The Royal College of Ophthalmologists has issued advice and guidance for ophthalmologists regarding COVID-19.
The full guidance can be read here: https://www.rcophth.ac.uk/wp-content/uploads/2020/03/Coronavirus-RCOphth-update-March-19th.pdf
The guidance encourages ophthalmology clinical leads and consultants to:
- Work with managers on emergency response planning including identifying which patients to defer, which to offer remote consultation and which to continue seeing–refer to RCOphth escalation policy document for guidance
- Support staff and help to identify how to maintain services including different deployment of staff, rotation and cover of gaps, and use of equipment and space
- Work with admin and non-medical staff to communication with patients and reassure that those who need to come will be protected as much as possible from COVID infection risks and those who are asked not to come now will be protected as much as possible from harm to eye condition and sight.
- Show leadership and maintain calm.
Regarding patients who must attend their appointments, the College recommends the following to reduce exposure:
- Minimise on site waiting time / patient journey time.
- Minimise close packed waiting areas.
- Reduce staff-patient contact time.
- Use treatment changes that can reduce the frequency of required attendances for the next few months, e.g. changes in intravitreal treatment regime or longer-acting drug.
- Limit the number of accompanying adults with the patient.
- Establish as much of the medical and ophthalmic history, or investigation results, as possible before calling the patient into the room.
- Keep more than one meter away from patients except where clinical examination requires it.
- When testing visual acuity, start from the lowest achievable line to speed things up.
- Keep the examination brief and pertinent to the decision making required.
- Avoid re-examination of patients who have already been assessed.
- Avoid a special test (visualfield, OCT, ultrasound) unless absolutely critical to decision making.
- Minimise lengthy procedures at the slit lamp.
- Use other investigations if they can provide the required clinical information and reduce the time of close contact, e.g. at slit lamp or gonioscopy e.g. van herick, ret cam, optos, OCT, anterior segment cameras, ultrasound.
- Where appropriate use an indirect ophthalmoscopy in preference to slit lamp examination or laser delivery.
- Restrict general anaesthesia to cases where there is no other option.
