We would like to expand on the comment by Ting et al. [1], by adding considerations for candidaemia retinal screening in ICU patients. Recently released Royal College of Ophthalmologists (RCOphth) candidaemia screening guidance replaces ‘urgent ophthalmology review’ with ‘review as an exception on a case by case basis’ (https://www.rcophth.ac.uk/wp-content/uploads/2020/04/Eye-Care-in-the-Intensive-Care-Unit-2020.pdf), a potentially lower standard of care. Ophthalmic candida carries a small but significant risk to sight. The current COVID-19 pandemic adds extra considerations when deciding whether to review these patients. COVID-19 is a novel disease with limited evidence in this context. Furthermore, there are risks to examiner, reports of limited personal protective equipment (PPE) and a depleted workforce. Whilst redeployed across Intensive Care Unit (ICU) COVID wards, the authors performed a service evaluation audit to better understand the burden of candidaemia screening during the pandemic.

The first confirmed COVID-19 case at Kings College, London, presented on 25th February 2020. Over the following 2 months there were 212 COVID-19 ICU admissions and of those, five patients developed an intravenous line related candidaemia. Two patients did not survive long enough to be referred for ophthalmic screening. Three were screened and found to have no ophthalmic involvement. Of these, two were receiving intravenous echinocandin antifungal medication (anidulafungin), and one ambisome (amphotericin).

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