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. Chloroquine resistance development Plaquenil rheumatoid arthritis remission Plaquenil retinal toxicity dosage Hydroxychloroquine sulfate tablets usp 200 mg REPORT OF VISION EXAMINATION SECTION 1 — APPLICANT COMPLETES THIS SECTION INSTRUCTIONS Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. You must sign and date the authorization line. All medical information received by the Department of Motor Vehicles DMV is confidential under Hydroxychloroquine Plaquenil Eye exam fax-back form Why do I need an eye exam? An eye exam can check for eye problems even if your vision seems fine. If you take hydroxychloroquine hahy-drok-si-KLOHR-uh-kwin Plaquenil all ophthalmology offices have the equipment to PLAK-wuh-nil, you have a higher risk of developing an eye problem Rx Side Effects New Plaquenil Guidelines and More ; Ophthalmic Pearls. Rx Side Effects New Plaquenil Guidelines and More. difficulty reading and progression of bull’s-eye maculopathy. Plaquenil’s long half-life in the body can cause irreversible and progressive damage, Dr. Fung said. An unusual form of the toxicity causes. 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. Plaquenil eye exam protocol report form Eye screening for patients taking hydroxychloroquine Plaquenil, Hydroxychloroquine Plaquenil Eye exam fax-back form Fundus plaquenil As optometrists, it is important that we are aware of the possible ocular complications that can occur from the use of high risk medications. Patients starting chloroquine CQ or hydroxychloroquine HCQ; i.e. Plaquenil should have a baseline examination that serves as a reference point, as well as to rule out any preexisting maculopathies. Quick Reference Screening for Chloroquine.. Rx Side Effects New Plaquenil Guidelines and More.. Medical Reporting Forms. Eye care professional report for Dilated Retinal Eye DRE exam Use this completed form to communicate results to your patient’s primary care provider. Patient name. ID # DOB. Health plan. PCP. Phone. FAX. Chief complaints Tonometry. Date of exam Right eye ; Plaquenil is a pretty widely used drug so I figure she should have an opinion on it. I would feel more comfortable having the baseline exam done first BUT I am pretty eager to get started on it ASAP as my eye is starting to bug me due to the morphea that is slowly spreading. Apr 20, 2011 Remember, any patient who is at a high risk for Plaquenil toxicity should be examined on an annual basis following the baseline exam. The goal of monitoring/screening is to identify early macular damage prior to irreversible vision loss or even before visible signs of bull’s eye maculopathy.