Dear Dr. SerVaas,
I was diagnosed with polymyalgia rheumatica about seven years ago. Recently, my sedimentation rate was elevated and a rheumatologist prescribed Hydroxychlor (generic name: plaquenil). He also suggested that I see my eye doctor every six months, as the drug can cause eye problems.
My sed rate is back to normal, and I am doing much better. However, I am having “crinkling” of the retina. My eye doctor says this is not due to the Hydroxychlor. Can you tell me what might cause the crinkling to develop? My vision is now slightly blurred. Thank you for any comments.
We consulted with ophthalmologist Dr. Thomas Ciulla, a retina specialist and researcher at the Midwest Eye Institute in Indianapolis. Dr. Ciulla explains:
“Plaquenil is commonly prescribed by rheumatologists for inflammatory conditions such as lupus and rheumatoid arthritis. When used for several years at doses of 200 mg twice per day, it can lead to toxicity of the macula, the central part of the retina responsible for fine visual tasks such as reading or sewing. Patients who use plaquenil are generally advised to have dilated eye exams at least yearly to monitor for this problem, and the drug is discontinued if there are any signs of toxicity such as pigmentary abnormalities in the macula forming a bull’s-eye pattern, a classic characteristic of late-stage macular toxicity.
“Macular pucker, or wrinkling of the macula, is an entirely different problem in which thin membrane-like scar tissue forms on the macula and distorts it, leading to blurred and sometimes wavy central vision. This condition is also known as epiretinal membrane, cellophane maculopathy, and surface wrinkling maculopathy. Scar tissue may form on the macula due to conditions such as vitreous detachment (in which the aging vitreous breaks down, leading to floaters), retinal tear, retinal detachment, ocular inflammation, eye injuries, or retinal blood vessel abnormalities such as diabetic retinopathy or retinal vein occlusion. If the macular pucker is severe, a vitrectomy can be performed to remove vitreous gel and macular scar tissue and improve the vision.”