Advocacy & Practice Updates — Clinical Updates

ASRS Releases Guidelines to Help Retina Practices Navigate COVID-19 Pandemic

The ASRS has released detailed guidelines to help retina practices reduce risk and help assure the health and safety of patients and medical personnel during the COVID-19 pandemic. The guidelines define what constitutes an essential visit and provide a means to categorize emergent, urgent and non-urgent cases for the purposes of negotiating for limited operating room access during these unprecedented times.

After receiving multiple inquiries from members, ASRS offers the following guidance for identifying those retinal surgery indications that, if not done in a certain timeframe, will result in severe vision loss. Such designations include: 1) Emergent, 2) Urgent, and 3) Non-urgent, non-elective. Examples of these indications are listed below.

For emergent surgical indications, the risk of permanent vision loss without early intervention is high and access to the operating room is vital. For urgent surgical indications, the risk of severe and permanent vision loss without immediate surgery is not as high and treatment can be delayed.  It is important that the retinal surgeon have discretion as an urgent situation can become emergent. For the non-urgent, non-elective indications, surgery can be delayed without significant risk to further vision loss. It is possible that, in following non-urgent, non-elective patients that their condition can worsen and the urgency increase. It is important that retina specialists are judicious with their use of the emergent and urgent designations. Many factors must be considered in assessing the need for and urgency of surgery and strict guidelines cannot be made.   

* Important Update: This revised list of urgent/emergent procedures was released 3.27.20. 

Examples of emergent surgical indications may include:

  1. Acute retinal detachment – macula attached*
  2. Acute retinal detachment – macula detached in a monocular patient*
  3. Retained lens fragments with elevated intraocular pressure not controlled medically
  4. Acute endophthalmitis with severe vision loss
  5. Open globe injury with or without an intraocular foreign body*
  6. Expulsive choroidal hemorrhage*
  7. Dense vitreous hemorrhage in monocular patient
  8. Exposed/infected scleral buckle or other ocular implant

*  May be urgent depending on location and character

Examples of urgent surgical indications may include**:

  1. Retinal detachment – macula detached
  2. Retained lens fragment with medically controlled intraocular pressure
  3. Vitreous hemorrhage in which a retinal tear or detachment is suspected

** These indications could be considered emergent if the patient is monocular or extenuating circumstances arise 

Examples of non-urgent, non-elective surgical indications may include***:

  1. Macular hole
  2. Dislocated intraocular implant lens
  3. Diabetic vitreous hemorrhage with no macula-threatening retinal detachment
  4. Retained silicone oil
  5. Macular epiretinal membrane/Vitreomacular traction

*** These indications could be considered urgent/emergent if the patient is monocular or extenuating circumstances arise

 

(Published 3.18.20; updated 3.20.19, updated 4.14.20)