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Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines.

Publication ,  Journal Article
Browning, DJ; Yokogawa, N; Greenberg, PB; Perlman, E
Published in: Am J Ophthalmol
November 2020

PURPOSE: To describe the rationale for revising the hydroxychloroquine (HCQ) dosing and screening guidelines and to identify the barriers to more effective guidelines in the future. DESIGN: Literature review. METHODS: A PubMed query of studies on HCQ dosing and HCQ retinopathy (HCQR) screening was conducted with a selective review of the English language literature. RESULTS: Three iterations of the American Academy of Ophthalmology HCQ dosing and HCQR screening guidelines have been published without including prescribing physicians on the writing committees. This may contribute to prescribing physicians' low adherence to the guidelines. As ancillary tests have improved, asymptomatic HCQR is being detected earlier, leading to a higher reported prevalence of HCQR and a drop in the ceiling for safe dosing. These trends put stricter constraints on prescribers and their patients, who may have had well-controlled autoimmune disease on HCQ doses that were previously considered to be below the high-risk threshold for HCQR. Indeed, stopping HCQ at the earliest sign of HCQR should be reconsidered; for cases of early HCQR, dose reduction and more intensive monitoring for retinopathy may strike a more appropriate balance between HCQ risk and benefits. A prospective study using the Diabetic Retinopathy Clinical Research Retina Network with standardized collection of data, HCQ blood levels, centralized grading of ancillary tests, and community and academic ophthalmologists would provide a stronger evidence base for future HCQ guidelines. CONCLUSIONS: The HCQ dosing and screening guidelines should be updated and a prospective study of HCQ dosing and HCQR should be initiated with the joint efforts of ophthalmologists and prescribing physicians.

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Published In

Am J Ophthalmol

DOI

EISSN

1879-1891

Publication Date

November 2020

Volume

219

Start / End Page

101 / 106

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retinal Diseases
  • Prospective Studies
  • Practice Guidelines as Topic
  • Ophthalmology & Optometry
  • Ophthalmology
  • Hydroxychloroquine
  • Humans
  • Diagnostic Techniques, Ophthalmological
  • Antirheumatic Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Browning, D. J., Yokogawa, N., Greenberg, P. B., & Perlman, E. (2020). Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. Am J Ophthalmol, 219, 101–106. https://doi.org/10.1016/j.ajo.2020.06.030
Browning, David J., Naoto Yokogawa, Paul B. Greenberg, and Elliot Perlman. “Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines.Am J Ophthalmol 219 (November 2020): 101–6. https://doi.org/10.1016/j.ajo.2020.06.030.
Browning DJ, Yokogawa N, Greenberg PB, Perlman E. Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. Am J Ophthalmol. 2020 Nov;219:101–6.
Browning, David J., et al. “Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines.Am J Ophthalmol, vol. 219, Nov. 2020, pp. 101–06. Pubmed, doi:10.1016/j.ajo.2020.06.030.
Browning DJ, Yokogawa N, Greenberg PB, Perlman E. Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. Am J Ophthalmol. 2020 Nov;219:101–106.
Journal cover image

Published In

Am J Ophthalmol

DOI

EISSN

1879-1891

Publication Date

November 2020

Volume

219

Start / End Page

101 / 106

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retinal Diseases
  • Prospective Studies
  • Practice Guidelines as Topic
  • Ophthalmology & Optometry
  • Ophthalmology
  • Hydroxychloroquine
  • Humans
  • Diagnostic Techniques, Ophthalmological
  • Antirheumatic Agents