Preoperative COVID-19 RT-PCR Testing of Asymptomatic Patients for Ophthalmic Surgery: Experience from Two Tertiary Referral Centers

Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.

Prevalence of Glaucoma in Cataract Patients - a Comparison between Pre-Covid and Post-Covid Periods

Objectives: Globally, cataract and glaucoma are the predominant causes of blindness. Screening glaucoma in patients referred for cataract surgery is a convenient tool for detecting glaucoma cases in rural population. The COVID period has adversely affected eye care as the routine screening and follow-ups at hospital were substantially reduced owing to pandemic restrictions. We aim to study the impact of COVID on detection of glaucoma in patients with cataract. Method(s): It was a retrospective study conducted to compare the prevalence of glaucoma in rural patients presenting with cataract pre- and post-COVID. Details of 975 consecutive patients each were taken prior to March 2020 (pre-COVID) and after October 2021 (post-COVID) from hospital database and patient case files. Result(s): The prevalence of glaucoma was higher during the pre-COVID time (3.8%) as compared to pre-COVID (3.8%), but the result was not statistically significant. In both the groups, primary open-angle glaucoma was the pre-dominant form of glaucoma, with prevalence being 1.5% and 2.2% in the pre-COVID and post-COVID groups, respectively. The mean intraocular pressure and mean VCDR values were higher in the post-COVID group as compared to the pre-COVID group, and the result was statistically significant. Conclusion(s): This was the first study to compare the prevalence of glaucoma in patients with cataract in rural population in the pre-COVID and post-COVID periods. In the aftermath of the pandemic, the present study emphasizes the role of screening and follow-ups in glaucoma management to prevent irreversible loss of vision.Copyright © 2023 The Authors.

Impact of COVID-19 pandemic on national cataract surgical rate: An interrupted time-series analysis

Introduction: Elective surgeries were suspended during the national lockdown implemented in March 2020 to curb the spread of the COVID-19 pandemic. Our study aimed to assess the impact of COVID-19 pandemic on national cataract surgical rates. Method(s): We conducted an interrupted time series analysis of cataract surgeries from 2017 to 2021 in Malaysia to evaluate the change in cataract surgical rates before and after the lockdown. Incidence rate ratios were estimated using a seasonally adjusted Poisson regression model. Stratified analyses were performed to establish whether the effect of the lockdown varied by COVID- 19 status of the hospital, sex, and age groups. Result(s): The mean monthly cataract surgical rates before lockdown was 14.1 per 100,000 population with an underlying trend of a 1.0% increase per month. The lockdown was associated with an abrupt 54.0% reduction in monthly rates (95%CI: 0.36-0.60;p<0.001). In May 2020, we observed a gradual recovery in the rates with a peak at 13.8 per 100,000 population in September 2020 although it has not rebounded to its pre-lockdown rate in December 2021. There was no evidence that the effect of the lockdown differed by COVID-status of the hospital, sex, or age groups. Conclusion(s): The initial lockdown period in March 2020 was associated with an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Although cataract surgical rates have marginally trended upward after restrictions were eased, efforts should be taken to restore the delivery of cataract services to its pre-pandemic level to mitigate the negative effects caused by service disruption.

Estimating Societal Costs Associated With Vision Loss And Delayed Cataract Surgery: The Potential Impact Of The COVID-19 Pandemic

