Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Plaquenil ophthalmologist or optometrist Hydroxychloroquine remission rheumatoid arthritis Plaquenil-induced toxicity usually will not occur before five years of taking the drug. “Eye damage due to Plaquenil is not common,” he says. “Rarely will anybody who has good vision and minimal symptoms develop loss of central vision or ability to read if annual screening is done and visual are symptoms reported as soon as they occur so. Aug 01, 2009 After seeing MANY professionals including a neurologist, a retinal specialist, neuro-ophthalmologist, and undergoing MANY different tests, she was diagnosed with Plaquenil toxicity. She does have field of vision loss, mostly on things that are close up. She took Plaquenil for almost five years before having any symptoms. Testing for Toxicity Visual Fields If VF defects are repeatable, then perform objective testing such as19 •SD-OCT • mfERG and/or FAF Some experts suggest that if the VF is unreliable -–or--shows multiple loci w/at least -4dB on pattern deviation, objective testing is warrented22 Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Oct testing in plaquenil macular toxicity Hydroxychloroquine Plaquenil Toxicity and Recommendations., Has anyone experienced plaquenil toxicity with damage to eyes? Plaquenil sjorens The American Academy of Ophthalmology has suggested guidelines in order to monitor patients on hydroxychloroquine therapy, recommending a baseline dilated fundus exam, automated macular perimetry and Amsler grid testing. 3 Patients should be monitored annually, as toxicity can be irreversible and even progress after drug cessation. Common Medications That May Be Toxic to the Retina. Early Plaquenil Toxicity Detected without Bull’s Eye.. My Take on New Ocular Screening Guidelines for Plaquenil.. Plaquenil toxicity first affects small areas of the retina between 5° and 15° from the fovea. Figures 2 and 3 show three patients at different stages of toxicity. Figure 2 bottom right shows a color display of normal mfERGs. The amplitude of the mathematically derived b-wave of the mfERG is displayed in a color scale. In obvious toxicity, the nasal inner subfield showed more thinning than the temporal inner subfield at 12 months after drug cessation p = 0.018, 95 % CI −1 to −8 μm. Conclusions Once HCQ retinopathy is diagnosed and the medication is discontinued, structural retinal changes commonly occur. The goal for Plaquenil Screening to detect toxicity early and stop the medication as soon as possible if present. Functional test that focus on central field sensitivity may pick up early toxicity. Early structural changes may be difficult to detect and high resolution optical coherence tomography OCT and fundus autofluorescence are very useful in detecting subtle changes.