REPORT: Royal College of Ophthalmologists, UK

   

Medical Retinal Management Plans during COVID-19

 

Due to the extreme pressure on the health service, the Royal College of Ophthalmologists has provided some suggestions on how to reduce medical retina outpatient visits. This is a pragmatic approach to maintain care for those patients who need it while deferring care for those patients who can wait. Individual eye departments can of course institute their own guidelines but the suggestions below are considered by the College as acceptable in these difficult times. Please read in conjunction with the general College guidance for care during the covid pandemic.

 

For patients already under review by the hospital eye service:

Wet AMD patients
Maintain all patients on 8 weekly anti-VEGF therapy with no clinic review unless they mention a significant drop in vision at their injection visit. Such patients may need OCT and VA assessments and management changed, if deemed appropriate. It is suggested that hospitals use only aflibercept for simplicity of maintaining an 8 weekly schedule.

 

DMO
Defer anti-VEGF injections and review in clinic after 4 months. Exceptions are eyes with severe NPDR and active PDR that may require anti-VEGF agents and PRP. Virtual review with OCT and wide field colour photography is the preferred option to review these patients.

 

BRVO
Defer review in clinic by 4 months

 

CRVO
For patients with macular oedema due to CRVO who have had at least 6 injections, consider PRP if required. Otherwise, review in clinic in 4 months. Inherited retinal diseases delay review by 6 months or longer.

 

CSCR
Delay review by 6 months or longer.

 

Uveitis
Consultant decision on a case-by-case basis, on whether a review is required within 4 months. Most cases should be deferred by 4 months. Patients on immunosuppression should be managed virtually with blood tests done in local GP practice and following the specific Academy of Medical Royal Colleges guidance.

 

PRP Laser
Complete PRP but with appropriate PPE ie surgical masks and breathguard. If feasible do one more extensive PRP laser to delay need for a second PRP session.

 

PDT laser for CSCR
Delay by 6 months or longer.

 

For New Patients:

Wet AMD
Diagnosis confirmed with OCT and OCTA, if available. Confirmed new wet AMD cases should be treated with a loading phase of 3 injections of aflibercept and then continued on 8 weekly with no clinic review. Consent is taken on the day of first injection.

 

DMO
Defer treatment for 6 months unless associated with R3. R3 patients should be treated with PRP.

 

BRVO
Defer review in clinic by 4 months.

 

CRVO
Provide 6 mandated loading phase if visual impairment due to macular oedema and then review in clinic. If in the opinion of the clinician that there is no hope of visual improvement an alternative approach is an extensive PRP laser to reduce the risk of rubeotic glaucoma. However visual outcomes are likely to be poorer with this approach.

 

Inherited retinal diseases
Delay appointments for 6 months or longer then see in clinic.

 

CSCR
Delay appointments for 6 months or longer then see in clinic.

 

Uveitis
Consultant case by case basis decision on whether to review or not. Patients on immunosuppression should be managed virtually with blood tests done in local GP practice and following the specific Academy of Medical Royal Colleges guidance.

 

Patients on clinical trials

This will be governed largely by individual trust research departments but, as a general principle, it is recommended that observational studies are suspended. Drug trials where the patient would come to harm if the study stopped should continue for patients already on trials but recruitment of new patients should be suspended. Visual acuity measurements may need to be subjective as opposed to objective refracted best corrected visual acuity measurements if optometry staff are not available.

COVID-19 Institution Reports

COVID-19 PPE for Eye Care

COVID-19 Related Links

Sign up to EURETINA


© EURETINA All rights reserved
Loading please wait