P099 National audit of England shows suboptimal compliance with ophthalmology recommendations for hydroxychloroquine retinopathy screening

Background/Aims Hydroxychloroquine (HCQ)retinopathy is a serious adverse event of long-term therapy, often irreversibleand asymptomatic until advanced. Royal College of Ophthalmologists (RCOphth)guidelines recommend annual retinopathy monitoring for patients receivinglong-term HCQ therapy (>5 years) due to heightened risk. Additionally, ifany of the following factors are present, including concurrent tamoxifen use, renal impairment (eGFR <60mL/min/1.73m2) or high dose HCQ use(>5mg/kg/day) retinal maculopathy screening is recommended after one year oftreatment with HCQ. The guideline recommends screening comprising bothspectral-domain optical coherence tomography (SD-OCT) and wide-field fundusautofluorescence imaging (FAF), the latter of which is usually only availablein hospital ophthalmology departments. This audit assesses national compliancewith these guidelines across England. Methods Data on prescriptions of hydroxychloroquine, along with clinical characteristics of those prescribed the medication were obtained from a large administrative dataset (ECLIPSE - Prescribing Services Limited) covering 28,689,113 patients in England. Using clinical coding frameworks and information on weight, renal function and concomitant tamoxifen prescription were linked to outpatient attendance at ophthalmology services via referral code on the e-referral service (e-RS). HCQ duration of treatment along with HCQ dose/weight ratios were calculated. Those meeting RCOphth criteria were checked against ophthalmic outpatient attendance within the previous 365 days. Results Date of data download was the 28th August 2025 with clinical codes for prescriptions available since the 1st January 2016. A total of 52,419 patients (79% of whom were female) had been prescribed hydroxychloroquine with a median age of 61 years (IQR 51 to 71 years) across 32 Integrated Care Boards (ICB). A total of 26,780 patients had an active hydroxychloroquine prescription within the last three months. The median dose/kg was 3.6 mg/kg (IQR 2.7 to 4.7mg/kg), with 5,338 patients prescribed >5mg/kg and of those 1,115 >6.5mg/kg. There were 7432 patients prescribed hydroxychloroquine for longer than six years. There were 3,702 patients with an eGFR <60mL/min/1.73m2 of whom 238 had an eGFR <30mL/min/1.73 m2. There were 125 patients co-prescribed tamoxifen. Those meeting the threshold for screening comprised 13,298 individuals of whom 2,808 (21.1%) had been seen in ophthalmology services in the previous 365 days. This proportion ranged from 0% to 45.9% according to ICB region. Conclusion There appears to be suboptimal compliance with suggested RCOphth guidelines for screening meaning patients are at risk. The variability by ICB region may be reflective of barriers to access or commissioning policy. Limitations include that coding frameworks were based on e-RS and therefore rejected referrals would not have been captured nor those that attended community opticians. Considering that risk factors may vary over time, patient records should be regularly updated to ensure that newly emerging risks are identified, to ensure timely monitoring is initiated.