Improving ophthalmic screening for hydroxychloroquine associated retinopathy

Background: Hydroxychloroquine is a safe and effective treatment for autoimmune disease. It can however result in a blinding retinopathy the prevalence of which may be 7.5% after five years. Ophthalmology departments must screen for this effect. Aims: To review all new referrals to an ophthalmology department for screening for hydroxychloroquine retinopathy and examine their identification of patient risk factors for its development. The utility of tests recommended in national screening programs elsewhere was evaluated. Methods: A retrospective review of referrals for screening for hydroxychloroquine retinopathy over a 30-month period. Results: 172 new referrals for screening were received. 164 were available for analysis. 139 (84.8%) were female. Rheumatology and dermatology departments were responsible for 88.4%. 5.7% of patients were taking the medication for greater than five years prior to their primary referral. 47.9% were taking hydroxychloroquine doses of >5 mg/kg/day. 22.1% had an eGFR of 5 mg/kg/day with an eGFR of Conclusions: Patients taking hydroxychloroquine should be referred for ophthalmology assessment within oneyear of commencing the drug. Referrals should elaborate patient risk factors for the development of the associated retinopathy. Increased awareness amongst prescribing physicians of the importance of early referral is crucial.