Cataract Services in the COVID-19 era: Risk, Consent and Prioritisation

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Abstract Background:The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigating the risks of transmitting COVID-19 are creating significant challenges to recommencement of all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery and report the demographics and comorbidities of patients on the NHS Fife waiting list. Methods:A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on risk factors for poor outcome from COVID-19 infection. Scores derived from the tool were used to generate 6 risk profile groups to call in time order for surgery.Results:There were 744 patients awaiting cataract surgery of which 66 (8.9%) patients were ‘shielding’. One hundred and thirty-two (19.5%) patients had no systemic comorbidities, 218 (32.1%) patients had 1 relevant systemic comorbidity and 316 (46.5%) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7%) did not have any ocular comorbidities.Conclusions:COVID-19 has presented every department an urgent challenge to deal with the mounting cataract surgery waiting list. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated recommencement of our cataract service taking into account biohazard measures of the COVID-19 era.

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