This article is more than 5 years old. Information may no longer be current.
Study: Only half of patients undergo appropriate screening for hydroxychloroquine toxicity
Click Here to Manage Email Alerts
Slightly more than half of patients who presented for hydroxychloroquine toxicity screening received appropriate evaluation, according to a study.
The American Academy of Ophthalmology released revised guidelines in 2011 regarding screening for hydroxychloroquine retinal toxicity, with the goal of detecting “functional and anatomic abnormalities related to toxicity at an early stage, with the hope of minimizing irrevocable central blindness,” the study authors said.
Proper screening was defined as one subjective test, Humphrey visual field, and one objective test, spectral-domain OCT, fundus autofluorescence or multifocal electroretinography.
The study included 756 patients who took hydroxychloroquine from 2011 to 2014 and underwent 1,294 screening visits.
Initial screenings were performed on 21 patients at an outside institution. Of the 735 remaining patients, 560 (76.2%) presented solely for hydroxychloroquine screening and 175 (23.8%) presented with chief complaints not related to hydroxychloroquine.
Of the 560 patients who presented for screening only, 307 (54.8%) were appropriately screened, 144 (25.7%) were underscreened and 109 (19.5%) were inappropriately screened.
The most common initial screening tests were SD-OCT in 56.6% of patients, Humphrey visual field in 55% and Amsler grid testing in 40%.
The most common follow-up screening tests were SD-OCT in 63.5% of patients, Humphrey visual field in 42.4% and Amsler grid testing in 31.3%.
Fundus autofluorescence was performed in 97 patients (13.2%) and multifocal electroretinography was performed in three patients (0.4%) at initial screening.
Treating physicians found signs of toxicity in 12 patients (1.6%).
“The lapses in screening protocol were commonly characterized as undergoing undertesting (25.7%) or inappropriate testing (19.5%). Not only is there underscreening of hydroxychloroquine patients as a whole ... and poor systematic failures to dose correctly ... but also there is a provider error in screening patients correctly,” the authors said. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Collapse
Au A, et al. Am J Ophthalmol. 2015;doi:10.1016/j.ajo.2015.06.009.
Click Here to Manage Email Alerts