Plaquenil (hydroxychloroquine) used for lupus and rheumatoid arthritis can cause toxicity to the retina leading to vision loss. In this episode of A State of Sight, Isaac Porter, MD explains how plaquenil and chloroquine can affect vision and why it is important to have screening eye exams when using the drugs.
Welcome to A State of Sight, I’m Isaac Porter from Porter Ophthalmology and this is your update in ophthalmology and eye care from Raleigh, North Carolina. In this episode, we are now trying some new lighting thanks to some new video tips from Alex Ferguson, who has been very helpful to our production.
In this episode, I would like to give you the details about Plaquenil screening, which is a drug that many people take for inflammation or arthritis. Plaquenil, which has the generic name hydroxychloroquine, and also a related drug chloroquine, can cause irreversible vision loss after people have been taking them for many years.
Both of these drugs were originally anti-malaria drugs, but they’ve been found also to work in inflammatory diseases like lupus or rheumatoid arthritis. Therefore, many patients have taken these drugs on a daily basis for years and it’s important that these patients have eye exams to make sure they are not getting into any trouble from these drugs.
These drugs are damaging to the area of the eye known as the macula. If you know about macular degeneration, the macula is in the retina, or the back part of the eye that senses light and is responsible for the fine central vision.
Over time, there can be deterioration and damage to this area from these drugs in rare situations. We recommend screening to detect any damage at an early stage, so hopefully it won’t get worse.
What is now recommended for patients who are on an average dose is a baseline eye exam including a central visual field test, which checks the vision in the macula, and a high definition scan of the retina (SD-OCT). These tests should be repeated after the patients have been taking the drug for five years because the effect of the drug is cumulative, which means the more you take over your lifetime, the higher your risk gets for getting a problem with the retina or the macula.
Then, once five years pass, we recommend an eye exam every year to check the fine central vision with a visual field test and SD-OCT. Another useful test is specialized autofluorescence photographs of the retina which can show any changes as times goes by.
Unfortunately, if there is damage, we think that the damage is irreversible, but if we notice any changes, you could possibly stop the drug and hopefully the problem would not get worse.
These drugs have been great for many patients since they have given relief from rheumatoid arthritis or other inflammatory diseases that were not any better using other treatments, therefore many patients like to be on the drugs and we’d like to help keep them on them as long as it’s safe.
If you have any questions or comments about Plaquenil or if you take the drug and are wondering anything about it, please post your comments and we would be happy to interact with you. Until next time, we hope to see you soon on A State of Sight.