title: Hydroxychloroquine screening practice patterns within a large multispecialty ophthalmic practice.
abstract: OBJECTIVE
  To determine provider compliance with hydroxychloroquine screening following the revised recommendations published in 2011 by the American Academy of Ophthalmology.
  
  
  METHODS
  Evaluation of adherence to a screening protocol.
  
  
  METHODS
  Subjects were identified with hydroxychloroquine as a medication by electronic query at a large multispecialty ophthalmic practice. Patients were excluded if patients: (1) were screened by an outside physician; (2) lacked recorded height, weight, start date, or dosing; or (3) took hydroxychloroquine for malaria prophylaxis. Screening tests were stratified by ophthalmic subspecialty. Guidelines define proper screening as 1 subjective test-Humphrey visual field (HVF), and 1 objective test-spectral-domain optical coherence tomography (SD OCT), fundus autofluorescence (FAF), or multifocal electroretinography (mfERG). Adherence to guidelines was determined by categorizing practices as: (1) "appropriate"-consistent with guidelines; (2) "underscreened"-insufficient testing; or (3) "inappropriate"-no testing.
  
  
  RESULTS
  The study comprised 756 patients with a mean age of 56 years undergoing 1294 screening visits. Twenty-one patients received initial screenings outside the institution. Most common screening tests employed included SD OCT (56.6%), 10-2 HVF (55.0%), and Amsler grid (40.0%). Of the 735 initial screenings, 341 (46.4%) were appropriately screened, 204 (27.8%) underscreened, and 190 (25.9%) inappropriately screened. Of those who presented solely for screening (560), 307 (54.8%) were appropriately screened, 144 (25.7%) underscreened, and 109 (19.5%) inappropriately screened.
  
  
  CONCLUSIONS
  Of patients presenting for hydroxychloroquine screening, 54.8% of patients received appropriate evaluation, indicating lack of adherence to guidelines. Overall, SD OCT and 10-2 HVF were the preferred screening modalities, with FAF and mfERG less frequently ordered.
authors.affiliation: Case Western Reserve School of Medicine, Cleveland, Ohio.
authors.forename: Adrian
authors.initials: A
authors.lastname: Au
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Vishal
authors.initials: V
authors.lastname: Parikh
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Yasha S
authors.initials: YS
authors.lastname: Modi
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Schachat
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: singhr@ccf.org.
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
mesh_terms: D000047:Academies and Institutes / Q000592:standards; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000633:toxicity*; D002648:Child; D004596:Electroretinography; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006886:Hydroxychloroquine / Q000633:toxicity*; D008297:Male; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D009885:Ophthalmology / Q000458:organization & administration / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012160:Retina / Q000187:drug effects; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine