The Incidence of Retinopathy in Rheumatic and Musculoskeletal Disease patients on long term Hydroxychloroquine (HCQ) use - A Prospective Study.

Hydroxychloroquine (HCQ) is an anti-malarial drug with immune-modulatory properties. It has also shown benefits in treating rheumatic and musculoskeletal diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and scleroderma .The risk of developing irreversible retinopathy and consequent vision loss is a possible serious complication with HCQ use . Modern screening can detect retinopathy early so that necessary dose modification/stoppage of the drug will stop progression of the same. HCQ retinopathy is defined as the presence of a single consistent abnormal test result (in case of HVF-repeated results) with normal findings in others (Possible retinopathy) or presence of definite abnormalities in two tests (one subjective and one objective-Definite retinopathy). In recent times, there is no prospective study to identify the incidence of this retinopathy though retrospective studies are available. The prevalence of retinopathy in long term use patients appears to be around 7.5% at 5 years .

Baseline Examination: All the demographic factors such as age, gender, height, weight, BMI, history of diabetes, hypertension and other systemic diseases and medications will be taken. Preliminary Vision testing & refraction, intraocular pressure recording, slit lamp biomicroscopy will be done to rule out any anterior segment anomalies followed by 90D fundus examination. Retinopathy secondary to diabetes, hypertension,  age related macular degeneration, glaucoma and other retinopathies will be excluded by fundoscopy. OCT, field analysis and other investigations will be done wherever necessary by the ophthalmologist.

Annual Screening: Annual screening examinations will include automated HVF (24-2) and SD-OCT with optional fundus autofluorescence (FAF) and/or multifocal electroretinogram (mfERG) as needed.