ABSTRACT
Purpose: Corneal collagen cross-linking (CCXL) is a minimally invasive treatment for progressive corneal ectatic disorders, recently introduced on the Australian Medicare Benefits Schedule in May 2018. We aim to explore CCXL service rates over time in Australia and investigate potential changes during the COVID-19 pandemic. Method(s): Retrospective analysis of CCXL services in Australia between 2018 and 2021, as recorded by Medicare. We used Poisson regression to explore changes in service rates with time, and to compare differences in distribution by age, sex and state/territory. Result(s): A total of 8009 CCXL services were performed during the study period, with the majority for males (66.5%), those aged 15-24 years (40.5%) and in Victoria (27.7%). CCXL rates tended to increase annually, rising from 7.55 (in 2018) to 9.15 (in 2021) services per 100 000 people. While CCXL rates increased by 14% between 2019 and 2020 (service rate ratio [RR] 1.14, 95% confidence interval [CI] 1.07-1.20), there was a 35% reduction between March and April 2020 when the COVID-19 pandemic began (RR 0.65, 95% CI 0.52-0.82). CCXL rates subsequently increased by 99% between April and August 2020 (RR 1.99, 95% CI 1.60-2.48). Conclusion(s): CCXL service rates increased annually in Australia from 2018. This could be attributable to increased access to treatment for progressive corneal ectasia, and/or an increasing burden of disease. CCXL rates decreased transiently early in 2020, likely due to lockdowns and elective surgery restrictions during the initial COVID-19 pandemic.
ABSTRACT
Purpose : The effect of coronavirus disease 2019 (COVID-19) on ophthalmic surgical case numbers in Australia and globally remains poorly characterised. Increased incidence of COVID-19 in Australia between March and April 2020 led to a national lockdown and elective surgery restrictions. The aim of this population-based study was to quantify the early impact of COVID-19 on ophthalmic surgery in Australia, comparing surgical service rates in 2019 and 2020. Methods : Retrospective analysis of the number of ophthalmic surgical services in 2019 and 2020 in all Australian States and Territories, as recorded by Medicare (Australian Government-funded universal health insurance scheme subsidising healthcare costs for Australian residents). Monthly surgical service rates were calculated and Poisson regression was used to compare the change in service rates between months. Results : Between March and April 2020, surgical service rates decreased for: cataract surgery (by 71%, 95% CI: 70-72%), cataract surgery with minimally invasive glaucoma surgical device insertion (by 71%, 95% CI: 65-75%), pterygium removal (by 67%, 95% CI: 60- 72%), corneal transplantation (by 31%, 95% CI: 9-48%), and collagen crosslinking for corneal ectasias (by 35%, 95% CI: 18-48%). Comparatively, service rates for these surgeries did not differ or decreased less between March and April 2019. Interestingly, glaucoma filtration surgery rates decreased between March and April in 2020 (by 44%, 95% CI: 29- 56%) and also in 2019 (by 45%, 95% CI: 31-55%), whilst retinal detachment surgery rates were unchanged between these months in 2020 (crude decrease 9%, 95% CI: -28 to 16%) and 2019 (crude decrease 11%, 95% CI: -26 to 9%). Conclusions : Despite relatively low rates of COVID-19 community transmission in Australia in 2020, ophthalmic surgical service rates decreased during months in lockdown and with restrictions, largely for non-time-critical conditions. These data may have health planning implications as the pandemic continues, with future lockdowns and restrictions possible, especially as COVID-19 variants emerge.