Biostatistical Consulting and Research Lab, Industry-University Cooperation Foundation, Hanyang University, Seoul, Republic of Korea.
Department of Ophthalmology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
JAMA Netw Open. 2023 May 1;6(5):e2314816. doi: 10.1001/jamanetworkopen.2023.14816.
Practice patterns of hydroxychloroquine retinopathy screening have not yet been reported at a national level in South Korea.
To investigate the practice patterns of timing and modality for hydroxychloroquine retinopathy screening in South Korea.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based cohort study of patients in South Korea used data from the national Health Insurance Review and Assessment database. Patients at risk were identified as those who had initiated hydroxychloroquine therapy between January 1, 2009, and December 31, 2020, and used it for 6 months or more. Patients were excluded if they underwent any of the 4 screening modalities recommended by the American Academy of Ophthalmology (AAO) for other ophthalmic diseases prior to hydroxychloroquine use. The timing and modalities of screening used in baseline and monitoring examinations were assessed between January 1, 2015, and December 31, 2021, among patients at risk and long-term (≥5 years) users.
Adherence of baseline screening practices to the 2016 AAO recommendations (fundus examination within 1 year of drug use) was evaluated; adherence of monitoring examinations in year 5 was classified as appropriate (≥2 tests recommended by the AAO), unscreened (no test performed), and underscreened (insufficient number of tests).
Timing of screening and modalities used at baseline and monitoring examinations.
A total of 65 406 patients at risk (mean [SD] age, 53.0 [15.5] years; 50 622 women [77.4%]) were included; 29 776 patients were long-term users (mean [SD] age, 50.1 [14.7] years; 24 898 women [83.6%]). Baseline screening was performed for 20.8% of the patients within 1 year, with a gradual increase from 16.6% in 2015 to 25.6% in 2021. Monitoring examinations, mostly using optical coherence tomography and/or visual field tests, were performed for only 13.5% of the long-term users in year 5 and for 31.6% of the long-term users after 5 years. Appropriate monitoring was performed for less than 10% of long-term users each year from 2015 to 2021; however, the percentage gradually increased over time. The percentage of patients undergoing any monitoring examination in year 5 was 2.3 times greater for those who had received baseline screening than for those who did not (27.4% vs 11.9%; P < .001).
This study suggests there is an improving trend in retinopathy screening among hydroxychloroquine users in South Korea; however, most long-term users remained unscreened after 5 years of use. Baseline screening may be useful in reducing the number of unscreened long-term users.
在韩国，尚未有关于羟氯喹视网膜病变筛查实践的全国性报告。
调查韩国羟氯喹视网膜病变筛查时机和方法的实践模式。
设计、设置和参与者：本研究是一项全国性的基于人群的队列研究，使用了韩国国民健康保险审查和评估数据库的数据。有风险的患者被确定为自 2009 年 1 月 1 日至 2020 年 12 月 31 日期间开始羟氯喹治疗且使用时间超过 6 个月的患者。如果患者在使用羟氯喹之前因其他眼科疾病接受了美国眼科学会（AAO）推荐的 4 种筛查方式中的任何一种，那么患者将被排除在外。在有风险的患者和长期（≥5 年）使用者中，评估了 2015 年 1 月 1 日至 2021 年 12 月 31 日期间基线和监测检查中使用的筛查时机和方法。
评估了基线筛查实践对 2016 年 AAO 建议（用药后 1 年内进行眼底检查）的依从性；第 5 年监测检查的依从性分为适当（进行了 AAO 推荐的≥2 项检查）、未筛查（未进行任何检查）和筛查不足（检查次数不足）。
基线和监测检查中筛查的时机和使用的方法。
共纳入 65406 名有风险的患者（平均[标准差]年龄 53.0[15.5]岁；50622 名女性[77.4%]）；29776 名患者为长期使用者（平均[标准差]年龄 50.1[14.7]岁；24898 名女性[83.6%]）。20.8%的患者在 1 年内进行了基线筛查，这一比例从 2015 年的 16.6%逐渐增加到 2021 年的 25.6%。仅对 13.5%的长期使用者在第 5 年进行了监测检查，对 31.6%的长期使用者在 5 年后进行了监测检查。每年接受长期治疗的患者中，适当监测的比例不到 10%，但这一比例随着时间的推移逐渐增加。与未接受基线筛查的患者相比，接受了基线筛查的患者在第 5 年接受任何监测检查的比例要高 2.3 倍（27.4%比 11.9%；P<0.001）。
本研究表明，韩国羟氯喹使用者的视网膜病变筛查呈改善趋势；然而，大多数长期使用者在使用 5 年后仍未接受筛查。基线筛查可能有助于减少未筛查的长期使用者数量。
