The Royal College of Ophthalmologists (RCOphth) has published updated guidelines on retinal monitoring for hydroxychloroquine (HCQ) and chloroquine. This update is the result of published audit data based on real-world outcomes of monitoring.
These changes to the guideline will help to alleviate pressures on ophthalmology departments and are a welcome update for rheumatology teams, ophthalmology departments and patients.
The major change to the guideline is that a baseline optical coherence tomography (OCT) scan is no longer recommended unless there are additional risk factors that would increase the risk of toxicity, which include:
High-dose of HCQ (>5mg/kg/day)
Concurrent tamoxifen use
Impaired renal function (eGFR <60ml/min/1.73m2)
If no additional risk factors, retinal screening starts after five years of treatment.
We're aware that many departments previously struggled to access baseline OCT scans for their patients and published a statement in March 2020 acknowledging this concern. You can access the updated guideline on the RCOphth website and the published Executive summary to read more.