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11.8 Miscellaneous opthalmic preparations


         11.8.1 Tear deficiency, ocular lubricants and astringents

              Lutein and Oral Antioxidants Vitamin Supplements for Eye Conditions - prescribing guidance
              Dry Eye Patient Information Leaflet
                    GREEN* Self-care policy applies - advise patient to purchase where appropriate   [Consider OTC/Self care]  
                    GREEN*       Sno-Tears® 1.4% eye drops [Polyvinyl alcohol]
                    GREEN*      Hypromellose 0.3% eye drops [AaproMel®, Dew Tear®, Lumecare®]
                    GREEN*      Clinitas Gel® eye drops [Carbomer]
                    GREEN*      HYLO-NIGHT® eye ointment (formerly VitA-POS® eye ointment)
                    GREEN*       Lacri-Lube eye ointment
                    AMBER       llube® eye drops   
                    AMBER       Hylo-Forte® eye drops  (Consultant initiation only, reserved for dexterity issues)
                                        [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
                    AMBER       Systane® BALANCE lubricant eye drops (Specialist initiation only for Dry eye  symptoms associated with 
                                        Meibomian gland dysfunction)   
                    AMBER       Ciclosporin (Ikervis®) unit dose eye drops - PRESCRIBE BY BRAND
                                        Ciclosporin for treatment of dry eye disease that has not improved despite treatment with artificial tears is 
                                        recommended as an option by NICE. NICE TA369 
                    AMBER       Sodieye® 5% PF eye drops [Sodium Chloride 5% eye drops] PRESCRIBE BY BRAND 
                    AMBER      Ciclosporin 0.1% eye drops 0.3ml unit dose (Verkazia®)  -- Specialist initiation
                    RED            Cross Linked Hyaluronic Acid & Co Enzyme Q10 (VisuXL®) Specialist use only
                    RED            Carbomer single use eye gel  (Viscotears® eye gel 0.6ml unit dose) NICU use only
             Severe Dry Eye Only 
                    GREEN*    Evolve HA® eye drops (preservative free) 
                                        [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
                    GREEN*    Xailin HA® (sodium hyaluronate 0.2% Preservative Free)
                                        [Self-care should be considered for mild/moderate dry eye not associated with a co-morbidity]
                    GREEN*    Blink® Intensive Tears** 10ml and 0.4ml unit dose drops [Sodium hyaluronate 0.2%)
                                        **[1st line choice hyaluronate in Primary Care]
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         11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment
               Ocular diagnostic preparations 
                    AMBER      Apraclonidine eye drops 0.5%
                    RED            Fluorescein unit dose eye drops 1%, 2%
                    RED            Proxymetacaine & fluorescein unit dose eye drops 0.5%
               Ocular peri-operative drugs
                    RED           Balanced Salt Solution® 
                    AMBER      Diclofenac unit dose eye drops 0.1%
                    AMBER      Ketorolac eye drops 0.5%
                    RED           Miochol-E® solution for intra-ocular irrigation
                    RED           Sodium hyaluronate injection 10mg/ml, 14mg/mL, 23mg/mL
               Approved for specific use in ophthalmolgy for volume enhancement of post-enucleation socket syndrome:
                    RED           Hyaluronic acid injection (Restylane Sub-Q,® Juvederm®) 
               Approved for use in opthalmology for those at higher risk of developing post-surgical cystoid macular oedema:
                    RED          Bromfenac eye drops (Yellox®) 
               Subfoveal choroidal neovas cullarisation  
               For use as per NICE guidance only. 
                    RED         Verteporfin injection 15mg vial
    Subfoveal choroidal neovascularisation
              Approved for use in line with NICE guidance
              NICE TA294     Wet age-related macular degeneration 
              NICE TA305     Visual Impairment caused by macular oedema secondary to central retinal vein occlusion
              NICE TA346     Treatment for some people with sight problems caused by diabetic macular oedema  
              NICE TA486     An option for treating visual impairment because of myopic choroidal  neovascularisation in adults,
                                       only if the company provides aflibercept  with the discount agreed in the patient access scheme
                    RED         Aflibercept  [Eylea 2mg/50microlitres solution for intravitreal injection]                   (NHS England Commissioned)
              Vitreomacular traction 
              Ocriplasmin for use in accordance with NICE guidance as an option in NICE TA297 
                    RED          Ocriplasmin concentrate for solution for intravitreal injection 2.5mg/mL
                                     (Each vial contains 0.5 mg of ocriplasmin in 0.2 ml solution)
              Approved for use in accordance with NICE guidance:
              NICE TA283      Visual Impairment caused by Macular oedema secondary to retinal vein occlusion
              NICE TA274      Diabetic macular oedema (DMO)
              NICE TA155      Wet age-related macular degeneration (AMD)
              NICE TA298      Choroidal neovascularisation associated with pathological myopia 
                    RED            Ranibizumab solution for intravitreal injection 10mg/mL vial
              Wet age-related macular degeneration
              NICE TA672    Recommended as an option for treating wet age-related macular degeneration in adults [as per guidance]
                    RED          Brolucizumab solution for injection pre-filled syringes 19.8mg/0.165ml
                                                                                                                                               CCG Commissioned Blueteq form required
            Wet age-related macular degeneration
            NICE TA800      Recommended as an option for treating wet age-related macular degeneration in adults, only if:
                                         > the eye has a best-corrected visual acuity between 6/12 and 6/96
                                         > there is no permanent structural damage ti the central fovea
                                         > the lesion size is 12 disc areas or less in  greatest linear dimension
                                         > there are signs of recent disease progression (for example, blood vessel growth as shown by fluorescein
                                            angiography, or recent visual acuity changes)
                                         > the company provides faricimab according to the commercial arrangement
                                                                                                                              ICB Commissioned (formerly CCG) Blueteq form required

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