Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Chloroquine dosing for lupus High risk medication with toxicity icd 10 plaquenil Due to the disagreement of specificity and sensitivity of these two tests, both may be considered as adjunctive to the examinations, but are no longer recommended for screening. The 10-2 visual field test continues to be recommended as a functional assessment of macular damage. One year later, a 10-2 HVF was obtained that showed dense paracentral scotomas bilaterally Figure 2, despite normal visual acuity, Amsler grid, and color vision testing. Upon the detection of the visual field defects, the hydroxychloroquine was stopped. Here, we’ll only talk about the Humphrey visual field perimeter, which is used for 99% of visual field tests. It’s an automated, static perimeter unlike Goldmann kinetic perimetry which requires a human operator, and uses a moving target. The Humphrey uses fixed points of light which are shown at different intensity levels. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Hydroxychloroquine visual field test Plaquenil Side Effects on Your Eyes and Vision, Hydroxychloroquine Plaquenil Toxicity and Recommendations. Plaquenil otc Upon the detection of the visual field defects, the hydroxychloroquine was stopped. She was taking hydroxychloroquine 5.0 mg/kg/day with a duration of 10 years with a cumulative dose of 1460g putting her at increased risk for hydroxychloroquine retinal toxicity. Hydroxychloroquine Plaquenil Toxicity and.. How to interpret visual fields 5 most common patterns.. Disparity between Visual Fields and Optical Coherence.. Abnormal test is the visual field test, you may be asked to repeat it to make sure of the results. You will be told if any other tests are necessary and when you should be screened again. In cases of possible retinopathy, you will be recommended to continue taking 8 9 Macular Society Eye screening for patients taking hydroxychloroquine Hydroxychloroquine Plaquenil is a drug that is classified as an anti-malarial drug. Plaquenil is prescribed for the treatment or prevention of malaria. It is also prescribed for the treatment of rheumatoid arthritis, lupus, and the side effects of lupus such as hair loss, joint pain, and more. The main outcomes were toxicity as determined by characteristic visual field loss or retinal thinning and photoreceptor damage. They also examined risk factors and prevalence. The study findings revealed that when hydroxychloroquine was used at doses 5mg /kg, the risk of retinopathy was 1% in the first 5 yrs. 2% in 10 yrs. 20 % after 20 yrs.