A 30-year-old woman with SLE on long-term hydroxychloroquine (200 mg daily for 8 years) presents for routine follow-up. She is asymptomatic with normal visual acuity. Which of the following screening recommendations is most appropriate for hydroxychloroquine retinal toxicity?

• A Annual fundoscopy alone
• B No screening needed at doses below 5 mg/kg/day
• C Fluorescein angiography every 2 years
• D Annual automated visual field testing plus spectral-domain OCT ✓

Explanation

The 2016 AAO guidelines recommend baseline screening within the first year, then annual screening after 5 years of use (or sooner with high risk). Screening should include both automated visual field testing and spectral-domain OCT (or multifocal ERG). Fundoscopy alone misses early bull's-eye maculopathy. The actual body weight-based dose threshold is 5 mg/kg/day; 200 mg in a typical adult is often above this, so screening is indicated regardless.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.