Hydroxychloroquine retinopathy — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyHydroxychloroquine retinopathySCE Rheumatology

A 61-year-old woman with rheumatoid arthritis has taken hydroxychloroquine 400 mg daily for 6 years. Her eGFR is 48 mL/min/1.73 m² and she reports difficulty reading in dim light. Visual acuity is unchanged and fundus examination is normal. She has not had formal ophthalmic screening. What is the most appropriate investigation?

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Correct answer: B — OCT with automated visual-field testing

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

Optical coherence tomography with visual field testing is best because OCT with visual field testing is appropriate because hydroxychloroquine retinopathy can be detected before fundoscopic changes are visible. B is less suitable because CT head does not assess parafoveal retinal damage; C is less suitable because orbital radiography does not assess retinal toxicity; D is less suitable because anti-retinal antibodies do not diagnose hydroxychloroquine maculopathy; E is less suitable because drug levels may help adherence assessment but do not replace retinal screening. Clinical pearl: renal impairment increases hydroxychloroquine retinopathy risk and should lower the threshold for careful screening.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions