Plaquenil Retinopathy Screening Requirements: Are You Up to Date on the New Standards?

7:00 AM

Macular OCT is one of the three ways that you can meet the
standards for current Plaquenil care.  Most optometrists have easy
access to OCT imaging, and may even have autofluorescence cameras.
MultifocalERG is the least likely test that will be found at your local
eye doctor's office, but some surgery centers or larger teaching
hospitals may have an ERG on site.   via
In 2011 the American Academy of Ophthalmology  published new clinical guidelines for appropriate annual screenings for those patients taking Plaquenil.  These guidelines are much different from the previous 2002 recommendations, and many practicing doctors were trained with the 2002 guidelines in mind.  Here are the new recommendations for how frequent and what tests should be performed with today's standard of care for Plaquenil patients:

1) Initial Baseline Screening upon first prescription:
  • Full comprehensive examination with dilation and/ or fundus photography to assess baseline macular health
  • Other possible screening tests: color vision testing, visual field 10-2 central field testing
  • One of the Required Standard Testing Items:

Required Standard Testing Items (this is the most important thing you can read on this post because this is the big area where guidelines have changed).
ONE of the following items MUST be performed: macular OCT, multifocal ERG, or Fundus Autofluorescence

2) Determine Risk (Low or High) 
Risk is based on patient's health, dosage (400 mg or less is the recommended daily dosage, so if the patient takes more than this they are at higher risk), and the initial baseline testing of macular health. If the patient is low risk (low dosage, good systemic health, no ocular health issues found on initial screening), then regular annual examinations-- without needing one of the above required standard testing items--should continue yearly for the next five years.

3) 5 Years Of Dosage and Thereafter
Begin yearly performance of 1 of the required standard testing items (either OCT of macula, multifocal ERG, or fundus autofluorescence) in addition to the yearly comprehensive examination.  The risk for toxicity increases after 5 years on the medication, and this why more intensive testing begins at this point.
OCT of Macula with Plaquenil induced Bulls Eye Maculopathy c/o Dr. Nathan Goldberg
Visual Field 10-2 with Plaquenil induced Bulls Eye Maculopathy c/o Dr. Nathan Goldberg
Take Home:
Remember, visual field 10-2 alone is a no longer standard of care.  It is a good supplemental item, just like macular photography and color vision testing.  But at the baseline exam and beginning at 5 years and thereafter of the patient taking the medication at least one of the required sstandard testing items has to be performed every year to meet these new guidelines.  Amsler grid testing is no longer recommended at all.

Special thanks to Dr. Nathan Goldberg for allowing me to share his images

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