Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity

Chiu, Stephan; Shaw, Jeremy; Luong, Tiffany; Fong, Donald S.; Modjtahedi, Bobeck S.

doi:10.2147/opth.s170789

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…For future analysis we also aim to include patient use of hydroxychloroquine, a treatment used for autoimmune conditions and capable of leading to retinal toxicity at higher dose concentrations. However, insurance claim databases at this time do not generally include dosage frequency, and inconsistencies in ICD-9 coding for hydroxychloroquine retinal toxicity have been observed 58. Despite the current limitations in health claim analysis, our analyses provide compelling data on the association between RA and dry AMD diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Increased Nonexudative Age-Related Macular Degeneration Diagnosis Among Medicare Beneficiaries With Rheumatoid Arthritis

Schnabolk

Rohrer

Simpson

2019

Invest. Ophthalmol. Vis. Sci.

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Purpose AMD is the leading cause of blindness in the United States. The role of secondary inflammatory disease on AMD progression is largely unknown. Here we investigate the association between AMD and rheumatoid arthritis (RA), using MarketScan data for patients aged ≥65 years on Medicare. Methods Baseline data were extracted for subjects with at least two International Classification, Ninth Revision (ICD-9) diagnosis codes of RA and control subjects (no RA) and were matched at baseline by propensity score. Matched cohort data were extracted post-baseline time and examined up to 4.5 years of follow-up for ICD-9 diagnosis code AMD records. Multivariable regression models compared risk of an AMD diagnosis post-baseline for RA subjects and matched controls. Days until first AMD diagnosis between RA patients and controls was examined using survival analysis. Results Risk of new AMD diagnosis was elevated in RA patients (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.98–2.18), with an increase in nonexudative AMD patients ( P < 0.0001). Risk was elevated in female ( n = 27,548) (OR 1.11; 95% CI 1.05–1.17) compared with male ( n = 9704; P < 0.001) patients. The time to first AMD diagnosis was shorter for RA subjects than controls ( P < 0.0001). Conclusions Our analysis provides support of association between RA diagnosis and increased nonexudative AMD diagnosis.

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Section: Discussionmentioning

confidence: 99%

Increased Nonexudative Age-Related Macular Degeneration Diagnosis Among Medicare Beneficiaries With Rheumatoid Arthritis

Schnabolk

Rohrer

Simpson

2019

Invest. Ophthalmol. Vis. Sci.

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“…The ICD codes used for HCQ retinopathy mostly were 362.10 and 362.55 in the previous literature. [13] However, in the early stage of HCQ retinal toxicity, the macular degeneration was relatively unspecific, thus 362.89 and 362.9 were also included in our study to detect potential HCQ retinopathy. We ruled out patients who were previously diagnosed these retinal disorders, and 5745 patients remained for analysis.…”

Section: Methodsmentioning

confidence: 99%

Current screening practice in patients under long-term hydroxychloroquine medication in Taiwan

