Impact of the revised american academy of ophthalmology guidelines regarding hydroxychloroquine screening on actual practice.
Am J Ophthalmol
; 155(3): 418-428.e1, 2013 Mar.
Article
em En
| MEDLINE
| ID: mdl-23218706
ABSTRACT
PURPOSE:
To determine the impact of the revised academy guidelines on screening for hydroxychloroquine retinopathy.DESIGN:
Retrospective, observational cohort study.METHODS:
setting:
Private practice of 29 doctors. study population Total of 183 patients for follow-up and 36 patients for baseline screening. observation procedure Review of charts, 10-2 visual fields (VFs), multifocal electroretinograms (mfERG), and spectral-domain optical coherence tomography (SD-OCT) images before and after the revised guidelines. main outcomemeasure:
Rates of use of ancillary tests and clinical intervention, costs of screening, follow-up schedules, and comparative sensitivity of tests.RESULTS:
New hydroxychloroquine toxicity was found in 2 of 183 returning patients (1.1%). Dosing above 6.5 mg/kg/d was found in 28 of 219 patients (12.8%), an underestimate because patient height, weight, and daily dose were not determined in 77 (35.1%), 84 (38.4%), and 59 (26.9%), respectively. In 10 of the 28 (35.7%), the dose was reduced, in 2 (7.1%) hydroxychloroquine was stopped, but in 16 (57.1%) no action was taken. The cost of screening rose 40%/patient after the revised guidelines. Fundus autofluorescence imaging was not used. No toxicity was detected by adding mfERG or SD-OCT. In no case was a 5-year period free of follow-up recommended after baseline screening in a low-risk patient.CONCLUSIONS:
Detection of toxic daily dosing is a cost-effective way to reduce hydroxychloroquine toxicity, but height, weight, and daily dose were commonly not checked. The revised guidelines, emphasizing mfERG, SD-OCT, or FAF, raised screening cost without improving case detection. The recommended 5-year screening-free interval for low-risk patients after baseline examination was ignored.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Retina
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Doenças Retinianas
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Padrões de Prática Médica
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Guias de Prática Clínica como Assunto
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Antirreumáticos
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Técnicas de Diagnóstico Oftalmológico
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Hidroxicloroquina
Tipo de estudo:
Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged80
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Ophthalmol
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Estados Unidos