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The Royal College of Ophthalmologists (RCOphth) has published updated guidelines on retinal monitoring for hydroxychloroquine (HCQ) and chloroquine. This update is the result of published audit data based on real-world outcomes of monitoring.

These changes to the guideline will help to alleviate pressures on ophthalmology departments and are a welcome update for rheumatology teams, ophthalmology departments and patients.

The major change to the guideline is that a baseline optical coherence tomography (OCT) scan is no longer recommended unless there are additional risk factors that would increase the risk of toxicity, which include:

  • High-dose of HCQ (>5mg/kg/day)

  • Concurrent tamoxifen use

  • Impaired renal function (eGFR <60ml/min/1.73m2)

  • Chloroquine use

If no additional risk factors, retinal screening starts after five years of treatment.

We're aware that many departments previously struggled to access baseline OCT scans for their patients and published a statement in March 2020 acknowledging this concern. You can access the updated guideline on the RCOphth website and the published Executive summary to read more.