Resuming cataract surgery in a high-risk COVID-19 population

The Royal College of Ophthalmologists published key principles addressing the restoration of services.2 Central Middlesex Hospital (CMH) serves Brent, a predominantly Black, Asian and Minority Ethnic population with high morbidity and mortality risk from COVID-19.3 Many preprint articles suggested increased risk of hospitalisation, admission to the intensive care unit and death for people of Black and Asian ethnicity.4 Brent had 210.9 COVID-19 deaths per 100 000; the highest age-standardised rate in England and Wales during the first pandemic wave.5 In addition, the cataract complexity rate for patients operated at CMH is the highest in the country.6 Restarting elective surgery presented a major challenge for NHS London Trusts hit first by the pandemic with greatest impact. [...]the modified Medically Necessary Time-Sensitive (modified-MeNTS) score (table 1) to determine the risk of morbidity and mortality from COVID-19 infection,7 and third, the cataract complexity score,2 to establish surgical risk. Table 1 Modified MeNTS scoring system that systematically integrates factors associated with greater severity of COVID-19 illness and COVID-19 transmission risk to facilitate triage and decision-making for medically necessary, time-sensitive procedures (MeNTS) COVID risk score: modified MeNTS 0 1 2 Total Age 85 Cardiovascular disease None Mild* Severe Chronic obstructive pulmonary disease None Inhaler CPAP Diabetes None Tablets Insulin Immunocompromised None Moderate Severe Anaesthetic Local Sedation GA BAME Other South Asian Black Exposure to COVID-19 positive in last 14 days No Possible Yes Lives in nursing home No – Yes Other (male sex, recent cancer therapy, high BMI, kidney or liver disease, severe dementia) None – Yes Total Low: 0–4 Moderate: 5–6 High: >6 Adapted from Prachand et al 2020,.7 *On medication only BAME, Black, Asian and Minority Ethnic; BMI, body mass index.