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Hydroxychloroquine and Chloroquine Retinopathy pp 107–131Cite as

Natural History of Hydroxychloroquine and Chloroquine Retinopathy

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Abstract

In the United States, screening for 4-aminoquinoline retinopathy (4AQR) is the standard of care. In this environment, a few cases occur despite attention to dosing by ideal body weight, other predisposing risk factors, and proper use and interpretation of ancillary tests. However, most clinically serious cases are iatrogenic, and arise from overdosing, missed screening for retinopathy, or tardy recognition of evidence of toxicity on ancillary testing. Symptoms and visual acuity are unreliable indicators of retinopathy, which develops as a continuum with three broadly defined stages: premaculopathy, early retinopathy, and advanced retinopathy. The boundaries between stages have been inconsistently specified. The probability of reversing retinopathy with cessation of 4-aminoquinolines decreases and the probability of progression despite cessation increases as the stage of retinopathy increases. No treatment exists for 4AQR.

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Abbreviations

4AQR:

4-aminoquinoline retinopathy

4AQs:

4-aminoquinolines (chloroquine and hydroxychloroquine)

BAL:

British anti-Lewisite

C:

Chloroquine

EOG:

Electro-oculogram

ERG:

Electroretinogram

FAF:

Fundus autofluorescence

HC:

Hydroxychloroquine

mfERG:

Multifocal electroretinogram

RA:

Rheumatoid arthritis

RPE:

Retinal pigment epithelium

SAP:

Standard automated perimetry

SD-OCT:

Spectral domain optical coherence tomography

SLE:

Systemic lupus erythematosus

VF-25:

Visual function 25 questionnaire

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    David J. Browning

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Browning, D.J. (2014). Natural History of Hydroxychloroquine and Chloroquine Retinopathy. In: Hydroxychloroquine and Chloroquine Retinopathy. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0597-3_6

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