FRI0314 Risk of ophthalmologic complications as a result of hydroxychloroquine therapy
Authors: A. Khaleel
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Hydroxychloroquine is a drug therapy licensed for patients with cutaneous and systemic lupus. A major side effect is maculopathy that can result in permanent visual loss. Often, symptoms are preceded by signs, and screening for preclinical retinopathy can decrease incidence and development of 'bullseye retinopathy'<sup>1,2</sup>. More recent high quality studies suggest cases of confirmed toxicity in 1% of patients at 5–7 years and therefore documentation of monitoring is imperative<sup>3,4</sup>. <h3>Objectives</h3> In accordance with the , British Rheumatology Society guidelines 2008 an audit was carried out in March 2017 to assess whether patients on hydroxychloroquine were being monitored for maculopathy while on therapy. <h3>Methods</h3> The sample group comprised of 76 patients who were on active hydroxychloroquine treatment for SLE, chosen through randomised computer generated numbers. Electronic notes for individual patients over the last 12 months was reviewed for mention of ophthalmologic monitoring, indicating the clinician is aware and surveilling possible signs of toxicity. <h3>Results</h3> Of all patients on hydroxychloroquine (regardless of dose), 64% of patients had no mention of ophthalmologic monitoring on their documented clinic letter. Documentation of monitoring did not vary by dose, despite the increased risk of toxicity for those on 400 mg daily. This audit suggests that Queens Medical Centre patients are not meeting the set standard of ophthalmological review. <h3>Conclusions</h3> The BSR guidelines have highlighted that there are organisational barriers to monitoring, but acknowledges that ophthalmological risks are present with the use of continued hydroxychloroquine therapy. High risk patients with existing or early signs of visual involvement, should be selected for early assessment and more vigilant follow up. SD-OCT was found to be significantly more cost effective than standard ophthalmological examination<sup>5</sup>. It should be acknowledged that the results of the audit reflect documentation as opposed to practice. Mention of ophthalmological monitoring does not ensure that doctors are actually asking about visual problems. Guidelines have since been updated in April 2017 that recommend annual screening only after 5 years of therapy is sufficient but with a full ophthalmological screening by an ophthalmologist. <h3>References</h3> [1] Melles R, Marmor M. The Risk of Toxic Retinopathy in Patients on Long-term Hy-droxychloroquine Therapy. JAMA Ophthalmology2014;132(12):1453. [2] Iselin K, Marti P, Pless M. Hydroxychloroquine-Induced Retinal Toxicity. Klinische Monatsblätter für Augenheilkunde. 2016;233(04):514–516. [3] Wolfe F, Marmor M. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care &amp; Research2010;62(6):775–784. [4] Silman A, Shipley M. Ophthalmological monitoring for hydroxychloroquine toxicity: a scientific review of available data. Rheumatology1997;36(5):599–601. [5.] Olson J, Sharp P, Goatman K, Prescott G, Scotland G, Fleming A,et al. Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema:a prospective, multicentre, UK study. Health Technology Assessment2013;17(51). <h3>Acknowledgements</h3> I would like to thank Dr Anindya Gupta for his support and helpful mentoring <h3>Disclosure of Interest</h3> None declared