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Area Prescribing Committee
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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Review date: January 2023

Non-formulary drugs: Any drug or formulation not listed in the formulary is deemed to be non-formulary.

Off-label use: Drugs are included in the formulary for their licensed indications – where inclusion of off-label use is considered to be included in the formulary this is specifically stated in the formulary entry for the drug N.B. also see Paediatrics note below.

Paediatrics: Drugs are included in the formulary for paediatric use for their BNF for Children recommended indications (indicated by symbol View childrens BNF) which may be off-label, unless otherwise stated. All drugs are deemed to have the same RAG status as they have for adults unless stated otherwise.

NHS England Specialised Commissioning
Drugs carrying the NHS England logo are commissioned by them. Links to key documents, national programmes of care, and clinical reference groups are found below.

NHSE NHS England Specialised Commissioning: Key documents

NHSE NHS England Specialised Commissioning: National programmes of care and clinical reference groups

 Details...
11.08.02  Expand sub section  Ocular diagnostic and peri-operative preparations and photodynamic treatment
11.08.02  Expand sub section  Ocular diagnostic preparations
 note  Fluorescein may be administered as a diagnostic aid in examination of the eye by competent practitioners. There are no indications for prescribing fluorescein.
11.08.02  Expand sub section  Ocular peri-operative drugs
 note 


Apraclonidine
View adult BNF View SPC online View childrens BNF
Formulary
Red

0.5% eye drops and 1% single dose eye drops

 

Amber Recommended 

Apraclonidine eye preparations may be recommended by specialists for the management of chronic glaucoma that is unresponsive to therapy in patients who would otherwise require surgery for their disease. Patients must have tried and failed, or had an adverse reaction, on all standard therapies before apraclonidine may be prescribed.

Apraclonidine 0.5% eye drops are licensed for short-term adjunctive therapy of chronic glaucoma in patients on maximally tolerated medical therapy who require additional intraocular pressure (IOP) reduction to delay laser treatment or glaucoma surgery. Use of 1% preservative-free preparation, or 0.5% eye drops other than previously described, is off-label. The ophthalmologist should clearly communicate the rationale for prescribing apraclonidine in the clinic letter to primary care.

Apraclonidine 1% preservative-free preparations must only be prescribed for patients who have a clearly documented allergy to preservatives contained in eye drops.

 
   
Bromfenac
View adult BNF View SPC online
Formulary
Red
0.09% eye drops

 
   
Diclofenac
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.1% eye drops, 0.1% unit dose eye drops

 
   
Flurbiprofen 0.03% & polyvinyl alcohol 1.4%
View adult BNF View SPC online View childrens BNF
Formulary
Red
eye drops

 
   
Ketorolac
View adult BNF View SPC online View childrens BNF
Formulary
Red
0.5% eye drops

 
   
Nepafenac
View adult BNF View SPC online View childrens BNF
Formulary
Red
1mg/ml (0.1%) eye drops 
   
Povidone-iodine
View adult BNF View SPC online View childrens BNF
Formulary
Red
5% single dose eye drops 
   
11.08.02  Expand sub section  Subfoveal choroidal neovascularisation
Aflibercept
View adult BNF View SPC online
Formulary
Red

solution for intravitreal injection
 

 
Link  NICE TA294: Aflibercept to treating wet age-related macular degeneration
Link  NICE TA305: Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA346: Aflibercept for treating diabetic macular oedema
Link  NICE TA409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA486: Aflibercept for treating choroidal neovascularisation
   
Ranibizumab
View adult BNF View SPC online
Formulary
Red

Solution for intravitreal injection

Grey for treatment of diabetic retinopathy

 
Link  NICE TA155 (2012). Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA274 (2013). Ranibizumab for treating diabetic macular oedema
Link  NICE TA283 (2013). Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA298 (2013). Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
Link  Pan Mersey APC (2019). RANIBIZUMAB solution for injection (Lucentis®) for the treatment of proliferative diabetic retinopathy
Link  Pan Mersey APC (2019). RANIBIZUMAB intravitreal injection (Lucentis®) for choroidal neovascularisation (non-NICE indications)
   
Pegaptanib
View adult BNF View SPC online
Formulary
Black
solution for intravitreal injection
Not recommended – see NICE TA155 
Link  NICE TA155, Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
   
Bevacizumab
View adult BNF
Unlicensed Drug Unlicensed
Red
Intravitreal injection

For pre-specified indications or as part of a clinical trial only. 
   
