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March 31, 2020
At some point, you might be the victim of one of these scenarios: You rub your eye really hard,...

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At some point, you might be the victim of one of these scenarios: You rub your eye really hard, you walk into something, or you just wake up with a red, painful, swollen eye. However it happened, your eye is red, you’re possibly in pain, and...

There are many opinions on the topic of texting and driving. The goal of this blog is to explore the effects on vision during texting.

So why does texting make you more likely to crash from a visual perspective? The problem lies in distraction...

We commonly see patients who come in saying that their eye is bleeding.

The patients are usually referring to the white part of their eye, which has turned bright red. The conjunctiva is the outermost layer of the eye and contains very fine...

Dry Eye Disease affects more than 5 million people in the United States, with 3.3 million being women and most of those being age 50 or over. And as people live longer, dry eye will continue to be a growing problem.

Although treatment options...

Despite requests that patients bring their current glasses to their office visit, many show up without them.

Sometimes it’s an oversight: “I was rushing to get here and forgot them”; “I left them in the car”; “I picked up my wife’s glasses...

We are frequently asked if it’s wise to have cataract surgery if you have Macular Degeneration.

Let’s start with some background.

  1. Cataracts and Age-related Macular Degeneration (AMD) are both leading causes of visual impairment in the...

So you’re going about your day and notice a slight twinge when you blink. It starts off as a mild awareness then proceeds to a painful feeling with every blink. You look in the mirror to see what could be causing it, and there you see a small red...

Age-related macular degeneration, often called ARMD or AMD, is the leading cause of vision loss among Americans 65 and older.

AMD causes damage to the macula, which is the central portion of the retina responsible for sharp central vision. AMD...

Remember back to the last time you experienced the birth of a baby. What was one of the most common questions people asked? Most likely, "WHAT COLOR ARE HIS EYES?,” was right up there.

What makes the color of our eyes appear as they do? What...

For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy.

In a trabeculectomy the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of...

1. Vision is so important to humans that almost half of your brain’s capacity is dedicated to visual perception.

2. The most active muscles in your body are the muscles that move your eyes.

3. The surface tissue of your cornea (the...

Hydroxychloroquine (Plaquenil) was originally used to treat malaria and is now used mostly to treat rheumatological and dermatological diseases. Its most frequent use now is for rheumatoid arthritis (RA) and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause.

One of the most significant side effects of the drug is its possibility of causing eye problems resulting in blurred or decreased vision. The most common issue is damage to the retina. It can impair your color vision or damage the retinal cells, particularly in the area right around the central vision.

In your retina, the area that you use to look straight at an object is called the fovea. The fovea is the area that provides you with the most definition when looking at an object. The area just around the fovea is called the macula and it has the ability to see objects with slightly less definition than the fovea but significantly better than the rest of your retina, which accounts for your peripheral vision. The most common place for Hydroxychloroquine to cause a problem is in a ring of the macula surrounding the fovea.

The reason it is important to detect any of these changes as early as possible is because in many instances the changes are not reversible even if you come off the medication.

The risk of this happening is highly correlated with the cumulative dose of the drug you have received. So, the higher the dose and the longer you have been on it the higher your risk.

The current recommendation is a daily dose that does not exceed 6.5 mg/kg/day (that is milligrams per kilograms per day).  There are approximately 2.2 pounds. in a kilogram.  The pills come in 200 mg tablets.  Most people who are on this drug are on either 200 mg once a day or 200 mg twice a day. The safety break point comes at around 135 pounds. People weighing more than that will stay within the safety guidelines (not more than 6.5mg/kg/day) at 400mg per day, but people under 135 pounds should probably only be taking 200 mg per day.

Other risk factors for Hydroxychloroquine retinal toxicity include kidney or liver disease and obesity. Obesity is a risk factor because the drug does not penetrate fat tissue so there is more of the drug in your lean body mass (including your retina and its supporting cells called the retinal pigment epithelium). What that means in real terms is that if you take two people who each weigh 140 pounds and put them both on 400 mg a day and one person is 4-foot 11 and the other is 5-foot 9, the 4-foot 11 inch person is at greater risk for side effects because the shorter person has more of their body weight in fat tissue. Since the hydroxychloroquine can’t penetrate the fat tissue that means there is a higher concentration of it in sensitive tissues like the retina.  People with kidney and liver problems have a tougher time eliminating the drug from their system so they are at higher risk because the body is going to retain more of the drug for a longer period of time.

The recommendation is to have a baseline eye exam with dilation and a visual field test before or soon after starting the drug. A repeat of that exam should occur every year if there is no evidence of toxicity.  

The actual incidence of retinal toxicity from hydroxychloroquine is difficult to pin down because there is usually a long time between being started on the drug and the start of any identifiable retinal toxicity. The overall rate of probable retinal toxicity is in the range of 1 of every 200 people treated. The rate is much lower than that in the first 7 years of treatment but gets to about 5 times higher after 7 years of treatment. Some of that data is old now and there is much greater awareness currently about keeping people below that 6.5 mg/kg/day dosage level.

I have been in practice for over 25 years and have seen “probable” retinal toxicity from hydroxychloroquine a total of 5 times and only once in the last 10 years when people have been more careful about keeping the dosage in the right range.

The drug can be very effective in its treatment of RA and Lupus and the likelihood of serious vision problems is small and can potentially be avoided with the correct dosing and monitoring of the eyes. Other drugs in the treatment for RA or Lupus may have more frequent or serious side effects then Hydroxychloroquine so it would be wise to consider it a viable treatment option and not easily dismiss it because of the risk of what amounts to a fairly infrequent eye issue.

Article contributed by Dr. Brian Wnorowski, M.D.

After a lot of hard work with EyeMotion, our website company, we’re pleased to be launching our brand-new website.  Our goal has been to create a site that would assist you in learning about us, whether it’s finding our location or email form, reading about our wonderful eye doctors, or discovering some of our quality products and services.

Have questions about an eye issue?  We think you might also benefit from our great optometric content on eye diseases and conditions.

Our plan is to use this area to keep you informed on new offerings, sales, trunk shows, events, and so much more.  Check back here from time to time to keep updated.

We’re glad you found us, and we hope to see you soon!

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