Evaluating the challenges in implementation of the royal college of ophthalmologists (RCOphth) 2020 guidelines on hydroxychloroquine retinopathy screening at Rochdale eye unit, United Kingdom

Abstract

AbstractPurpose: The Royal College of Ophthalmologists (RCOphth) updated their hydroxychloroquine (HCQ) retinopathy screening guidelines in 2020. The aim of our study was to analyse the implementation of these guidelines at Rochdale Eye Unit, UK, along with identification of any challenges/areas for development.Methods: A retrospective study of patients visiting the hydroxychloroquine screening clinic at Rochdale Eye Unit between 1st January – 1st of March 2022 was performed. Utilizing the 2020 RCOphth guidelines as a “gold standard” screening clinic checklist, data were collected determining if patients fulfilled screening criteria, if the department's data collection proforma identified patients with risk factors for developing retinopathy, the investigations undertaken, documentation and communication of the diagnosis, and selection of an appropriate outcome.Results: 54 patients were identified, 14 males and 40 females, 100% of whom were on HCQ therapy. 37% did not meet the screening criteria. A paper proforma comprising of drug, dose, duration, renal disease, tamoxifen use, and macular co‐morbidity was completed for 100% of patients, however, did not include patient's ethnicity, weight (cumulative dose calculation), or last renal function. 51 patients (94%) had SD‐OCT and FAF as first line investigation. 10 patients (19%) also had Visual Field‐10‐2. Currently, there is no standardized process for interpretation of investigations and documentation of findings. Although, 100% of diagnoses were communicated to the GP, there no was evidence of written information about HCQ retinopathy or results of investigations being sent to patients at present. 19 patients (35%) had the incorrect outcome selected, including re‐invitation for annual monitoring despite treatment cessation or prior to >5 years of HCQ treatment.Conclusions: To address the encountered challenges, we recommend review of all bookings unfulfilling screening criteria, devising a more comprehensive proforma (including ethnicity, weight, last renal function) and a six‐point clinician's checklist comprising of proforma review, investigation interpretation/documentation aid, prompt for communicating with patient/referrer, considering driving eligibility, and guidance for selecting appropriate outcome.