A Multidisciplinary Collaborative Approach to Retinal Toxic Effects Screening for Dermatology Patients Taking Antimalarials

CLINICAL QUESTION What are the roles of antimalarial therapy prescribers and eye care specialists in regard to antimalarial dosing, screening for retinal toxic effects, and antimalarial treatment cessation? BOTTOM LINE Antimalarial prescribers should prescribe antimalarial dosages at 5 mg/kg/d or less of actual body weight. A baseline retinal examination with optical coherence tomography should be performed within 6 months of starting antimalarial therapy to rule out confounding disease. Patients at low risk for retinopathy do not require annual screening until 5 years of antimalarial use. Eye care clinicians should not stop treatment with antimalarials because of equivocal findings, as retinopathy occurs slowly, and therefore there is time for repeated testing. Antimalarial treatment cessation should be a collaborative decision that involves the patient, the prescriber, and the eye care clinician and that focuses on patient values, the severity of the underlying disease, and the estimated risk of visual loss if treatment with the drug is continued.