In Reply We agree fully with the comments from Dr Marmor, whom we consider the leading authority regarding hydroxychloroquine maculopathy. A bull’s-eye should never be seen if patients are well screened, as it signifies advanced disease.
These images were intended to remind ophthalmologists that hydroxychloroquine maculopathy still exists, especially when patients have been poorly followed up or overdosed. In preventive medicine, however, the question of discontinuation of hydroxychloroquine often places the health care practitioner who is screening for soft signs of early toxic effects in the difficult position of discontinuing an excellent and systemically safe drug vs risking irreversible vision loss from toxicity. Confirmatory tests such as autofluorescence and multifocal electroretinography may facilitate the decision on whether to observe or stop the medication.
Gorovoy IR, Gorovoy MS. Fundus Autofluorescence Is Not the Best Early Screen for Hydroxychloroquine Toxicity—Reply. JAMA Ophthalmol. 2013;131(11):1488. doi:10.1001/jamaophthalmol.2013.5077