A 45-YEAR-OLD woman with an 18-year history of rheumatoid arthritis had a recent onset of decreased central vision. She had been taking a daily dose of 400 mg of hydroxychloroquine (8.5 mg/kg per day) for 6 years (cumulative dose of 876 g). Corrected visual acuity was 20/50 OU. Ishihara plate test results were 2/15 OU. Fundus examination showed pigment mottling in the macula of both eyes (Figure 1). Fluorescein angiography showed window defects in a bull's-eye pattern in both eyes (Figure 2). Static perimetry with a red test object (Humphrey Field Analyzer 10-2; Humphrey Instruments Inc, San Leandro, Calif) showed deep central scotomas in both eyes (Figure 3). Standardized Ganzfeld electroretinography revealed normal photopic and scotopic voltage and latency. Flicker response was normal (Figure 4). Multifocal electroretinography showed a markedly decreased electrical response in the macular areas of each eye (Figure 5).
Maturi RK, Folk JC, Nichols B, Oetting TT, Kardon RH. Hydroxychloroquine Retinopathy. Arch Ophthalmol. 1999;117(9):1262-1263. doi:10.1001/archopht.117.9.1262