Research Digest

Shortcomings in Hydroxychloroquine Retinopathy Screenings

A study comparing current hydroxychloroquine retinopathy screening practices with 2002 American Academy of Ophthalmology Preferred Practice Patterns (PPP) found that while the vast majority screen as recommended in the PPP, there was a "general lack of familiarity with evidence-based guidelines" that "may affect patient care and healthcare costs."¹

Researchers at the University of Minnesota, Minneapolis, distributed multiple-choice surveys to 105 U.S. ophthalmologists to assess both current screening practices and knowledge of patient risk factors for hydoxychloroquine retinopathy, linked to the drug frequently prescribed for autoimmune diseases, including rheumatoid arthritis. Sixty-seven surveys were completed. Results were compared with the PPP guidelines and a cost analysis of the PPP and survey paradigms was conducted.

Of the respondents, 55% screened one to 25 hydroxychloroquine patients annually, 31% screen 26-50, 12% screen 51-75 and 2% screen 76-100 patients annually. Sixty-seven percent of respondents were comprehensive ophthalmologists.

Results also indicated that 90% screen for hydoxychloroquine retinopathy correctly according to the PPP (with either central automated threshold perimetry or Amsler grid). Knowledge of evidence-based risk factors — daily dose, duration of therapy and patient age — was "poor," the investigators wrote. The number of "I don't know" responses on the risk factors was similar for all ophthalmologists, regardless of the number of hydroxycholoroquine patients seen.

Additionally, excessive follow-up was common. Eighty percent screened high-risk patients every 6 months, as opposed to the PPP recommendation of an annual screening, while 65% screened low-risk patients yearly instead of the one visit the PPP recommends for the first 5 years.

Cost analysis revealed that bringing screening for low-risk patients in line with PPP recommendations would save approximately $44 million every 5 years. Screening high-risk patients according to PPP guidelines would bring the current cost from $68.9 million every 5 years to approximately $36.4 million — a savings of $32.4 million 5-year savings. OM

Reference

1. Semmer AE, Lee MS, Harrison AR, Olsen TW. Hydroxychloroquine retinopathy screening. Br. J. Ophthal. 2008;92:1653-1655.

Epi-LASIK vs. Off-Flap Epi-LASIK for Myopia

Greek researchers compared the early posteroperative course and the 1-year clinical results of Epi-LASIK vs. off-flap Epi-LASIK for the treatment of low and moderate myopia in 112 myopic eyes (56 patients).¹ Epithelium was separated in all eyes with a Centurion SES epikeratome (Norwood Abby EyeCare, Vic, Australia) in the pilot double-masked, randomized study. One eye of each patient was treated with standard Epi-LASIK, while in the contralateral eye the epithelial sheet was not retained on the photoablated stroma.

Mean preoperative spherical equivalent was -3.50+-1.22 D in the Epi-LASIK eyes and -3.61+-1.22 D in the off-flap Epi-LASIK group. Corneal ablations were performed with the Allegretto 200 Hz (Alcon, Fort Worth, Texas). Patients were followed up daily until epithelial healing was complete, then at months 1, 3, 6 and 12.

Researchers evaluated epithelial healing time, subjective pain score and UCVA during the first postoperative days. UCVA, spherical equivalent refraction, best spectacle-corrected VA, haze scores and wavefront aberrations were recorded at each subsequent follow-up visit.

There was no significant difference in epithelial healing time between the two groups. While no significant difference in UCVA was found during the early postoperative days, UCVA was significantly better in Epi-LASIK eyes at 6 months (-0.05+-0.08 in Epi-LASIK eyes vs 0.00+-0.07 in off-flap Epi-LASIK eyes); however, that difference was not visible at any other interval. No significant difference in pain scores was reported between the techniques.

Additionally, researchers found no significant difference in the spherical equivalent, line gain or loss, haze scores and other higher-order aberrations between the two groups. Preoperative wavefront aberrations did not change significantly 1 year after either Epi-LASIK or off-flap Epi-LASIK. OM

Reference

1. Kalyvianaki MI, Kymionis GD, Kounis GA, Panagopoulou SI, Grentzelos MA, Pallikaris IG. Comparison of Epi-LASIK and Off-Flap Epi-LASIK for the Treatment of Low and Moderate Myopia. Ophthalmology. 2008:115(12);2174-2180.