Introduction. Cataract surgery is the most commonly performed surgical procedure in the UK (approx. 472,000 annually). The suspension of interventions due to the COVID-19 pandemic, has had a devastating impact on patients' access to care. In the UK a complete cessation of elective cataract surgery during the crisis has been an unfortunate reality and encompassed a 14 week hiatus to services in the National Health Service. Patients on prolonged waiting lists may experience negative outcomes during the wait period, including vision loss, increased risk of falls, and ultimately, poorer healthrelated quality of life (HRQoL). The objective of this research was to estimate the potential societal costs associated with vision-loss related to prolonged waiting times for cataract surgery, as a consequence of COVID-19 in the UK. Methods. In this analysis, we present estimates relating to two cohorts: a hypothetical cohort of 1,000 cataract surgeries and quarterly estimates of cataract surgeries in the UK. Quarterly estimates (n=122,969) were chosen to reflect a suspension of cataract surgeries for 14 weeks during the COVID-19 crisis. UK cataract surgery numbers were attained from EUROSTAT. Estimates for decreasing visual acuity for those waiting for surgery were attained from the literature, as were the cost estimates associated with cataract-related sight-loss, which were made up of direct, indirect and intangible costs. Five scenarios (at 20% intervals) were simulated for the cost estimates, assuming from 20 percent to 100 percent clearing of waiting lists. Results. For cohort 1 (1,000 patients), the societal costs associated patients remaining on waiting list for one year, ranged between GBP 237,765 (EUR 279,533) (20% of patients remain untreated) to GBP 1.18m (EUR 1.39m) (100% remain untreated). For cohort 2 (n=122,969) cost estimates are in the region of GBP 29.23m to GBP 146.18m (EUR 34.36m to EUR 171.73m). Estimates consist of direct (15.6%), indirect (28.7%) and intangible costs (55.6%). Conclusions. Cataract surgery is a sight saving procedure and its impact on HRQoL is overwhelmingly positive. Prolonged waiting times for cataract patients due to COVID-19 is likely to be associated with significant societal costs.

Examination of cataract surgical data: Is access equity improving for Aboriginal and Torres Strait Islander Australians?

Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method(s): Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Result(s): Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusion(s): Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territorylevel programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to populationbased needs.

The six episodes of ischemic stroke during 16 years. Clinical case in a young woman

Background: Up to 23-25% of patients experience a second stroke within the first 5 years after the first episode despite prophylaxis. Aim(s): Our aim is to discuss the risk factors of recurrent ischemic stroke and the efficiency of anticoagulation therapy. Method(s): A report of a 50-year- old female patient who presented with a medical history of migraine, hypertension, 3 episodes of ischemic stroke within 12 years (the last one occurring 2 months ago), right hemiplegia, 2 miscarriages and multiple surgeries: appendectomy, myomectomy, hysterectomy due to adenomyosis, cataract surgery, cervical polypectomy, oophorectomy, meniscectomy after trauma. Result(s): Thrombophilia testing revealed heterozygous mutations of F13A1, ITGA2 and PAI1 genes. Antiphospholipid antibodies were within normal ranges. She received treatment with Rivaroxaban 20 mg/daily 1 month, B-Complex vitamins, after which Clopidogrel 75 mg was prescribed. But the next ischemic stroke with hemorrhagic transformation occurred within 6 months. Type 2 diabetes was diagnosed 1 year later and Metformin hydrochloride was initiated. She underwent cholecystectomy due to benign tumors of the gallbladder and received treatment for Helicobacter pylori after which fifth episode of ischemic stroke happened. One year later she complained of headache, dizziness, unsteady gait, memory impairment, syncope and convulsions. Electroencephalography and echocardiography findings were not remarkable, ultrasound revealed multinodular goiter (TIRADS 2). COVID-19 PCR test and anti-SARS- CoV- 2 IgG/IgM antibodies were negative. Labs showed 40.9% lymphocytes, prolonged APTT (45.4 s, reference range 30-40 s), slightly elevated ALT (34.9 U/L, reference range < 33). Urinalysis detected 0.03 g/L albumin and 1.13 HPF mucus. Two weeks later the sixth episode of ischemic stroke occurred despite receiving antiaggregation with Acetylsalicylic acid. Double testing for antiphospholipid antibodies, Protein C and S, homocysteine were normal, antithrombin III was 123.0%. Conclusion(s): Although low-risk thrombophilia mutations, type 2 diabetes, hypertension, overweight and multiple surgeries are the risk factors of 6 thrombotic events, cancer should be excluded taking into account her anamnesis.

Acute panuveitis after COVID-19 mRNA booster vaccination following cataract surgery.

