Screening and management of hydroxychloroquine retinopathy

Hydroxychloroquine is a drug increasingly used in the treatment of systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune disorders. The use of hydroxychloroquine is increasing, with an estimated 11,000 new treatment initiations per year in England and Wales. Modern retinal imaging techniques identify the prevalence of hydroxychloroquine retinopathy at around 7.5% in patients taking the drug for more than 5 years, increasing to 20–50% after 20 years. These data suggest a large patient cohort with detectable pre-symptomatic hydroxychloroquine retinopathy in the United Kingdom who continue to take the medication. The Royal College of Ophthalmologists now recommends annual assessment for patients who are taking hydroxychloroquine for more than 5 years. They also recommend a safe dose as 5 mg/kg per day. A key point is that the doctor prescribing this medication is responsible in ensuring their patient can be adequately screened to avoid complications of the therapy. As such, the onus is on those who prescribe hydroxychloroquine (including general practitioners who re-prescribe it on behalf of consultants) to ensure that the ophthalmic resources are available for screening for long-term complications in their locality