2nd Opinion DR adds Plaquenil but NO eye | Arthritis Information

....Prescribed Plaquinil this week by new doc who did not mention or suggest anything about an eye exam. It seems like everything I have read here about people on plaquinil has included starting and continuing eye exams throughout their plaquinil treatment.

So I am wondering if anyone here might think this strange or not. That a doc would prescribe Plaquinil without any kind of eye exam.

My main reason in even going to this 2nd Rheumy (reputed to be a highly respected practice) this past week for a second opinion was just to make sure I am doing everything on my part to be active in monitoring my own treatment. I brought all my records with me and he examined me. Not my eyes though, and as a matter of fact, I haven't had an eye exam as an adult ever other than possibly for the DMV at some point for getting / renewing drivers license... So there certainly aren't any notes about my eyes in my med records either...

The end result of the appt was that he then prescribed plaquinil to go along with the methotrexate, pred. and folic acid that my first doc has me on.

BTW, I also asked about the biologics, but he said that he would never consider prescribing them for someone unless they had been on mtx and/or plaquinil for at least 4 - 6 months without working. Suggested I needed to be more patient as I have only been on the mtx for 4 weeks at this point.

I don't know what to do here now.... I don't know if Doc 1 or Doc 2 is doing the right thing... I haven't filled the plaq prescription because it seems odd that so many people here have had their eyes checked before / during treatment with this drug. Right???

Any feedback would be appreciated.

Thanks so much,

Melly

My RD would not let me start the Plaq until he had heard from the eye
doctor that it was ok for me to take it. He was pretty strict about it. But the
opthamologist told me he didn't feel it necessary to see me but every 2
years but I am making an appt with him at a year anyway just to be safe. I
would call him and insist ona referral. Your medical insurance will now pay
for your eye exams which is a plus.I'm not on Plaq but when I went for my yearly eye exam my eye dr. stressed that some meds for RA can seriously affect the eyes, Plaq being at the top of the list. I'd get myself to the eye dr. if I were you and definitely talk to the RD about this.

Lorster and Honey,

Thanks so much for your speedy response!

And another quick and related question which I would love your (or anyones) opinion on as well...

Would you be put off by the fact that this second doc prescribed the plaquinil for me, fully expecting me, I guess, to just start taking it without ever addressing any possible issues about eyes? Would that make you think that the first doc might be the better one for me after all in spite of the second practice being the one that is actually known locally as having such a good reputation???

It isn't like I have been unhappy or anything like that with the first doctor - just thought I should do my due diligence and get a second opinion....primarily to try to make sure as much as is possible that I am being treated aggressively enough....

Again thanks for the feedback you have already given and thanks in advance to you all and anyone else for any other opinions on this matter!

I'm so anxious these days that I've pulled yet another "All Nighter" which I seem to be doing at least weekly at this point....I have at least made an appt with a Therapist finally which is actually this evening, so hopefully that will help me de-stress a little...

Regards,

Melly

Melly,

I started plaquenil with no eye exam. My RD does cover all complications, but said he had never actually seen complications from plaquenil. Just to get my eyes checked once a year. I have absolutely no side effects from plaquenil.

Melly,

My RD made me get an eye exame before starting Plaquenil. He mentioned that it could cause problems with the eyes but that it was very rare.

The eye doctor also told me that it was rare and usually appeared after you've been on it for a long time. The eye doctor said to let them know if I start not being able to see red colors - they'll start looking grey. My RD wanted me to have an exam every 6 months, but the eye doctor said every year was sufficient.

I've only heard of one person on another message board that had problems, but she said that it caused eye pain. I think as long as you report any eye problems immediately, you should be o.k.

As far as which RD you should chose - I'm thinking maybe you've lost confidence in RD #2 over this and that could be a problem. It's important that you have confidence in your RD.

It's been many years since I was prescribed plaquenil but my doctor told me to make an appointment for an eye exam as soon as he prescribed it. I didn't have to have the eye exam first; but he did want me to go right away and every year there after.

When you know facts like these speak up. Tell your doctor that you've read of the dangers and let him know you are aware of things. I kind of feel like it keeps the doctors on their toes when they know they can't just bullsh*t their way through visits with you because you know the facts and you'll call them on their mistakes.

Any doctor that said it's not nessesary to have your eyes monitored while on Plaquenil is mistaken and I'd be weary of this doctor in the future.

