Hydroxychloroquine retinopathy screening
- 1Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA
- 2Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
- 3Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
- 4Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
- 5Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
- Dr M S Lee, 420 Delaware Street SE, MMC 493, Minneapolis, MN 55455, USA;
- Accepted 22 August 2008
- Published Online First 1 October 2008
Aim: To compare current hydroxychloroquine retinopathy screening practices with the published 2002 American Academy of Ophthalmology (AAO) Preferred Practice Patterns (PPP).
Methods: A multiple-choice survey was distributed to 105 ophthalmologists to assess current screening practices and knowledge of patient risk factors. Results were compared with the PPP guidelines. A cost analysis of the PPP and survey paradigms was conducted.
Results: Sixty-seven (64%) of 105 surveys were completed. The majority (90%) of physicians screen for hydroxychloroquine retinopathy with either central automated threshold perimetry or Amsler grid as recommended by the PPP. Most survey respondents could not correctly identify the evidence-based risk factors. The majority screen more frequently than recommended: 87% screen high-risk patients and 94% screen low-risk patients more frequently than recommended in the PPP. The increased screening frequency of low-risk patients translates into an excess of $44 million in the first 5 years of therapy. If all patients were screened using exact PPP paradigm, savings could exceed $150 million every 10 years.
Conclusions: Ophthalmologists currently screen for hydroxychloroquine retinopathy correctly; however, their lack of familiarity with evidence-based guidelines may result in excessive follow-up. Increasing awareness and implementation of the PPP could potentially reduce hydroxychloroquine retinopathy screening costs significantly.
Funding: This work was supported by an unrestricted grant to the University of Minnesota from Research to Prevent Blindness New York and Minnesota Lions.
Competing interests: None.
Ethics approval: Ethics approval was provided by the Institutional Review Board, University of Minnesota, Minneapolis, MN.