Hydroxychloroquine, a widely prescribed medication for conditions like lupus and rheumatoid arthritis, offers significant therapeutic benefits but carries a potential risk of ocular toxicity, primarily retinopathy. Recognizing and managing this risk is paramount for patient well-being. The established guidelines for screening and monitoring Hydroxychloroquine users emphasize early detection and intervention to preserve vision.

The concern for retinopathy is dose- and duration-dependent. While the risk is generally low at recommended daily doses, it increases with prolonged use, typically exceeding five years, and with cumulative doses exceeding 1000 grams. Factors such as age (over 60), pre-existing retinal conditions, and severe kidney or liver impairment can further elevate this risk. Therefore, a proactive approach to ocular health is essential for all patients initiating Hydroxychloroquine therapy.

Current recommendations, developed by leading ophthalmological and rheumatological bodies, suggest that patients should undergo a baseline ophthalmologic examination within the first year of starting Hydroxychloroquine. This initial assessment typically includes best-corrected distance visual acuity (BCVA), automated threshold visual field (VF) testing, and spectral domain ocular coherence tomography (SD-OCT). These tests help establish a baseline and identify any early signs of toxicity.

For most patients on standard doses without significant risk factors, annual follow-up eye exams can often be deferred until five years of treatment. However, for those with increased risk factors, such as higher doses or longer treatment durations, annual monitoring should commence sooner. It is crucial for patients to report any new visual symptoms, such as changes in color vision, blurred vision, or difficulty adapting to light, to their ophthalmologist immediately. Early recognition of retinal changes, even in the absence of symptoms, allows for timely intervention, such as discontinuing the medication, which can help prevent further vision loss.

The goal of this rigorous monitoring is not to prevent toxicity entirely, but to identify it at its earliest, most treatable stages. By adhering to these screening guidelines, healthcare providers can ensure that patients continue to benefit from Hydroxychloroquine's therapeutic effects while safeguarding their precious vision, emphasizing a commitment to comprehensive patient care.