et al. 2019

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Hydroxychloroquine (HCQ), an analog of chloroquine, is widely used in various rheumatologic and dermatologic disorders. However, it may cause severe retinopathy with long-term use. The guidelines proposed by the American Academy of Ophthalmology suggested a baseline fundus examination and an annual screening after 5 years by using automated visual fields (VF) plus spectral-domain optical coherence tomography (SD-OCT). Both multifocal electroretinogram (mfERG) and fundus autofluorescence (FAF) can also be used to improve the accuracy of diagnosis. The purpose of this study was to examine if the current HCQ screening practice in Taiwan was sufficient according to the guidelines to prevent severe macular complications. This study could remind every doctor to explain visual side effects thoroughly to every patient using HCQ, and refer patients for the ophthalmologic survey to eliminate potential visual impairment caused by this medicine. This nationwide population-based cohort study included all patients who started taking HCQ (n = 5826) from January 1, 1997, to December 31, 2007, in the Longitudinal Health Insurance Database 2000. The ICD codes used for HCQ retinopathy were 362.10, 362.55, 362.89, and 362.9. Patients previously diagnosed these retinal disorders were excluded. Demographic data including sex, age, diagnostic tools used, and the date of the initial diagnosis of the subsequent HCQ-related retinal disorder were collected. Patients were divided into 2 groups. The patients taking HCQ <5 years were defined as group 1, and >5 years as group 2. The risk of developing retinal diseases between these 2 groups was compared with a 2-sample t -test for continuous variables, and Fisher's exact test for discrete variables. Multiple logistic regressions were used for odds ratio calculation. The baseline examination ratio of the automated VF, SD-OCT scans, and multifocal electroretinograms (mfERGs) in the first 3 months were only 0.2% in both groups. The screening ratio of the 3 examination tools after 5 years were 1.1% in group 1 and 1.2% in group 2. 2.5% and 3.9% of patients developed a retinal disorder after HCQ use in group 1 and 2, respectively. The risk of developing retinal disorder was significantly higher in group 2 (relative risk = 1.53, P = .006). The odds ratio (OR) was also significantly higher in group 2 (1.67 with 95% cumulative incidence 1.20–2.30) The examination ratio according to the guidelines was very low in Taiwan. Thus, it is very important for doctors who prescribe HCQ to schedule both baseline and annual ophthalmology screening tests and inform patients of possible severe ocular complications, even in the patient taking HCQ <5 years. It is also important for ophthalmologists to review medical history carefully to find out the causes of retinotoxicity. Medications should be stopped, if possible when toxicity is recognized or strongly suspected.

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“…Although we did not conduct the equivalent screening manually, in previous work, we were able to use our AI to match a published systematic literature review on inflammatory bowel disease [14], and therefore have already demonstrated that we can generate the equivalent screening using our tool to that obtained with a manual process. [15] incidence of hydroxychloroquine-related retinopathy patients who were treated with recommended dosages of the drug for a mean of 8.7 years 400 2 Mavrikakis et al [15] retinal toxicity was noted during the first 6 years of treatment hydroxychloroquine 526 0 Spinelli et al [16] ophthalmological alterations, confirmed by the ophthalmological examination chloroquine, hydroxychloroquine, or both 845 46 Navajas et al [17] developed retinal toxicity with scotomas in the Amsler grid and Humphrey 10-2 automated perimetry, as well as abnormal multifocal electroretinography 800 mg/day hydroxychloroquine 12 3 Singh et al [18] documented blindness, in all cases attributed to a cause other than hydroxychloroquine-related ocular toxicity long-term hydroxychloroquine 11 0 Chiu et al [19] had hydroxychloroquine toxicity hydroxychloroquine 678 35…”

Section: Rma Process For the Association Of Eye Issues With Hydroxychloroquine Usementioning

confidence: 98%

Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine (Preprint)

Michelson¹,

Chow²,

Martin³

et al. 2020

Preprint

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UNSTRUCTURED Rapid access to evidence is crucial in times of evolving clinical crisis. To that end, we propose a novel mechanism to answer clinical queries: Rapid Meta-Analysis (RMA). Unlike traditional meta-analysis, RMA balances quick time-to-production with reasonable data quality assurances, leveraging Artificial Intelligence to strike this balance. This article presents an example RMA to a currently relevant clinical question: Is ocular toxicity and vision compromise a side effect with hydroxychloroquine therapy? As of this writing, hydroxychloroquine is a leading candidate in the treatment of COVID-19. By combining AI with human analysis, our RMA identified 11 studies looking at ocular toxicity as a side effect and estimated the incidence to be 3.4% (95% CI: 1.11-9.96%). The heterogeneity across the individual study findings was high, and interpretation of the result should take this into account. Importantly, this RMA, from search to screen to analysis, took less than 30 minutes to produce.

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Coding patterns used by ophthalmologists for hydroxychloroquine retinal toxicity

Cited by 8 publications

References 5 publications

Increased Nonexudative Age-Related Macular Degeneration Diagnosis Among Medicare Beneficiaries With Rheumatoid Arthritis

Increased Nonexudative Age-Related Macular Degeneration Diagnosis Among Medicare Beneficiaries With Rheumatoid Arthritis

Current screening practice in patients under long-term hydroxychloroquine medication in Taiwan

Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine (Preprint)

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