Purpose: To report a case of presumed COVID-19 Pfizer third dose (booster) vaccination leading to severe panuveitis mimicking acute endophthalmitis in the early postoperative period following routine cataract extraction and intraocular lens implantation. Observations: A 68-year-old female with mild refractive error who previously received 2 doses of the BNT162b2 vaccine underwent routine cataract extraction and intraocular lens implantation in the right eye. On postoperative day (POD) 2 the patient received her BNT162b2 booster vaccination. On POD 3 the patient's vision was hand motion at face with photophobia. Anterior segment examination was significant for 2+ conjunctival injection, mild stromal edema, 4+ cell and flare with trace hypopyon, and 4+ anterior vitreous cell without any wound leak. Subsequent Gram staining, culture for aerobic and anaerobic bacteria, KOH preparation, and PCR testing for infectious organisms were also obtained, all of which were found to be negative. ESR and CRP values were also negative. The patient was started on intravitreal injections of vancomycin and ceftazidime, as well as oral moxifloxacin, fortified vancomycin and tobramycin drops, prednisolone acetate 1%, and atropine 1%. On POD 5 the patient reported significant improvement of her vision and was found to have 20/80 vision. On POD 12 her vision improved to 20/25, and improved further on POD 19 to 20/20 vision with a completely normal examination. Cultures remained negative throughout the entire course. Conclusions and importance: This is the first report to suggest a possible association between the BNT162b2 booster vaccination and development of acute panuveitis in the postoperative period after routine cataract extraction and intraocular lens implantation. This condition may mimic acute bacterial postoperative endophthalmitis and may portend a more favorable prognosis, but the authors believe such cases should nonetheless be treated aggressively as presumed infection.

Long-term safety and efficacy of sepofarsen in a Ph1b/2 INSIGHT extension trial in CEP290-associated Leber congenital amaurosis (LCA10)

Purpose : Autosomal recessive CEP290-LCA (LCA10) is a severe inherited retinal disease resulting in early vision loss and currently has no treatment. Sepofarsen is an RNA antisense oligonucleotide targeting the most common c.2991+1655A>G disease-causing variant in the CEP290 gene. Long-term safety and efficacy of sepofarsen in the first eye treated (FE) and safety and efficacy in the second eye treated (SE) in this extension trial (Insight;NCT03913130) were evaluated. Methods : Subjects who completed the Ph1b/2 sepofarsen trial could enroll in the extension trial for continued dosing in the FE and initiation in the SE with the 160/80μg loading/maintenance dose. Frequency and severity of adverse events, and change in best-corrected visual acuity (BCVA) and full-field stimulus testing (FST) threshold were assessed. Baseline was defined as the value measured within the same month of-or last measurement prior to-the first dosing for each eye. Due to covid-19, some participants have missed scheduled injections. As such data up to-or available measurement prior to-6 months after the last dosing have been included in the analysis for each eye. Results : At data cut-off in mid-October 2021, 9 subjects (of 11 from the Ph1b/2 trial) aged 15-45 years were followed up to 46 months, 5 of them received at least one intravitreal injection of sepofarsen in the SE. Three subjects developed cataracts in the FE and 2 in the SE, of which 2 recovered following cataract surgery. Time to onset since initial dose was 13 months or later. Between 35-46 months after the 1 injection, long term BCVA improvement was reported in 4/6 FE ranging from-0.20 to-0.54 logMAR and 5/5 FE improved in either blue FST, red FST or both ranging from-0.21 to-2.06 log cd/m2. The SE showed a similar trend as the FE in BCVA (3/5 SE showed a change ranging from-0.06 to-2.50 logMAR) and in blue and red FST (4/4 SE showed improvement ranging from-0.27 to-4.57 log cd/m2). st Conclusions : The longer-term sepofarsen safety profile is consistent with that observed in the Ph1b/2. Meaningful BCVA and FST improvements observed in the Ph1b/2 continued up to 46 months. The responses in the SE were similar to the responses seen in the FE in both visual acuity and retinal sensitivity improvements. A Phase 2/3 (ILLUMINATE;NCT03913143), multiple dose, double-masked, randomized, sham-controlled trial is ongoing.

Impact of COVID-19 on ophthalmic surgery in Australia

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.

