Impact and Determinants of COVID-19 Pandemic on the Cataract Surgery Rate at a Tertiary Referral Center

Abstract

Purpose Preventive measures to mitigate the spread of coronavirus, minimized workload on health-care systems and redirected resources to COVID-19 patients resulting in a reduction of elective procedures such as cataract surgery. We report the changes in monthly cataract surgery rate and its associated determinants at a tertiary eye hospital during different periods of the pandemic. Studying the impact of COVID-19 pandemic on cataract surgery rate will help health-care policymakers to better understand the barriers to overcome the expected surgical backlog. Methods A retrospective review of medical records was performed for cataract surgeries from November 2018 to January 2022, five thousand and ninety-two eyes that underwent cataract surgery during different phases of the COVID-19 pandemic were included. The monthly cataract surgery rate (MCSR) was calculated and compared before (Phase 1), during (Phase 2) and after the COVID-19 pandemic (Phase 3 and 4). Changes in monthly cataract surgery rate during and after the pandemic were presented as ratios and compared pre- to post-pandemic levels to evaluate the impact of different determinants. Results Of 9701 cataract patients, 5092 (52.5%) were operated in P1, 71 (0.73%) in P2, 116 (1.2%) in P3 and 4422 (45.6%) in P4. The MCSR varied significantly based on the degree of visual impairment in the operated and fellow eyes, and by the type of operating surgeon (P < 0.05). Age, gender, laterality, and place of residence were not significantly different throughout the study period. During phase 1135 (2.6%) eyes had rupture of the posterior capsule (PCR), while 6 eyes (8.4%) had PCR in phase 2. Conclusion The monthly cataract surgery rate declined during the pandemic and has not recovered to pre-pandemic levels. This should alert the key stakeholders to address the identified barriers to surpassing the baseline monthly surgical rate as this is crucial to eliminate the surgical backlog after the pandemic.

Trends in cataract surgery and healthcare system response during the COVID-19 lockdown in Malaysia: Lessons to be learned

“…However, the recovery of cataract surgeries was uneven across regions, independent of country income status. Studies in some regions gathered similar results to ours [ [18] , [19] , [20] ]. In other regions [ 12 , 13 , 21 ], cataract surgeries returned to or exceeded pre-COVID-19 vol a few months after the initial cancellation of elective ophthalmic service during the pandemic.…”

“…In our study, the majority of patients who underwent cataract surgery were aged 40 years and above (98 %). However, during the lockdown, the number of cataract surgeries performed in older patients were relatively fewer than those in younger patients, which have been observed in studies in India [ 13 ] and Saudi Arabia [ 19 ]. Older age is an important risk factor for increased COVID-19 related morbidity and mortality [ 27 ] in all phases of the pandemic, which may have led to healthcare professionals postponing cataract surgeries in older patients, or patients themselves electing to defer their surgeries even if hospitals have resumed elective surgeries under strict infection control procedures [ 20 ].…”

The Ophthalmology Workload during the Lebanese Crisis and Pandemic

“…[ 14 ] The load of cataract surgeries per month decreased during the pandemic and did not recover to prepandemic levels in Saudi Arabia, and a 41.6% decrease in the number of rhegmatogenous retinal detachments was noted during the 2 months lockdown period in 2020 in France, without compensating postlockdown activity. [ 15 16 ] At Moorfields Eye Hospital in London, a 92% reduction in corneal elective work was observed during the lockdown period. [ 17 ] In the current study, and during the lockdown, a overall decrease in the surgical workload was noted in all subspecialties: cornea/refractive surgery (75.8%), glaucoma/anterior segment (56.8%), pPediatric/neuro-ophthalmology (45.2%), retina/uveitis (37.5%), and oculoplastics (33.3%).…”