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. Hydroxychloroquine false positive drug test Chloroquine metabolism 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 Optometrists and ophthalmologists need to be aware of the American Academy of Ophthalmology’s 2011 guidelines on screening for retinal toxicity associated with plaquenil. Newer studies have preferred practice protocols be changed to using spectral-domain OCT technology as the main screening device for detection of early retinal changes in plaquenil toxicity. Time Domain OCT in Hydroxychloroquine Plaquenil Toxicity Time domain OCT does not have the resolution that spectral domain OCT has, making detection of hydroxychloroquine maculopathy by this modality less sensitive. 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., Plaquenil-Induced Toxic Maculopathy - Decision-Maker PLUS Effect of chloroquine injectionLichen planopilaris treatment hydroxychloroquineDoes plaquenil increase fertilityPlaquenil sulfateHow long does chloroquine itching last In particular, chloroquine and hydroxychloroquine Plaquenil are two such medications, with the potential for retinal toxicity. Given that the retinal damage from these medications is largely irreversible, screening by a retinal specialist is critical to detect early retinal toxicity to try and limit the extent of visual loss. Retinal Screening for Hydroxychloroquine Plaquenil Toxicity.. Time Domain OCT in Hydroxychloroquine Plaquenil Toxicity.. This is Why You Need Multifocal ERG if You Have Plaquenil.. Abstract. 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. Many systemic medications may cause retinal toxicity. One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine Plaquenil, a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus. 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.