Trends in California ophthalmology surgical volume during the COVID pandemic

Purpose : Pandemic era restrictions on non-essential travel, redistribution of healthcare resources, and nursing shortages have impacted the ability of ophthalmologists to deliver care. California had among the strictest 2020 restrictions during the pandemic with reallocation of non-essential surgical resources. This study assesses changes in surgical volume of common ophthalmic procedures in California since the COVID-pandemic. Methods : The California Health and Human Services Agency (Office of Statewide Health Planning & Development) maintains ambulatory and emergency room procedural databases. Common ophthalmic procedures and surgical volumes were extracted for 29 CPT codes from 2014-2020. Procedures with fewer than 100 cases were excluded. Results : Overall, ophthalmology surgical volume decreased by 19% from 2019 to 2020. Greatest declines were for anterior lamellar corneal transplant (39%) and pterygium with graft (38%). Simple cataract surgeries declined by 29% in 2020, compared to an average annual decline of 3% from 2014-2019. Volume increased only for two surgeries: aqueous shunt with graft (2%) and complex retinal detachment (0.2%). Temporal artery biopsies, historically stable with 0.2% average change from 2014-2019, declined by 28% in 2020. Retinal detachment repairs declined by 20% and 17% (with and without vitrectomy, respectively). In comparison, laparoscopic appendectomy only declined by 2% in 2020. Limitations of this study include role of population changes and changes in annual coding practices. Conclusions : COVID era declines were noted across almost all ophthalmic surgeries with steep drops in perceived non-urgent procedures such as pterygium and cataract. However, delays in cataracts and other conditions can result in increased disease burden and morbidity for patients. Uniquely, tube shunt procedures increased, perhaps due to progression of glaucoma from delayed routine care. For vision-preserving surgeries such as retinal detachment repair, lack of accessible care during the pandemic is especially concerning.

Predicted backlog in ophthalmic surgeries associated with COVID-19 pandemic in Ontario: a time series modelling analysis

Purpose : Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada. Methods : Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results : In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. Conclusions : The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impact of the pandemic on the ophthalmic surgical backlog in Ontario.

US National Trends in Ophthalmic Procedures During the COVID-19 Pandemic

Purpose : To evaluate the relationship between COVID-19 case volume and ophthalmic procedural volume during the pandemic. Methods : A retrospective cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health records research network comprising multiple large health organizations in the United States. Monthly Current Procedural Terminology (CPT)- specific volumes per HCO were clustered chronologically to calculate average volumes into three-month seasons to calculate average volumes. Seasonal averages from a combination of 2018 and 2019 data were used to provide a baseline comparison to pre-pandemic procedural volume. An aggregate of the total pandemic period (March 2020-August 2021) was compared to the corresponding figures in pre-pandemic timeframes. Results : 670,541 unique ophthalmic procedures from among 573 HCOs between March 2018 and August 2021 were included. Intravitreal injections was the most prevalent procedure with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure with 144,816 uncomplicated (82.2%) and 31,279 complicated (17.8%). Intravitreal injections had the highest mean seasonal volume per HCO for each of the five COVID-19 pandemic seasons. From March 2020-August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p<0.05) in procedures compared to pre-pandemic mean of 280.8 (SD = 26.1). During the five COVID-19 pandemic seasons, the seasonal mean volume almost always differed from pre-pandemic comparisons. Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (88%). Spring 2021 had the largest count of significant increase in procedure volume (18%). Aggregate mean volume per HCO showed significant decreases for 11 out of 17 procedures in the 12-month March 2020-February 2021 timeframe and significant decreases for 10/17 procedures over the 18-month March 2020-August 2021 timeframe. A relative inverse relationship between COVID-19 case volume and ophthalmic procedure volume was observed. Conclusions : This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in the US. Reduction in procedural volume may result in delayed care with potential for vision loss. Awareness and understanding of these trends could help ophthalmologists prepare should a similar cycle occur in the setting of the omicron and future variants.

Patient Impact and Economic Burden of Waiting for Cataract Surgery in Canada: A Targeted Literature Review

