Impact of Three Waves of the COVID-19 Pandemic on the Rate of Elective Cataract Surgeries at a Tertiary Referral Center: A Polish Perspective

Trends in cataract surgery and healthcare system response during the COVID-19 lockdown in Malaysia: Lessons to be learned

Background

Elective surgeries were suspended during the national lockdown in March 2020 to curb the spread of the COVID-19 pandemic in Malaysia. We sought to evaluate the impact of the lockdown on cataract surgeries and suggest lessons for future outbreaks.

Study design

We conducted an interrupted time series analysis to examine rates of cataract surgery before and during the lockdown.

Methods

We used national cataract surgical data between 2015 and 2021 from the Malaysian Cataract Surgery Registry. Segmented regression with a seasonally adjusted Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the lockdown on cataract surgeries varied by hospital designation, type of cataract service, sex, and age groups.

Results

Cataract surgeries began falling in March 2020 at the onset of the lockdown, reached a trough in April 2020, and subsequently increased but never recovered to pre-lockdown levels. Cataract surgical rates in December 2021 were still 43 % below the expected surgical volume, equivalent to 2513 lost cataract surgeries. There was no evidence of a differential effect of the lockdown between COVID-19 designated and non-COVID-19 designated hospitals. The relative decrease in cataract surgical rates appears to have been greatest in outreach services and in people 40 years and older.

Conclusions

The lockdown caused an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Despite its gradual recovery, further delays remain to be expected should there be no redistribution or increase in resources to support backlogs and incoming new cases.

Impact of COVID-19 pandemic on a world-wide private ophthalmic practice

Purpose

To assess the impact of the COVID-19 pandemic on a worldwide private ophthalmic practice.

Design

In this retrospective study, we reviewed the 2020 monthly outpatient and surgical volume of refractive, cataract, and retinal disease in Aier Eye clinics/hospitals of different regions, including the United States, Germany, Spain, Italy, and six major cities in China (Wuhan, Beijing, Shanghai, Shenyang, Urumqi and Yili). All of these data were compared to those of the same period of 2019.

Results

Overall, during the early stage (2020 January to 2020 April) of COVID-19 outbreak, the outpatient and surgical volume of three main type ocular diseases (refractive, cataract and retinal surgery) showed an obvious reduction and reached the bottom in February in China. The data from the United States, Germany, Spain and Italy revealed the same trend, but the visit count nadir occurred until April, which is consistent with the spread trend of COVID-19 disease around the world. The average change rates of surgery volume (refractive, cataract and retinal surgery) in Chinese centers are 5.59%, -26.38%, 11.76%. The change rates of refractive (REF) and cataract volumes (CAT) in the United States are -8.62% and -10.58%, in Germany are -13.71% and -20.49%, in Spain are 15.35% and 27.97%, in Italy are 30.43% and -22.64%. In addition, the optometry outpatient volumes keep going up since May, with an average increasing rate of 21.18%, ranging from 7.43% to 49.51%.

Conclusion

In conclusion, in this global chain of eye care units, the visit volumes of cataract, retinal and refractive changed significantly with the spread of COVID-19 pandemic. Among them, cataract surgery was the most affected sub-specialty, and refractive surgery and optometry volumes showed a potential growth in the near future. Therefore, medical institutions should make corresponding adjustments to the disease diagnosis and treatment strategies.

Ophthalmology procedure trends in the United States during the COVID-19 pandemic

PURPOSE

To evaluate the relationship between the COVID-19 pandemic and ophthalmic procedural volume.

METHODS

A retrospective cohort study using TriNetX, a federated electronic health record's research network was done. Monthly Current Procedural Terminology-specific volumes per healthcare organization were clustered chronologically to calculate average volumes into 3-month seasons to calculate average procedural volumes. An aggregate of the total pandemic period (March 2020-August 2021) was compared to corresponding figures in pre-pandemic timeframes.

RESULTS

Intravitreal injections were the most prevalent procedure in this time period with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure. From March 2020 to August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p < 0.05) in procedures compared to the pre-pandemic mean of 280.8 (SD = 26.1). Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (- 88%). The largest count of statistically significant increases in procedure volume was in Spring 2021 (+ 18%). The 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 out of 17 procedures over the 18-month March 2020-August 2021 pandemic period.

