| Formulary Chapter 11: Eye - Full Chapter
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| Chapter Links... |
 NICE NG242: Diabetic retinopathy: management and monitoring |
| NICE NG77: Cataracts in adults: management |
| NICE NG81: Glaucoma: diagnosis and management |
| NICE NG82: Age-related macular degeneration |
| Details... |
| 11.08 |
Miscellaneous ophthalmic preparations |
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Potassium ascorbate
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 Unlicensed
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Eye drops 10%
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| 11.08.01 |
Tear deficiency, ocular lubricants, and astringents |
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Ocular lubricants under normal circumstances should be purchased OTC. |
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Acetylcysteine (Ilube®)
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Formulary
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Eye drops 5%
 For treatment of filamentary keratitis only
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Carbomer 980 eye drops
(polyacrylic acid)
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Formulary
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Liquid gel eye drops 0.2%
Unit dose liquid gel eye drops (preservative free) 0.2%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Carmellose
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Formulary
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Multidose / unit dose preservative free eye drops 0.5%, 1%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Ciclosporin 0.1% eye drops
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Formulary
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Unit dose eye drops emulsion 0.1% (Ikervis) - For adult patients
Unit dose eye drops emulsion 0.1% (Verkazia) - For children and adolescents
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 LSCMMG: Ciclosporin (Verkazia) eye drops NMR
NICE TA369: Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears
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Hypromellose
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Formulary
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Eye drops 0.3%
Preservative free eye drops 0.3%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Polyvinyl Alcohol
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Formulary
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Eye drops 1.4%
Unit dose eye drops (preservative free) 1.4%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Sodium Chloride
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Formulary
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Unit dose eye drops (preservative free) 0.9% Minims®
Eye drops multidose / unit dose (preservative free) 5%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Sodium Hyaluronate
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Formulary
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Eye drops 0.2%
Eye drops (preservative free) 0.1%, 0.2%
Unit dose eye drops (preservative free) 0.1%, 0.2%
Eye drops (preservative free ) Sodium hyaluronate 0.15% and trehalose 3% (Thealoz Duo®)
Eye drops sodium hyaluronate 2% & tamarind seed polysaccharide 0.2% (Hydramed Night®)
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
The most cost effective option should be used.
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White soft paraffin / Vitamin A 250IU/g (Hylo-night®)
(formerly known as VitA-Pos®)
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Formulary
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Eye ointment preservative free
2nd line to Hydramed Night
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| 11.08.02 |
Ocular diagnostic and peri-operative preparations and photodynamic treatment |
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| 11.08.02 |
Ocular diagnostic preparations |
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Fluorescein Sodium
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Formulary
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Unit dose eye drops (preservative free) 1%, 2%
Injection 10% - For fluorescein angiography of the ocular fundus
Injection 20% (unlicensed product)
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Indocyanine green
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Formulary
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Injection 25mg
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Trypan Blue (Vision Blue®)
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Formulary
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Injection
For use in cataract surgery
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| 11.08.02 |
Ocular peri-operative drugs |
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Acetylcholine Chloride (Miochol-E® Miphtel®)
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Formulary
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20mg powder and solvent for solution for intraocular irrigation
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Apraclonidine (Iopidine®)
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Formulary
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Unit dose eye drops (preservative free) 1%
For perioperative use only.
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Balanced Salt Solution
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Formulary
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Sterile irrigation solution 15mL, 500mL
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Bromfenac (Yellox®)
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Formulary
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Eye drops 0.09%
For treatment of postoperative ocular inflammation following cataract extraction.
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Diclofenac (Voltarol® Ophtha)
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Formulary
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Eye drops 0.1%
Unit dose eye drops (preservative free) 0.1%
Preservative free preparation only to be used for those patients with documented allergies to preservatives.
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Ketorolac
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Formulary
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Eye drops 0.5%
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Povidone iodine
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Formulary
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Unit dose eye drops (preservative free) 5% single use only
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Sodium hyaluronate
(Obtained from central stores)
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Formulary
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Injection 1%
Injection prefilled syringe 15mg in 1mL
Injection prefilled syringe 14mg in 1mL (Haelon GV®)
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Disodium edetate
(EDTA)
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Unlicensed
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Preservative free solution 0.37%
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| 11.08.02 |
Subfoveal choroidal neovascularisation |
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Aflibercept (Eylea®)
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Formulary
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Solution for intravitreal injection pre-filled syringe 40mg/mL
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LSCMMG: Opthalmology Macular Pathways
MHRA: EYLEA 40 mg/mL (aflibercept solution for intravitreal injection): Higher risk of intraocular pressure increase with the pre-filled syringe
NICE TA294: Aflibercept solution for injection for treating wet age‑related macular degeneration
NICE TA305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
NICE TA346: Aflibercept for treating diabetic macular oedema
NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
NICE TA486: Aflibercept for treating choroidal neovascularisation
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Aflibercept 8mg in 0.07ml inj
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Formulary
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Brolucizumab  (Beovu®)
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Formulary
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Solution for intravitreal injection 19.8mg/0.165ml
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LSCMMG: Opthalmology Macular Pathways
MHRA: Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
NICE TA672: Brolucizumab for treating wet age-related macular degeneration
NICE TA820: Brolucizumab for treating diabetic macular oedema
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Faricimab (Vabysmo ®)
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Formulary
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Solution for intravitreal injection 120 mg/mL
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NICE TA1004: Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion
NICE TA799: Faricimab for treating diabetic macular oedema
NICE TA800: Faricimab for treating wet age-related macular degeneration
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Ranibizumab
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Formulary
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Solution for intravitreal injection 10mg/mL
Ranibizumab biosimilars - Byooviz, Ongavia, Rimmyrah and Ximluci
 For NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal).
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LSCMMG: Opthalmology Macular Pathways
NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
NICE TA274: Ranibizumab for treating diabetic macular oedema
NICE TA283: Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
NICE TA298: Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
NICE TA637: Ranibizumab for treating diabetic retinopathy (terminated appraisal)
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Verteporfin injection
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Formulary
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Powder for solution for infusion 15mg
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Bevacizumab gamma
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Formulary
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NICE TA1022: Bevacizumab gamma for treating wet age-related macular degeneration
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Pegaptanib
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Formulary
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NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
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| 11.08.02 |
Vitreomacular traction |
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| 11.08.02 |
Uveitis |
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Adalimumab
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Formulary
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Solution for injection
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MHRA: Tumour necrosis factor alpha inhibitors
NICE TA460: Adalimumab and dexamethasone for treating non-infectious uveitis
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| 11.08.03 |
Reduction of elevated intra-ocular pressure |
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| .... |
Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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