Objectives: To collate and review published evidence to assess patient impact and economic burden of cataract surgery wait times in Canada. Methods: A targeted literature search was conducted using PubMed from January 1, 2007–December 10, 2021, and supplemented by grey literature search. Included studies were those reporting Canada-specific data. Results: Overall, six publications were included. All 6 reported patient impact related to waiting for cataract surgery in Canada, including decline in visual acuity(n=4);greater risk of falls(n=4), motor vehicle accidents(n=3), and depression(n=3);reduced quality life(n=3);interference with treating other eye diseases such as glaucoma, diabetic retinopathy, and AMD(n=1);permanent disability(n=1);and even increased risk of death(n=1). Eye Physicians and Surgeons of Ontario (2018) also highlighted challenges recent ophthalmology graduates face to secure operating room time. This can potentially lead to a lack of surgical competency resulting in more complications, greater incidence of unsuccessful surgeries, decline in ophthalmologists able to perform cataract surgery, and ultimately longer wait times. Canadian Council of the Blind reported an estimated 143,000 necessary eye surgeries missed or delayed in 2020 due to COVID-19, resulting in increased risk of vision loss (vision loss costing $27,251/person/year). It’s also projected from 2021 to 2023, costs of vision loss due to additional wait times of ophthalmic surgeries (most specifically cataract surgery) will be $520.2 million annually in Canada;owing 85% of these costs to loss of well-being ($442.2 million/year) and the remainder to direct healthcare system costs ($78 million/year). Further, average costs incurred by someone with vision loss until they receive surgery is $54/day. Conclusions: Increased cataract surgery wait times in Canada has negative implications, including worse patient outcomes and increased patient and healthcare system costs. There remains an urgent need to reduce wait times to ensure timely treatment access for individuals undergoing cataract surgery in Canada.

Canada National and Provincial Cataract Surgery Wait Times (2017-2021): A Targeted Literature Review

Objectives: Pan-Canadian benchmark for cataract surgery wait times is 16 weeks, with aim for 90% of patients to meet this target timeframe. A targeted literature review was conducted to assess recent trends of Canada’s cataract surgery wait times, including impact of COVID-19. Methods: PubMed was searched January 1, 2017–December 10, 2021, and supplemented by grey literature search. Search terms included cataract surgery, wait times, epidemiology, Canada, and COVID-19. Inclusion criteria comprised of literature reporting national and provincial (Ontario, Quebec, British Columbia, Alberta) data with outcomes of interest: percentage of patients treated within 16-week benchmark, 90th percentile wait time (10% waited >x weeks), and 50th percentile/median wait time (half waited >x weeks). Results: Published data from 8 unique sources were included (n=3 white papers, n=5 government data). Canadian Institute for Health Information (CIHI) reported percentage of patients treated within 16 weeks nationally (2017=71%, 2018=70%, 2019=71%, 2020=45%) and by province (Ontario: 2017=69%, 2020=40%;Quebec: 2017=85%, 2020=53%;British Columbia: 2017=63%, 2020=53%;Alberta: 2017=56%, 2020=34%). Five sources reported 90th percentile: CIHI national data showed 10% waited >30.0-31.0 weeks from 2017–2019, and >44.0 weeks in 2020;for Ontario in 2018, 10% waited >28.9 weeks, according to the Eye Physicians and Surgeons of Ontario;provincial government data showed similar results for Alberta (2017–2018=>38.6, 2020–2021=>41.0-63.0) and British Columbia (2021=>27.9). Median wait times (weeks) were reported by 5 sources, with similar national results by CIHI and OECD (2017–2019=9.3-9.6, 2020=18.9);Fraser Institute also reported 2020 national (20.6 [12.0-64.0]) and provincial (Ontario=17.0, Quebec=12.0, British Columbia=28.0, Alberta=24.0) data. Conclusions: Approximately 30% of patients experienced a wait longer than the 16-week pan-Canadian benchmark from 2017–2019, growing to 55% in 2020 amidst COVID-19. To mitigate the impact of COVID-19 and bring wait times to the recommended threshold, collaboration among provincial health authorities and clinicians may be necessary with prioritization of stable funding and reimbursement for cataract surgery.

Impact of Covid-19 on the Morphology of Cataract

Objective: To see the impact of Covid-19 on the morphology of cataract during lockdown. Study Design: Observational and interventional study. Place and Duration of Study: Department of Ophthalmology, Niazi Medical and Dental College from 1st April 2020 to 30th September 2020. Methodology: All the patients of eye related complaints were referred to eye department from emergency of hospital after screening them for Covid-19 suspected symptoms as well as patients coming directly to eye OPD from reception. Patients suffering from phacomorphic, phacolytic glaucoma and cataract of every type except traumatic type were included. Results: The ratio of males and females patients was almost equal because cataract is a common age related problem in both sexes. Due to lock down there is a significant increase in the number of mature cataract as well as phacomorpic and phacolytic glaucoma which was decreased for last many years .Although the awareness increased regarding cataract surgery but due to stop of elective work like other specialties and COVID 19 become the focus point the morphology of cataract changed (mature and hypermature), complicated cataract (phacomorphic, phacolytic glaucoma) irrespective of socioeconomic status of patients. Conclusion: During lockdown period there is increase in the maturity of cataracts and secondary glaucoma (phacolytic, phacomorphic). Although this pattern of cataract presentation has been decreased for last many years but due to covid 19 strong lock down occur and this pattern was again observed.

