Retinal toxicity is a side effect of hydroxychloroquine and can lead to irreversible vision loss. The incidence of retinal toxicity is related to dose and duration of treatment. The American Academy of Ophthalmology (AAO) published guidelines on safe dosing in 2016 and recommended a maximum daily dose of ≤5mg/kg.¹ An analysis of all patients seen at Cleveland Clinic from 1/1/2018 to 12/31/2018 was performed. The prevalence of excess weight-based dosing among rheumatologists was 27% (29% in women and 18% in men). Dermatologists were more likely to dose excessively compared with rheumatologists (OR 1.93, CI1.23-3.03).
An Epic alert was created (in collaboration with the Cole Eye Institute) for any placed order exceeding the dosing guidelines. Captured data includes patient, department/hospital, prescriber, override reason, ordered dose, and percentage over the maximum dose. Excess dosing declined from 27% to 21% overall and to 18% among rheumatologists, a significant reduction (p<0.001).²
¹Marmor MF, et al. Ophthalmology. 2016;123:1386-94
²Chen RI, Chen AX, Greenlee TE, Conti TF, Deal C, Singh RP. Hydroxychloroquine Prescription Practices after 2016 American Academy of Ophthalmology Recommendations. Ophthalmology 2021; 128(7): 1112-1114