04 February 2020
Update: 30 March 2020
In response to our concerns that RCOphth's published guidance is not being followed by all ophthalmology departments and the wider implications, RCOphth has asked that prescribers, CCGs and ophthalmologists work together to deliver an effective monitoring service. One suggestion is that this is carried out ‘virtually’, with technicians collecting data that can be reviewed by an ophthalmologist later.
Its guideline committee is aware of new, unpublished data that may call in to question the need for a baseline assessment and once published may look to revise the current guideline in light of this evidence. We recommend that rheumatology colleagues make individual patients aware of the situation so that patients can make an informed decision about whether they wish to remain on the medication. We will keep you informed of any planned revisions to the guideline.
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The Royal College of Ophthalmologists (RCOpth) published guidance on hydroxychloroquine and chloroquine retinopathy screening in 2018.
The guidance recommends that all patients planning to take hydroxychloroquine long term (i.e. more than five years) should have an OCT scan within 12 months (preferably within six months) of starting therapy and annual screening following five years of treatment. However, this guidance is not being uniformly followed by ophthalmology departments due to a lack of resources to do these scans.
It has come to our attention that this is a cause for concern for rheumatologists as their patients’ care is not compliant with published guidance. Rheumatologists are in a position where they are advising a medication that is not being safely monitored in line with the Royal College of Ophthalmologists’ recommendations.
We recognise that this may also cause concern to patients who are not being screened for a complication which may result in permanent visual impairment. The prevalence of retinopathy in long term patients is approximately 7.5%, but may be higher dependent on dose and duration of therapy.
We are aware that Eyecare Scotland, an umbrella organisation representing ophthalmology and optometrists, is working on a Scottish guideline and is liaising with the RCOpth to develop an alternative approach to screening that fits Scotland's model of eye healthcare.
We have written to the Royal College of Ophthalmologists to highlight concerns that their published guidance is not being followed by all ophthalmology departments and of the wider implications. We recommend that rheumatology colleagues make individual patients aware of the situation, so that patients can make an informed decision about whether they wish to remain on the medication.
In response to our concerns that their published guidance is not being followed by all ophthalmology departments and the wider implications, RCOphth has asked that prescribers, CCGs and ophthalmologists work together to deliver an effective monitoring service. One suggestion is that this is carried out ‘virtually’, with technicians collecting data that can be reviewed by an ophthalmologist later. Their guideline committee is aware of new, unpublished data that may call in to question the need for a baseline assessment and once published may look to revise the current guideline in light of this evidence.
We recommend that rheumatology colleagues make individual patients aware of the situation so that patients can make an informed decision about whether they wish to remain on the medication. We will keep you informed of any planned revisions to the guideline.
In response to our concerns that their published guidance is not being followed by all ophthalmology departments and the wider implications, RCOphth has asked that prescribers, CCGs and ophthalmologists work together to deliver an effective monitoring service. One suggestion is that this is carried out ‘virtually’, with technicians collecting data that can be reviewed by an ophthalmologist later. Their guideline committee is aware of new, unpublished data that may call in to question the need for a baseline assessment and once published may look to revise the current guideline in light of this evidence.
We recommend that rheumatology colleagues make individual patients aware of the situation so that patients can make an informed decision about whether they wish to remain on the medication. We will keep you informed of any planned revisions to the guideline.