Related Experiment Videos
Current practices for monitoring ocular toxicity related to hydroxychloroquine (Plaquenil) therapy
S A Mazzuca1, R Yung, K D Brandt
1Department of Medicine (Rheumatology and Biostatistics Divisions), Indiana University School of Medicine, Indianapolis.
Objective:
Growing interest in aggressive early management of rheumatoid arthritis (RA) with hydroxychloroquine (alone or in combination with other immunomodulating drugs) is reason to review current practices for monitoring ocular toxicity in patients who take antimalarial therapy.
Methods:
We surveyed by mail all ophthalmologists and rheumatologists in the State of Indiana about their practices in this regard.
Results:
Twenty-nine of 31 rheumatologists (94%) responded. All but one recommended ophthalmologic examinations every 6 months and 41% would leave the choice of testing procedures to the ophthalmologist. Fifty percent had discontinued hydroxychloroquine because of a patient's failure to make and/or keep an appointment with the ophthalmologist. Of 213 ophthalmologists surveyed, 150 (70%) responded. Seventy-nine percent recommended semiannual examinations. Funduscopy, visual acuity, and color vision tests were reported to be performed routinely. Eleven of 13 retina specialists (85%), but only 25% of 127 general ophthalmologists, would obtain macular photographs (p < 0.001). Forty-two percent of general ophthalmologists, compared with 8% of retina specialists, would perform computerized perimetry (p < 0.001). Recognition of retinal hyperpigmentation as a classic sign was surprisingly low in both groups. Concurrent review of the medical records of 24 patients with RA or systemic lupus erythematosus showed extremely variable followup intervals for ophthalmologic examination; 7 of the 24 patients had no record of an ophthalmologic evaluation.
Conclusion:
As interest in the early, aggressive management of RA continues to grow, significant education needs to be devoted to the monitoring and diagnosis of ocular toxicity of hydroxychloroquine by both rheumatologists and ophthalmologists.
Insights
Ophthalmologists and rheumatologists need more education on monitoring hydroxychloroquine ocular toxicity. Current practices show variable follow-up and low recognition of key diagnostic signs for rheumatoid arthritis patients.
Area of Science:
- Ophthalmology
- Rheumatology
- Pharmacology
Background:
- Growing interest in early rheumatoid arthritis (RA) management with hydroxychloroquine.
- Need to review current practices for monitoring ocular toxicity in patients on antimalarial therapy.
Purpose of the Study:
- To survey ophthalmologists and rheumatologists in Indiana regarding their practices for monitoring hydroxychloroquine ocular toxicity.
- To identify gaps in current monitoring and diagnostic practices.
Main Methods:
- Mail survey of all ophthalmologists and rheumatologists in Indiana.
- Analysis of survey responses regarding examination frequency, testing procedures, and reasons for drug discontinuation.
- Review of medical records for patient follow-up intervals.
Main Results:
- High rheumatologist (94%) and ophthalmologist (70%) response rates.
- Most physicians recommended semiannual examinations, but practices varied.
- Low recognition of retinal hyperpigmentation; significant differences in macular photography and perimetry use between general ophthalmologists and retina specialists.
- Variable patient follow-up and lack of documented evaluations in a subset of patient records.
Conclusions:
- Significant educational needs exist for both rheumatologists and ophthalmologists regarding hydroxychloroquine ocular toxicity monitoring.
- Improved diagnostic strategies and consistent follow-up are crucial for patients with rheumatoid arthritis on antimalarial therapy.