Ep. 024: Medications That Can Be Harmful to the Retina with Christiane Hunt, DO

Side effects from medications are common. What may not be common knowledge is that there are systemic medications that can affect the eyes. For example, anti-hypertensive medications and some psychiatric medications are known to exacerbate dry eyes. Some oral medications can also adversely affect the retina, the delicate tissue inside the eye that receives the visual information.

One of the most commonly used medications that can affect the retina is hydroxychloroquine (Plaquenil), a medication used to treat rheumatoid arthritis and systemic lupus erythematosus. Its cousin, chloroquine, an anti-malarial medication, can also have the same effect on the retina. Use of hydroxychloroquine after years may cause accumulation of the medication in the RPE (retinal pigment epithelium), the layer underneath the retina. It is most likely to accumulate in the macula, the part of the retina that is responsible for central vision. Thus, this can cause significant loss of distance and reading vision.

Risk factors for retinal toxicity from hydroxychloroquine or chloroquine

• Daily dosage greater than 400 mg per day or total cumulative dosage of over 1,000 grams.
• Medication use for over 5 years
• Kidney or liver disease
• History of macular disease such as macular degeneration
• Age greater than 60 years

Patients who take these medications should have an annual eye examination that may include OCT (ocular coherence tomography), visual field testing, color vision testing, and possibly an ERG (electroretinogram). Many times, early changes can be detected by the examination and ancillary testing even before the patient has symptoms. There is no treatment for this other than to stop the medication immediately. The blind spots that can occur are usually irreversible.

Pentosan polysulfate (Elmiron) is a medication used for interstitial cystitis, a condition that can cause bladder pressure and pain. This drug can also affect the central macula and mimic macular degeneration. The risk factors for these changes are similar to hydroxychloroquine. There is no treatment other than to stop taking the medication.

Here are some links to learn more about how these medications can affect the retina.

https://www.aao.org/eyenet/article/hydroxychloroquine-induced-retinal-toxicity

https://www.aao.org/eyenet/article/pentosan-polysulfate-maculopathy

To find out more about Dr. Christiane Hunt and her practice, go to her practice’s website or Facebook page.

I am pleased to announce that in the past few weeks, Healthy Eyes 101 was ranked as the number 6 eye health podcast by Feedspot. Without all of you devoted listeners, this honor would not have been possible - so thank you for supporting this podcast!

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.