July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Characteristics of hydroxychloroquine retinopathy in African American patients
Author Affiliations & Notes
  • Robert Carroll
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Drew Scoles
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Brian L VanderBeek
    Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Robert Carroll, None; Drew Scoles, None; Brian VanderBeek, None
  • Footnotes
    Support  1K23EY025729-01, 2P30EY001583
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5018. doi:
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      Robert Carroll, Drew Scoles, Brian L VanderBeek; Characteristics of hydroxychloroquine retinopathy in African American patients. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5018.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Hydroxychloroquine is an anti-malarial medication with immunosuppressive properties commonly used to treat many autoimmune diseases. An infrequent, yet serious, side effect is a toxic retinopathy leading to irreversible blindness. Classical cases demonstrate a parafoveal “bull’s-eye” pattern; however Asian patients are more likely to have a unique “pericentral” or “mixed” pattern that manifests further from the foveal center. It is less clear which pattern African Americans exhibit. We aim to determine the characteristics of hydroxychloroquine retinopathy in this population.

Methods : A retrospective chart review of all African American patients prescribed hydroxychloroquine and having an ophthalmology visit at an academic institution from January 2010 through November 2018 was carried out. Patients with a retinal screening exam, defined as being performed by an ophthalmologist with at least a macula spectral domain ocular coherence tomography or 10-2 automated visual field, were included. Demographic characteristics, dosage and length of hydroxychloroquine therapy, and renal function were recorded for all patients. For patients with toxicity, ophthalmic exam findings, diagnostic imaging modalities, and pattern and severity of retinopathy were also recorded. All patients with toxicity were required to have been diagnosed by a retina specialist.

Results : Of 436 patients reviewed, 200(45.9%) had a screening examination. 190(95%) were women and 5(2.5%, 9 eyes total) were found to have evidence of hydroxychloroquine retinopathy. Toxicity could not be determined in 1 eye of 1 patient with end stage viral retinitis. The dosage and length of therapy for 1 patient was unclear; for all others the average daily dose at diagnosis was 350 mg and the average cumulative dose was 2,273.75 gm over 17.5 years. All but 1 eye had a best-corrected visual acuity of 20/60 or better. 5 eyes(55.6%) showed evidence of pericentral or mixed retinopathy, and 7 eyes(77.8%) demonstrated moderate or severe toxicity.

Conclusions : Results suggest an increased prevalence of pericentral or mixed hydroxychloroquine retinopathy in African Americans. The majority with retinopathy exhibited at least a moderate level of toxicity, suggesting that current screening measures may not adequately identify all patterns of retinopathy. Future evaluation of additional African American patients with hydroxychloroquine toxicity may help to support these findings.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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