Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020.

OBJECTIVE: To assess the volume of deferred ophthalmic surgeries in Ontario associated with the COVID-19 pandemic from March to December 2020 and suggest strategies and time required to clear the backlog. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan in 2017-2020. METHODS: Backlog and clearance time for ophthalmic surgeries associated with the COVID-19 pandemic were estimated from time-series forecasting models and queuing theory. RESULTS: From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog needing operating rooms was 92,150 surgeries (95% prediction interval, 71,288-112,841). Roughly 90% of the delayed surgeries were cataract surgeries, and a concerning 4% were retinal detachment surgeries. Nearly half the provincial backlog (48%; 44,542 of 92,150) was in patients from the western health region. In addition, an estimated 23,755 (95% prediction interval, 14,656-32,497) anti-vascular endothelial growth factor injections were missed. Estimated provincial clearance time was 248 weeks (95% CI, 235-260) and 128 weeks (95% CI, 121-134) if 10% and 20% of operating room surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. CONCLUSIONS: Ontario data demonstrate that the magnitude of the ophthalmic surgical backlog in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues, the accrued backlog size is likely to increase. Planning and actions are needed urgently to better manage the collateral impacts of the pandemic on the ophthalmic surgical backlog.

Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic.

OBJECTIVE: To investigate the use and trends of virtual care in ophthalmology and examine associated factors in a universal health care system during the COVID-19 pandemic in 2020. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan. METHODS: We used physician billing data from 2017-2020 to describe the use of virtual versus in-person care. We used logistic regression to examine factors associated with virtual care use. RESULTS: The uptake of ophthalmic virtual visits increased immediately following the government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%), peaked 2 weeks later (55.8%), and decreased immediately after the directive was lifted (24.2%). In March-December 2020, virtual visits were higher in female (11.6%) versus male (10.3%) patients and in patients <20 years of age (16.4%) and 20-39 years of age (12.3%) versus those aged 40-64 years (10.8%) and 65+ years (10.6%). Patients residing in the poorest/poorer neighbourhoods (10.9%) had similar use as their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or nonurgent diagnosis (16.2%) had the highest use. Those with retinal disease had the lowest use (4.2%). Female ophthalmologists (15.4%) provided virtual care more often than male ophthalmologists (9.9%). Ophthalmologists aged 60-69 years (13.1%) provided virtual care more often than any other age groups (<40 years: 11.3%; 40-49 years: 11.0%; 50-59 years: 10.0%; and 70+ years: 7.7%). Multiple logistic regression models revealed similar results. CONCLUSION: Virtual care in ophthalmology increased significantly during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.

The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study.

BACKGROUND: Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario. METHODS: This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years. RESULTS: A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries). INTERPRETATION: The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.

SARS-CoV-2 Not Detectable in Ocular Specimens of a Patient with a Past Infection.

Purpose: To present a a case study that aims to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the ocular tissue samples of a patient previously infected with COVID-19 and determine its transmissibility.Study Design: Case ReportResults: In this case study, SARS-CoV-2 was not detected in the vitreous and uveal tissue samples by RT-PCR for detection of three gene targets in a patient with a past COVID-19 infection 15 days prior to presention with a globe rupture.Conclusions: Our findings suggest that patients with long-term existence of SARS-CoV-2 at low detectable levels may not have active intraocular viral shedding. This is of particular importance as ophthalmic surgical procedures may potentiate virus spread from patients infected with SARS-CoV-2.

Ophthalmology-focused publications and findings on COVID-19: A systematic review.

PURPOSE: To summarize COVID-19 research endeavors by ophthalmologists/researchers in terms of publication numbers, journals and author countries, and to detail key findings. METHODS: The LitCovid database was systematically reviewed for ophthalmology-focused COVID-19 articles. The quality of the evidence was assessed for articles investigating conjunctivitis in COVID-19 patients. RESULTS: There were 21,364 articles in LitCovid on June 12, 2020, of which 215 (1%) were ophthalmology-focused. Of articles on COVID-19 transmission, 3.3% were ophthalmology-focused. Ophthalmology-focused articles were published in 68 journals and originated from 25 countries. The top five countries publishing ophthalmology-focused articles (China, India, United States of America, Italy, and United Kingdom) produced 145/215 (67%) articles. A total of 16 case reports/series from eight countries reported that conjunctivitis can be the initial or the only symptom of COVID-19 infection. Conjunctivitis may occur in the middle phase of COVID-19 illness. A total of 10 hospital-based cross-sectional studies reported that between 0% and 31.6% of COVID-19 patients have conjunctivitis or other ocular conditions, with a pooled prevalence of 5.5% reported in a meta-analysis. Viral RNA was detected in conjunctival swabs of patients with and without ocular manifestations, after resolution of conjunctivitis, after nasopharyngeal swabs turned negative and in retina of deceased COVID-19 patients. CONCLUSION: Within 3 months of declaring the COVID-19 pandemic, 215 ophthalmology-focused articles were published in PubMed, concentrating on disease manifestations and transmission. The reported presence of conjunctivitis or other ocular conditions in COVID-19 patients is varied. Clinicians should be alert for ocular involvement in COVID-19 infections and possible ocular transmission even in patients without ocular symptoms.