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 Formulary Chapter 11: Eye - Full Chapter
Notes:

Preservative Free Eye Drops
Microbial contamination of multidose bottles of eye drops can cause eye infections that may lead to damage of the eye and in extreme cases loss of sight. To minimise the risk, multidose bottles of eye drops contain an antimicrobial preservative such as benzalkonium chloride. The preservatives used in eye drops are normally well tolerated, but they are not completely harmless. They can cause irritation and damage to the corneal epithelium. This risk is understood to be greater in patients with pre-existing damage to the ocular surface and where large quantities of preservative containing eye drops are applied repeatedly over a prolonged period (e.g. if applied more than 4 to 6 times daily for several weeks/ months).
To avoid these problems the use of preservative-free eye drops is recommended in:
 Patients who have experienced hypersensitivity reactions or irritation due to preservatives in eye drops.
 Patients who have received corneal grafts.
 Patients with conditions where there is already damage to the ocular surface as a result of disease or trauma, such as dry eye, blepharitis, ocular burns etc.
Treatment with preservative-free eye drops will usually be initiated by an ophthalmologist.
Chapter Links...
Link   North of Tyne, Gateshead and North Cumbria - Ophthalmology Referral Guidelines
 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
11.08.02  Expand sub section  Ocular peri-operative drugs
11.08.02  Expand sub section  Subfoveal choroidal neovascularisation
Aflibercept  (Eylea®)
View adult BNF View SPC online View childrens BNF 		Formulary
Red
High Cost Medicine
CCG
  • 40mg/1ml & 114.3mg/1ml solution for injection
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for macular oedema – central retinal vein occlusion in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for treating visual impairment caused by macular oedema after branch retinal vein occlusion in line with NICE.
  • Approved as an option for treating visual impairment because of myopic choroidal neovascularisation in adults in line with NICE

 

 
Link  NICE TA 294 Aflibercept solution for injection for treating wet age‑related macular degeneration
Link  NICE TA 305 Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion
Link  NICE TA 346 Aflibercept for treating diabetic macular oedema
Link  NICE TA 409: Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion
Link  NICE TA 486: Aflibercept for treating choroidal neovascularisation
 
Brolucizumab (Beovu®)
View adult BNF View SPC online View childrens BNF 		Formulary
Red
High Cost Medicine
CCG
  • 19.8mg/0.165mL solution for injection (pre-filled syringes)
    • Approved for treating wet age-related macular degeneration in adults in line with NICE
 
Link  MHRA Drug Safety Update (Jan 2022): Brolucizumab (Beovu▼): risk of intraocular inflammation and retinal vascular occlusion increased with short dosing intervals
Link  NICE TA672: Brolucizumab for treating wet age-related macular degeneration
Link  NICE TA820: Brolucizumab for treating diabetic macular oedema
 
Faricimab (Vabysmo® )
View adult BNF View SPC online View SMC online View childrens BNF 		Formulary
Red
CCG
  • 120mg/1ml solution for injection
    • Approved for the treatment of diabetic macular oedema in adults in line with NICE
    • Approved for the treatment of wet age-related macular degeneration in line with NICE
    • Approved for the treatment of visual impairment caused by macular oedema after retinal vein occlusion in line with NICE
 
Link  NICE TA799: Faricimab for treating diabetic macular oedema
Link  NICE TA800: Faricimab for treating wet age-related macular degeneration
Link  TA1004: Faricimab for treating visual impairment caused by macular oedema after retinal vein occlusion
 
Ranibizumab 10mg/1ml injection (Lucentis®)
View adult BNF View SPC online View childrens BNF 		Formulary
Red
High Cost Medicine
CCG
  • Approved for wet age related macular degeneration in line with NICE.
  • Approved for diabetic macular oedema in line with NICE.
  • Approved for visual impairment caused by macular oedema secondary
    to retinal vein occlusion in line with NICE.
  • Approved as a possible treatment for sight problems caused by choroidal neovascularisation in people who also have pathological myopia in line with NICE.

 

 

 
Link  NICE TA 274 Ranibizumab for treating diabetic macular oedema
Link  NICE TA 155 Ranibizumab and pegaptanib for the treatment of age-related macular degeneration
Link  NICE TA 283 Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion
Link  NICE TA 298 Ranibizumab for treating choroidal neovascularisation associated with pathological myopia
 
Verteporfin 15mg Injection (Visudyne®)
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Red

Approved for photodynamic therapy in wet age-related macular degeneration in line NICE.

 
Link  NICE NG82: Age-related macular degeneration
Link  NTAG Decision Summary June 2020: Verteporfin
 
Bevacizumab 1.25mg/0.5ml intravitreal injection
View adult BNF View SPC online View childrens BNF 		Unlicensed Drug Unlicensed
Red
CCG
  • NETAG approved for use in the management of macular oedema
    secondary to retinal vein occlusion. This is considered a more cost
    effective treatment option in RVO compared with ranibizumab.
  • NTAG approved for age related macular degeneration.

 

 
 
11.08.02  Expand sub section  Vitreomacular traction to top
11.08.02.04  Expand sub section  Other products - Mainly for treating ocular injuries
11.08.02.04  Expand sub section  Antifungals
11.08.02.04  Expand sub section  Cytotoxics / wound healing modulators
11.08.02.04  Expand sub section  Fibrinolytic drugs
11.08.02.04  Expand sub section  Glues - ocular to top
11.08.02.04  Expand sub section  Immunosuppressants
11.08.02.04  Expand sub section  Treatment of burns
11.08.02.04  Expand sub section  Visco-elastics
11.08.02.04  Expand sub section  Other
 ....
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
Cytotoxic Drug
 Cytotoxic Drug
CD
 Controlled Drug
High Cost Medicine
 High Cost Medicine
NHSE
 NHS England
Homecare
 Homecare
CCG
 CCG

Traffic Light Status Information

Status Description

Red

 Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

 Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

 Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

 Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

 NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

 UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

 NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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