HCQ Retinal Screening — RACP Adult Medicine MCQ

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EasyRheumatologyHCQ Retinal ScreeningRACP Adult Medicine

A 35-year-old woman with SLE on hydroxychloroquine for 8 years reports blurred vision. She has been taking hydroxychloroquine 400 mg daily (6.5 mg/kg — exceeds recommended maximum of 5 mg/kg). What screening should she have had?

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Correct answer: D — Annual retinal screening with OCT and visual fields

HCQ retinal toxicity screening per Royal Australian and NZ College of Ophthalmologists and AAO: baseline eye exam within first year, then annual screening after 5 years (or sooner if additional risk factors: renal impairment, high dose >5 mg/kg actual body weight, tamoxifen use, macular disease). Screening includes spectral-domain OCT (most sensitive) ± Humphrey visual field 10-2. HCQ dose should not exceed 5 mg/kg actual body weight (this patient is overdosed). HCQ retinopathy is irreversible — early detection via screening allows cessation before symptomatic visual loss.

Reference: RANZCO – 2024 – HCQ Retinal Screening; AAO 2024