Author: Mya Thida Ohn (United Kingdom)
Co-authors: Ahmed Wanas, Aman Chandra, Niral Karia
Purpose
To identify percentage of cases diagnosed with definite hydroxychloroquine retinopathy in a virtual clinic setting in which diagnostic tests and history taking were performed by a technician and the diagnostic test results were reviewed by an ophthalmologist. It is also to detect percentage of cases who required annual screening according to the new Clinical Guidance Recommended by the Royal College of Ophthalmologist in December 2020 in which baseline screening was no longer recommended.
Setting/Venue
All patients who attended virtual hydroxychloroquine (HCQ) retinopathy screening in Southend University Hospital during 2019 were included in the analysis. Patients had visual acuity, near vision, central 10-2 or 30-2 automatic visual field test, SD-OCT, fundus auto-fluorescence (FAF) and color fundus photos. The tests were performed by a technician and the results were reviewed by an ophthalmologist within two weeks. History was also taken by the technician during the monitoring visit and it included dose and duration of hydroxychloroquine taken by the patient. Clinic letter and outcome were sent out to the patient and referring clinicians, GP and Rheumatologist.
Methods
A retrospective analysis was performed and electronic case records were used for data collection.
Results
Total 110 patients were included with male: female ratio of 1:3. Mean age was 61.19 and age ranged from 21 years to 90 years. Majority of patients were taking HCQ for the treatment of Rheumatic Arthritis (43.64%) followed by SLE (17.27%) and Sjogren`s (16.36%). HCQ dose varied between each patients, however 99.09% were taking less than 400mg per day. 1.82% were taking more than 400mg/day of HCQ. As screening during 2019 included all referrals received from Rheumatology and General Practitioners, patients were in different range of duration on HCQ treatment. 55.45% of patients were on HCQ treatment for more than 5 years and 44.55% were screened as baseline. Five patients (4.55%) were found to be not suitable for virtual screening because of pre-existing macular pathology which disturbed the morphology of IS-OS junction, media opacity and difficulty to take images due to positioning issue. These patients were booked to face to face clinic. HCQ retinopathy was identified in 2 patients (1.82%) and we informed to Rheumatologist. Diagnosis was made by using two or more positive test results. MfERG was requested and patients were seen in face to face clinic within two weeks.
Conlusions
Hydroxychloroquine have been used in treatment of inflammatory diseases for 70 years and reports of retinal toxicity in the early years led to the development of various screening programmes. It has also been a topic for much discussion following the publication of a paper by Melles and Marmor in 2014 who, using spectral domain optical coherence tomography and wide field auto-fluorescence, suggested that the rate of HCQ retinopathy was higher than previously thought. In our analysis, 1.82% of cases were diagnosed with HCQ retinopathy based on at least two positive diagnostic tests and it was confirmed by mfERG. Diagnostic tests included Visual Field, SD-OCT, FAF and fundus photos. Clinical recommendation on monitoring Hydroxychloroquine Retinopathy published by the Royal College of Ophthalmologists in December 2020 has confirmed here is no longer requirement for baseline monitoring. This would significantly reduce workload on HCQ screening clinics. Our analysis has shown percentage of cases who underwent baseline screening in Southend Hospital Eye Service in a year was as high as 44.55%. Percentage of patients who required annual screening in our unit in 2019 was 55.54% as adjusted by Royal College Recommendation, 2020. Majority of patients were suitable for virtual monitoring.
Financial Disclosure
No financial interest or relation to any company.
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