key: cord-0946765-75omt5ea
authors: Ting, Darren Shu Jeng; Deshmukh, Rashmi; Said, Dalia G.; Dua, Harminder S.
title: The impact of COVID-19 pandemic on ophthalmology services: are we ready for the aftermath?
date: 2020-10-20
journal: Ther Adv Ophthalmol
DOI: 10.1177/2515841420964099
sha: 9ca18de70629a74bf3c0ddcd817a26f61039bfa3
doc_id: 946765
cord_uid: 75omt5ea

nan

Since the World Health Organization's declaration of the pandemic status of Coronavirus Disease 2019 (or COVID-19) on 11 March 2020, many countries across the world, including the United Kingdom, had imposed nationwide lockdown. Routine healthcare services were cancelled, and patients were advised to avoid hospital visits, unless critically necessary, to minimize the risk of COVID-19 transmission, leading to significant disruption to the provision of healthcare service and patient care.

Ophthalmology represents one of the busiest and most heavily outpatient-oriented specialties, with ~7.5 million outpatient appointments and >500,000 surgical procedures being provided in the United Kingdom each year. 1 The recent pandemic lockdown had resulted in cancellation of thousands of ophthalmic clinical visits and surgeries, which could potentially lead to permanent and significant harm to patient's vision. 2 In addition, our recent survey among the general public with eye diseases highlighted a significant negative psychosocial impact of lockdown on individuals with visual impairment, with around 50% of them expressing fear of further sight loss due to delayed review or treatment. 3 Therefore, it is important that efficient measures are implemented during and after the COVID-19 pandemic to avoid any irreversible sight loss among these patients. However, effective reformation, adaptation, and delivery of the ophthalmic service require a full grasp of the impact of pandemic lockdown, for which the data are limited in the literature.

With this in mind, we recently conducted a retrospective analysis of the changing trend in capacity and workload of the ophthalmology service in Queen's Medical Centre, Nottingham, United Kingdom, between 01 June 2019 and 31 June 2020. All data, including the number of clinical and surgical activities, and cases that breached the 18-week referral-to-treatment (RTT) waiting time (https://www.england.nhs.uk/rtt/), were collected from the hospital-wide database and were analysed. The 18-week RTT is a national initiative implemented by the UK government to ensure that all patients were reviewed and treated in hospitals within 18 weeks of the referral initiated by their primary care physicians. It is often used as an indicator of the backlog of clinical and surgical work. For this study, the date, 18 March 2020, was used as the cut-off point to analyse the impact of COVID-19 lockdown. This study was approved by the Nottingham University Hospital NHS Trust as a service evaluation study (Ref: 20-351 C).

When comparing June 2019 (pre-COVID-19) and June 2020 (during COVID-19 pandemic), we observed a substantial 63% and 67% reduction in the outpatient and surgical activities, respectively. In addition, there was a significant ~1800% increase in the number of virtual-or teleconsultation visits (p < 0.0001; Figure 1 ), highlighting the real-world utility and patient receptivity of telemedicine during the COVID-19 period. From 18 March 2020 to 01 July 2020 (a 15-week period), there was a significant increase in the 18-week RTT breaches/waiting list in outpatient review (by 75%) and surgeries (by 471%; Figure 2 ). Cataract surgery (53%) formed the majority of the surgical backlog, followed by YAG laser procedures (24%) and oculoplastic surgeries (8%; Table 1 ).

COVID-19 has paralysed the healthcare system globally and understanding of the true impact helps strategise service delivery planning and 4 similarly reported a significant impact of COVID-19 pandemic on the ophthalmology service in India, with clinical and surgical services being reduced by >95%. Interestingly, only a low (~2%) utility of tele-consultation was observed, which was in contrast to our findings. The disparity is likely attributed to the cultural difference, level of education, and patient receptivity of telemedicine.

Cataract surgery is by far the most commonly performed procedure in ophthalmology. In view of its elective nature, cancellation of routine ophthalmic service has resulted in a significant increase in the cataract surgery backlog during the COVID pandemic, as shown in our study. Lin and colleagues 5 have recently highlighted several valuable strategies to cope with the backlog of cataract surgery, including the adoption of telemedicine, modification of face-to-face encounters, better theatre organisation, and immediate sequential bilateral cataract surgery, among others.

With the mounting pressure on ophthalmic service compounded by the recent pandemic, adoption of digitalized healthcare systems using telemedicine and/or artificial intelligence-assisted platforms is urgently required to tackle this unprecedented impact on healthcare systems and patients. 6, 7 However, it is noteworthy to mention that any plan to maximize throughput of clinical visits and ophthalmic elective surgeries, particularly cataract surgery, needs to be carried out in the context of the entire service and prioritization of emergency services.

Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

Psychosocial impact of COVID-19 pandemic lockdown on people living with eye diseases in the UK. Eye (Lond)

To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute

Cataract service redesign in the post-COVID-19 era

Artificial intelligence-assisted telemedicine platform for cataract screening and management: a potential model of care for global eye health

Artificial intelligence for anterior segment diseases: emerging applications in ophthalmology

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We thank Kathryn Skill, Jaimie Porter, Arun Lakshmanan and Lynn Soar for their help with the data extraction.

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Darren Shu Jeng Ting https://orcid.org/0000-0003-1081-1141