Eye screening for patients taking hydroxychloroquine

Hydroxychloroquine is a medication used to treat several conditions including rheumatoid arthritis,
systemic lupus erythematosus, some skin conditions (especially photosensitive ones) an others that involve inflammation. 

It was previously used in the treatment and prevention of malaria although it is no longer effective in this use as the malaria parasite has developed resistance to hydroxychloroquine and chloroquine.

Hydroxychloroquine retinopathy

It is known that some people who take hydroxychloroquine for more than five years and/or in high doses are at increased risk of damage to their retina, the light sensitive layer of cells at the back of the eye. This is known as retinal toxicity or retinopathy. 

Overall, around seven patients out of every 100 taking hydroxychloroquine for more than five years
may develop retinopathy that can be detected with specialised tests. The risk is much higher in patients who have been taking the drug for 20 years or more. In these patients between 20 and 50 out of 100 will develop retinopathy.

Severe retinopathy, especially in the central area called the macula, causes significant, irreversible sight loss.

Screening for hydroxychloroquine retinopathy

The aim of screening is not to prevent retinopathy but to detect the earliest definitive signs of it before a patient notices any symptoms.

The eye screening tests for patients taking hydroxychloroquine 

There are several tests used to screen your eyes for signs of retinopathy. They all involve different
types of imaging of the retina and are noninvasive (they do not cause pain and do not risk damaging the eye in any way).

At the first, or ‘baseline’ screening appointment you will have two tests:

1. Fundus (Retina) Photograph
The first is a colour photograph taken of the surface of your retina, called a fundus photograph. 

2. OCT
The second is a scan that provides a cross-sectional image of the various layers of your retina.
This is called an Optical Coherence Tomography (OCT) scan. 

Additional Screening tests:
If there is some changes on Retina, Retina Specialist doctors can also do FAF imaging. 
This is a scan that detect abnormal levels of a substance called lipofuscin in the retina, which may be an early sign of disease. This test is called fundus autofluorescence (FAF) imaging. and If there is any sign of disease retina specialist doctor will advice for another test called a visual field test.

Reference:
Macular Society 


Early findings include mottling of the RPE and blunted foveal reflex. As the retinopathy progresses, a bull's-eye maculopathy develops, as seen in these photos.  In addition to the bull's-eye maculopathy, patients can demonstrate paracentral scotomas on visual field testing and parafoveal outer retinal atrophy on OCT.
Photo Source: Eyerounds.org under CC3 Licence


Eye screening Hospital/clinic for patients taking hydroxychloroquine in Nepal

Major Eye Hospitals having Retina Clinic/Department of Nepal have screening test facility for Patient taking hydroxychloroquine such as Tilganga Eye Hospital, Nepal Eye Hospital, B.P. Koirala Lions Center For Ophthalmic Studies, BP Eye Foundation, Himalaya Eye Hospital Pokhara, Lumbini Eye Institute Bhairahawa, Mechi Eye Hospital, Biratnagar Eye Hospital, Sagarmatha Choudhary Eye Hospital Lahan, Geta Eye Hospital, and others provide eye screening test for hydroxychloroquine effects on eyes.

Many of Private eye clinics in Kathmandu, Pokhara and major cities of Nepal also have this screening tests facilities. Such as 
1. Metro Eye Care, Subidhanagar, Kathmandu
2. Netradham Eye Care Center, Kupandole
3. icare eye clinic, Naxal
4. Drishti Eye Center, Kalanki
5. Matrika Eye Center, Near Seto pool
6. Kathmandu Eye Center, Patan

Info: You can add your clinic if there is hydroxychloroquine patient's eye screening facility on the comment box below.