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Update on Screening Recommendations for Hydroxychloroquine Retinopathy

Update on Screening Recommendations for Hydroxychloroquine Retinopathy To the Editor A recent Invited Commentary by Kim1 on the article titled “Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy”2 pointed out current knowledge about the varying sensitivity of tests used to screen for hydroxychloroquine retinopathy. However, it was written in a small window of time between publication of the articles that have amplified knowledge of this disease and adoption of this knowledge into a new set of American Academy of Ophthalmology screening recommendations, which have just been published.3 This 2016 revision modifies key points from the previous 2011 guidelines.4 We urge readers to consult this new document, and herein we summarize the most critical changes in recommended practice. Of greatest importance, dosage should now be calculated by real rather than ideal weight and with a different value: patients should stay under 5 mg/kg of real weight.5 Dose relative to weight is more critical for judging risk than prior metrics such as 1000-g total dose since smaller patients take lesser doses and overdosage accelerates the appearance of retinopathy. Contrary to the 2011 recommendations, age, liver disease, and obesity are not well correlated with the risk of retinopathy.5 The major risk factors are dose and duration, underlying maculopathy, renal disease, and tamoxifen use.3 The new recommendations reinforce advice in the Invited Commentary by Kim to look beyond the macula when screening Asian patients and to combine visual fields (sensitive) with spectral-domain optical coherence tomography (specific) for the most effective screening regimen. Adherence to this updated information along with the testing recommendations outlined by Kim will improve screening and ultimately save vision in our patients. Back to top Article Information Corresponding Author: Judy E. Kim, MD, Department of Ophthalmology, Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI 53226 (jekim@mcw.edu). Published Online: May 12, 2016. doi:10.1001/jamaophthalmol.2016.1252. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Kim reported receiving personal fees from Bausch & Lomb, Allergan, Alimera Sciences, Bayer, and Novartis and nonfinancial support from Notal Vision and Optos. No other disclosures were reported. References 1. Kim JE. Which test is the best for hydroxychloroquine toxicity screening? [published online March 17, 2016]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0323.PubMedGoogle Scholar 2. de Sisternes L, Hu J, Rubin DL, Marmor MF. Analysis of inner and outer retinal thickness in patients using hydroxychloroquine prior to development of retinopathy [published online March 17, 2016]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0155.PubMedGoogle Scholar 3. Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF; American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision) [published online March 16, 2016]. Ophthalmology. doi:10.1016/j.ophtha.2016.01.058.PubMedGoogle Scholar 4. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF; American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118(2):415-422.PubMedGoogle ScholarCrossref 5. Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014;132(12):1453-1460.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Ophthalmology American Medical Association

Update on Screening Recommendations for Hydroxychloroquine Retinopathy

JAMA Ophthalmology , Volume 134 (7) – Jul 1, 2016

Update on Screening Recommendations for Hydroxychloroquine Retinopathy

Abstract

To the Editor A recent Invited Commentary by Kim1 on the article titled “Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy”2 pointed out current knowledge about the varying sensitivity of tests used to screen for hydroxychloroquine retinopathy. However, it was written in a small window of time between publication of the articles that have amplified knowledge of this disease and adoption of this knowledge into a...
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References (5)

Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6165
eISSN
2168-6173
DOI
10.1001/jamaophthalmol.2016.1252
Publisher site
See Article on Publisher Site

Abstract

To the Editor A recent Invited Commentary by Kim1 on the article titled “Analysis of Inner and Outer Retinal Thickness in Patients Using Hydroxychloroquine Prior to Development of Retinopathy”2 pointed out current knowledge about the varying sensitivity of tests used to screen for hydroxychloroquine retinopathy. However, it was written in a small window of time between publication of the articles that have amplified knowledge of this disease and adoption of this knowledge into a new set of American Academy of Ophthalmology screening recommendations, which have just been published.3 This 2016 revision modifies key points from the previous 2011 guidelines.4 We urge readers to consult this new document, and herein we summarize the most critical changes in recommended practice. Of greatest importance, dosage should now be calculated by real rather than ideal weight and with a different value: patients should stay under 5 mg/kg of real weight.5 Dose relative to weight is more critical for judging risk than prior metrics such as 1000-g total dose since smaller patients take lesser doses and overdosage accelerates the appearance of retinopathy. Contrary to the 2011 recommendations, age, liver disease, and obesity are not well correlated with the risk of retinopathy.5 The major risk factors are dose and duration, underlying maculopathy, renal disease, and tamoxifen use.3 The new recommendations reinforce advice in the Invited Commentary by Kim to look beyond the macula when screening Asian patients and to combine visual fields (sensitive) with spectral-domain optical coherence tomography (specific) for the most effective screening regimen. Adherence to this updated information along with the testing recommendations outlined by Kim will improve screening and ultimately save vision in our patients. Back to top Article Information Corresponding Author: Judy E. Kim, MD, Department of Ophthalmology, Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI 53226 (jekim@mcw.edu). Published Online: May 12, 2016. doi:10.1001/jamaophthalmol.2016.1252. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Kim reported receiving personal fees from Bausch & Lomb, Allergan, Alimera Sciences, Bayer, and Novartis and nonfinancial support from Notal Vision and Optos. No other disclosures were reported. References 1. Kim JE. Which test is the best for hydroxychloroquine toxicity screening? [published online March 17, 2016]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0323.PubMedGoogle Scholar 2. de Sisternes L, Hu J, Rubin DL, Marmor MF. Analysis of inner and outer retinal thickness in patients using hydroxychloroquine prior to development of retinopathy [published online March 17, 2016]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0155.PubMedGoogle Scholar 3. Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF; American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision) [published online March 16, 2016]. Ophthalmology. doi:10.1016/j.ophtha.2016.01.058.PubMedGoogle Scholar 4. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF; American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118(2):415-422.PubMedGoogle ScholarCrossref 5. Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014;132(12):1453-1460.PubMedGoogle ScholarCrossref

Journal

JAMA OphthalmologyAmerican Medical Association

Published: Jul 1, 2016

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