Rheumatologists' attitudes toward routine screening for hydroxychloroquine retinopathy

Area of Science:

• Ophthalmology
• Rheumatology
• Clinical Practice Guidelines

Background:

• Hydroxychloroquine (HCQ) is frequently prescribed for autoimmune conditions.
• HCQ retinopathy is a serious potential side effect requiring monitoring.
• Current screening practices among rheumatologists vary.

Purpose of the Study:

• To assess rheumatologists' current practices and attitudes regarding ophthalmologic screening for HCQ retinopathy.
• To evaluate the acceptability of potential guidelines that discourage routine screening.

Main Methods:

• A survey was emailed to 300 US rheumatologists from the ACR Directory.
• Participants were queried on current screening habits, reasons for screening, and response to hypothetical guidelines.
• Logistic regression analyzed factors influencing adherence to discouraging guidelines.

Main Results:

• 94% of responding rheumatologists screen patients annually for HCQ retinopathy.
• Key reasons for continued screening include zero risk tolerance for visual loss (75%) and legal liability concerns (74%).
• 44% would continue routine screening even if guidelines discouraged it; unwillingness to risk visual damage was a significant factor against guideline adherence.

Conclusions:

• The majority of rheumatologists routinely screen for HCQ retinopathy.
• Many rheumatologists are unlikely to follow guidelines discouraging this screening, prioritizing patient safety and risk aversion.
• Physician attitudes toward risk significantly influence adherence to practice guidelines.