Trends and practices following the 2016 hydroxychloroquine screening guidelines

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Hydroxychloroquine (HCQ) is widely prescribed for autoimmune conditions like lupus and rheumatoid arthritis.
• Ocular toxicity is a known risk associated with HCQ, necessitating regular screening.
• The American Academy of Ophthalmology (AAO) updated screening guidelines in 2016.

Purpose of the Study:

• To characterize HCQ users, referral patterns, and dosing.
• To evaluate adherence to the 2016 AAO screening guidelines by various eye care providers.
• To identify disparities in screening practices, particularly concerning visual field testing in different ethnic groups.

Main Methods:

• Retrospective review of electronic health records (EHR) for 166 patients prescribed HCQ.
• Data collection included patient demographics, HCQ indications and dosage, managing provider type, and imaging modalities used.
• Analysis focused on adherence to AAO guidelines for screening.

Main Results:

• Common indications: Systemic lupus erythematosus (52.4%), rheumatoid arthritis (18.7%).
• Over half of patients (55.4%) received higher-than-recommended HCQ doses (>5 mg/kg/day), particularly those with lower body weight.
• Visual field testing adherence was low (8.3% for Asian patients vs. 71.1% for non-Asian patients). Retinal specialists showed better adherence to overall screening modalities.

Conclusions:

• Significant variability exists in HCQ prescribing and ophthalmic screening practices compared to current AAO recommendations.
• There is a critical deficit in appropriate visual field testing for Asian patients.
• Findings underscore the need for interventions to enhance HCQ toxicity screening protocols and guideline adherence.