About Plaquenil Toxicity
Plaquenil toxicity refers to a retinal condition caused by the use of the drug Plaquenil (hydroxychloroquine). Plaquenil is most commonly prescribed to patients with rheumatoid arthritis, systemic lupus, and Sjögren’s syndrome, but it is also sometimes used in dermatological contexts due to its anti-inflammatory properties.
In some patients, long-term use or high dosages of Plaquenil can damage the macula (central portion of the retina), leading to irreversible vision loss. Retinal toxicity due to Plaquenil is fairly uncommon with only about 7% of patients developing the condition after five years of use. The risk increases with prolonged use, reaching up to 50% of patients after 20 or more years. Primary physicians, rheumatologists, and dermatologists who prescribe Plaquenil to their patients generally recommend that they receive retinal exams at least once per year after five years of taking the drug.
It is possible to detect retinal toxicity before the patient has any noticeable symptoms; however, it is not possible to prevent the toxicity or reverse any damage that occurs. Therefore, it is extremely important that patients using Plaquenil follow their doctor's recommendation for regular eye exams.
At Solomon Eye Physicians and Surgeons, we recognize the importance of these exams and are extensively trained and experienced in detecting retinal toxicity due to the use of hydroxychloroquine. We also perform baseline exams for patients who have not yet begun treatment with the drug to provide accurate measurements of any macular changes during follow-up exams. If you are taking Plaquenil or are about to begin, contact our Greenbelt or Bowie, MD office to set up your Plaquenil toxicity exam schedule.
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Who Should Be Tested?
Anyone who is prescribed Plaquenil should have an initial eye exam done before beginning treatment. This is important because it provides a baseline of the condition of the patient's retina, which can then be used as a reference to determine any changes in later exams.
After this initial exam, the American Academy of Ophthalmology recommends that patients taking the recommended daily dose (5 mg per kg of body weight) receive yearly exams after five years taking Plaquenil. Patients taking higher doses, who have been taking Plaquenil longer than five years, or who have other risk factors, such as existing retinal disease, kidney or liver disease, and obesity, should have retinal toxicity exams every six months.
Plaquenil toxicity retinopathy is usually very gradual, and most patients will not have any symptoms until they have developed irreversible visual impairment. This is why it is so important to have regular exams. The exams can detect the retinal damage before there is noticeable vision loss, and then the patient and his or her rheumatologist can decide how or whether to continue the use of Plaquenil. In advanced cases of Plaquenil toxicity, stopping the drug will usually not stop the progression of the condition. If a patient does have symptoms, they may include:
- Diminished ability to see color, especially red
- Central blind spots
- Blurred vision and difficulty reading
- Light flashes
What To Expect
The initial baseline exam and the follow-up exams typically consist of two types of noninvasive retinal imaging. Your pupils will be dilated, and you'll sit comfortably at a large machine that can take color photographs of your retina (because the damage occurs in the pigmented layer of your retina). We will also do an Optical Coherence Tomography (OCT) scan, which takes an image of a cross-section of your retina. Then, depending on whether you have any preexisting retinal conditions, we may need to perform other tests or imaging procedures.
None of the imaging procedures are painful or uncomfortable, and they are all completed in just a matter of minutes. The pupil dilation lasts for a few hours so you will need to have someone drive you home from these exams.
If there are no signs of retinal toxicity found during a follow-up exam, you can feel assured that you can safely continue with the Plaquenil for the next year. However, no signs of toxicity do not mean that it is less important to continue with your yearly exams. Toxicity develops gradually and at different paces for different patients.
If any signs of retinal toxicity are found during any of your follow-up exams, further tests may be done to determine whether the condition is mild, moderate, or severe. Based on this, you and your rheumatologist will decide whether you should continue using the Plaquenil or if changing to an alternative treatment is the best course of action.
Plan Your Procedure
Plaquenil Toxicity Detection
Plaquenil is prescribed to treat the symptoms of diseases, like rheumatoid arthritis and lupus, because of its remarkable ability to bring relief to patients. However, in a very small percentage of patients, it does cause irreversible retinal damage. If you have been prescribed Plaquenil, it is important that you receive yearly or twice-yearly retinal exams by an ophthalmologist trained to detect this specific condition. Contact Solomon Eye Physicians and Surgeons at our Greenbelt or Bowie, MD location to schedule your initial or follow-up exam today.