11.08.02  Expand sub section  Vitreomacular traction to top
Ocriplasmin
View adult BNF View SPC online
Formulary
Red
intravitreal injection 
Link  NICE TA297: Ocriplasmin for treating vitreomacular traction
   
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Medicines considered suitable for non-specialist prescribing in primary or secondary care.  

Amber Recommended

Requires specialist assessment to enable patient selection.  Amber Recommended medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Following specialist assessment, the medicine is suitable for prescribing in Primary Care.  

Amber Initiated

Amber Initiated. Requires specialist initiation of prescribing. Prescribing to be continued by the specialist until stabilisation of the dose is achieved and the patient has been reviewed. Amber Initiated medicines must meet criteria: (1) Requires specialist assessment to enable patient selection (2) Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable   

Amber Retained

Amber Patient Retained. Requires specialist initiation of prescribing. Prescribing to be continued by specialist until stabilisation of the dose is achieved and the patient had been reviewed. Patient remains under the care of specialist (ie not discharged) as occasional specialist input may be required. Amber Patient Retained medicines must meet criteria: (1)Requires specialist assessment to enable patient selection (2)Medicine is suitable for on-going prescribing in Primary Care (3) Requires short to medium term specialist prescribing and monitoring of efficacy or toxicity until the patient’s dose and condition is stable (4) May require occasional specialist input indefinitely and therefore the patient should not be discharged from specialist care   

Amber

Medicines recommended or initiated by specialists in primary or secondary care. Non-specialist prescribing in primary care may follow according the RAG criteria. In process of being superceded by Amber Recommended, Amber Initiated and Amber Patient Retained.  

Purple

Shared Care. Medicines are considered suitable for Primary Care prescribing and/or management, following specialist initiation of therapy, with on-going communication between the Primary Care prescriber and specialist, within the framework of a Shared Care Agreement. Medicines designated as requiring Shared Care require on-going input from both Specialist and Primary Care clinicians and patients should not be discharged from Specialist care. Where prescribing and monitoring are required under shared care, it is implicit that the responsibility for both of these tasks rests with the prescriber. A Shared Care Agreement will always be available for Shared Care medicines and this document will include a Shared Care Agreement pro-forma which will be completed by all involved clinicians. This pro-forma will record agreement to take on defined aspects of care e.g. monitoring and/or on-going prescribing for the individual patients. A policy detailing clinician responsibilities in Shared Care Agreements must be referred to in all cases of Shared Care. All drugs to be included in this category must meet Shared Care criteria 1 to 3: SC1 Requires specialist assessment to enable patient selection and also initiation, stabilisation and review of treatment and the patient`s condition. SC2 Prescribing and/or management of the drug in Primary Care with specialist support and input, within the framework of the Shared Care Agreement is safe and convenient and that there is an appropriate mechanism for individual patient access in Primary Care. SC3 Requires specific long-term monitoring (blood test or other measurement) for adverse effects and / or efficacy of the drug to be completed in Primary Care, and requires on-going specialist support for the dose changes or management of adverse effects. Monitoring is required on a regular basis (typically four times a year). Implicit in any shared care agreement is the understanding that participation is at the discretion of the Primary Care prescriber subject to their clinical confidence.   

Red

Primary care prescribing of these medicines is NOT recommended. These treatments should be initiated by specialists only; ongoing prescribing is retained within secondary care.   

Black

Not recommended for use. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist.   

Grey

Not recommended for use at this time. Deviation from the policy may be considered on an individual basis where exceptional circumstances exist. Further guidance will be issued when more information or evidence is made available.  

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