Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists

Abstract

Précis: The change in glaucoma surgical volumes due to the COVID-19 pandemic was not uniform across procedure types and unequal between rural and urban practice locations. Purpose: To quantify the impact of the COVID-19 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. Methods: This retrospective cohort analysis of the CMS Medicare Public Use File extracted all glaucoma surgeries including micro-invasive glaucoma surgeries, trabeculectomy, goniotomy, lasers, and cataract surgery performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percent change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P<0.05. Results: In 2020, fellowship trained glaucoma surgeons operated mostly in urban areas (N=810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N=56,781). MIGS experienced a 86% and 75% decrease in rural and urban areas respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% (P>0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (−22% and −12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (−18% and −10%, respectively). Conclusions: Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas was the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.