How do you approach the use of hydroxychloroquine in patients with a history of visual field defect from another cause such as macular degeneration or diabetic retinopathy?  

As Dr. @Rosenbaum noted, close collaboration with an ophthalmologist is critical, as the findings of HCQ-toxicity on advanced imaging with modalities such as an OCT can often be distinguished from other causes, and hence there is not an absolute contraindication in most cases. A few considerations t...

Great discussion by @Jason Kolfenbach and Dr. @Rosenbaum, and I'll add another important thing. In my experience, too many ophthalmologists with less familiarity with HCQ retinopathy will recommend that the HCQ be discontinued when they see VF 10-2 or SD-OCT changes, not realizing the subtle differ...

Many diseases including diabetic retinopathy, macular degeneration, glaucoma, occlusion of a retinal blood vessel, or stroke could cause a visual field defect. The visual field changes secondary to hydroxychloroquine are usually in a characteristic circle around the macula. (Patients from East Asia ...