POSA401 Impact of COVID-19 on Surgical Activity: Experience from a French University Teaching Hospital

Objectives: The COVID-19 pandemic outbreak forced hospitals to postpone or cancel surgeries so staff and equipment could be reallocated to intensive care units. However, few studies have measured the impact of the pandemic on surgical activities. This study aimed at quantifying the impact of COVID-19 and lockdowns on surgical activity in a French university teaching hospital. Methods: All surgeries for the period between 01/2017 and 04/2021 were extracted. Seven specific surgeries were selected and classified as urgent (appendectomy, osteosynthesis [hip]) or non-urgent (forefoot & cataract surgery, cholecystectomy, arteriovenous fistula creation and total hip arthroplasty) based on expert opinion. We undertook time-series analyses of the weekly count of surgeries using negative binomial and Poisson regression models to measure the effect of COVID-19-related lockdowns (three lockdown periods: March-May 2020, October-December 2020 and April-May 2021). The effects of all lockdown periods combined were analyzed and we controlled for seasonality and year-related factors. Results: We observed a significant decrease by -24% (p<0.01) in overall surgical activity during lockdown periods. Significant reductions were also noticed for non-urgent surgeries such as total hip arthroplasty, forefoot surgery and cataract surgery, with -38% (p<0.05), -48% (p<0.01) and -64% (p<0.001) respectively. Inversely, a significant increase in urgent osteosynthesis [hip] activity was observed (+46%;p<0.05), while a non-significant augmentation in appendectomies was noted (+24%). Conclusions: Significant decreases in activity were observed for non-urgent surgeries, suggesting those operations were postponed or cancelled so that resources could be reallocated internally. Furthermore, ambulatory surgeries such as forefoot & cataract surgeries were considerably impacted. Conversely, surgeries labelled as urgent seemed unaffected, indicating emergencies were still carried on during lockdowns. Our results highlight the impact of the COVID-19 pandemic and associated lockdowns on surgical activities, but the consequences on patient opportunity losses should also be explored.

Kimberley region ophthalmology 2019-21: Service changes with a new regional Eye Hub at Lions Outback Vision

Purpose: To evaluate specialist eye care in the Kimberley region after introduction of the Lions Outback Vision Kimberley Hub. The regionally based service commenced in 2020 and was established in new premises with retinal surgical services since March 2021. Kimberley region serves a population of 34,364 people including 14,299 Aboriginal people (41.6%). Methods: Ophthalmology activity in the Kimberley was compared between 2019-2021 sampling the first six-months of the year with a retrospective audit of an electronic medical records database. Population-based needs were determined with a service delivery planning calculator at Indigenous Eye Health Unit, University of Melbourne. Results: In the first six-months of 2021, there were 731 ophthalmology attendances in the Kimberley region. This compares to 310 in Jan-Jun 2020 and 662 in Jan-Jun 2019. Highest rate of telehealth consultations was during first 6 months of 2020 (19.2%) compared to 2019 (4.0%) and 2021 (6.5%). Of 102 cataracts surgeries, 50 were for Aboriginal patients in first half of 2021 compared to 26 in 2020 and 32 in 2019. Reduction in the failure to attendance rates in 2021 (21.3%) compared to 2019 (29.1%). Conclusion: A regionally-based service has resulted in an uplift in specialist eye care in the Kimberley region. COVID-19 impacted the initial services in 2020 but in 2021 there has been an increase in cataract surgeries to 74% of population-based needs for 2021 (Jan-Jun). Introduction of retinal services has resulted in eleven pars-plana vitrectomies for diabetic eye disease. This audit serves as a baseline for further monitoring of service delivery in the region.

Examination of cataract surgical data: Is access equity improving for Aboriginal and Torres Strait Islander Australians?

Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method: Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Results: Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusions: Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territory-level programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to population-based needs.