All of the following are criteria for high risk of deveoping chloroquine retinopathy except
**Core Concept**
Chloroquine retinopathy is a well-known side effect of long-term chloroquine use, characterized by damage to the retina, particularly the macula. The risk of developing chloroquine retinopathy is influenced by several factors, including duration of treatment, cumulative dose, and individual susceptibility.
**Why the Correct Answer is Right**
The correct answer is based on the criteria established by the American Academy of Ophthalmology for assessing the risk of chloroquine retinopathy. These criteria include:
* Duration of treatment exceeding 5 years
* Cumulative dose exceeding 1000 g (equivalent to 2500 mg per year for 5 years)
* Age over 40 years at the start of treatment
* Pre-existing retinal disease
* Concurrent use of other antimalarial drugs
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it is a known risk factor for chloroquine retinopathy. The American Academy of Ophthalmology recommends monitoring patients with a history of retinal disease for signs of retinopathy.
**Option B:** This option is incorrect because it is a criterion for assessing the risk of chloroquine retinopathy. The cumulative dose is a critical factor in determining the risk of retinopathy.
**Option D:** This option is incorrect because it is a criterion for assessing the risk of chloroquine retinopathy. Age over 40 years at the start of treatment is a known risk factor for developing retinopathy.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that the risk of chloroquine retinopathy increases with the duration of treatment and the cumulative dose. Patients on long-term chloroquine therapy should be monitored regularly for signs of retinopathy, including visual field defects, blurred vision, and changes in color vision.
**Correct Answer:**
D.