Bill Harvey: Lupine howl

I heard something interesting last week about the new screening protocol for patients taking hydroxychloroquine.

As we reported last year (Optician 19.11.18), this drug is increasingly being prescribed for a range of inflammatory illnesses, most notably lupus. Its adverse ocular effects are well known and, historically, were monitored (inadequately) by colour fields testing. With the latest technology, a much more accurate way of screening is available using autofluorescence and OCT. For this reason, the RCO implemented a screening guideline last year to this effect, but said it must be done in the hospital under ophthalmology guidance.

I suggested last year that this was likely to become an opportunity for community optometry. Last week, a dermatologist told me: ‘The ophthalmologists are refusing to see the patients because they say they are not funded for it. I refer them anyway because guidelines are guidelines. Ours is not the only ophthalmology department that is not cooperating, it seems a general action. I spoke to a colleague in Scotland who said it’s the same there and that the ophthalmologists are ignoring the guidelines. I don’t think a single patient I have referred has been seen. These patients have lupus or similar conditions so we are left with the choice, stop treatment and risk complications from the condition, use a treatment we know has worse side effects, or continue a treatment that experience says has far less side effects than others. Most people do the latter, we may drop the dose to try and comply partially with these guidelines. It would be incredibly handy if there was a way to get our patients screened.’