How to set up a Hydroxychloroquine Retinopathy Screening Service

Zaidi, F H; Rennie, Christina; Drinkwater, A. K.; Sahu, Debendra; Akyol, Engin; Lotery, Andrew

doi:10.1038/s41433-019-0418-y

Cited by 9 publications

(6 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such virtual clinic pathways have been well described in the literature. 16,17 Further initiatives include integration of telehealth pathways in our daily practice, such as phone review of symptoms for patients who had undergone uncomplicated cataract surgery at the first postoperative week. 18 These initiatives have been found to be safe and effective and have been integrated into our existing suite of clinical services.…”

Section: Mitigating Exposure Risksmentioning

confidence: 99%

Policy recommendations in response to the resurgence of COVID-19 cases for institutional medical practice from an ophthalmic perspective

Lim¹,

Lim²,

Goh³

et al. 2020

Asian JO

View full text Add to dashboard Cite

Objectives: The COVID-19 pandemic has been declared a public health emergency of international concern. Singapore was one of the first countries to identify imported cases and also experience a second wave of outbreaks. A slew of measures enacted by the government to ‘flatten the curve’ has directly impacted upon the way we practice. Study design/Methods: This article describes steps enacted by our department to ensure sustainability of our ophthalmic practice. Results: We share considerations at various time points and policies implemented in a stepwise approach in response to the worsening community situation. We further discuss our phased approach towards reinstating our services safely and effectively for patients and staff in a markedly different practice climate. Conclusions: The COVID-19 pandemic has markedly upended the way we practice medicine. Reflecting on the ideal measures required for such occurrences in the future will empower practices with the ability to respond effectively to future outbreaks.

show abstract

Section: Mitigating Exposure Risksmentioning

confidence: 99%

Policy recommendations in response to the resurgence of COVID-19 cases for institutional medical practice from an ophthalmic perspective

Lim¹,

Lim²,

Goh³

et al. 2020

Asian JO

View full text Add to dashboard Cite

show abstract

“…We welcome the data that Gunasekera and Gupta provide in their letter on monitoring for hydroxychloroquine (HCQ) retinal toxicity in response to the Royal College of Ophthalmologists' guidance and our published experience in setting up such a service together with some early results from University Hospital Southampton NHS Foundation Trust (UHS) [1]. The Royal College guidance on monitoring for retinal toxicity from hydroxychloroquine was based on extensive review of the existing dataset at the time up to the start of 2018 and was supported in addition to ophthalmologists by representatives from the specialities of both dermatology and rheumatology [2].…”

Section: To the Editormentioning

confidence: 99%

Hydroxychloroquine retinopathy: screening and genetics

Zaidi

Rennie

Drinkwater

et al. 2020

Eye

Self Cite

View full text Add to dashboard Cite

“…In a British study, where 1,500 adults and 25 children were on HCQ, the average dose of children was found to be higher than adults at 6.5 mg/kg. 23 Another study of 1,681 patients, where 162 (10%) of them were younger than 18 years, reported that lower weight (<68 kg) was a risk factor for a higher HCQ dose than recommended (<5 mg/kg). 24 Furthermore, patients with rheumatic conditions may have more severe disease requiring higher doses of HCQ and longer duration of therapy 8 increasing their overall risk for HCQ retinopathy.…”

Section: Introductionmentioning

confidence: 99%

Improving eye screening practice among pediatric rheumatology patients receiving hydroxychloroquine

AlAhmed

Way

Akoghlanian

et al. 2020

Lupus

View full text Add to dashboard Cite

Objective Hydroxychloroquine (HCQ) is commonly used in the treatment of various autoimmune diseases related to its many benefits and favorable safety profile. Although HCQ retinopathy was considered to be uncommon, a prevalence of 7.5% was described in a recent study making early detection critical. The most updated screening guidelines by the American Academy of Ophthalmology were published in 2016; however, it lacked pediatric-specific recommendations and the overall compliance with screening guidelines was poor in previous studies. We developed a quality improvement (QI) initiative aiming to create institutional screening recommendations. Additionally, to increase eye screening in pediatric rheumatology clinic for patients receiving HCQ from 65% to 85% in 12 months and to sustain that rate for at least 6 months. Methods We formed a multidisciplinary team of pediatric rheumatologists and ophthalmologists, clinical pharmacist, clinic nurses, QI specialist, quality data technician and administrative staff. We included patients receiving HCQ and who were evaluated at Nationwide Children’s Hospital rheumatology clinic. A key driver diagram was formulated to identify barriers to compliance and determine possible interventions. Main interventions included summarizing screening guidelines in a step by step algorithm, increasing awareness of these guidelines among patients and providers, improving collaboration and communication with ophthalmologists, and initiating pre-visit planning. Results Baseline performance data included 164 patients. Fifty-four (33%) of those patients were at high risk for HCQ retinopathy. Of them, 50% were on HCQ dose of >5 mg/kg/day and 31.5% had been taking HCQ for ≥5 years. Two center line shifts were noticed over the course of the project. The target of 85% compliance was reached in February 2019 and was sustained until December 2019. Conclusions Our study highlights the importance of interdisciplinary communication to increase awareness of screening guidelines among medical providers and patients. Pre-visit planning played a major role in identifying patients and opportunities for optimizing eye screening in patients at risk for HCQ retinopathy. Collaboration between rheumatologists and ophthalmologists is crucial in managing patients on HCQ. The implementation of same-day eye screening allowed this collaboration to be more efficient. Future efforts are being directed at monitoring and improving utilization of the effective interventions.

show abstract

How to set up a Hydroxychloroquine Retinopathy Screening Service

Cited by 9 publications

References 7 publications

Policy recommendations in response to the resurgence of COVID-19 cases for institutional medical practice from an ophthalmic perspective

Policy recommendations in response to the resurgence of COVID-19 cases for institutional medical practice from an ophthalmic perspective

Hydroxychloroquine retinopathy: screening and genetics

Improving eye screening practice among pediatric rheumatology patients receiving hydroxychloroquine

Contact Info

Product

Resources

About