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Mark Elder, FRANZCO; Anmar M. A. Rahman, FRANZCO

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We thank Dr Bienfang for his valuable comments on our article. Of 4 patients who developed hydroxychloroquine sulfate toxic effects among our population of 262 patients, all of them developed visual field defects indicative of toxic effects within a mean onset of 3.5 years of treatment. All of the defects were detected within the 1-year gap between visual field tests, hence our recommendation of screening at baseline, after 2 years of initiation of therapy, and annually thereafter irrespective of the therapeutic dose of hydroxychloroquine.

In regard to our assessment of the visual symptoms, our study is unfortunately limited by its retrospective design. We therefore cannot ensure the consistency of the type of questions asked in the screening process. However, all of the patients are asked about blurring of vision for both distance and near (eg, driving or reading) as well . . . [Full Text of this Article]

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