To the Editor: Hydroxychloroquine is used infrequently (in less than 0.1% of Australians) for the long-term management of chronic conditions (eg, rheumatoid arthritis).1 Hydroxychloroquine retinopathy is a rare but sight-threatening side effect that is usually not reversible.2-5 Various eye screening recommendations for hydroxychloroquine toxicity have been proposed overseas,3-5 but there is no recommended consensus for eye screening in Australia. As a result, screening is currently not uniform or universal, and this sometimes leads to significant consequences.
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- 1. Australian Government. Pharmaceutical Benefits Schedule Item Reports. Canberra: Medicare Australia. https://www.medicareaustralia.gov.au/cgi-bin/broker.exe?_PROGRAM=sas.pbs_item_standard_report.sas&_SERVICE=default&itemlst=%2701512N%27&ITEMCNT=1&_DEBUG=0&LIST=1512N&VAR=SERVICES&RPT_FMT=1&start_dt=200807&end_dt=200906 (accessed Apr 2010).
- 2. Gass JDM. Stereoscopic atlas of macular diseases: diagnosis and treatment. 4th ed. St Louis: CV Mosby Company, 1997.
- 3. Yam JCS, Kwok AKH. Ocular toxicity of hydroxychloroquine. Hong Kong Med J 2006; 12: 294-304.
- 4. Royal College of Ophthalmologists. Hydroxychloroquine and ocular toxicity. Recommendations on screening. October 2009. London: RCO, 2009. http://www.rcophth.ac.uk/docs/publications/published-guidelines/Hydroxychloroquine_and_Ocular_Toxicity_final_Oct_2009.pdf (accessed Apr 2010).
- 5. Marmor MF, Carr RE, Easterbrook M, et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 2002; 109: 1377-1382.
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We thank the Medical Photographic Imaging Centre at the Royal Victorian Eye and Ear Hospital for the images.