A patient on long-term hydroxychloroquine therapy for rheumatoid arthritis develops bull's eye maculopathy. The American Academy of Ophthalmology (AAO) 2016 revised screening guidelines recommend baseline screening and annual screening beginning at what duration of use?

• A Baseline, then annually from year 1
• B No baseline; annual from year 3 in all patients
• C Baseline only; repeat at 10 years unless symptoms develop
• D Baseline, then annually from year 5 (or earlier in high-risk patients) ✓

Explanation

The 2016 AAO revised guidelines recommend a baseline examination within the first year of starting hydroxychloroquine to document any pre-existing maculopathy, followed by annual screening beginning after 5 years of use (or earlier in high-risk patients: those on >5 mg/kg/day, impaired renal function, tamoxifen use, or pre-existing macular disease). The preferred screening modality is multifocal ERG combined with spectral-domain OCT and automated visual fields. Early detection of retinopathy is critical as damage is irreversible.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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