RANZCO has published new triage guidelines and warned of the potential ramifications for ophthalmologists that perform unnecessary cataract procedures during a government-imposed suspension of elective surgery amid COVID-19.
On 26 March, the college and the Australian Society of Ophthalmologists (ASO) sent an alert to ophthalmologists to advise elective cataract surgery was not considered a priority at present and that day surgeries could place their accreditation to operate in jeopardy if they breach new elective surgery rules.
It comes after the Federal Government announced that elective procedures in both public and private systems will cease from 11.59pm Wednesday 1 April, except for Category 1 and urgent Category 2 cases. The measure is designed to preserve medical supplies and free up hospital beds and ventilators to cope with a rapid rise in COVID-19 patients.
“RANZCO and the ASO are making it very clear to Fellows that we do not consider elective cataract surgery fits within these categories,” the email to members said.
“Some Fellows may think they should be able to continue as normal or to categorise their patients in a way that might meet some urgent criteria. There can be no reason why cataracts cannot wait until this crisis is over.”
It continued: “Sacrifices are being made across the whole of medicine and the whole of Australia. We need to play our part. We have been advised that any day-surgeries found to be flaunting the directive of government may find their accreditation to operate or any future financial support from the government very quickly cancelled.
“In the meantime, there are patients who will require urgent and essential treatments to keep their sight. It is our job to service these patients.
“It is up to every one of us to ensure that individuals do not damage the profession of ophthalmology during these difficult times.”
New triage guidelines
To ensure the appropriate triage of patients during the pandemic, RANZCO CEO Dr David Andrews told Insight the college had adapted Moorfields Eye Hospital Guidelines to suit an Australian context. The RANZCO COVID-19 Triage Guidelines can be accessed to inform clinical decision-making for ophthalmologists.
The guidelines define high, medium and low urgency. They state that high and medium urgency are time-sensitive (should be reviewed within three months) and should continue for now.
According to the college, low urgency should be deferred for four to 12 months at the clinician’s discretion, however this is subject to further review and amendment. All elective cataract surgery must cease.
The guidelines also state that all nasolacrimal procedures (nasal syringing, lacrimal surgery and nasal endoscopy) should cease unless absolutely medically indicated (attempt medical therapy first) due to the high risk of COVID-19 infection from the nasopharynx.
Whenever possible, the college advises that telehealth is preferred, with most conjunctivitis manageable by telehealth.
Prior to the government’s elective surgery ban, RANZCO united with other prominent medical colleges to advocate for a stop to all elective surgery, except for urgent cases.
The group has been working to identify the critical procedures that cannot be postponed, with RANZCO president Associate Professor Heather Mack emphasising that “urgent, sight-preserving, eye surgery needs to continue”.
Prime Minister Mr Scott Morrison said the cancellation of elective surgeries will allow the preservation of resources, including personal protective equipment and allow health services to prepare for their role in the COVID-19 outbreak.