Hydroxychloroquine and Chloroquine Retinopathy: Recommendations on Monitoring

Following the publication of recommendations for monitoring patients on these drugs in 2018, new published evidence highlighting that hydroxychloroquine retinopathy is more common than previously reported, has prompted a review of the guideline, and new recommendations.

SPS commentary:

The prevalence in long-term users appears to be around 7.5% and depending on dose and duration of therapy can increase to 20-50% after 20 years of therapy. Risk increases for patients taking more than 5mg/kg/day.

It is recommended that all patients be referred for annual monitoring after 5 years of therapy and be reviewed annually thereafter whilst on therapy.  Monitoring may be started one year after therapy is initiated if additional risk factors exist e.g. very high dose of drug therapy. Chloroquine appears to be more retinotoxic than hydroxychloroquine and so monitoring should begin after 1 year of therapy for all patients on chloroquine. Also testing for new initiators of hydroxychloroquine or chloroquine is no longer recommended because of recent evidence of a low rate of drug discontinuation as a result of baseline testing (less than 4%) and recognition that a significant proportion of patients discontinue hydroxychloroquine in the first 5 years of therapy.


Royal College of Ophthalmologists

Resource links:

Updated guideline