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Comment & Response |

Fundus Autofluorescence Is Not the Best Early Screen for Hydroxychloroquine Toxicity

Michael F. Marmor, MD1
[+] Author Affiliations
1Byers Eye Institute at Stanford, Palo Alto, California
JAMA Ophthalmol. 2013;131(11):1487-1488. doi:10.1001/jamaophthalmol.2013.4835.
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To the Editor I was pleased to see pictures of hydroxychloroquine toxicity in the recent Ophthalmic Images,1 as a reminder that the problem still exists. However, some readers may draw an erroneous impression from the caption, which suggests that fundus autofluorescence may “be useful to determine whether patients with macular pigmentary change may continue using hydroxychloroquine.”

The problem is that the image shows “late” toxicity with a visible bull’s-eye, and effective screening nowadays should detect toxic effects well before any visible fundus changes or dark arcuate rings appear on autofluorescence. The early finding in this image is actually the wider hyperfluorescent glow that can be seen before pigmentary damage—but this can be subtle and is less reliable as a primary screening tool. Retinopathy in this patient would have been recognized in fields and on spectral-domain optical coherence tomography long before this autofluorescent bull’s-eye became apparent,2,3 and that would have been the optimal time to stop the drug.


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November 1, 2013
Ian R. Gorovoy, MD; Mark S. Gorovoy, MD
1Department of Ophthalmology, University of California, San Francisco
2Gorovoy Eye Specialists, Fort Myers, Florida
JAMA Ophthalmol. 2013;131(11):1488. doi:10.1001/jamaophthalmol.2013.5077.
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