Current practices for monitoring ocular toxicity related to hydroxychloroquine (Plaquenil) therapy.
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.


CONCLUSIONS
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.
Mazzuca
S A
SA
Department of Medicine (Rheumatology and Biostatistics Divisions), Indiana University School of Medicine, Indianapolis.
Yung
R
R
Brandt
K D
KD
Yee
R D
RD
Katz
B P
BP
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005123:Eye / Q000187:drug effects*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009885:Ophthalmology / Q000379:methods; D012219:Rheumatology / Q000379:methods
D006886:Hydroxychloroquine