PATIENT INFORMATION - Hydroxychloroquine monitoring

The Hydroxychloroquine Retinopathy Screening Service is a community-based NHS service provided by specially trained optometrists working in local optical practices.

It is designed for patients who are taking hydroxychloroquine or chloroquine, medications commonly used to treat conditions such as rheumatoid arthritis and lupus.

These medications are generally safe but, in very rare cases, can affect the central retina (the light-sensitive layer at the back of the eye). This is known as maculopathy.

The purpose of this service is to monitor for early signs of retinal changes related to your medication use and refer you for further care if needed. Early detection is important, as changes to the retina may not cause symptoms at first.

This service is for patients registered with a Southeast London GP who:

• Are aged 18 years or over
• Are taking chloroquine and have been on treatment for at least 1 year

OR

• Are taking hydroxychloroquine
• Have been on treatment for 5 years or more
• Have been on treatment for at least 1 year and have additional risk factors

Examples of additional risk factors include:

• Taking certain other medications (such as tamoxifen)
• Taking a high dose of hydroxychloroquine
• Reduced kidney function

Your GP or specialist will confirm that you are suitable for this service before referring you. If you suspect you may meet the criteria for screening but have not been referred for screening, you should discuss with your GP or specialist

During your appointment, the optometrist will carry out a series of tests to assess the health of your retina, including:

• Measuring your vision
• Optical Coherence Tomography (OCT) scan of the macula (central retina)
• Fundus autofluorescence imaging to assess retinal health
• A visual field test (in some cases) to check your central vision

In some cases, eye drops may be used to dilate your pupils to allow a better view of the retina. The optometrist will explain this if required.

After dilation your vision may be blurred for a few hours, and you may be more sensitive to light. You should not drive until your vision returns to normal and it is recommended to bring sunglasses with you.

After your assessment, one of the following may happen:

• No signs of maculopathy – annual monitoring will continue whilst you are taking the medication.
• Onward referral – if there are signs of possible maculopathy

This service is NHS-funded, so there is no charge for the assessment.

It is important to attend your screening appointments, even if your vision feels normal.

If you notice any changes in your vision, such as difficulty reading or distortion, you should seek advice promptly.