Monitoring people who take hydroxychloroquine or chloroquine to help prevent avoidable sight loss

The West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups met in public on 5 November 2019. At this meeting, the Joint Committee agreed the adoption of a single clinical pathway and commissioning policy for hydroxychloroquine and chloroquine retinopathy monitoring.

Hydroxychloroquine and chloroquine are drugs used to treat various conditions including rheumatoid arthritis, systemic lupus erythematosus (SLE), some skin conditions (especially photosensitive ones) and other conditions that involve inflammation.

Like most medicines, these drugs can cause side effects and some people who take hydroxychloroquine or chloroquine for more than five years, or in high doses, are at increased risk of damage to their retina at the back of the eye, a condition known as hydroxychloroquine retinopathy.

Today, the use of specialised retinal imaging techniques makes it possible to detect early signs of hydroxychloroquine retinopathy before any symptoms of retinal damage are apparent. The introduction of this pathway and policy follows recommendations on monitoring issued by The Royal College of Ophthalmologists. Having a consistent approach will ensure that patients across the region who are prescribed hydroxychloroquine or chloroquine are effectively monitored, preventing avoidable sight loss and avoiding unnecessary interventions. It is estimated that around 4,000 patients across West Yorkshire and Harrogate will access this monitoring each year.

There are currently no commissioned hydroxychloroquine retinopathy monitoring services in West Yorkshire and Harrogate. The Improving Planned Care Programme is working with its partner organisations across eye care services to consider the various options for delivering this service following the implementation of the new pathway and policy across the region within the next three years.

We have identified the key challenges in the most pressurised areas of ophthalmology which are: age-related macular degeneration (AMD); cataracts; diabetic retinopathy; glaucoma; and children’s eye care services. Ongoing transformation work in these areas is aiming to maximise capacity in the system which could create the opportunity to add hydroxychloroquine retinopathy monitoring to the wide range of hospital eye services already being delivered.

Other options being considered could involve community optometry practices or bespoke providers of hydroxychloroquine retinopathy monitoring services, both of which already have the capacity to be able to take on the provision of this service. All alternatives will be considered but the option selected will be one that best meets the criteria of being effective, sustainable and financially viable.

West Yorkshire and Harrogate Health & Care Partnership is hosted by NHS Wakefield Clinical Commissioning Group.
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