title: Impact of the revised american academy of ophthalmology guidelines regarding hydroxychloroquine screening on actual practice.
abstract: OBJECTIVE
  To determine the impact of the revised academy guidelines on screening for hydroxychloroquine retinopathy.
  
  
  METHODS
  Retrospective, observational cohort study.
  
  
  METHODS
  setting: Private practice of 29 doctors. study population: Total of 183 patients for follow-up and 36 patients for baseline screening. observation procedure: Review of charts, 10-2 visual fields (VFs), multifocal electroretinograms (mfERG), and spectral-domain optical coherence tomography (SD-OCT) images before and after the revised guidelines. main outcome measure: Rates of use of ancillary tests and clinical intervention, costs of screening, follow-up schedules, and comparative sensitivity of tests.
  
  
  RESULTS
  New hydroxychloroquine toxicity was found in 2 of 183 returning patients (1.1%). Dosing above 6.5 mg/kg/d was found in 28 of 219 patients (12.8%), an underestimate because patient height, weight, and daily dose were not determined in 77 (35.1%), 84 (38.4%), and 59 (26.9%), respectively. In 10 of the 28 (35.7%), the dose was reduced, in 2 (7.1%) hydroxychloroquine was stopped, but in 16 (57.1%) no action was taken. The cost of screening rose 40%/patient after the revised guidelines. Fundus autofluorescence imaging was not used. No toxicity was detected by adding mfERG or SD-OCT. In no case was a 5-year period free of follow-up recommended after baseline screening in a low-risk patient.
  
  
  CONCLUSIONS
  Detection of toxic daily dosing is a cost-effective way to reduce hydroxychloroquine toxicity, but height, weight, and daily dose were commonly not checked. The revised guidelines, emphasizing mfERG, SD-OCT, or FAF, raised screening cost without improving case detection. The recommended 5-year screening-free interval for low-risk patients after baseline examination was ignored.
authors.affiliation: Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA. dbrowning@ceenta.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Browning
mesh_terms: D000047:Academies and Institutes / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001824:Body Constitution; D003362:Cost-Benefit Analysis; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics / Q000592:standards*; D016903:Drug Monitoring; D004596:Electroretinography / Q000191:economics / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000592:standards; D008875:Middle Aged; D009885:Ophthalmology / Q000191:economics / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012160:Retina / Q000187:drug effects / Q000473:pathology*; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000191:economics; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000191:economics / Q000592:standards; D014481:United States; D014794:Visual Fields; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine