Bradford LOC has been receiving comments from its members recently that patients have been presenting at their practices after being told by the hospital that they “need to go for an eye test and then have an eye test every year thereafter”. Upon further questioning it transpires that these patients have been sent by the rheumatology department and are currently taking or starting to take hydroxychloroquine or chloroquine.
The basis for the sudden appearance of these requests is undoubtedly the recently issued Royal College of Ophthalmologist Clinical Guidelines – Hydroxychloroquine and Chloroquine Retinopathy - Recommendations on Screening. (see link below for full document)
In a nutshell, the guidelines recommend specific tests which would certainly not be considered as part of an NHS eye examination, even if practices did have this instrumentation available. These include
· Humphrey 10-2 Visual Field assessment
· Pupillary dilation and imaging with Spectral Domain Optical Coherence Tomography (SD-OCT)
· Pupillary dilation and imaging with Widefield Fundus Autofluorescence (FAF)
Hence at the present time these recommendations mean that it would be inappropriate to undertake any sort of screening in community optometric practices as it would fall outside of the RCOphth and NICE guidance. The guidance recommends that this screening is carried out within the HES. It is noteworthy that optometry is not mentioned at all in the document.
In addition, these tests fall outside the remit of GOS and therefore these patients should not be reviewed for these screening purposes under a GOS eye test.
As such it is the recommendation of the Bradford LOC that patients requesting such a review, be given a copy of the attached information sheet which explains further the purpose of the screening, what it should involve and the reasons it should not be conducted in high street practices. A letter has been sent by the Chair of our LOC to the Rheumatology department at the BRI explaining the position and politely requesting that they stop giving the impression to patients that they can “pop in” for an NHS eye-test at their local opticians and be reassured that their medication is not causing any ocular problems.
Please note, and as explained in the attached information sheet, they are welcome to book an eye test, but if this is to be NHS funded then patients must be eligible both in terms of timing and eligibility criteria and you would be wise to clarify that you will of course test their vision and assess the health of their eyes but the detail of this will fall sort of the scans required by NICE, for the purpose of hydroxychloroquine screening.
I hope that this is all self-explanatory but if you do have any questions or concerns please do let the LOC know by email at firstname.lastname@example.org