#3-83E. Beyond the Bull's-Eye: Assessing Hydroxychloroquine Retinal Toxicity (ACR, 2026)

Hydroxychloroquine is a cornerstone therapy for rheumatic diseases, but how can we effectively mitigate its insidious risk of irreversible retinal toxicity in real-world practice? This systematic review and meta-analysis evaluated the prevalence and cumulative incidence of hydroxychloroquine retinopathy (HCQ-R) among long-term users, specifically focusing on objective screening utilizing spectral-domain optical coherence tomography (SD-OCT). The study demonstrates that HCQ-R cumulative incidence steadily increases over time, reaching 5.6% at 15 years. Crucially, the evidence identifies a daily dose exceeding 5 mg/kg of actual body weight and the presence of chronic kidney disease (CKD) as prominent risk factors that significantly elevate the hazard of retinopathy. However, a critical appraisal reveals that the reliance on retrospective cohorts may introduce bias; unmeasured confounders such as irregular screening frequencies and varying medication adherence could potentially distort these risk estimates. For physicians, these findings emphasize the paramount importance of strict dose optimization based on actual body weight and the necessity for intensified, proactive ophthalmologic monitoring, especially for high-risk demographic groups and patients with renal impairment.

Citation: Daftarian N, Avina-Zubieta JA. Risk of Retinopathy Associated with Long-Term Use of Hydroxychloroquine in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis. Arthritis Care & Research. 2026. DOI: 10.1002/acr.80033.

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