroquine (brand name: Plaquenil®) is used to treat rheumatoid arthritis, lupus, and other autoimmune disease. This medication is known to cause visual changes, or even vision loss, in some patients after long periods of use. For this reason, it is important for hydroxychloroquine users to have their eyes examined each year to look for changes with their eyes and vision. Hydroxychloroquine binds to melanin which is found in the retinal pigment epithelium (RPE) layer of the retina. The RPE can collect hydroxychloroquine over time and result in the vision changes sometimes seen with chronic use of hydroxychloroquine. Retinal toxicity is more likely to occur in individuals taking high doses for many years, persons 60 years of older, or in those patients with significant kidney disease. As many as 7.5% of patients taking hydroxychloroquine are found to have had visual changes.

Risk Factors of Retinal Toxicity

  • Current excessive daily dose by actual weight (more than 5mg/kg)
  • History of renal or liver disease
  • Patients prescribed Tamoxifen (can result in 5-fold increase in toxicity)
  • History of macular disease
  • Age

Components of an Annual Hydroxychloroquine Exam

  • Threshold visual field (side vision) testing
  • Optical Coherence Tomography (OCT) of the macula
  • Retinal imaging
  • Color vision testing (D-15)

The doctors at Vista Eye Care advocate yearly eye and vision exams for all hydroxychloroquine patients to look for early signs of macular toxicity. We will communicate all of our findings in a report to your primary care physician and/or rheumatologist. Please call our office at (303) 450-2020 to schedule your annual hydroxychloroquine examination, or use the button below to schedule your exam online:

Vista Eye Care

13695 Colorado Blvd. Thornton, CO 80602
Phone: (303) 450-2020
Fax: (303) 920-1440

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