Adherence of Ophthalmologists and Rheumatologist to the Latest Recommendations of HCQ Retinopathy Screening in Saudi Arabia

Purpose: To assess how well ophthalmologists and rheumatologists followed the latest HCQ retinal toxicity detection recommendations. Methods: A cross-sectional study was carried out on a purposive sample of 149 ophthalmologists and rheumatologists in Saudi Arabia. A purposive sample was used to target physicians with experience in HCQ prescribing and monitoring. An online questionnaire was used to collect data on participants’ demographics, practice level, the number of patients treated with HCQ, the dosage recommended to reduce the risk of retinopathy (optimal dose defined as ≤5 mg/kg/day actual body weight), the recommended screening tests, including baseline and annual retinal evaluation using OCT and visual field testing, the timing of follow-up screening for patients with and without risk (patients “at risk” defined as those with renal or liver dysfunction, high cumulative dose, prolonged treatment duration, or concurrent medications such as tamoxifen), and actions to be taken if screening tests were abnormal. However, since purposive sampling is a non-random method, the findings may not be fully generalizable to all ophthalmologists and rheumatologists in Saudi Arabia. Results: 149 participants, 57.7% were ophthalmologists, 57.5% were female, and 53% were consultants. Overall, 53.7% reported the optimal HCQ dose to reduce retinopathy risk as ≤5 mg/kg/day actual body weight, and 56.4% performed screening before initiating HCQ. In cases of abnormal screening results, 59.7% reported stopping HCQ therapy. The most reported risk factor for retinal toxicity was cumulative HCQ dose (30.9%). Comparative analysis showed that ophthalmologists had a significantly higher percentage of performing screening tests and were more likely to stop treatment when SD-OCT findings were abnormal (p < 0.05). They also reported significantly higher recognition of key risk factors, including age > 70 years, impaired liver and renal function, HCQ dose, cumulative HCQ dose and use, prior ocular pathology and treatment duration (p < 0.05). Conclusion: There is a need for better compliance with established recommendations among rheumatologists.