Few SLE Patients Receive Retinal Examinations With Hydroxychloroquine Initiation

Clinician conducting a retinal examination on a patient.
Clinician conducting a retinal examination on a patient.
Researchers examined the proportion of Medicaid patients with systemic lupus erythematosus who receive baseline retinal examinations when initiating treatment with hydroxychloroquine.

Approximately one-third of patients with systemic lupus erythematosus (SLE) who receive Medicaid undergo baseline retinal examinations when initiating treatment with hydroxychloroquine, according to the results of an analysis published in Arthritis Care & Research.

The researchers sought to investigate the proportion of Medicaid patients with SLE who were starting hydroxychloroquine therapy, a medication that has been associated with retinal damage, who had undergone baseline ophthalmologic examinations. Using billing code data, the authors identified patients with SLE between 18 and 65 years of age who were enrolled in Medicaid and resided in the 29 most populated states between 2000 and 2010. Participants who recently started hydroxychloroquine were identified by filling a prescription for the medication, with no prescriptions filled 12 months prior to the study. The characteristics of patients who did and did not receive retinal examinations over the years of the study were compared with bivariable and multivariable logistic regression models.

A total of 12,755 patients with SLE who recently started hydroxychloroquine treatment were identified. Of these, 32.5% received baseline dilated ophthalmologic examinations. The proportions of patients who received baseline eye examinations did not increase significantly over the course of the study (31.0% in 2001 to 34.4% in 2009; P for linear trend over time =.12). In addition, only 30% of patients with lupus nephritis, who are at a higher risk for retinal toxicity, received baseline ophthalmologic examinations.

Factors associated with increased likelihood of receiving a retinal eye examination included female vs male gender (adjusted odds ratio [aOR], 1.30; 95% CI, 1.08-1.55; P <.01); Asian vs white race (aOR, 1.30; 95% CI, 1.06-1.60; P <.01); and having other eye conditions, including cataracts, glaucoma, and diabetes (P <.01 for all). Moreover, significantly lower proportions of black and Native American patients with SLE underwent baseline retinal examinations compared with white patients (OR, 0.85; 95% CI, 0.77-0.93 and OR, 0.69; 95% CI, 0.47-1.02, respectively; P <.01 for both).

Related Articles

The researchers concluded that the sociodemographic variation in the level of ophthalmologic care reported among people who receive Medicaid and are started on hydroxychloroquine for SLE requires both additional investigation and interventions to address this discrepancy.


Lin TC, Marmor MF, Barbhaiya M, et al. Baseline retinal examinations among SLE patients newly initiating hydroxychloroquine in a U.S. Medicaid SLE population, 2000-2010 [published online February 6, 2018].  Arthritis Care Res (Hoboken). doi: 10.1002/acr.23530