Original articleImpact of the Revised American Academy of Ophthalmology Guidelines Regarding Hydroxychloroquine Screening on Actual Practice
Section snippets
Methods
This was a retrospective, observational cohort study. Waiver of informed consent and waiver of HIPAA authorization was approved by the Presbyterian Hospital institutional review board. The revised guidelines were published in February 2011.1 The medical records of 219 patients undergoing hydroxychloroquine screening in a multispecialty ophthalmology practice of 26 ophthalmologists and 3 optometrists between May 3, 2011 and June 12, 2012 were reviewed using a prespecified template for the
Results
Characteristics of the patients and eyes reviewed are listed in Table 1. Of the 219 patients screened, 36 (16.4%) were for baseline examinations and 183 (83.6%) were for follow-up examinations. Women made up 91.3% (200/219) of those screened. Seventy-six percent (166/219) of patients took hydroxychloroquine for systemic lupus erythematosus or rheumatoid arthritis. Factors that place a patient at higher risk include preexisting macular disease, concomitant renal or liver disease, higher age, and
Discussion
In the United States, it is estimated that 150 000 patients take hydroxychloroquine for autoimmune diseases. The screening costs associated with an annual eye examination and 10-2 VF at 2011 Medicare reimbursement levels, as in the 2002 guidelines, would be $29.0 million. Although both these guidelines and the 2011 guidelines allow for a 5-year period without screening for low-risk patients, this study shows that clinicians ignore this proviso. The screening costs associated with the 2011
David J. Browning MD, PhD, is a retina specialist with Charlotte Eye, Ear, Nose, and Throat Associates. His research interests are diabetic retinopathy, retinal vein occlusions, and medical retina.
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David J. Browning MD, PhD, is a retina specialist with Charlotte Eye, Ear, Nose, and Throat Associates. His research interests are diabetic retinopathy, retinal vein occlusions, and medical retina.
See Accompanying Editorial on page 413.