She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Hydroxychloroquine effectiveness rheumatoid arthritis Plaquenil guidelines aao 2016 In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy. Testing included a comprehensive eye exam that consisted of an assessment of the posterior segment with careful evaluation of associated macular changes or signs of retinal disease. 4 Baseline fundus photography was considered as an optional test. Previous 30 recommendations by the AAO to limit HCQ dosing to 6.5 mg/kg of ideal body weight have been 31 revised to 5 mg/kg of actual body weight 5. Some authors recommend 6.5 mg/kg of actual 32 body weight with a cap at 400 mg per day and further adjustments for renal insufficiency 10. Of course the aim is avoid drug related retinal toxicity, which on ophthalmic examination, appears as the classic Bull’s eye change affecting the macula. Once retinal toxicity from hydroxychloroquine occurs, it is thought that the retinal changes are permanent and the disease can progress even if hydroxychloroquine is stopped for 1 to 3 years. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Eye screening tests for plaquenil guidelines RCOphth guideline Hydroxychloroquine and Chloroquine., AMERICAN COLLEGE OF RHEUMATOLOGY Fundus autofluorescence in hydroxychloroquine toxicity AAO Screening Guidelines for Plaquenil by S P Check out my recent review/summary of the American Academy of Ophthalmology’s statement on the Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy 2016 Revision from the Ophthalmology Journal 2016;186-1394. AAO Screening Guidelines for Plaquenil. My Take on New Ocular Screening Guidelines for Plaquenil.. Plaquenil Guidelines Point Out New Risks, New Presentation.. Dr. Corte provides a quick reference guide based on the AAO's updated screening guidelines for chloroquine and hydroxychloroquine Plaquenil retinopathy. As optometrists, it is important that we are aware of the possible ocular complications that can occur from the use of high risk medications. What can Hydroxychloroquine Plaquenil do to my eyes? Hydroxychloroquine Plaquenil was originally used to treat malaria and is now used mostly to treat rheumatological and dermatological diseases. Its most frequent use now is for Rheumatoid Arthritis RA and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause. Safe use of Plaquenil. In our eye clinic we frequently see patients who need to be screened because they have been prescribed hydroxychloroquine Plaquenil and have concerns, so I wanted to write a short article summarizing the necessity and purpose of proper eye screening in these individuals.