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Plaquenil Toxicity

Why screening is important

Medications like hydroxychloroquine (Plaquenil) and chloroquine (Aralen) are commonly prescribed for conditions such as:

  • Lupus erythematosus

  • Rheumatoid arthritis

  • Other inflammatory and dermatologic diseases

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While these medications are highly effective, they carry a small risk of permanent vision loss due to damage to the retina. Regular screening is important because once damage occurs, it cannot be reversed and may continue to progress even after stopping the medication.

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Your referring doctor believes that, at this time, the benefits of taking these medications outweigh the risks. Regular eye screening helps us detect any early signs of toxicity and protect your vision.

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Normal Macula

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Plaquenil Toxicity

How does the screening process work?

Ongoing Monitoring

Once referred for Plaquenil screening, you will be monitored annually by an ophthalmologist for as long as you are on the medication.

  • In some cases, screening may continue up to 5 years after stopping the medication.

  • You will also monitor your vision at home monthly using a simple test called the Amsler grid.

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Your First Visit

Your first screening will be an in-person assessment with an ophthalmologist. If no problems are found, follow-up testing will take place once per year at the Royal Alexandra Hospital Testing Centre.

What tests are included in the screening protocol?

Amsler Grid
Home Test: Monthly

  • A simple grid chart used monthly at home to check for changes in central vision.

  • Hold the grid about 30 cm (12 inches) from your face and wear your reading glasses if needed.

  • Cover one eye and focus on the center dot. Look for any faded, distorted, or missing areas. Repeat with the other eye.

  • Contact your ophthalmologist immediately if you notice any changes.

Color Photography
Hospital: Annually

  • Captures detailed images of your retina and cornea to check for medication build-up or damage.

  • Provides a permanent record for comparison in future visits.

Visual Field Test (10-2)
Hospital: Annually

  • Checks for any loss of central vision, which can be an early sign of toxicity.

  • You’ll watch for flashing lights in different parts of your vision. The test takes about 10 minutes per eye.

D-15 Colour Testing
Hospital: Annually

  • Assesses color vision by asking you to arrange colored discs.

  • Hydroxychloroquine damage can affect color vision.

Multifocal ERG (Electroretinogram)
Hospital: As Needed

  • Measures the retina’s electrical response to light and can detect early damage.

  • This test may be repeated to confirm results before making decisions about your medication.

Fluorescein Angiography
If required

  • Only done if damage is suspected.

  • A dye is injected into your arm, and photos of your retina are taken to look for damage patterns.

What is your role in protecting your vision?

  • Keep all testing appointments at the Royal Alexandra Hospital. If you need to reschedule, contact the testing centre or your ophthalmologist’s office as soon as possible so another patient can be accommodated.

  • Use your Amsler grid monthly to monitor your vision at home. Report any changes or concerns right away.

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While the risk of vision loss is low, regular monitoring is essential to catch any early signs of damage. Our goal is to help you safely continue your treatment while protecting your eyesight.

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If you have any questions or need help with the Amsler grid, contact your ophthalmologist.

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