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RCOphth statement: NICE rapid guideline on Covid-19 testing and the potential adverse effect on the return to routine cataract surgery

9 September 2020

The Royal College of Ophthalmologists is responding to the NICE rapid guideline on Covid-19 testing and the potential adverse effect on the return to routine cataract surgery.

Guidance regarding, the need for and timing of testing for COVID-19 for patients undergoing elective surgery patients, has been evolving as cataract surgery resumes in the UK. Infection prevention and control guidance is likely to continue to develop in line with better understanding of the virus and its behaviour.

The incidence of Covid-19 in the community has generally fallen considerably in most but not all areas and this incidence has a direct effect on the risk of a patient attending hospital with the disease (either symptomatic or asymptomatic). This continues to be a dynamic situation.

The most recent NICE COVID-19 rapid guideline on arranging planned care in hospitals and diagnostic services states that, in order to minimise the risk of COVID‑19 transmission to other patients and healthcare workers, people having planned care involving any form of anaesthesia or sedation should:

  • follow comprehensive social distancing and hand-hygiene measures for 14 days before admission and
  • have a test for SARS‑CoV‑2 within 3 days before admission and self-isolate from the day of the test until the day of admission

The RCOphth is concerned that the current wording of the NICE guidance will lead providers to mandate COVID-19 pre-operative testing for cataract patients. This can significantly limit the restoration of routine services in some areas whilst the benefit of this guidance in asymptomatic patients remains unclear.

We are in discussion with NICE to address this concern and with recommendations to provide clearer guidance.  The preferred guidance should allow ophthalmologists and providers to locally determine the safest, most reliable and efficient pathway for patients undergoing cataract surgery. The guidance must provide safe but practical recommendations for similar short local anaesthetic procedures whilst not restricting access to care.

  • Some eye units are not testing all cataract surgery patients (topical anaesthesia) with no reported adverse effects on patients and staff of COVID-19 transmission
  • Patient symptoms – no symptomatic patient should undergo elective surgery of any description
  • Patient’s age, sex and whether they are from a black, Asian or other minority ethnic group, or have any underlying conditions that could increase their risk of getting COVID‑19 and of having a severe illness
  • Local community Covid-19 rates
  • Individual surgeon’s and surgical team’s characteristics and risk profile
  • Local availability of, and patient access to, testing
  • Likely patient journey time ie time spent in the hospital
  • Whether the unit utilises a green site/ green pathway; standalone theatres or a very clear blue/ green separation reduces the risk to patients

Read the full NICE guideline:

COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services