Hi, is the reason you are taking plaqq. and mtx, is so that you can get off of the prednisone? That is the goal of my doctor. Find meds that work for me and stop the pred. I was taking remicade, but that's not working for me so now (today) I think they'll be suggesting either enbril or humira. I don't take any other meds, pain meds or anything. Just vitamins. I don't have pain, but stiffness and now a strange weak feeling in my legs?, sarah

Thanks again for input All!

Hurts (Sarah), Neither Doc has ever mentioned me ever stopping taking prednisone.

Actually Doc #1 made it sound like it woulde be for the rest of my life (just at this lower maintenance dose I am on now instead of being on and off of super high dose pred packs several times like I was over the past year.

And Doc #2 (that prescribed the plaq to go along with the meth) even suggested that I should be on a higher dose of pred until the meth and/or plaq started working...

This is a personal problem I am sure (which is why I have set myself up to see a therapist) but I feel like whenever I question what a doc suggests, they get completely offended....

ARGH......

Melly

Hi Melly,

I was put on Plaq. very recently and was told it was very important for me to have my eyes checked prior to starting it.

When I went the get my eyes checked, the Dr. explained that complications from Plaq. are very rare, but they monitor it just be sure.

I hope I was able help.
My rhumy said I could not start the Plaquenil until I had an exam by an eye specialist...not just my regular eye Dr. ( having a brain fart...can't remember the name...oh yeah, opthamologist.) And I have to have this specific eye test done every 6 months as long as I'm on the Plaq.

My RD "suggested" I get an eye exam and the eye doc said it wasn't really necessary cuz you have to be on plaquenil quite a while before that possibility even exists.

As far as the biologics, it is true, my doc wouldn't give me biologics until I had been on Plaq and MTX without results. I quit the plaq in a month cuz I had some nasty side effects, but I had to be on the MTX for 4 months before biologics. In fact your insurance won't cover it either unless you do it that way. My insur. wouldn't even allow enbrel until I had tried Humira first (i think it's less expensive). But I've had really good results with the MTX/Humira combo.

Hi Melly,

I was put on Plaq. 7 mo. ago. I had to have an eye exam before starting it, and every 6mo while on it.

It was my understanding that if problems did arrise from plaquinel (w/eyes) they could quickly be corrected if caught early. You can't catch them if you never see a doctor. It's quick and easy and insurance pays. It's highly unlikely to happen.....but it can.

not a doc but i read alot....I used to take quinine for leg cramps until they stopped selling it OTC.

I believe Plaquinel was a maleria(sp) drug derived from quinine. It can damage the optic nerve, same as quinine.

Melly, my opthamologist told me he has little concern about Plaquinil and
my eyes. He told me that many of the studies that were done regarding this
was done on people who had macular degeneration so it was possible that
there were already other things going on. He felt pretty comfortable with
me not coming back for two years. I didn't start the Plaq for several more
months after getting the Rx because I was so afraid of the side effects. I
wish I would not have done that because I have no side effects and I feel so
much better all the time. I'm glad I take this drug and I have had no
problems with my eyes. I have been on the med since September.

My doc told me to get my eyes examined by an opthamologist every 6 months. The first 6 months were a 'freebie'.

I was only on plaq for 6 months - it neither helped or hurt me. I couldn't tell the difference even after I got off.

hi melly,

when i was prescribed plaquinel i was sent for an eye test by my consultant and was told that they can sometimes cause probs with the eyes make sure you get checked out.i am on sulphasalazine at the moment and have blood tests every 3-4 weeks. will be starting mtx at the end of this month and will have to go for tests every 2-3 weeks for the first couple of months i have a great lady consultant and a fab team of nurses who are so understanding!!

good luck,

marcelle.

When I was put on plaquenil I had to have an eye exam and every 6 months after that. But I didn't stay on it long enough for the 2nd eye exam after the 6 months. When I took it last year I had to get an eye exam. It is rare but it can cause macular degeneration which can cause blindness. The dr wanted a baseline to compare results in the future. I took it for 4 months it didn't do anything for me. I hope it works for you!

Wow, it really is very interesting how different everyone's experiences are.

I am supposed to see Doc 1 this Thursday and I do think I feel more confidence in him, so I guess I will let him know what Doc 2 suggested (and hopefully not offend him too much in the process of obviously letting him know I went for a 2nd opinion "behind his back").

Oh Yi Yi