Cataract surgery could feature in an initial wave of elective procedures that are allowed to recommence as the Federal Government prepares to lift a suspension on non-urgent surgery.
In a decision welcomed by RANZCO this week, Federal Health Minister Mr Greg Hunt revealed elective surgery is likely to resume after it was cancelled on 1 April to free up bed space and resources amid concerns about the strain of coronavirus patients on the healthcare system.
Hunt made the announcement after Australia received 60 million face masks with another 100 million more set to arrive at the end of May. The minster acknowledged the National Cabinet would likely sign off on the proposal when the Prime Minister, premiers and chief ministers meet this week.
During the course of the outbreak, RANZCO supported the government’s decision to halt non-urgent surgery. However, with a sustained flattening of the curve, it is now backing a gradual easing of restrictions to ensure Australians can regain access to sight-saving surgery.
“Many non-urgent eye surgeries have been delayed, which was appropriate at the time,” RANZCO president Associate Professor Heather Mack said.
“But as we now all understand how to work with social distancing, the national stocks of [personal protection equipment (PPE)] are being replenished and we’re working together to flatten the curve, it will soon be appropriate to restart surgery, such as fixing cataracts.”
According to the college, ophthalmologists believe it is important to begin with cataract surgery, the most performed eye procedure in Australia that now has an increasing backlog of patients.
Associate Professor Andrew Chang, a RANZCO board director and head of ophthalmology at the Sydney Eye Hospital, told Insight the college welcomed a “staged approach” to the resumption of elective surgery.
He said eye surgeries were effective and life-changing procedures that had a low risk of cross-transmission of infection. In particular, cataract surgery could be among the first to restart because it is considered a high value and high impact procedure that produces predictable outcomes without draining vital PPE supplies and resources.
“If you consider major surgery, which are aerosol generating procedures and general anaesthesia, then full PPE is needed and this is needed by the surgeons, the nursing staff and the anaesthetist. But cataract surgery is performed under local anaesthetic, the drapes cover the mouth and nose, reducing the risk of cross transmission, which is why cataract surgery may be considered for early lifting of the suspension of elective surgery,” he said.
“We also appreciate that access to PPE has been a real concern for the government and an issue for the medical sector as a whole. The disposable equipment that we use is pre-packaged especially for eye surgery, which include drapes and gowns, and this does not reduce the national stockpile of PPE required for COVID patients.”
Chang added that cataract patients could typically be sent home on the same day after surgery, meaning they would not occupy hospital bed space.
RANZCO has produced its own COVID-19 Triage Guidelines to ensure the safety of patients and ophthalmologists. Chang said eyecare professionals also understood the mandated requirements, which would be observed when any elective surgery recommences.
“Hospitals have made changes to their waiting rooms, staggered patients so they are further apart and have encouraged patients to attend with only one escort, which is helping reduce the number of people entering the facilities,” he said.
Ophthalmologists would also review and update their treatment protocols to minimise the number of face-to-face appointments following surgeries, Chang added.
Australian Society of Ophthalmologists president Dr Peter Sumich said the health sector understood that COVID as a whole could be damaging, “but we don’t want the secondary health impact of delayed procedures to end up being greater than COVID”.
“We are very mindful that everything that’s been deferred or delayed might have an impact – whether it’s a middle aged man with chest tightness that doesn’t go for an angiogram or a person with belly pain who doesn’t have a colonoscopy done, so we are just starting to have that conversation amongst ourselves about when is the right time to go back,” he told RN Breakfast.
