Implementation and uptake of an orthoptist-led chloroquine and hydroxychloroquine retinopathy clinic at Liverpool Hospital: July 2020 to May 2021

ABSTRACT

Background: In July 2020, in response to COVID-19 clinic restrictions, Liverpool Eye Clinic instituted an orthoptist-led clinic, with subsequent virtual retinal specialist reviews, to screen and monitor for chloroquine/hydroxychloroquine (CQ/HCQ) retinopathy. We discuss its implementation, uptake and issues. Standard American Academy of Ophthalmology Revised Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy. Methods: The screening protocol included collecting data on patients' demographics, CQ/HCQ retinopathy risk factors, visual acuity, dilated fundus examination, automated visual fields (HVF) and macular spectral domain optical coherence tomography (SD-OCT). Results were reviewed by a retinal VMO, with clinic review if abnormal. Records of patients seen in this clinic from inception to May 2021 were audited. Results: Forty-six patients (female n = 35, 76.1%) were screened during this period. Twenty-six patients had CQ/HCQ retinopathy risk factors. All patients underwent baseline SD-OCT and 10-2 HVF with 24-2 HVF performed on those of Asian background (n = 19, 41.3%). Patients with pre-existing pathology or positive risk factors were appropriately referred for further ophthalmic review. Although orthoptists complied with examination protocols, issues included delays in retinal specialist review of SD-OCT and/or fundus photography, discoordination with scheduled main clinic follow up for other pathology, and non-attendance for dilated fundus examination if required at a second visit. Recommendations: Screening and monitoring for CQ/HCQ retinopathy can be effectively performed by an orthoptist with virtual ophthalmologist oversight. However, appropriate systems are needed to ensure that all examination results are reviewed, and abnormal results managed accordingly.