11.8. Miscellaneous ophthalmic preparations
Restrictions:
Use of adalimumab for the treatment of non-infectious uveitis is restricted to specialist use in accordance with NICE TA460.
Prescribing Notes:
Adalimumab should be prescribed by brand name. Amgevita® is the preferred biosimilar.
For the use in other indications, see sections 1.5.3, 10.1.3 and 13.5.3
Restrictions:
The treatment of visual impairment in adolescents and adults with Leber's Hereditary Optic Neuropathy (LHON) is restricted to use only by consultant neuro-ophthalmologists in patients with LHON who are not yet blind (i.e. they do not meet the UK criteria to be registered as severely sight-impaired).
11.8.1. Tear deficiency, ocular lubricants, and astringents
Patients with chronic dry eye conditions should be educated that long-term and regular use of eye lubricants is recommended to achieve maximum benefit. Many of the preparations for dry eyes are considered to be medical devices rather than medicines. The preparations listed in this section are all included in Part 3 of the Scottish Drug Tariff (Appliances) and are able to be prescribed on a GP10 prescription.
In November 2023 the MHRA issued a safety alert for use of certain carbomer eye drops. This has now been widened to a safety alert for all carbomer eye drops in certain patient groups click here.
11.8.1.1. Carbomer-based preparations
Prescribing Notes:
- Clinitas gel is considered the first line treatment for dry eye conditions.
- Contains carbomer 980 0.2% as the active ingredient.
- Preservatives: cetrimide, sodium edetate.
In November 2023 the MHRA issued a safety alert for use of certain carbomer eye drops. This has now been widened to a safety alert for all carbomer eye drops in certain patient groups click here.
Prescribing Notes:
- Contains carbomer 0.2%.
- Preservatives: cetrimide, disodium edetate
In November 2023 the MHRA issued a safety alert for use of certain carbomer eye drops. This has now been widened to a safety alert for all carbomer eye drops in certain patient groups click here.
11.8.1.2. Paraffin-based preparations
Prescribing Notes:
- Hylo-Night is the preferred paraffin-based preparation and until recently was known as VITA-POS.
- The recommended frequency is once daily at night.
- Contains retinol palmitate 259units/g, liquid paraffin and wool fat.
- Preservatives: preservative-free.
Prescribing Notes:
- Contains white soft paraffin, white mineral oil and lanolin alcohols.
- Preservatives: preservative-free.
11.8.1.3. Sodium hyaluronate preparations
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Considered the first line sodium hyaluronate preparation.
- Contains sodium hyaluronate 0.2%, polyethylene glycol 0.25%.
- Preservatives: borax, boric acid.
Restrictions:
Restricted to use in severe dry eye only.
Prescribing Notes:
- This preparation should be considered for patients with dexterity problems and for whom this administration system is suitable.
- Contains sodium hyaluronate
- Preservatives: preservative-free.
Restrictions:
Restricted to use in severe dry eyes when Blink Intensive Tears or Eyeaze are not appropriate and the addition of trehalose is desirable (corneal damage).
Prescribing Notes:
- Contains sodium hyaluronate (0.15%) and trehalose (3%)
- Preservatives: preservative-free
11.8.1.4. Carmellose-based preparations
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Contains carmellose sodium 0.5%
- Preservatives: boric acid
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Single dose units contain carmellose sodium 0.5%.
- Preservatives: preservative-free.
11.8.1.5. Other ocular lubricant preparations
Restrictions:
Restricted to initiation by consultant ophthalmologists for the treatment of severe keratitis in adults with dry eye disease which has not improved despite treatment with tear substitutes.
Restrictions:
Excludes single dose unit preparations.
Prescribing Notes:
Use for short-term management of simple dry-eye. Other treatment options may be more appropriate for chronic dry eyes.
Contains hypromellose 0.3%. Preservatives may include benzalkonium chloride.
Restrictions:
Restricted to initiation by specialist for use in severe dry eyes only.
Prescribing Notes:
- Contains acetylcysteine 5% and hypromellose 0.35%
- Preservatives: benzalkonium chloride, disodium edetate
Restrictions:
Restricted to use in severe dry eyes only.
