Ophthalmology Times flags antipsychotic retinopathy
What happened
- Ophthalmology Times on October 23, 2025 reported Sharon Fekrat’s AAO 2025 presentation in Orlando on retinal manifestations linked to antipsychotic medications. - Sharon Fekrat said thioridazine toxicity risk rises above 800 mg daily and can progress from pigmentary retinopathy to retinal pigment epithelium atrophy. - AAO and EyeWiki materials continue to list phenothiazines including thioridazine and chlorpromazine among drugs associated with pigmentary maculopathy.
Why it matters
Ophthalmology Times on October 23, 2025 published a report from the American Academy of Ophthalmology’s 2025 meeting in Orlando on retinal findings associated with antipsychotic drugs. Sharon Fekrat, a retina specialist, said the best-known example remains thioridazine, a first-generation antipsychotic tied to pigmentary and granular retinopathy that can later progress to more destructive retinal pigment epithelium and choriocapillaris changes. The report’s practical message was not that every atypical retinal finding is drug toxicity. It was that incomplete medication history can send clinicians toward the wrong diagnosis when psychiatric drugs are part of the picture. ### Which antipsychotic drew the clearest warning? Sharon Fekrat identified thioridazine as the antipsychotic most closely associated with retinal toxicity in her AAO 2025 remarks. Ophthalmology Times quoted her as saying the toxicity can start as a mild pigmentary and granular retinopathy, often temporal to the macula, and can progress to nummular atrophy involving the retinal pigment epithelium and choriocapillaris. (ophthalmologytimes.com) EyeWiki, an American Academy of Ophthalmology resource updated in August 2025, places phenothiazines including thioridazine and chlorpromazine among drugs that can induce pigmentary maculopathy. The same reference says drug-induced retinal injury can in some cases continue to matter even after the inciting drug is stopped, with permanent or progressive vision loss possible in a minority of cases. ### Why can this look like a primary retinal disease? (ophthalmologytimes.com) Ophthalmology Times said these medication-related findings matter because retina specialists may be evaluating unexplained pigmentary change, visual symptoms or atypical imaging without an obvious drug clue at first glance. Fekrat told the publication that systemic medications should stay on the differential when clinicians assess unexplained retinal findings. (eyewiki.aao.org) The American Academy of Ophthalmology’s broader education materials describe the same diagnostic problem across drug toxicities. A 2024 AAO report on systemic-agent toxicity said establishing a correlation between a drug and an ocular side effect can be difficult, and speakers stressed the need to rule out masquerade syndromes and other causes. ### What did Fekrat say about dose, timing and newer drugs? (ophthalmologytimes.com) Fekrat said toxicity risk with thioridazine rises at daily doses above 800 milligrams. She also said delayed retinal toxicity can still appear in patients who were exposed previously, even though Ophthalmology Times reported the branded drug was discontinued in 2005. Second-generation antipsychotics were presented as a different category. (aao.org) Ophthalmology Times said risperidone is considered less likely to cause retinal toxicity, though rare cases of cystoid macular edema have been reported. That distinction matters because the article did not frame all antipsychotics as carrying the same retinal risk profile. ### What should clinicians ask when the retina findings do not fit? (ophthalmologytimes.com) Medication review is the immediate step that emerges from the reporting. Fekrat’s comments, as summarized by Ophthalmology Times, point clinicians toward asking specifically about current and prior psychiatric medications when pigmentary change, unusual macular findings or unexplained visual symptoms do not fit a standard inherited or degenerative pattern. (ophthalmologytimes.com) AAO educational materials support that approach in broader drug-toxicity workups. EyeWiki says the most common manifestation of direct injury to the retina and retinal pigment epithelium is pigmentary maculopathy, and the 2024 AAO coverage said multimodal detection and careful correlation with treatment history are central to avoiding missed toxicity. ### What did the report not say? Ophthalmology Times on October 23, 2025 did not call psilocybin a retinal toxin. (ophthalmologytimes.com) Fekrat said the substance, which she described in the context of self-medication, has no known retinal toxicity. The same report also did not recommend blanket screening protocols for all psychiatric drugs. Its narrower point was clinical recognition: when retinal findings are unexplained, the medication list — including older antipsychotic exposure — may provide the missing link. (eyewiki.aao.org) AAO and EyeWiki resources available as of May 2026 continue to list phenothiazines among drugs associated with pigmentary maculopathy, giving retina specialists a named class to keep in view during future workups. (ophthalmologytimes.com)
Key numbers
- Ophthalmology Times on October 23, 2025 reported Sharon Fekrat’s AAO 2025 presentation in Orlando on retinal manifestations linked to antipsychotic medications.
- Sharon Fekrat said thioridazine toxicity risk rises above 800 mg daily and can progress from pigmentary retinopathy to retinal pigment epithelium atrophy.
- Ophthalmology Times on October 23, 2025 published a report from the American Academy of Ophthalmology’s 2025 meeting in Orlando on retinal findings associated with antipsychotic drugs.
- Sharon Fekrat identified thioridazine as the antipsychotic most closely associated with retinal toxicity in her AAO 2025 remarks.
