Ahn Seong Joon, Kim Ji Hong
Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
Front Med (Lausanne). 2023 Sep 21;10:1238226. doi: 10.3389/fmed.2023.1238226. eCollection 2023.
Late diagnosis of hydroxychloroquine retinopathy remains a major concern, with the potential for irreversible visual impairment. This study aimed to investigate the causes of late diagnosis in a hospital-based cohort of Korean patients with hydroxychloroquine retinopathy and assess the trend of late diagnosis from 2015 to 2022.
Thirty-eight patients with a late diagnosis (severe stage at diagnosis) among 94 patients with hydroxychloroquine retinopathy were included in the analysis. The causes of late diagnosis were categorized as referral-related, patient-related, and screening-related factors.
The most prevalent cause was no or late referral to ophthalmologists, contributing to a significant gap in timely identification. Patient-related causes included delayed monitoring visits despite scheduled appointments and early-onset disease. Screening-related causes encompassed an insufficient number of sensitive tests, leading to inadequate evidence for diagnosis, and missed or wrong diagnoses by screening physicians. The proportion of late diagnoses decreased over time, indicating improvements in overall screening and detection. The decreasing proportions of screening-related causes suggest advancements in screening practices and the use of multiple sensitive tests for screening.
Efforts to further reduce late diagnoses and improve screening and diagnostic processes are necessary. Our data emphasize the importance of timely referral to ophthalmologists for early detection and management.
羟氯喹视网膜病变的晚期诊断仍然是一个主要问题，存在不可逆视力损害的风险。本研究旨在调查韩国医院中羟氯喹视网膜病变患者晚期诊断的原因，并评估2015年至2022年期间晚期诊断的趋势。
94例羟氯喹视网膜病变患者中有38例晚期诊断（诊断时为严重阶段）纳入分析。晚期诊断的原因分为转诊相关、患者相关和筛查相关因素。
最常见的原因是未转诊或延迟转诊至眼科医生，导致及时识别方面存在显著差距。患者相关原因包括尽管有预约但监测就诊延迟以及疾病早发。筛查相关原因包括敏感检查数量不足，导致诊断证据不足，以及筛查医生漏诊或误诊。晚期诊断的比例随时间下降，表明总体筛查和检测有所改善。筛查相关原因比例的下降表明筛查实践有所进步，且使用了多种敏感检查进行筛查。
进一步减少晚期诊断并改善筛查和诊断流程的努力是必要的。我们的数据强调了及时转诊至眼科医生以进行早期检测和管理的重要性。
