PMID- 26992838
OWN - NLM
STAT- MEDLINE
DCOM- 20170626
LR  - 20221207
IS  - 1549-4713 (Electronic)
IS  - 0161-6420 (Linking)
VI  - 123
IP  - 6
DP  - 2016 Jun
TI  - Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy 
      (2016 Revision).
PG  - 1386-94
LID - S0161-6420(16)00201-3 [pii]
LID - 10.1016/j.ophtha.2016.01.058 [doi]
AB  - BACKGROUND: The American Academy of Ophthalmology recommendations on screening 
      for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are revised in 
      light of new information about the prevalence of toxicity, risk factors, fundus 
      distribution, and effectiveness of screening tools. 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. There are no similar demographic data for CQ, but dose comparisons in 
      older literature suggest using </=2.3 mg/kg real weight. RISK OF TOXICITY: The risk 
      of toxicity is dependent on daily dose and duration of use. At recommended doses, 
      the risk of toxicity up to 5 years is under 1% and up to 10 years is under 2%, 
      but it rises to almost 20% after 20 years. However, even after 20 years, a 
      patient without toxicity has only a 4% risk of converting in the subsequent year. 
      MAJOR RISK FACTORS: High dose and long duration of use are the most significant 
      risks. Other major factors are concomitant renal disease, or use of tamoxifen. 
      SCREENING SCHEDULE: A baseline fundus examination should be performed to rule out 
      preexisting maculopathy. Begin annual screening after 5 years for patients on 
      acceptable doses and without major risk factors. SCREENING TESTS: The primary 
      screening tests are automated visual fields plus spectral-domain optical 
      coherence tomography (SD OCT). These should look beyond the central macula in 
      Asian patients. The multifocal electroretinogram (mfERG) can provide objective 
      corroboration for visual fields, and fundus autofluorescence (FAF) can show 
      damage topographically. Modern screening should detect retinopathy before it is 
      visible in the fundus. TOXICITY: Retinopathy is not reversible, and there is no 
      present therapy. Recognition at an early stage (before any RPE loss) is important 
      to prevent central visual loss. However, questionable test results should be 
      repeated or validated with additional procedures to avoid unnecessary cessation 
      of valuable medication. COUNSELING: Patients (and prescribing physicians) should 
      be informed about risk of toxicity, proper dose levels, and the importance of 
      regular annual screening.
CI  - Copyright (c) 2016 American Academy of Ophthalmology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Marmor, Michael F
AU  - Marmor MF
AD  - Department of Ophthalmology and Byers Eye Institute, Stanford University School 
      of Medicine, Palo Alto, California.
FAU - Kellner, Ulrich
AU  - Kellner U
AD  - Zentrum fur Seltene Netzhauterkrankungen, AugenZentrum Siegburg, Siegburg, 
      Germany.
FAU - Lai, Timothy Y Y
AU  - Lai TY
AD  - Department of Ophthalmology and Visual Sciences, The Chinese University of Hong 
      Kong, Kowloon, Hong Kong.
FAU - Melles, Ronald B
AU  - Melles RB
AD  - Department of Ophthalmology, Kaiser Permanente, Redwood City Medical Center, 
      Redwood City, California.
FAU - Mieler, William F
AU  - Mieler WF
AD  - Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, 
      University of Illinois, Chicago, Illinois.
CN  - American Academy of Ophthalmology
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
DEP - 20160316
PL  - United States
TA  - Ophthalmology
JT  - Ophthalmology
JID - 7802443
RN  - 0 (Antirheumatic Agents)
RN  - 4QWG6N8QKH (Hydroxychloroquine)
RN  - 886U3H6UFF (Chloroquine)
SB  - IM
CIN - Ophthalmology. 2017 Mar;124(3):e28-e29. PMID: 28219513
CIN - Ophthalmology. 2017 Mar;124(3):e29-e30. PMID: 28219514
MH  - Academies and Institutes
MH  - Adult
MH  - Antirheumatic Agents/administration & dosage/*toxicity
MH  - Asian People/ethnology
MH  - Chloroquine/administration & dosage/*toxicity
MH  - Electroretinography/drug effects
MH  - Female
MH  - Fluorescein Angiography
MH  - Humans
MH  - Hydroxychloroquine/administration & dosage/*toxicity
MH  - Maximum Allowable Concentration
MH  - Middle Aged
MH  - Ophthalmology/organization & administration
MH  - Retinal Diseases/chemically induced/*diagnosis/ethnology
MH  - Risk Factors
MH  - Tomography, Optical Coherence
MH  - United States
MH  - Vision Disorders/chemically induced/*diagnosis/ethnology
MH  - Visual Acuity/drug effects/physiology
MH  - Visual Field Tests
MH  - Visual Fields/drug effects/physiology
EDAT- 2016/03/20 06:00
MHDA- 2017/06/27 06:00
CRDT- 2016/03/20 06:00
PHST- 2016/01/28 00:00 [received]
PHST- 2016/01/28 00:00 [revised]
PHST- 2016/01/28 00:00 [accepted]
PHST- 2016/03/20 06:00 [entrez]
PHST- 2016/03/20 06:00 [pubmed]
PHST- 2017/06/27 06:00 [medline]
AID - S0161-6420(16)00201-3 [pii]
AID - 10.1016/j.ophtha.2016.01.058 [doi]
PST - ppublish
SO  - Ophthalmology. 2016 Jun;123(6):1386-94. doi: 10.1016/j.ophtha.2016.01.058. Epub 
      2016 Mar 16.