American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use With Respect to Retinal Toxicity

Arthritis Rheumatol. 2021 Jun;73(6):908-911. doi: 10.1002/art.41683. Epub 2021 Apr 26.


Four major medical societies involved with hydroxychloroquine (HCQ) therapy concur on the need for common principles and cooperation to minimize the risk of ocular toxicity. At a daily dosage of ≤5 mg/kg/day actual body weight, the risk of retinal toxicity from HCQ is <2% for usage up to 10 years. Widespread adoption of more sensitive testing techniques, such as optical coherence tomography and automated visual fields, by eye care providers will allow the detection of early toxicity and thus preserve the patient's visual function. Baseline testing is advised to rule out confounding disease when a patient is started on HCQ. Annual screening with sensitive tests should begin no more than 5 years after treatment initiation. Providers should be sensitive to the medical value of HCQ, and not stop the drug for uncertain indications. It is important to note that effective communication among prescribing physicians, patients, and eye care providers will optimize the utility and safety of HCQ.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antirheumatic Agents / adverse effects*
  • Deprescriptions
  • Dermatology
  • Humans
  • Hydroxychloroquine / adverse effects*
  • Mass Screening
  • Ophthalmology
  • Retinal Diseases / chemically induced*
  • Retinal Diseases / diagnosis
  • Retinal Diseases / ethnology
  • Rheumatology
  • Societies, Medical
  • Tomography, Optical Coherence
  • Visual Field Tests


  • Antirheumatic Agents
  • Hydroxychloroquine