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Hydroxychloroquine screening practice patterns within a large multispecialty ophthalmic practice.

Adrian Au1, Vishal Parikh2, Yasha S Modi2

  • 1Case Western Reserve School of Medicine, Cleveland, Ohio.

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Ophthalmologist adherence to hydroxychloroquine screening guidelines is low, with only 54.8% of patients receiving appropriate evaluation. This highlights a need for improved hydroxychloroquine eye screening protocols.

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Area of Science:

  • Ophthalmology
  • Pharmacology
  • Medical Compliance

Background:

  • Hydroxychloroquine (HCQ) requires regular screening to prevent ocular toxicity.
  • The American Academy of Ophthalmology revised HCQ screening recommendations in 2011.
  • Provider adherence to these updated screening guidelines is crucial for patient eye health.

Purpose of the Study:

  • To assess provider compliance with 2011 American Academy of Ophthalmology guidelines for hydroxychloroquine (HCQ) screening.
  • To evaluate the frequency and appropriateness of HCQ retinopathy screening methods used in clinical practice.

Main Methods:

  • Retrospective chart review of 756 patients on HCQ at a large ophthalmic practice.
  • Screening tests analyzed included Humphrey visual field (HVF) and spectral-domain optical coherence tomography (SD OCT).
  • Adherence categorized as appropriate (guideline-compliant), underscreened, or inappropriate (no testing).

Main Results:

  • Only 46.4% of initial screenings (735) met guideline criteria.
  • Among patients presenting solely for screening (560), 54.8% received appropriate evaluation.
  • Spectral-domain optical coherence tomography (SD OCT) and 10-2 HVF were the most common tests, while fundus autofluorescence (FAF) and multifocal electroretinography (mfERG) were less utilized.

Conclusions:

  • A significant proportion of patients undergoing hydroxychloroquine screening do not receive evaluations compliant with current guidelines.
  • Findings indicate suboptimal adherence to recommended screening protocols for HCQ ocular toxicity.
  • Improved implementation of comprehensive screening, including both subjective and objective tests, is necessary.