Prescribing Notes:
- Do not use more than four times daily
- Contains polyglycol 0.3% and polyethylene glycol 400 0.4%
- Preservatives: boric acid, disodium edetate
11.8.2. Ocular diagnostic and peri-operative preparations and photodynamic treatment
Restrictions:
Restricted to specialist use for indications detailed under Prescribing Notes.
Prescribing Notes:
Formulary indications are:
- Use in adults for the treatment of neovascular (wet) age-related macular degeneration.
- Treatment of visual impairment due to macular oedema secondary to central retinal vein occlusion in accordance with NHSGGC protocol.
- Treatment of visual impairment due to macular oedema secondary to branch retinal vein occlusion (protocol in development)
- Treatment of visual impairment due to diabetic macular oedema (DMO) in adults. It is restricted to specialist use for the treatment of visual impairment due to DMO in adults with best corrected visual acuity (BCVA) 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.
- Treatment of visual impairment due to myopic choroidal neovascularisation (myopic CNV) in line with national guidance.
Restrictions:
Restricted to specialist initiation for the diagnosis of Hornor’s syndrome and post-laser surgery.
Prescribing Notes:
For use in the management of glaucoma, see section 11.6.7
Restrictions:
Restricted to specialist use in accordance with local protocol for the following indications:
- treatment of adults with neovascular (wet) age-related macular degeneration (AMD).
- as a second-line agent for the treatment of visual impairment due to diabetic macular oedema in adults with best corrected visual acuity 75 Early Treatment Diabetic Retinopathy Study letters or less at baseline.
Restrictions:
Restricted to specialist use for the treatment of
- visual impairment due to DMO in adults with best corrected visual acuity (BCVA) of 75 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or less at baseline.
- treatment of adult patients with neovascular (wet) age-related macular degeneration (nAMD).
Restrictions:
Restricted to intitiation by or on the advice of a specialist.
Prescribing Notes:
Duration of treatment to be advised by the specialist, but should not exceed three weeks post-operatively
Restrictions:
the reduction of postoperative macular oedema associated with cataract surgery in diabetic patients is restricted to specialist initiation in diabetic patients with retinopathy.
Prescribing Notes:
Initial supply should be obtained from the specialist centre with GP prescribing only necessary where the specialist considers extending the course of treatment to a total duration of 60 days.
For the relevant SMC advice click here
Restrictions:
Restricted to specialist use for reduction in the risk of postoperative macular oedema associated with cataract surgery in diabetic patients.
Prescribing Notes:
Nepafenac 3mg/mL eye drops provide a once daily alternative to nepafenac 1mg/mL eye drops (administered three times daily).
The use of nepafenac 3mg/ml eye drops is not recommended by SMC for use for postoperative pain and inflammation associated with cataract surgery and remains non-formulary.
Restrictions:
Ranibizumab is restricted to specialist use in accordance with local protocols for the following indications:
- The treatment of neovascular (wet) age-related macular degeneration (AMD)
- The treatment of visual impairment due to diabetic macular oedema (DMO)
- The treatment of visual impairment due to macular oedema secondary to retinal vein occlusion (branch RVO or central RVO)
- The treatment for visual impairment due to choroidal neovascularisation secondary to pathologic myopia
NHSGGC Protocols for the Formulary indications can be searched for and accessed here.
Prescribing Notes:
Ranibizumab is not recommended by SMC and is therefore non-Formulary for the following indication:
- Treatment of proliferative diabetic retinopathy in adults (non-Submission to SMC)
Restrictions:
Restricted to specialist use for the treatment of patients with vision loss due to inherited retinal dystrophy caused by confirmed biallelic RPE65 mutations and who have sufficient viable retinal cells.
Prescribing Notes:
- This therapy is available via the Scottish Government Ultra-orphan pathway
- Formulary status will be reconsidered following the reassessment by SMC (expected September 2023).
11.8.3. Advanced Therapy Medicinal Products within Ophthalmology
Restrictions:
Restricted to specialist use for the treatment of patients with moderate to severe limbal stem cell deficiency, unilateral or bilateral, due to physical or chemical ocular burns.
Prescribing Notes:
Prescribing Notes:
- This therapy is available via the Scottish Government Ultra-orphan pathway
- Formulary status will be reconsidered following the reassessment by SMC (expected September 2023).