An important letter from our President and the Royal College of Ophthalmology
In an attempt to halt the spread of COVID-19, most routine UK surgery was stopped at very short notice; this included cataract surgery, one of the life bloods of our august society. Our patients are still in need of surgery but are in fear for their lives if they become infected with the dreaded virus; for our part we grieve the cessation of this supremely effective health intervention.
It appears, however, that the COVID tide is now turning; the Government has announced a continued decline in both infections and deaths from this awful disease - we have passed the peak. Plans are afoot to restart elective surgery, including the ‘reboot’ of cataract services, alongside easing of social lockdown measures that have paralysed society.
A variety of factors will conspire to hinder our return to high volume surgery for the foreseeable future, not least of which the need for to social distancing and other cumbersome but necessary infection control practices such as PPE and COVID-testing protocols. But just as the world has changed rapidly, so have we adapted. It has been quite astonishing to observe the enormous scale of change in ophthalmic and other medical services over the past 6 weeks, embraced with flexibility and determination that most of us would have thought impossible a few short months ago.
Last week, a number of UKISCRS Council members were approached by their NHS Trusts to triage patients on waiting lists, as part of plans to restart elective surgery. We quickly convened a UKISCRS tele-council meeting to discuss the issues, in an attempt to find standardised solutions that were both pragmatic and relevant. As a specialist society of cataract surgeons, it is important that we fully engage with the process; we have worked long hours to develop guidelines, refined in close collaboration with the RCOphth Professional Standards and Cataract Workforce Committees.
As a result of our endeavours I am delighted to report that jointly with the RCOphth, we have now published guidance to assist UK Ophthalmologists in general, and our members in particular, in the challenging task of restarting cataract services. We hope that our guidance, entitled “Cataract Surgery Guidelines for the Post COVID-19 Era: Recommendations”, will be of assistance in the validation of cataract surgery waiting lists and in the prioritisation of surgery for those in greatest need. The guidance also applies to new referrals. I am particularly pleased that UKISCRS is increasingly being regarded as a national ‘voice’, long may this continue to be the case.
As emphasised in the document, these guidelines are only intended to prioritise according to need in the immediate post-COVID era: they must not be used to restrict access to eye care. Furthermore, this guidance should not be misinterpreted by commissioners or private medical insurers as an indication of support for the rationing of cataract surgery. UKISCRS rejects the practice of restricting access to life-improving cataract surgery based on visual acuity alone, and fully endorses the current NICE cataract surgery guidelines [https://www.nice.org.uk/guidance/ng77] in which such issues are fully considered.