June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Construction of an Electronic Medical Record-Based Monitoring, Screening, and Referral System for Pentosan Polysulfate Sodium Drug-Induced Maculopathy
Author Affiliations & Notes
  • Grant Lee Hom
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Blanche L Kuo
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
  • Resya Sastry
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • James Ross
    Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, United States
  • Graham Chapman
    Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, United States
  • Rishi P Singh
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Sumit Sharma
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Grant Hom None; Blanche Kuo None; Resya Sastry None; James Ross None; Graham Chapman None; Rishi Singh Genentech/Roche, Alcon/Novartis, Zeiss, Bausch + Lomb, Regeneron Pharmaceuticals Inc., Gyroscope, Asceplix, Code C (Consultant/Contractor), Apellis, Graybug, Code F (Financial Support); Sumit Sharma Regeneron Pharmaceuticals Inc, Eyepoint Pharmaceuticals Inc, Genentech Inc,, AbbVie Inc, Code C (Consultant/Contractor)
  • Footnotes
    Support  NH Grant IP30EY025585 and Fight For Sight Summer Student Fellowship
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3770 – F0191. doi:
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      Grant Lee Hom, Blanche L Kuo, Resya Sastry, James Ross, Graham Chapman, Rishi P Singh, Sumit Sharma; Construction of an Electronic Medical Record-Based Monitoring, Screening, and Referral System for Pentosan Polysulfate Sodium Drug-Induced Maculopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3770 – F0191.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Pentosan polysulfate sodium (PPS) is an oral-based medication used for interstitial cystitis that has recently been linked to retinal toxicity. Recent guidelines indicate that PPS patients should undergo baseline retinal examination upon treatment initiation with periodic monitoring while continuing treatment. This study aims to understand current PPS practice patterns and examine the utility of an EMR alert system for patients on PPS to help non-ophthalmic prescribing providers make appropriate referrals.

Methods : Phase one of this study characterized the population receiving PPS at a single institution with an IRB-approved retrospective study and included patients older than 18 taking PPS from 2005-2020. Variables studied included PPS exposure time and cumulative dosing, demographic information, the presence of ophthalmology monitoring, and the types of physicians prescribing the medication. An automated electronic medical record (EMR) best practice alert (BPA) was developed and implemented to fire upon PPS prescription or renewal. Rates of alert firing, ophthalmic referrals, and imaging were periodically collected.

Results : Our single institution initially identified 1407 patients who have taken PPS for characterization with a majority being female (1220, 86.7%). Starting age was 48.0 ± 15.7 and mean cumulative drug exposure was 669.7 ± 569.2 grams. 151 (10.7%) of PPS users had an eye exam within our institution. Before BPA intervention, 31 (2.2%) had optical coherence tomography (OCT) imaging to document baseline retinal status. 3-month post-BPA intervention results show the alert fired for 12 patients on 14 encounters. Of these 14 visits, ophthalmology was consulted 7 times (50%, p<0.001) and OCT macula were ordered 3 times (21.4%, p<0.001).

Conclusions : These results indicate that a limited number of patients taking PPS may be receiving appropriate ophthalmic monitoring per recent guidelines. Notwithstanding, many patients fit the criteria for screening for maculopathy onset (e.g., after 500 grams cumulative exposure). An EMR-based alert is a useful tool to improve ophthalmic screening and referral rates for PPS maculopathy. More work needs to be done to explore cross- specialty understanding of PPS drug-induced maculopathy and their role in detecting and minimizing deleterious effects of this condition.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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