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Invited Commentary
December 2014

We Need to Be Better Prepared for Hydroxychloroquine Retinopathy

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2014;132(12):1460-1461. doi:10.1001/jamaophthalmol.2014.4090

From the first discovery of chloroquine by Hans Andersag at Bayer in 1939 and later development of its hydroxyl and less toxic form hydroxychloroquine (HCQ), these medications have been one of the most abundantly used around the world and have been instrumental in saving countless lives from malaria. Hydroxychloroquine is currently listed in the World Health Organization Model List of Essential Medicines as a disease-modifying agent for rheumatoid arthritis. Its use is becoming ubiquitous for a variety of autoimmune disorders from lupus to rheumatoid arthritis and now finding its way into dermatology and oncology.1 There are more than 50 studies evaluating HCQ in various disorders including many tumors. With the results of the LUMINA (Lupus in Minorities: Nature vs Nurture) trial showing clear benefit of HCQ use by decreasing mortality and end organ damage, HCQ use has significantly increased and is being advocated by the rheumatology community with clinical trials reporting its use in 50% of patients with lupus, with tertiary care centers reporting the rate of up to 90% (Baltimore Lupus Cohort; Michele Petri, MD, MPH, Johns Hopkins Hospital, written communication, June 25, 2014). Given the increasing use of HCQ and retinopathy being the only absolute contraindication for its use, it is more critical than ever to advocate for screening, detection, and prevention of retinopathy. Of note, most of these screenings are not performed by retina specialists but by general ophthalmologists.2