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| plaquenil [2015/06/22 04:25] – admin | plaquenil [2025/06/14 03:55] (current) – [Recommended Screening Procedures] Scott Larson | ||
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| + | ====== Chloroquine and Hydroxychloroquine Screening Procedures ====== | ||
| + | ===== Risk ===== | ||
| + | * Risk increases in the following: | ||
| + | * After 5 years of use | ||
| + | * Hydroxycholoroquine Daily dose > | ||
| + | * Cholorquine Daily dose >2.3 mg/kg real weight | ||
| + | * Renal disease- subnormal glomerular filtration rate | ||
| + | * Tamoxifen use | ||
| + | * Preexisting macular disease | ||
| + | * Risk may be higher than previously believed as more sensitive testing employed (OCT, MERG) | ||
| + | |||
| + | ===== Toxicity ===== | ||
| + | * Irreversible Toxicity as evidenced by perimacular retinal thinning, photoreceptor and RPE loss | ||
| + | * Early signs are loss of outer segment structural lines and increased parafoveal autofluorescence | ||
| + | |||
| + | ===== Timeline ===== | ||
| + | * Baseline Examination within first year of use | ||
| + | * Annual Screening after 5 years of use if on acceptable doses without other risk factors | ||
| + | ===== Recommended Screening Procedures ===== | ||
| + | === Ocular Exam === | ||
| + | * Dilated Retinal Exam (low sensitivity) | ||
| + | === Automated Visual Field === | ||
| + | * White 10-2 | ||
| + | * Interpret with a low threshold for abnormality | ||
| + | * Retest if abnormalities appear | ||
| + | |||
| + | === One or More Objective Tests (abnormalities may be before field loss) === | ||
| + | * SD-OCT | ||
| + | * Cross section of macula | ||
| + | * localized thinning of parafoveal region especially the outer-segments and RPE structural lines | ||
| + | * loss of the inner-/ | ||
| + | * {{: | ||
| + | * mfERG | ||
| + | * Especially in suspicious or unreliable visual field loss | ||
| + | * Paracentral voltage reduction | ||
| + | * Fundus Autofluorescence | ||
| + | * Increased autofluorescence possibly from accumulation of outersegment debris | ||
| + | * {{:: | ||
| + | |||
| + | ===== Tests NOT recommended for screening ===== | ||
| + | * Fundus photography | ||
| + | * Time-Domain OCT | ||
| + | * Fluorescein Angiography- not proved to be more senstive than other tests | ||
| + | * Full-field ERG- may be useful in those with manifest toxicity to evaluate degree of damage | ||
| + | * Amsler grid | ||
| + | * EOG | ||
| + | |||
| + | Source: | ||
| + | |||
| + | {{tag> | ||