CONCLUSIONS

This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in America. Quantifying ophthalmic procedure trends is important in retrospectively assessing surgical disruptions and prospectively accommodating delayed surgeries. Furthermore, awareness of these trends could help ophthalmologists prepare should similar disruptions occur in the setting of future pandemics or national disasters.

The Effects of an Increased Workload in Cataract Surgery Since the Pandemic in a Tertiary Care Clinic

Objective: To evaluate the progress of cataract surgery in a training institution providing tertiary care since the removal of pandemic restrictions. To evaluate ocular and demographic characteristics of cataract cases in a tertiary care teaching institution since the lifting of pandemic restrictions. Methods: Patients who underwent cataract surgery in our clinic in the pre-pandemic period September 2019-March 2020 (group 1, n=353) and in the post-pandemic period September 2021-March 2022 (group 2, n=459) were retrospectively screened. The cases were operated by two educator ophthalmologists and residents. The main parameters evaluated were cataract morphology, surgical parameters, and posterior capsular rupture complications. Results: The case rate increased by 30% in group 2 once pandemic restrictions were relaxed. Preoperative best corrected visual acuity (BCVA) in groups 1 and 2 was 0.840±0.63 and 1.26±0.75 log MAR, respectively (p<0.001). The percentage of mature cataracts was 15.3% in group 1 and 31.2% in group 2 (p<0.001). Significantly higher cumulative dissipated energy (CDE), total aspiration time, and fluid amount (p<0.001 for all) were found in group 2. During the training phase, 25.2% of the cases in group 1 and 24.6% in group 2 were performed by resident doctors (p=0.870). Residents in groups 1 and 2 had mature cataract case rates of 6.7% and 13.3%, respectively (p<0.001). The incidences of posterior capsule rupture in the instances of residents was 3.4% in group 1 and 4.4% in group 2 (p=0.498). A negative correlation (r=-0.424, p<0.001) between CDE and BCVA and a positive correlation (r=0.40, p<0.001) between cataract hardness and CDE were both found. Conclusions: The number of cataract surgeries increased after the COVID-19 pandemic. Poor vision and increasing rates of mature cataracts are other effects of this backlog. Residents have to deal with challenging cases. Our results are just the tip of the iceberg. Urgent planning is needed to deal with the remaining cases. Abbreviations: COVID-19 = coronavirus infection, PCR = posterior capsular rupture, BCVA = best corrected visual acuity, IOP = intraocular pressure, CDE = cumulative dissipated energy, TAT = total aspiration time, ZD = zonular separation.

Extent of interocular (a)symmetry based on the metabolomic profile of human aqueous humor

Aims: Interocular comparison of the metabolomic signature of aqueous humor (AH) was performed. The aim of the study was to quantitatively evaluate the symmetry in concentrations of various metabolites belonging to different categories.

Methods: The study included AH samples from 23 patients, 74.17 ± 11.52 years old, undergoing simultaneous bilateral cataract surgery at the Ophthalmology Department of the Medical University of Bialystok, Poland. Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS)-based targeted metabolomics and lipidomics analyses of AH samples were performed using the AbsoluteIDQ® p180 kit. Out of 188 metabolites available in the kit, 67 were measured in the majority (&gt;70%) of the samples: 21/21 amino acids, 10/22 biogenic amines, 9/40 acylcarnitines, 0/14 lysophosphatidylcholines, 21/76 phosphatidylcholines, 5/15 sphingolipids, and 1/1sum of hexoses.

Results: The comparison of both eyes revealed that the concentrations of metabolites did not differ significantly (p &lt; 0.05) except for taurine (p = 0.037). There was moderate-to-strong positive interocular correlation (r &gt; 0.5) between most metabolites regarding concentration. This was confirmed by the high intraclass correlation coefficient (ICC) values of different levels, which varied for the different metabolites. However, there were exceptions. Correlations were not significant for 2 acylcarnitines (tiglylcarnitine and decadienylcarnitine) and 3 glycerophospholipids (PC aa C32:3, PC aa C40:2, and PC aa C40:5).

Conclusion: With a few exceptions, a single eye was found to be representative of the fellow eye in terms of the concentration of most of the analyzed metabolites. The degree of intraindividual variability in the AH of fellow eyes differs for particular metabolites/metabolite categories.

