Implementation of a virtual screening service for hydroxychloroquine and chloroquine retinopathy: One‐year results

Abstract

AbstractPurpose: To evaluate the results of a new virtual screening service for hydroxychloroquine (HQC) and chloroquine (CQ) retinopathy.Methods: Prospective study including patients under long‐term HCQ or CQ therapy referred for screening at a single ophthalmic centre in Portugal over a one‐year period. The virtual clinic consisted of a visit for functional and structural testing, in accordance with the guidelines on HCQ retinopathy screening1,2, followed by a later review by an experienced consultant. Individualized counselling for both patients and prescribing physicians was provided on retinal toxicity risk, safe dosing, and adequate screening intervals.Results: A total of 93 patients under treatment with HCQ attended the virtual clinic. Systemic lupus erythematosus (38.7%) and rheumatoid arthritis (18.3%) were the most prevalent diagnoses. Mean daily HCQ dosing was 5.2 ± 1.6 mg/Kg, with 46.2% patients using a daily dose greater than 5 mg/Kg. Median treatment duration was 48 months (range: 1–264) and 49.5% patients had been treated for longer than 5 years. Renal disease was present in 11 patients (11.8%) and 7 (7.5%) had pre‐existing retinal conditions. Structural changes in macular optical coherence tomography and fundus autofluorescence were rarely detected (3.3%). In contrast, 16 patients (17.2%) presented with abnormal 10‐2 visual field testing. Multifocal electroretinogram was performed in 14 patients (15.1%), detecting characteristic abnormalities of drug toxicity in one patient, with a definite diagnosis of severe HCQ retinopathy. Recommendation for dose adjustment was given in 47.3% of cases, including advice to discontinue HCQ use in 7 (7.5%) patients based on risk factors.Conclusions: Retinal toxicity is a rare adverse effect of HCQ, a therapy increasingly used in the management of autoimmune disorders. Virtual clinics could be a safe and sustainable care delivery system for adequate counselling, risk assessment and early retinopathy detection.References.1. Marmor MF, et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 2016; 123:1386–1394.2. Royal College of Ophthalmologists. Hydroxychloroquine and chloroquine retinopathy: recommendations on monitoring. London: Royal College of Ophthalmologists, 2020.