The Royal College of Ophthalmologists issued monitoring guidelines in 2020 that recommend annual retinopathy monitoring to begin after 1 year of drug therapy for patients with additional risk factors for retinal toxicity: 

• Concomitant tamoxifen use
• Impaired renal function (eGFR <60ml/min/1.73m2)
• Dose of hydroxychloroquine greater than 5mg per kg per day
• Chloroquine use

For all other patients, monitoring begins after 5 years of drug therapy.

The current arrangements for opthalmology monitoring are:

East Surrey Place: see narrative below from Feb 2020

Guildford & Waverley Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

North West Surrey Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

Guidelines from the Royal College of Ophthalmologists: Hydroxychloroquine-and-Chloroquine-Retinopathy-Monitoring-Guideline.pdf (rcophth.ac.uk)

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a change in traffic light status for hydroxychloroquine for patients within adult services from BLUE to AMBER.

ESCCG and SASH LOCAL ARRANGEMENTS:

The Royal College of Ophthalmologists issued guidelines which recommend that all patients planning to take hydroxychloroquine long term i.e. over five years have a baseline examination in a hospital eye department ideally within six months, but definitely within 12 months. Patients should be referred for annual screening after five years of therapy and be reviewed annually thereafter whilst on therapy.

A retinopathy screening service is available at SASH NHS Trust and three referral letters have been developed for use - see template letters below