Plaquenil (hydroxychloroquine, Sanofi-Aventis) has been used as anti-rheumatic drug therapy for conditions such as systemic lupus erythematosus and rheumatoid arthritis for years, despite its risk of irreversible macular toxicity. Historically, patients have been monitored using subjective measures such as visual field testing and objective findings during fundus examination, often leading to diagnosis of late-stage toxicity. However, it is crucial that clinicians identify the earliest signs of toxicity, as the risk of progressive vision loss extends even after discontinuation of Plaquenil. This is where new guidelines and advanced technology can help.
This article discusses the risks associated with Plaquenil therapy and the updated American Academy of Ophthalmology guidelines designed to help clinicians better detect and monitor macular toxicity associated with long-term Plaquenil use. Several diagnostic tools are key to detecting macular toxicity as early as possible to ensure discontinuation of the drug before adverse sequelae threaten patients’ vision.
By Beth Norris, OD, and Sara Henney, OD, with Sara Weidmayer, OD
Review of Optometry, August 2017
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