The government and NHS England published a joint plan last week setting out how they intend to support the recovery of elective services over the next three years. RCOphth Policy Manager Jordan Marshall summarises the key implications for ophthalmology services. Prime Minister Boris Johnson recently announced the government’s intention to end all domestic pandemic restrictions […]

The Royal College of Ophthalmologists (RCOphth) has welcomed the announcement that the NHS in England will receive an extra £5.4 billion over the next six months to support its response to COVID-19 and help tackle waiting lists. This includes £1.5 billion to manage the elective surgery backlog (including £500 million capital funding), with delays to cataract surgery identified by government as a particular concern.

There have been several case reports on the use of nitrous oxide in the presence of intraocular gas after vitreoretinal surgery with severe loss of vision due to central retinal artery occlusion.2-6 There have also been some cases identified via national incident reporting systems. Nitrous oxide leaves the bloodstream and vitreous cavity quickly once inhalation is terminated,7 restoring the position of the lens-iris diaphragm and reperfusion of the central artery can happen. However, irreparable damage to the retina is known to occur after 100 minutes of ischaemia.7 The extent of damage to the eye may therefore be dependent on the duration of general anaesthesia / use of Entonox and the size of intraocular gas bubble at that time. There is a theoretical risk of harm (raised intraocular pressure or hypoxic iris) in anterior chamber gas bubbles during keratoplasty in the same circumstances, that is flying, high altitude or nitrous oxide use. It is currently unclear whether this represents a significant risk, as there is little published, but some corneal surgeons are warning their patients not to fly postoperatively.

As the voice of the profession, we work closely with our members, partners across the eye care sector and policymakers to improve public policy so key challenges facing ophthalmology services across the UK are recognised and addressed. Since our last roundup, we: Published the third in our series of case studies detailing examples of best […]

The College recognises that botulinum toxin and surgical treatment for strabismus* are important procedures that are performed in children and adults to promote, improve or re-establish binocular function, manage diplopia and restore ocular alignment and balance. Surgical intervention (including botulinum toxin injections) performed to achieve these aims is thus not a cosmetic procedure and does not fall under the GMC guidance for cosmetic surgery. Commissioning pathways for the management of squints reflect this.