Ophthalmology prioritization framework*
| Variable | 1 | 2 | 3 | 4 | 5 | |
|---|---|---|---|---|---|---|
| Procedure factors | OR time, min | < 30 | 30–60 | 60–120 | 120–180 | ≥180 |
| Surgical team size, n | 1 | 2 | 3 | 4 | > 4 | |
| Estimated LOS | Outpatient | < 23 h | 24–48 h | ≤ 3 d | > 4 d | |
| Need for GA | No | Yes | ||||
| Disease factors | Availability & acceptability/ effectiveness of nonsurgical treatment option** | None available or high SE | Available but < 40% as effective as surgery or moderate SE | Available and 40% to 60% as effective as surgery | Available and 60% to 95% as effective as surgery, low risk of SE | Available and equally effective |
| Vision that falls below functional needs** | Monocular patient | Difficulty with ADLs or significant impact on development | Below driving/ occupational requirements or moderate impact on development | Approaching driving/occupational requirements or minimal impact on development | No functional limitation or impact on development | |
| Disease process causes irreversible vision loss | Never reversible | Partially reversible, central-involving | Partially reversible, non-central-involving | Always reversible | ||
| Risk of significant vision loss or progressive disease with 6-wk delay | Extremely high | High | Moderate | Low | Extremely low or none | |
| Impact of 6-wk delay in increase surgical difficulty, surgical risk, or risk of additional intervention | Significantly worse | Worse | Moderately worse | Slightly worse | No worse | |
| COVID-19 exposure risk of nonoperative treatment compared with surgery** | Not applicable/ significantly worse | Somewhat worse | Equivalent | Somewhat better | Significantly better | |
| Patient factors | Age, yr | < 20 | 20–50 | 51–69 | 70–79 | ≥ 80 |
| Fall risk | High risk | Moderate risk | Minimal risk | No fall risk | ||
| Degree of pain or poor QOL (i.e., diplopia) | Extreme distress or discomfort | Moderate distress or discomfort | Low distress or discomfort | No distress or discomfort | ||
| Social factors complicating care** | Significant social factors | Few social factors | No social factors | |||
| Lung disease (asthma, COPD, CF) | None | — | — | Minimal (rare inhaler) | > Minimal | |
| Obstructive sleep apnea | Not present | — | — | Mild/moderate (no CPAP) | On CPAP | |
| CV disease (HTN, CHF, CAD) | None | Minimal (no meds) | Mild (≤ 1 med) | Moderate (2 meds) | Severe (≥ 3 meds) | |
| Diabetes | None | — | Mild (no meds) | Moderate (PO meds only) | > Moderate (insulin) | |
| Immunocompromised | No | Moderate | Severe | |||
| ILI symptoms (fever, cough, sore throat, body aches, diarrhea) | None (asymptomatic) | — | — | — | Yes | |
| Exposure to known COVID-19 positive person in past 14 d | No | Probably not | Possibly | Probably | Yes |
ADL = activities of daily living; CAD = coronary artery disease; CF = cystic fibrosis; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CPAP = continuous positive airway pressure; CV = cardiovascular; GA = general anesthesia; HTN = hypertension; ILI = influenza like illness; LOS = length of stay; OR = operating room; PO = per os; QOL = quality of life.
* Shaded rows were unchanged from the original scoring system. (3) Reprinted from Prachand VN, Milner R, Angelos P, et al. Medically Necessary, Time-Sensitive Procedures: scoring system to ethnically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J Am Coll Surg 2020;231:281–288, with permission from Elsevier.
↵** Additional explanation of these variables available in Prachand et al. (3)