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Clinical Guidelines

Our guidelines are systematically generated to help clinicians make better decisions about appropriate healthcare for specific eye disorders, enhancing clinician and patient decision making by describing and appraising the scientific evidence and reasoning behind clinical recommendations.

They are developed to make recommendations for the majority of clinical situations; however they are intended as an aid to clinical judgment not to replace it. Guidelines do not provide the answers to every clinical question, nor guarantee a successful outcome in every case. The ultimate decision about a particular clinical procedure or treatment will always depend on each individual patient’s condition, circumstances and wishes, and the clinical judgment of the healthcare team.’

All guideline recommendations are agreed via consensus of the guideline development group (GDG).  They are based on the evidence presented to and reviewed by the group. Where an agreement is not secured, there is a majority vote with the chair holding the casting vote.  The RCOphth complaints procedure is followed if any member of the GDG formally judges that the issue remains unresolved.  Our clinical guidelines are published in accordance with the majority consensus process, unless otherwise noted in the guideline document.

We also list guidelines published by other organisations that are relevant to ophthalmologists and those working in the ophthalmic sector e.g. NICE cataract surgery guidelines. 

Take part in our guideline consultations

The Royal College of Ophthalmologists (RCOphth) invites all ophthalmologists, clinicians and allied health professionals involved in eye care to take part in our consultation guideline updates. Find information about our current consultations below:

RCOphth Clinical Guidelines

The aim of College Clinical Guidelines is to identify the best medical evidence, set standards of patient care and ensure patient safety, providing a benchmark for outcomes within which high quality Ophthalmology can be practiced in the UK health service.

Hydroxychloroquine and Chloroquine Retinopathy Monitoring – Executive Summary

Hydroxychloroquine and Chloroquine Retinopathy Monitoring Guideline

Hydroxychloroquine and Chloroquine Retinopathy Monitoring Lay Summary

Hydroxychloroquine is a medicine that is effective in treating various long-term inflammatory disorders of the joints and skin. In general, it is a safe and cost-effective medication, particularly when compared to newer anti-inflammatory medicines which can more significant adverse effects on the body. However, some patients taking hydroxychloroquine, or a similar medication called chloroquine, can suffer permanent loss of vision due to the harmful long-term effect of hydroxychloroquine on the retina.

The Guideline, written with input for Rheumatology and Dermatology colleagues, is in response to the publication of evidence that shows that hydroxychloroquine retinopathy is more common than previously recognised.  It makes specific recommendations regarding the techniques and timing of baseline and follow-up monitoring tests for both hydroxychloroquine and chloroquine retinopathy, and further recommendations regarding the organisation of the monitoring programme and communication between ophthalmologists and prescribing clinician.

Serum Eye Drops Guideline 2017

Serum Eye Drops Guideline Executive Summary 2017

Serum Eye Drops Guideline Lay Summary 2017

Dry eye disease is a global public-health problem with significant impact on quality of life. Serum Eye Drops (SED) contain many nutritional factors that aid therapeutics. Across the NHS There is variation in practice, inequality of access to SED service and no regulated monitoring outcome. This guideline sets out defined criteria for the use of Serum Eye Drops, monitoring of clinical and patient-reported outcomes to improve patient morbidity and standards of care.
These guidelines are not intended to be prescriptive but to act as an aid to considering referral of patients to the nationally designated ocular oncology centres. Referring ophthalmologists should continue to exercise discretion based on the individual clinical presentations of individual patients.
Retinal Vein Occlusion (RVO) Guidelines July 2015

Executive Summary Eye advance online publication 28 August 2015; doi: 10.1038/eye.2015.164

These guidelines (July 2015) reflect changes in treatments, since the 2010 Interim RVO Guidelines. The guidelines provide evidence-based, clinical advice for the management of different aspects of RVO. The scope is limited to current diagnostic tools, management and service set-up and delivery to facilitate delivery of optimal care. They are aimed primarily at ophthalmologists but are relevant to other healthcare professionals, service providers, and commissioning organisations as well as patient groups. It is hoped that, if used appropriately, the guidelines will lead to a uniformly high standard of management of patients with RVO.
  • AMD guidelines 2013 ARCHIVED
The RCOphth AMD guidelines 2013 have been archived. NICE published its Guidelines on Macular Degeneration on 23 January 2018. Following the publication of this Guideline the College released a joint statement with NHS Commissioners regarding potential costs savings for the NHS regarding anti-VEGF treatments. If you require a copy of the archived RCOphth 2013 guidelines please contact [email protected]

AMD Electronic Referral Form

The guidance was developed by a guideline working party (GWP) from the Royal College of Ophthalmologists (RCOphth) and the Royal College of Paediatrics and Child Health (RCPCH). It brings together previous publications of the RCO and an update of the literature since these publications. The guidance is presented under a number of clinically relevant questions developed by the GWP. It is divided into four main chapters: 1. Aetiological factors and experimental models, 2. Clinical features and pathology. 3. Differential diagnosis and confounding conditions and 4.Guidance for the Ophthalmologist.The guidance includes a standardised proforma for documenting retinal findings in Appendix 3.The guidance has primarily been developed for ophthalmologists but is an evidence based resource for any physician or surgeon involved in child protection.
These guidelines will now cover the management of patients undergoing most routine ophthalmic procedures and are not limited to intraocular surgery. The purpose of these guidelines is to provide information for all members of the ophthalmic team in order to promote safe and effective local anaesthesia for ophthalmic patients. They are intended to apply to practice in the United Kingdom.
The aim of the guidelines is to provide evidence-based, clinical guidance for the best management of different aspects of diabetic eye disease. The foundations of the guidelines are based on evidence taken form the literature and published trials of therapies as well as consensus opinion of a representative expert panel convened by the Royal College of Ophthalmologists with an interest in this condition. The scope of the guidelines is limited to management of diabetic retinopathy with special focus on sight threatening retinopathy. It offers guidance regarding service set up to facilitate delivery of optimal clinical care for patients with retinopathy. The guidelines are prepared primarily for ophthalmologists, however they are relevant to other healthcare professionals, service providers and commissioning organisations as well as patient groups.
This guideline is designed for ophthalmologists managing children with strabismus (syn.squint), which is defined as a pathological misalignment of the visual axes. This is a broad subject and the reader is referred to comprehensive texts, for further information see bibliography.  The guidelines are intended to give general principles of management. It is assumed throughout this document that professionals dealing with common and uncommon cases of strabismus will have had adequate training and experience to manage children with these conditions.
The section on paediatric cataract surgery in the RCOphth Cataract Surgery Guidelines 2010 is being reviewed as the NICE Guideline October 2017 does not cover paediatric cataract surgery.
This evidence-based guideline for the screening and treatment of ROP was developed by a multidisciplinary guideline development group (GDG) of the Royal College of Paediatrics & Child Health (RCPCH) in collaboration with the Royal College of Ophthalmologists (RCOphth), British Association of Perinatal Medicine (BAPM) and the premature baby charity BLISS.It provides 25 evidence-based recommendations and 21 good practice points.This guideline has been produced specifically for use within the UK and supersedes the previous guideline. It will not be applicable in countries where more mature babies are at risk of sight threatening ROP.

Other documents

Review of the Ocular side effects of Topiramate 2010

Ocular side effects of Topiramate: Frequently asked questions 2010

The Ocular Side-Effects of Vigabatrin (Sabril) Information and Guidance for Screening 2008