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Cumulative dose of hydroxychloroquine dictates potential for retinopathy, speaker says
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SALT LAKE CITY — Recently revised guidelines for monitoring hydroxychloroquine toxicity underscore the effect of cumulative dosing in the potential development of retinopathy, according to a presenter here at Optometry's Meeting.
Blair Lonsberry, MS, OD, MEd, FAAO, clinic director and professor of optometry at Pacific University College of Optometry, told attendees here at the Optometric Retina Society-sponsored Specialty Day that dosing used to be based on body size.
"We found out that a ton of patients were being overdosed," he said. "It should not be based on their weight; it should be based on their height and their ideal body weight. Otherwise, it takes a long time to process through the system."
Dr. Lonsberry said the new recommendations came from the American Academy of Ophthalmology. "This has not changed what the rheumatologists and pediatricians might be doing," he cautioned.
Hydroxychloroquine is primarily used in the U.S. to treat inflammatory disorders such as systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and post-Lyme disease arthritis, according to a white paper developed by the Optometric Retina Society.
Revised recommendations for retinopathy screening in patients taking this agent were published this year in the journal, Ophthalmology, Dr. Lonsberry said.
"Significant changes were made in light of new data on the prevalence of retinal toxicity and sensitivity of new diagnostic techniques," he said.
The risk of toxicity after years of hydroxychloroquine use is higher than previously believed, Dr. Lonsberry said.
Amsler grid was removed as an acceptable screening technique, he said, and it is strongly advised that a 10-2 visual field test is supplemented by multifocal ERG, spectral domain optical coherence tomography or fundus autofluorescence.
An initial baseline exam should be performed within the first year of taking the medication, according to the new guidelines, and then screening for toxicity should occur no more than 5 years after starting the medication.
"Parafoveal loss is the most common visual defect you'll see," Dr. Lonsberry said.
He noted that any fundus changes detected will not be reversible. "If you're seeing fundus changes, it's more than likely to get worse," he said.