• Selective Systematic Review of Ophthalmic Screening Methods for Hydroxychloroquine Associated Retinopathy

      Apgar, David; Begaye, Adrienne; Parsa, Roohieh; College of Pharmacy, The University of Arizona (The University of Arizona., 2010)
      OBJECTIVES: This is a selective systematic review of the methods used to monitor for the ocular adverse effects of chronic hydroxychloroquine use. This was done to describe the screening methods for detecting retinal toxicity and the recommendations for early detection of hydroxychloroquine associated retinopathy. METHODS: A literature search of OVID-MEDLINE and the Evidence Based Medicine (EBM) search database in the AHSL website were performed for the date range October 1999 to October 2009. Articles were selected based on content related to our purpose statement. Each article must have had at least one or more ophthalmic screening test including: fundus photography, Amsler grid, perimetry, color vision, and multifocal electroretinography. RESULTS: The search results returned a total of 67 articles. A total of twelve articles were selected for review. A total of 959 human subjects were studied and 22 patients had reported retinal changes attributed to hydroxychloroquine. Nine of the eleven studies that included mfERG recommended this specific test for monitoring for hydroxychloroquine induced retinopathy. Only six of the studies recommended the frequency of testing. The most common recommendation was to test at baseline and then at least annually. CONCLUSIONS: The results suggest the mfERG is the most sensitive and objective exam for early documentation of toxic retinopathy. In addition baseline and annual testing was suggested most often. The data also suggest that high risk patients be followed more closely as the most severe and irreversible damage occurs in this population.