PMID- 23218706
OWN - NLM
STAT- MEDLINE
DCOM- 20130404
LR  - 20220317
IS  - 1879-1891 (Electronic)
IS  - 0002-9394 (Linking)
VI  - 155
IP  - 3
DP  - 2013 Mar
TI  - Impact of the revised american academy of ophthalmology guidelines regarding 
      hydroxychloroquine screening on actual practice.
PG  - 418-428.e1
LID - S0002-9394(12)00681-2 [pii]
LID - 10.1016/j.ajo.2012.09.025 [doi]
AB  - PURPOSE: To determine the impact of the revised academy guidelines on screening 
      for hydroxychloroquine retinopathy. DESIGN: 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.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Browning, David J
AU  - Browning DJ
AD  - Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA. 
      dbrowning@ceenta.com
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20121204
PL  - United States
TA  - Am J Ophthalmol
JT  - American journal of ophthalmology
JID - 0370500
RN  - 0 (Antirheumatic Agents)
RN  - 4QWG6N8QKH (Hydroxychloroquine)
SB  - IM
CIN - Am J Ophthalmol. 2013 Mar;155(3):413-4. PMID: 23394729
CIN - Am J Ophthalmol. 2013 Aug;156(2):410-1. PMID: 23870364
CIN - Am J Ophthalmol. 2013 Aug;156(2):410. PMID: 23870365
MH  - Academies and Institutes/standards
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antirheumatic Agents/*adverse effects
MH  - Arthritis, Rheumatoid/drug therapy
MH  - Body Constitution
MH  - Cost-Benefit Analysis
MH  - Diagnostic Techniques, Ophthalmological/economics/*standards
MH  - Drug Monitoring
MH  - Electroretinography/economics/standards
MH  - Female
MH  - Health Care Costs
MH  - Humans
MH  - Hydroxychloroquine/*adverse effects
MH  - Lupus Erythematosus, Systemic/drug therapy
MH  - Male
MH  - Mass Screening/economics/standards
MH  - Middle Aged
MH  - Ophthalmology/economics/standards
MH  - Practice Guidelines as Topic/*standards
MH  - Practice Patterns, Physicians'/*standards
MH  - Retina/drug effects/*pathology
MH  - Retinal Diseases/chemically induced/*diagnosis/economics
MH  - Retrospective Studies
MH  - Tomography, Optical Coherence/economics/standards
MH  - United States
MH  - Visual Fields
MH  - Young Adult
EDAT- 2012/12/12 06:00
MHDA- 2013/04/05 06:00
CRDT- 2012/12/11 06:00
PHST- 2012/07/23 00:00 [received]
PHST- 2012/09/19 00:00 [revised]
PHST- 2012/09/19 00:00 [accepted]
PHST- 2012/12/11 06:00 [entrez]
PHST- 2012/12/12 06:00 [pubmed]
PHST- 2013/04/05 06:00 [medline]
AID - S0002-9394(12)00681-2 [pii]
AID - 10.1016/j.ajo.2012.09.025 [doi]
PST - ppublish
SO  - Am J Ophthalmol. 2013 Mar;155(3):418-428.e1. doi: 10.1016/j.ajo.2012.09.025. Epub 
      2012 Dec 4.