Pericentral retinopathy and racial differences in hydroxychloroquine toxicity

Ophthalmology. 2015 Jan;122(1):110-6. doi: 10.1016/j.ophtha.2014.07.018. Epub 2014 Aug 31.


Purpose: To describe patterns of hydroxychloroquine retinopathy distinct from the classic parafoveal (bull's eye) maculopathy.

Design: Retrospective case series.

Participants: Patients from a large multi-provider group practice and a smaller university referral practice diagnosed with hydroxychloroquine retinopathy. Patients with widespread or "end-stage" retinopathy were excluded.

Methods: Review of ophthalmic studies (fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, visual fields) and classification of retinopathy into 1 of 3 patterns: parafoveal (retinal changes 2°-6° from the fovea), pericentral (retinal changes ≥ 8° from the fovea), or mixed (retinal changes in both parafoveal and pericentral areas).

Main outcome measures: Relative frequency of different patterns of hydroxychloroquine retinopathy and comparison of risk factors.

Results: Of 201 total patients (18% Asian) with hydroxychloroquine retinopathy, 153 (76%) had typical parafoveal changes, 24 (12%) also had a zone of pericentral damage, and 24 (12%) had pericentral retinopathy without any parafoveal damage. Pericentral retinopathy alone was seen in 50% of Asian patients but only in 2% of white patients. Patients with the pericentral pattern were taking hydroxychloroquine for a somewhat longer duration (19.5 vs. 15.0 years, P < 0.01) and took a larger cumulative dose (2186 vs. 1813 g, P = 0.02) than patients with the parafoveal pattern, but they were diagnosed at a more severe stage of toxicity.

Conclusions: Hydroxychloroquine retinopathy does not always develop in a parafoveal (bull's eye) pattern, and a pericentral pattern of damage is especially prevalent among Asian patients. Screening practices may need to be adjusted to recognize pericentral and parafoveal hydroxychloroquine retinopathy.

Publication types

  • Case Reports
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / toxicity*
  • Asian Continental Ancestry Group / ethnology*
  • Databases, Factual
  • Electroretinography
  • European Continental Ancestry Group / ethnology*
  • Female
  • Fluorescein Angiography
  • Fovea Centralis
  • Fundus Oculi
  • Humans
  • Hydroxychloroquine / toxicity*
  • Middle Aged
  • Retinal Diseases / chemically induced*
  • Retinal Diseases / diagnosis
  • Retinal Diseases / ethnology*
  • Retrospective Studies
  • Rheumatic Diseases / drug therapy
  • Risk Factors
  • Severity of Illness Index
  • Tomography, Optical Coherence
  • Visual Acuity
  • Visual Field Tests
  • Visual Fields


  • Antirheumatic Agents
  • Hydroxychloroquine