Diagnosis: Plaquenil Retinal Toxicity

  • Although this unfortunate, symptomatic patient has somewhat advanced retinal toxicity with abnormal visual acuity, visual fields and color vision, her fundus exam is still normal.
  • It is likely that asymptomatic patients with normal VA but early Plaquenil toxicity (perhaps documented by ring scotomas or color vision loss) will also present with a normal fundus exam.
  • optomap® FA reveals a dramatic Bull’s Eye maculopathy which still appears to be undetectable with ophthalmoscopy and various forms of fundus photography.
  • The Cirrus Spectral Domain OCT abnormalities, especially a loss of the PIL in a ring around the fovea, may occur earlier than traditional clinical abnormalities.
  • A SD OCT study is presently underway to determine at what stage the SD OCT becomes abnormal and diagnostic in patients taking Plaquenil.