The 2016 American Academy of Ophthalmology Hydroxychloroquine Dosing Guidelines For Short, Obese Patients.

Purpose: The increasing prevalence of obesity over the past 60 years implies the need to reassess the risk of hydroxychloroquine retinopathy (HR) in obese women using the American Academy of Ophthalmology (AAO) 2016 guidelines.

Design: Cross-sectional study.

Participants: Medical records of 64 patients with HR from the practices of 2 ophthalmologists, 11 of whom were women with body mass index of 30 kg/m or more, were reviewed.

Methods: Daily dosing based on real and ideal weight was calculated.

Main Outcome Measure: Determine the number (and percentage) of patients given daily dosing according to real-weight and ideal-weight guidelines.

Results: In 4 patients (36%), daily dosing was more than 5 mg/kg based on real weight and more than 6.5 mg/kg based on ideal weight. In 4 patients (36%), daily dosing was 5 mg/kg or less based on real weight and 6.5 mg/kg or less based on ideal weight. In 3 patients (27%), daily dosing was 5 mg/kg or less based on real weight and more than 6.5 mg/kg based on ideal weight. No patient had daily dosing of more than 5 mg/kg based on real weight and 6.5 mg/kg or less based on ideal weight.

Conclusions: Twenty-seven percent of cases of hydroxychloroquine retinopathy in obese women had ostensibly safe dosing based on 2016 AAO guidelines. Overdosing of obese women by 2016 AAO guidelines is not rare. Daily dosing based on the older 6.5-mg/kg ideal weight threshold is safer in women with a body mass index of 30 kg/m or more.