Cataract risk stratification and prioritisation protocol in the COVID-19 era

Area of Science:

• Ophthalmology
• Public Health
• Health Services Research

Background:

• The COVID-19 pandemic significantly disrupted non-emergency surgeries, including cataract surgery, across Scotland.
• Implementing safety measures for COVID-19 transmission poses challenges to resuming surgical services.
• A substantial waiting list for cataract surgery developed due to the pandemic-induced halt.

Purpose of the Study:

• To develop a risk stratification tool for prioritizing patients awaiting cataract surgery.
• To balance individual patient COVID-19 risk factors with surgical 'need' for prioritization.
• To report the demographic and comorbidity profile of patients on the cataract surgery waiting list.

Main Methods:

• A prospective review of electronic patient records was conducted.
• A risk stratification tool was created by synthesizing literature on COVID-19 risk factors and surgical need.
• Patients were categorized into 6 risk profile groups for prioritized surgical allocation.

Main Results:

• 744 patients were on the cataract surgery waiting list; 8.9% were shielding.
• A significant proportion of patients had comorbidities: 19.5% none, 32.1% one, 46.5% two or more.
• The risk stratification tool identified 23% of patients for the highest 3 priority stages; most patients fell into lower priority stages due to age and comorbidities.

Conclusions:

• The COVID-19 pandemic necessitates pragmatic changes in assessing risks and benefits for cataract surgery.
• A risk stratification tool combining objective risk assessment, patient need, and shared decision-making facilitated service resumption.
• The developed method enabled the safe and successful restart of the cataract surgery service amidst pandemic challenges.