Understanding Macular Disease: What You Need to Know About Central Vision Loss
Hydroxychloroquine, commonly known by its brand name Plaquenil, is a medication that has been widely used for decades. Originally developed as an antimalarial drug, it is now more commonly prescribed for autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE).
In autoimmune diseases, the body’s immune system mistakenly attacks its owntissues, causing inflammation, pain, and damage. Plaquenil is an immune-modulating drug, that regulates the immune system to help reduce the overactive immune response while still allowing the body to defend against infections.
While it can be a highly effective treatment, one of the most important potential side effects of long-term Plaquenil use involves your eyes.
The primary concern with long-term Plaquenil use is a condition knownas Plaquenil retinopathy, or more broadly, hydroxychloroquine retinopathy. This condition involves damage to the retina—the thin layer of tissue at the back of the eye responsible for converting light into visual signals sent to the brain.
The damage is typically irreversible and can continue to worsen even after the medication is discontinued, making early detection critical.
The risk of developing retinal toxicity from Plaquenil is influenced by several factors:
Dosage and duration: The risk increases significantly after five years of use or a total cumulative dose exceeding 1,000 grams.
High daily doses: Taking more than 5 mg/kg of actual body weight per day increases the risk.
Kidney or liver dysfunction: These organs help clear the drug from the body; if they’re impaired, the drug can accumulate.
Pre-existing retinal disease or macular degeneration.
Age: Older patients may be more susceptible.
In the early stages, there may be no noticeable symptoms, which is why regular eye exams are so important. As the condition progresses, patients may experience:
Blurred vision
Difficulty reading
Blind spots in the central vision
Changes in colour perception
Eventually, if unchecked, it can lead to significant vision loss, particularly in the central field of vision, which is crucial for tasks like reading and recognizing faces.
Modern screening tools make it possible to detect retinal changes before symptoms appear. These include:
Visual field testing: an exam that measures how well you can see in all areas of your vision—including your central and peripheral (side) vision
Optical Coherence Tomography (OCT): A non-invasive imaging test that provides detailed images of the retina.
The current recommendations for Plaquenil monitoring are:
Baseline screening within the first year of starting Plaquenil.
Annual screenings after five years of use (or sooner if additional risk factors are present).
If signs of retinal toxicity are detected early, stopping the medication can often prevent further damage, though the existing vision loss may be permanent. Your prescribing physician and eye doctor will work together to assess whether the benefits of continuing treatment outweigh the risks.
Plaquenil remains a valuable medication for many chronic autoimmune conditions, and when used appropriately, the risk of serious eye damage is relatively low. However, patients should be vigilant, informed, and committed to regular eye exams. By staying on top of your ocular health, you can help ensure that Plaquenil remains a safe and effective part of your treatment plan.
Always talk to your healthcare provider or ophthalmologist if you have concerns about your vision or medications.
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