Rheumatologists' attitudes toward routine screening for hydroxychloroquineretinopathy

Objective. To examine rheumatologists' attitudes toward routine ophthalmolo gic screening for hydroxychloroquine (HCQ) retinopathy and to estimate the acceptability of hypothetical guidelines discouraging this practice. Methods. We E-mailed a random sample of 300 US rheumatologists listed in th e American College of Rheumatology (ACR) Directory who treat adults. We ask ed about current screening practice, reasons for screening, and the effect of hypothetical guidelines discouraging routine screening on future practic e. Associations between adherence to guidelines and clinical variables were evaluated using multiple logistic regression. Results. Of 56% who responded, almost all (94%) currently screen their pati ents at least once per year. Seventy-five percent stated that they would co ntinue to screen because they are unwilling to accept ally risk of visual l oss among their patients; 74% would continue to screen because of legal lia bility; and 56% felt their patients would insist on being screened regardle ss of their physician's opinion. Forty-four percent stated that they would continue to screen regularly, even if the ACR published guidelines discoura ging routine screening. Rheumatologists unwilling to accept any risk of ret inopathy were less likely to follow guidelines discouraging screening (46 v s 77%, adjusted OR 0.2, 95% CI 0.1-0.6), Patient insistence and fear of leg al liability were not significantly associated with predicted adherence to guidelines. Conclusion. Our survey indicates that the majority of rheumatologists curre ntly routinely screen their patients for HCQ retinopathy, and that many wou ld not follow ACR guidelines discouraging this practice, at least in part b ecause they are unwilling to accept any risk of visual damage.