title: Implementation of recommendations for the screening of hydroxychloroquine retinopathy: poor adherence of rheumatologists and ophthalmologists.
abstract: The American Academy of Ophthalmology published in 2011 revised recommendations regarding screening for hydroxychloroquine (HCQ) toxicity. We aimed to assess implementation of these recommendations by rheumatologists and ophthalmologists. A questionnaire regarding screening practices for HCQ toxicity was distributed among all members of the Israeli societies of Rheumatology and Ophthalmology. A total of 128 physicians responded to the questionnaire (rheumatologists: 60, ophthalmologists: 68). Only 5% of the rheumatologists and 15% of the ophthalmologists are aware of ophthalmologic assessments recommended for baseline and follow-up evaluation. When an abnormal test is detected, even if inappropriate for HCQ toxicity screening, 60% of the responders recommend cessation of therapy. Only 13% of the responders recommend first follow-up after five years for patients without risk factors; the remainder recommend more frequent testing. Ninety-six percent of the responders are not aware of all of the known risk factors for HCQ toxicity. Use of inappropriate tests to detect HCQ retinal toxicity may lead to unnecessary cessation of beneficial treatment with risk of disease flare, while lack of consideration of risk factors may put patients at risk for toxicity. These results emphasize the importance of implementing the recommendations to ensure safe and effective use of this drug.
authors.affiliation: 1 Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Shulman
authors.affiliation: 2 Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Wollman
authors.affiliation: 2 Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Brikman
authors.affiliation: 2 Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Padova
authors.affiliation: 2 Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Elkayam
authors.affiliation: 2 Department of Rheumatology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Paran
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use / Q000633:toxicity*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use / Q000633:toxicity*; D007557:Israel; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008403:Mass Screening / Q000592:standards*; D000072163:Ophthalmologists; D017410:Practice Guidelines as Topic; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis*; D000072140:Rheumatologists; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine
keywords: Hydroxychloroquine; risk factors; systemic lupus erythematosus; toxicity