Hydroxychloroquine toxicity

Hydroxychloroquine screening lacks adherence to recommended guidelines

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).

Hydroxychloroquine toxicity

(c) ophth.uiowa.edu – the above image is not related to the study highlighted in this article

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.

To read more about hydroxychloroquine-induced retinal toxicity, click on the following: 1, 2 & 3.

Featured image: (c) ophth.uiowa.edu

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