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. Plaquenil & iron supplements how to take Chloroquine resistance map How much is plaquenil with insurance Plaquenil medication Fluorescein angiography showed the atrophic window defect characteristic of hydroxychloroquine maculopathy. On June 10, 1999 her Humphrey 10-2 visual field showed an annular scotoma bilaterally. Follow up on December 7, 1999 showed stable 20/50 best-corrected visual acuity and unchanged Humphrey 10-2 visual fields Figure 6, Figure 7. Fluorescein Angiography. Fluorescein angiography can recognize subtle RPE defects, but it has not proven to be more sensitive than tests of functional loss or noninvasive retinal imaging. Full-field Electroretinogram. The full-field ERG is a global test of retinal function and will only show abnormalities in very late CQ or HCQ toxicity. Nov 14, 1998 Editor —The articles cited by May et al confirm that the incidence of hydroxychloroquine retinopathy resulting in permanent or progressive visual loss is extremely low. If the drug was introduced today it would be difficult to justify the initiation of a screening programme. 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. Fluorescein angiography and hydroxychloroquine maculopathy screening Retina Today - Imaging in Hydroxychloroquine Toxicity April., Revised Recommendations on Screening for Chloroquine and. Artemisia annua plaquenil Fluorescein angiography FA Optical coherence tomography OCT Fundus autofluorescence; Multifocal electroretinograms mf ERG. Early detection of any maculopathy is critical to prevent central visual loss. The Retina Group of New York provides all of these testing modalities and is the only center on Long Island with mf ERG. Treatment Plaquenil Toxicity Screening - Retina Group of New York. Screening for hydroxychloroquine retinopathy Screening.. Screening for hydroxychloroquine retinal toxicity Current.. New Guidelines for Hydroxychloroquine Visual Screening. Christina M. Sorenson, OD. the risk of converting to hydroxychloroquine retinopathy is 4% every year thereafter. fluorescein. Mar 01, 2011 Fluorescein angiography demonstrated bilateral bull's eye–type pigmentary abnormalities Figures 7-8. This case demonstrates that advanced visual loss can occur with little or no changes detectable on dilated fundus examination, and that ancillary testing is important in screening for early disease. Figures 1 and 2. A pilot study conducted in 15 patients on chloroquine or hydroxychloroquine therapy found that the 10 patients with known or suspected toxicity—based on standardized visual field testing, fluorescein angiography, or both—all demonstrated significant hyperacuity defects on PHP testing.