Compliance With Hydroxychloroquine Screening Guidelines at a Large Academic Medical Center

Abstract

Purpose: Long-term hydroxychloroquine use can result in irreversible maculopathy and vision loss. New screening guidelines to identify early maculopathy were issued by American Academy of Ophthalmology (AAO) in 2016; however, few studies have evaluated compliance with these updated guidelines.

Methods: This cross-sectional study evaluated compliance with hydroxychloroquine maculopathy screening examinations at a large academic institution. Patients seen in the ophthalmology department who were prescribed hydroxychloroquine between 2011 and 2021 were included. This retrospective chart review included patients screened for hydroxychloroquine toxicity between 2011 and 2021. The main outcome measure was compliance with AAO screening guidelines (based on 2011 guidelines for patients screened between 2011 and 2015 and on 2016 guidelines for those screened in 2016 and later).

Results: Of the 419 patients included, 239 were evaluated between 2011 and 2015 and 357 between 2016 and 2021. Only 60.7% of patients screened before 2016 met the recommended screening examination frequency, while 40.6% received adequate visual field screenings. Of patients screened after 2016, 55.3% met the recommended examination screening frequency, 46.4% received screening with macula ocular coherence tomography at the recommended interval, and 21.0% received appropriate visual field screening. One third of patients were prescribed higher than the recommended 5 mg/kg/day of hydroxychloroquine. Ten patients developed definite macular toxicity; most had concomitant risk factors for toxicity.

Conclusions: Despite clear guidelines set forth by AAO in 2011 and 2016, compliance with screening was suboptimal. Hydroxychloroquine prescribers and eye care providers must collaborate to ensure patients are not overdosed and that they receive appropriate maculopathy screening.

Keywords: hydroxychloroquine; hydroxychloroquine maculopathy; macular ocular coherence tomography retinal toxicity; medication screening; visual field.

Figure 1.

Percentage of patients on hydroxychloroquine screened after 2016 meeting the 2016 American Academy of Ophthalmology hydroxychloroquine maculopathy screening guidelines for examination by an ophthalmologist.

Figure 2.

Percentage of patients on hydroxychloroquine screened after 2016 meeting the 2016 American Academy of Ophthalmology hydroxychloroquine maculopathy screening guidelines for macula ocular coherence tomography (OCT).

Figure 3.

Percentage of patients on hydroxychloroquine screened after 2016 meeting the 2016 American Academy of Ophthalmology hydroxychloroquine maculopathy screening guidelines for visual field analysis.