Objective:

To update screening recommendations for hydroxychloroquine (HCQ) retinopathy based on recent advances in retinal imaging and artificial intelligence.

Approach:

Key Findings:

• Risk of HCQ retinopathy is less than 1% within 5 years and less than 2% within 10 years at doses up to 5 mg/kg/day.
• Annual risk remains below 5% after 20 years for patients without prior toxicity.
• Risk of toxicity increases with higher doses, longer durations, renal disease, and older age at treatment initiation.

Interpretation:

With proper dosing and annual screening, most patients can safely use HCQ for extended periods with a low risk of retinal toxicity.

Limitations:

• Risk estimates depend on adherence to dosing and screening.
• Newer AI-based imaging technologies are not yet fully validated for routine clinical use.

Conclusion:

Baseline screening is recommended at treatment initiation, with annual follow-ups, although screening may be deferred for low-risk patients.

Sources:

• Ophthalmology
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