Case Study: A Teacher’s Fight Against Preventable Blindness

A Life of Teaching and Helping Children

For most of her life, our client dedicated herself to helping children learn. A soft-spoken woman from Maryland, she spent decades tutoring students with dyslexia and working in education. Teaching was not just her career — it was her calling.

Our client was also a cancer survivor, having overcome both cervical and breast cancer. Despite her health struggles, she remained resilient and active, pouring her energy into her work and her family.

That changed forever after she was prescribed Plaquenil (hydroxychloroquine) for rheumatoid arthritis.

The Long Road on Plaquenil

She first began taking Plaquenil in 2000. By the time she moved to Maryland in 2007, she had already been on the medication for seven years. Her new doctors — a rheumatologist and an ophthalmologist — continued her on the drug at 400 mg per day.

From that point forward, her care fell into dangerous neglect. Despite clear national guidelines requiring annual specialized eye testing after five years of use, her ophthalmologist never once performed the recommended Humphrey 10-2 visual field test. In fact, he only gave her a single outdated Amsler grid test back in 2007 — and then relied on exams that were incapable of detecting Plaquenil toxicity.

At the same time, her rheumatologist never tracked her cumulative dosage, never calculated her safe daily dose by body weight, and never checked whether she was receiving appropriate eye screenings. Both doctors failed to communicate with one another about her treatment, even as the risks escalated.

Warning Signs Ignored

Over the years, she began to notice changes in her vision: difficulty reading small print, trouble driving at night, halos around lights. Each time she raised concerns, she was reassured that it was just aging or cataracts.

By 2014, she had already been on Plaquenil for more than 13 years — well past the threshold where the risk of retinal toxicity becomes extremely high. She had all seven recognized risk factors for Plaquenil-induced blindness: long duration of use, high cumulative dose, daily dose at the upper limit, advancing age, visual symptoms, cataracts, and renal insufficiency. Still, her doctors continued the medication and failed to order the right tests.

Even when a retinal specialist later suggested stopping Plaquenil because of possible toxicity, no one explained the seriousness of the condition to her. She was told her problems were due to cataracts. She even underwent cataract surgery, only to find no improvement.

Frustrated and scared, she sought a second opinion. Then, for the first time, she was told the truth: she had advanced Plaquenil toxicity. The damage was permanent and irreversible.

Living with Blindness

By the time of her diagnosis, it was too late. She is now legally blind. Her corrected vision measures 20/250 in one eye and 20/400 in the other.

The impact on her daily life has been devastating. She can no longer cook, shop, or dress independently. Reading and tutoring — the passions of her life — are no longer possible. She depends on friends for transportation and cannot recognize faces in social settings.

Once independent, she now describes feeling like a prisoner in her own home.
The emotional toll is equally profound. Losing her sight meant losing her career, her hobbies, and her confidence. She had to give up the very work that gave her life purpose.

What Went Wrong

Our client’s blindness was not an inevitable outcome of her arthritis treatment. It was the direct result of systemic medical negligence:

• Her ophthalmologist failed to perform the very tests required to catch toxicity in time, despite having the necessary equipment in his office. He later admitted he simply didn’t follow the national guidelines.
• Her rheumatologist failed to calculate or track her cumulative Plaquenil dose, failed to recognize her risk factors, and continued prescribing without verifying proper eye monitoring.

Neither doctor ever warned her of the risks or explained that Plaquenil could cause irreversible blindness. Neither coordinated her care.

Had either physician followed the standard of care, her toxicity could have been detected years earlier — before her vision was destroyed.

Why This Case Matters

This case is about more than one woman’s blindness. It is about accountability. Patients trust their doctors to not only prescribe medication, but to protect them from preventable harm.

Plaquenil toxicity is not a rare or unforeseeable complication. Its risks are well-documented, its warning signs clear, and its prevention simple: correct dosing, proper monitoring, and honest communication with patients.

Our client’s story is a reminder of what can happen when those standards are ignored. She lost her independence, her livelihood, and her greatest joy — teaching children — all because her doctors failed to follow the rules designed to protect her.