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JAMA Ophthalmology Clinical Challenge
October 2018

Bilateral Severe Decreased Vision With Normal Examination Findings

Author Affiliations
  • 1USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Ophthalmol. 2018;136(10):1201-1202. doi:10.1001/jamaophthalmol.2018.0485

An adult patient with a medical history of systemic lupus erythematosus and cystic fibrosis was seen with painless, rapidly declining vision in both eyes of 1-month duration. The patient had initially seen a general ophthalmologist 1 week after noticing a change in vision and was diagnosed as having bilateral cataracts. Given a continued decline in vision over the next 2 weeks, the patient sought a second opinion. The patient reported taking 400 mg of hydroxychloroquine sulfate daily (6.3 mg/kg/d) during the past 2 years, with normal renal function, but denied any recent change in medications.

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