title: Evaluation of a follow-up protocol for patients on chloroquine and hydroxychloroquine treatment.
abstract: OBJECTIVE
  To review the problems found after a new follow-up protocol for patients on chloroquine and hydroxychloroquine treatment.
  
  
  METHODS
  Retrospective study was conducted between May 2012 and January 2013 on the clinical files, retinographies, fundus auto-fluorescence (FAF) images, and central-10 degree visual fields (VF) of patients who were referred to the Ophthalmology Department as they had started treatment with hydroxychloroquine.
  
  
  RESULTS
  One hundred twenty-six patients were included; 94.4% were referred from the Rheumatology Department and 5.6% from Dermatology. Mean age was 59.7 years, and 73.8% were women. All of them were on hydroxychloroquine treatment, and 300mg was the most frequent daily dose. Rheumatoid arthritis was the most common diagnosis (40.5%), followed by systemic lupus erythematosus (15.9%). The mean Snellen visual acuity was 0.76, and 26 patients had lens opacities. The VF were normal in 97 patients, 8 had mild to moderate defects with no definite pattern, and in 9 the results were unreliable. Of the 51 patients older than 65years, 16 (31.4%) had altered or unreliable VF. The FAF was normal in 104 patients (82.5%), and abnormal, but consistent with ophthalmoscopic features, in 12 patients (pathological myopia, age related changes, early, middle or late age-related macular degeneration).
  
  
  CONCLUSIONS
  Visual fields as a reference test for the diagnosis of AP toxicity are not quite reliable for patients over 65. Therefore, the FAF is recommended as primary test, perhaps combined with another objective test, such as SD-OCT instead of VF.
authors.affiliation: Servicio de Oftalmología, Complejo Asistencial Universitario de Palencia, Palencia, España; Grupo de Investigación de Retina del IOBA, Universidad de Valladolid, Valladolid, España. Electronic address: msanabria@saludcastillayleon.es.
authors.forename: M R
authors.initials: MR
authors.lastname: Sanabria
authors.affiliation: Servicio de Oftalmología, Complejo Asistencial Universitario de Palencia, Palencia, España.
authors.forename: S C
authors.initials: SC
authors.lastname: Toledo-Lucho
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D002738:Chloroquine / Q000009:adverse effects*; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012160:Retina; D012164:Retinal Diseases / Q000139:chemically induced; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014794:Visual Fields
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D002738:Chloroquine
keywords: Adverse reactions; Campos visuales; Chloroquine; Cloroquina; Drug-related side effects; Efectos secundarios; Examen ocular; Fotos de autofluorescencia; Fundus auto-fluorescence; Hidroxicloroquina; Hydroxychloroquine; Reacción adversa; Retinal toxicity; Toxicidad retiniana; Vision screening; Visual fields