J Rheum Dis 2018; 25(3): 153-157  
Hydroxychloroquine Retinopathy Update
Seong Joon Ahn, Byung Ro Lee
Department of Ophthalmology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
Correspondence to: Seong Joon Ahn http://orcid.org/0000-0002-4545-8344
Department of Ophthalmology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail:ahnsj81@gmail.com
Received: May 21, 2018; Accepted: May 26, 2018; Published online: July 1, 2018.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Hydroxychloroquine (HCQ) has been used widely for the treatment of several rheumatologic and dermatologic conditions, including systemic lupus erythematosus and rheumatoid arthritis. Its toxic effects on the retina, HCQ retinopathy, is not uncommon among long-term users, and produces characteristic irreversible and progressive outer retinal damage. Recent studies of Asian populations showed different patterns of retinopathy according to ethnicity; for example, a pericentral pattern is more common in Asian populations, whereas the parafoveal type is more prevalent in Caucasian patients. The pericentral pattern, which is common in Asian patients, is likely to lead to a late diagnosis with conventional imaging modalities, thereby necessitating increased attention to the screening of Asian patients. The most recent American Academy of Ophthalmology guidelines suggest optical coherence tomography and a visual field examination as the primary screening tests, and multifocal electroretinogram and fundus autofluorescence as other recommended objective screening tests. The optimal timing and frequency of annual screening depend on the systemic and ocular risk factors. Annual screening should begin from 5 years of drug use in cases without any known risk factors, but patients with major risk factors require earlier regular screening. After a diagnosis of HCQ retinopathy, a decision regarding whether to stop the drug should be made in consultation with the prescribing physician, and the progression of retinopathy should be monitored carefully because the retinopathy can progress even after drug cessation.
Keywords: Hydroxychloroquine, Retinal diseases, Diagnosis


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