Hydroxychloroquine Screening Practice Patterns Within a Large Multispecialty Ophthalmic Practice

Au, Adrian; Parikh, Vishal S.; Modi, Yasha S.; Ehlers, Justis P.; Schachat, Andrew P.; Singh, Rishi P.

doi:10.1016/j.ajo.2015.06.009

Cited by 19 publications

(22 citation statements)

References 23 publications

(33 reference statements)

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“…In the 2011 AAO revised guidelines, recommended retinal exams included one subjective test and one objective test (SD-OCT, multifocal ERD or fundus autofluorescence) 3 . HCQ screening entirely consistent with the later 2011 AAO guidelines was reported to be 54% in a study of 2011-2014 HCQ users seen in a large ophthalmologic clinic in Cleveland 15 .…”

Section: Discussionmentioning

confidence: 71%

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Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000–2010

Lin

Marmor

Barbhaiya

et al. 2018

Arthritis Care & Research

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Only one-third of patients with SLE enrolled in Medicaid and in whom HCQ was newly initiated received the recommended baseline retinal examinations, and this proportion did not significantly increase from 2000 to 2010. The sociodemographic variation in this recommended care has been observed for other recommended medical care in SLE and requires both further investigation and interventions to address it.

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Section: Discussionmentioning

confidence: 71%

“…Physician specialty is not available within MAX. Ophthalmologic sub-specialty preferential practice patterns have been reported for HCQ eye exams: retinal specialists may perform more retinal imaging, while comprehensive ophthalmologists rely upon Amsler grid testing 15 .…”

Section: Discussionmentioning

confidence: 99%

Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000–2010

Lin

Marmor

Barbhaiya

et al. 2018

Arthritis Care & Research

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“…In this study, 25.7% received fewer than the recommended investigations; SD-OCT and 10-2 visual field testing were often performed, but AF and mfERG often omitted. 77 Should a screening programme for HCQ retinopathy be instituted, additional administrative support and regional organisation, similar to that used to organise retinal screening for patients with diabetes in the UK, may be required to introduce quality control into the process of screening: ensuring patients are assessed, and recalled when required. The caring physicianeither Rheumatologist or General Practitionerand patients on HCQ will need to be aware of the schedule for screening so that patients requiring screening receive it.…”

Section: Adherence To Screeningmentioning

confidence: 99%

Hydroxychloroquine retinopathy

Yusuf

Sharma

Luqmani

et al. 2017

Eye

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189

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Hydroxychloroquine (HCQ; Plaquenil) is used increasingly in the management of a variety of autoimmune disorders, with well established roles in dermatology and rheumatology and emerging roles in oncology. Hydroxychloroquine has demonstrated a survival benefit in patients with systemic lupus erythematosus; some clinicians advocate its use in all such patients. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20% after 20 years of treatment. This review aims to provide an update on HCQ/CQ retinopathy. We summarise emerging treatment indications and evidence of efficacy in systemic disease, risk factors for retinopathy, prevalence among HCQ users, diagnostic tests, and management of HCQ retinopathy. We highlight emerging risk factors such as tamoxifen use, and new guidance on safe dosing, reversing the previous recommendation to use ideal body weight, rather than actual body weight. We summarise uncertainties and the recommendations made by existing HCQ screening programmes. Asian patients with HCQ retinopathy may demonstrate an extramacular or pericentral pattern of disease; visual field testing and retinal imaging should include a wider field for screening in this group. HCQ is generally safe and effective for the treatment of systemic disease but because of the risk of HCQ retinal toxicity, modern screening methods and ideal dosing should be implemented. Guidelines regarding optimal dosing and screening regarding HCQ need to be more widely disseminated.

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“…Physician adherence to ophthalmologic guidelines is reported at about 50%. 33 This statistic is jarring, given the potential for permanent loss of vision in those with hydroxychloroquine-mediated retinopathy, and demonstrates the importance of reinforcing proper understanding of the use of hydroxychloroquine in clinical practice.…”

Section: Shippey and Colleaguesmentioning

confidence: 99%