Patient of rheumatoid ahritis are given hydroxychloroquine which cause painless loss of vision due to bull's eye maculopathy characterized by a foveolar island of pigment surrounded by a depigmented zone of RPE atrophy, which is itself encircled by a hyperpigmented ring (A). There is moderate to severe reduction in VA (6/36-6/60). A more substantial macular lesion follows, with widespread RPE atrophy surrounding the fovea (B). Later retinal aerioles may become attenuated, and pigment clumps can form in the peripheral retina.(C)