Screening for hydroxychloroquine toxicity by Texas ophthalmologists

Objective. To determine current practice patterns for screening for hydroxychloroquine (HCQ) toxicity by Texas ophthalmologists. Methods. A survey was sent to all comprehensive ophthalmologists and retina specialists in the state of Texas. Questions included need for baseline examinations, frequency of followup, tests used to monitor for toxicity, and influences on monitoring regimen. Results. Two hundred ninety of 577 surveys were returned correctly completed (response rate = 50.3%). Two hundred fifty-seven respondents (88.6%) felt a baseline examination was necessary prior to beginning HCQ therapy, and 223 (76.9%) followed patients every 6 months during HCQ therapy. Visual acuity, slit lamp examination, and dilated fundus examination were performed on almost all patients, and about three-quarters of respondents also checked visual fields and color vision. While 183 ophthalmologists (63.1%) used the Ishihara pseudoisochromatic plates to check color vision, there was no consensus on the preferred visual field test. One hundred twenty-two respondents (42.1%) stated they had diagnosed a patient with HCQ ocular toxicity. Conclusion. Most ophthalmologists in Texas continue to perform baseline examinations and follow HCQ patients semiannually for the development of ocular toxicity despite recent recommendations questioning the need for such close followup. The majority check visual acuity, perform slit lamp and dilated fundus examinations, and test color vision and visual fields, although there is no consensus on the preferred method to test visual fields.