Study Clarifies the Long-term Eye Safety of Popular Treatment Hydroxychloroquine

Vancouver (March 31, 2026) —A new study led by Arthritis Research Canada trainee Dr. Narsis Daftarian and scientists Dr. J. Antonio Aviña-Zubieta and Dr. Hui Xie provided new insight into the long-term safety of hydroxychloroquine, a commonly prescribed medication for people living with rheumatic diseases. The findings highlighted how the risk of vision defects changes over time while taking this medication and reinforced the importance of regular eye screening.

Hydroxychloroquine is widely used to manage conditions such as lupus and rheumatoid arthritis. While effective and well tolerated, it has been known to potentially cause damage to the retina at the back of eye that can lead to permanent vision loss.

Because there is no effective treatment once this vision defect occurs, current guidelines recommend regular eye exams by an eye specialist using an imaging scan called spectral domain optical coherence tomograph (SD-OCT). This damage can be detected and prevented early, before people notice any changes in their vision, in what is called the preclinical stage.

To better understand the risk of vision defects at the preclinical stage, the research team reviewed more than 800 studies and selected 19 high-quality studies for analysis from around the world. There were a total of 15,338 participants who were adult long-term hydroxychloroquine users with rheumatic diseases and underwent SD-OCT screening. They then combined the results using advanced statistical methods to estimate the risk of early retinal damage in adults with rheumatic diseases who had taken hydroxychloroquine for more than one year.

“Although the overall risk of preclinical changes in the retina from hydroxychloroquine remains low, it increases over time and with higher doses of more than five milligrams per actual body weight per day,” said Daftarian.  

Approximately one out of 1,000 people taking hydroxychloroquine experienced retinal damage within the first five years. By 15 years of continuous treatment, the risk had increased to about 56 out of 1,000 people. The study also identified groups who may be at higher risk of developing retinal toxicity, which included patients who are on hydroxychloroquine of more than five milligrams per actual body weight per day, those living with chronic kidney disease, and patients who are female or of Asian descent.

“It’s important to know that preclinical changes in the retina are often detected before your vision is affected by using imaging methods,” added Daftarian, “With appropriate doses and regular eye exams by eye specialists using SD-OCT imaging, patients can continue to use this medication safely.”

Hydroxychloroquine is still a widely used and safe treatment option for many rheumatic diseases, and for most patients, its benefits continue to outweigh its risks.

Read the full study here.

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