What happens next
- (ophthalmologytimes.com) Ophthalmology Times said these medication-related findings matter because retina specialists may be evaluating unexplained pigmentary change, visual symptoms or atypical imaging without an obvious drug clue at first glance.
- Its narrower point was clinical recognition: when retinal findings are unexplained, the medication list — including older antipsychotic exposure — may provide the missing link.
- (eyewiki.aao.org) AAO and EyeWiki resources available as of May 2026 continue to list phenothiazines among drugs associated with pigmentary maculopathy, giving retina specialists a named class to keep in view during future workups.
Quick answers
What happened in Ophthalmology Times flags antipsychotic retinopathy?
Ophthalmology Times on October 23, 2025 reported Sharon Fekrat’s AAO 2025 presentation in Orlando on retinal manifestations linked to antipsychotic medications. Sharon Fekrat said thioridazine toxicity risk rises above 800 mg daily and can progress from pigmentary retinopathy to retinal pigment epithelium atrophy. AAO and EyeWiki materials continue to list phenothiazines including thioridazine and chlorpromazine among drugs associated with pigmentary maculopathy.
Why does Ophthalmology Times flags antipsychotic retinopathy matter?
Ophthalmology Times on October 23, 2025 published a report from the American Academy of Ophthalmology’s 2025 meeting in Orlando on retinal findings associated with antipsychotic drugs. Sharon Fekrat, a retina specialist, said the best-known example remains thioridazine, a first-generation antipsychotic tied to pigmentary and granular retinopathy that can later progress to more destructive retinal pigment epithelium and choriocapillaris changes. The report’s practical message was not that every atypical retinal finding is drug toxicity. It was that incomplete medication history can send clinicians toward the wrong diagnosis when psychiatric drugs are part of the picture. Which antipsychotic drew the clearest warning? Sharon Fekrat identified thioridazine as the antipsychotic most closely associated with retinal toxicity in her AAO 2025 remarks. Ophthalmology Times quoted her as saying the toxicity can start as a mild pigmentary and granular retinopathy, often temporal to the macula, and can progress to nummular atrophy involving the retinal pigment epithelium and choriocapillaris. (ophthalmologytimes.com) EyeWiki, an American Academy of Ophthalmology resource updated in August 2025, places phenothiazines including thioridazine and chlorpromazine among drugs that can induce pigmentary maculopathy. The same reference says drug-induced retinal injury can in some cases continue to matter even after the inciting drug is stopped, with permanent or progressive vision loss possible in a minority of cases. Why can this look like a primary retinal disease? (ophthalmologytimes.com) Ophthalmology Times said these medication-related findings matter because retina specialists may be evaluating unexplained pigmentary change, visual symptoms or atypical imaging without an obvious drug clue at first glance. Fekrat told the publication that systemic medications should stay on the differential when clinicians assess unexplained retinal findings. (eyewiki.aao.org) The American Academy of Ophthalmology’s broader education materials describe the same diagnostic problem across drug toxicities. A 2024 AAO report on systemic-agent toxicity said establishing a correlation between a drug and an ocular side effect can be difficult, and speakers stressed the need to rule out masquerade syndromes and other causes. What did Fekrat say about dose, timing and newer drugs? (ophthalmologytimes.com) Fekrat said toxicity risk with thioridazine rises at daily doses above 800 milligrams. She also said delayed retinal toxicity can still appear in patients who were exposed previously, even though Ophthalmology Times reported the branded drug was discontinued in 2005. Second-generation antipsychotics were presented as a different category. (aao.org) Ophthalmology Times said risperidone is considered less likely to cause retinal toxicity, though rare cases of cystoid macular edema have been reported. That distinction matters because the article did not frame all antipsychotics as carrying the same retinal risk profile. What should clinicians ask when the retina findings do not fit? (ophthalmologytimes.com) Medication review is the immediate step that emerges from the reporting. Fekrat’s comments, as summarized by Ophthalmology Times, point clinicians toward asking specifically about current and prior psychiatric medications when pigmentary change, unusual macular findings or unexplained visual symptoms do not fit a standard inherited or degenerative pattern. (ophthalmologytimes.com) AAO educational materials support that approach in broader drug-toxicity workups. EyeWiki says the most common manifestation of direct injury to the retina and retinal pigment epithelium is pigmentary maculopathy, and the 2024 AAO coverage said multimodal detection and careful correlation with treatment history are central to avoiding missed toxicity. What did the report not say? Ophthalmology Times on October 23, 2025 did not call psilocybin a retinal toxin. (ophthalmologytimes.com) Fekrat said the substance, which she described in the context of self-medication, has no known retinal toxicity. The same report also did not recommend blanket screening protocols for all psychiatric drugs. Its narrower point was clinical recognition: when retinal findings are unexplained, the medication list — including older antipsychotic exposure — may provide the missing link. (eyewiki.aao.org) AAO and EyeWiki resources available as of May 2026 continue to list phenothiazines among drugs associated with pigmentary maculopathy, giving retina specialists a named class to keep in view during future workups. (ophthalmologytimes.com)
