Of patients presenting for hydroxychloroquine screening at a large multispecialty ophthalmic practice, almost half of the patients on hydroxychoroquine did not receive appropriate evaluation, indicating lack of adherence to guidelines. Spectral-domain optical coherence tomography (SD OCT) and 10-2 Humphrey visual field (HVF) were found to be the preferred screening modalities, with others being fundus autofluorescence (FAF) and multifocal electroretinography (mfERG).
In this study, published in the American Journal of Ophthalmology, subjects were identified with hydroxychloroquine as a medication by electronic query at a large multispecialty ophthalmic practice. Patients were excluded if patients: (1) were screened by an outside physician; (2) lacked recorded height, weight, start date, or dosing; or (3) took hydroxychloroquine for malaria prophylaxis. Screening tests were stratified by ophthalmic subspecialty. Guidelines define proper screening as 1 subjective test—HVF, and 1 objective test—SD OCT, FAF) or mfERG. Adherence to guidelines was determined by categorizing practices as: (1) “appropriate”—consistent with guidelines; (2) “underscreened”—insufficient testing; or (3) “inappropriate”—no testing.
The study comprised 756 patients with a mean age of 56 years undergoing 1294 screening visits. Twenty-one patients received initial screenings outside the institution. Most common screening tests employed included SD OCT (56.6%), 10-2 HVF (55.0%), and Amsler grid (40.0%). Of the 735 initial screenings, 341 (46.4%) were appropriately screened, 204 (27.8%) underscreened, and 190 (25.9%) inappropriately screened. Of those who presented solely for screening (560), 307 (54.8%) were appropriately screened, 144 (25.7%) underscreened, and 109 (19.5%) inappropriately screened.
Of patients presenting for hydroxychloroquine screening, 54.8% of patients received appropriate evaluation, indicating lack of adherence to guidelines. Overall, SD OCT and 10-2 HVF were the preferred screening modalities, with FAF and mfERG less frequently ordered.
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