We have read with great interest the recent article by Wickham et al. on ‘The impact of COVID policies on acute ophthalmology services—experiences from Moorfields Eye Hospital NHS Foundation Trust’ [1]. During the pandemic, the authors noted a >50% decline in attendances to their Accident & Emergency (A&E) departments and a sharp decline in new referrals for age-related macular degeneration (ARMD) with an almost 25% ‘Did Not Attend’ (DNA) rate by patients already known to the ARMD service [1].

Prior to the Covid-19 pandemic the majority (66.7%) of medical retina departments received more than 20 new urgent ARMD referrals per month, while in April and May 2020 most units (83.3%) reported less than 20 monthly referrals (Fig. 2). In addition, an increase in the DNA or cancellation rate of existing ARMD patients was noted by 77.8% of units. Four respondents estimated this rate to be equivalent to 20–30% of their booked appointments, while three consultants reported cancellations and DNAs in the region of more than 100 patients per month. One unit kept their cancellation rate at ~10% by proactively ringing patients to explain their new protocols.

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