Pros and Cons of Immediate Sequential Bilateral Cataract Surgery from a Patient Perspective: A Survey

The aim of the study was to analyze patients' experiences with immediate sequential bilateral cataract surgery (ISBCS). An anonymous survey was sent by post to patients who underwent ISBCS between 1 May 2020 and 30 April 2022. A total of 195 participants completed the survey. Specifically, 94.6% of the respondents were satisfied with the possibility of having both eyes treated during one surgical procedure, 89.7% would choose ISBCS again if offered a choice, and 89.2% would recommend this procedure to their family members. ISBCS provided a subjective benefit for 84.6% of the respondents. The most commonly reported ISBCS-related problems were the necessity to sleep in a supine position (32.8%), inability to read shortly after the surgery (27.7%), having both eyes protected with a dressing (24.6%), and application of eyedrops to both eyes at the same time (17.4%). All patients were able to identify some pros of ISBCS, with the most common being single stay in the operating room (82.6%), lower number of visits to the clinic (62.6%), quick normalization of eyesight (61%), time savings for family members (54.9%), quick adjustment of reading glasses (32.3%), and economical aspects (23.6%). The perception of difficulties associated with ISBCS and the benefits offered by this procedure differed depending on patients' gender, age, marital status, education, place of residence, occupational activity, level of care dependence, and everyday activities. Understanding patients' opinions about ISBCS provides insight into the advantages and disadvantages of this procedure from a broader perspective.

Impact and Determinants of COVID-19 Pandemic on the Cataract Surgery Rate at a Tertiary Referral Center

PURPOSE

Preventive measures to mitigate the spread of coronavirus, minimized workload on health-care systems and redirected resources to COVID-19 patients resulting in a reduction of elective procedures such as cataract surgery. We report the changes in monthly cataract surgery rate and its associated determinants at a tertiary eye hospital during different periods of the pandemic. Studying the impact of COVID-19 pandemic on cataract surgery rate will help health-care policymakers to better understand the barriers to overcome the expected surgical backlog.

METHODS

A retrospective review of medical records was performed for cataract surgeries from November 2018 to January 2022, five thousand and ninety-two eyes that underwent cataract surgery during different phases of the COVID-19 pandemic were included. The monthly cataract surgery rate (MCSR) was calculated and compared before (Phase 1), during (Phase 2) and after the COVID-19 pandemic (Phase 3 and 4). Changes in monthly cataract surgery rate during and after the pandemic were presented as ratios and compared pre- to post-pandemic levels to evaluate the impact of different determinants.

RESULTS

Of 9701 cataract patients, 5092 (52.5%) were operated in P1, 71 (0.73%) in P2, 116 (1.2%) in P3 and 4422 (45.6%) in P4. The MCSR varied significantly based on the degree of visual impairment in the operated and fellow eyes, and by the type of operating surgeon (P < 0.05). Age, gender, laterality, and place of residence were not significantly different throughout the study period. During phase 1135 (2.6%) eyes had rupture of the posterior capsule (PCR), while 6 eyes (8.4%) had PCR in phase 2.

CONCLUSION

The monthly cataract surgery rate declined during the pandemic and has not recovered to pre-pandemic levels. This should alert the key stakeholders to address the identified barriers to surpassing the baseline monthly surgical rate as this is crucial to eliminate the surgical backlog after the pandemic.

Evaluation of Urgent Retinal Practice and Safety Measures for Physicians and Patients During COVID-19 Pandemic

Purpose

To assess the impact of the COVID-19 pandemic on urgent retina practice and factors influencing adherence of physicians and patients to safety measures.

Methods

In this clinical audit, urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the period of 15th March-15th May 2020 were compared with the period just before the pandemic declaration (15th December 2019-15th February 2020). Additionally, two questionnaires assessing the adherence to safety measures were circulated to the medical personnel and a sample of patients. The collected data were analyzed, and accordingly, recommendations were proposed to the hospital administration and specific corrective measures were applied. The outcome of applying these corrective measures was assessed in the re-audit cycle during the period of 15th June-15th August 2020.

Results

There was a significant decrease in the number of urgent or emergent vitreoretinal surgical disorders that presented to our hospital during the pandemic (161 versus 302 cases in a similar period before the pandemic; p = 0.022). Just with the pandemic recession, there was a significant increase in the number of urgent cases (391 versus 161 cases during the pandemic; p = 0.006), also there was an increased number of complex cases. Residents and fellows were less compliant than attending physicians in adherence to safety measures.

Conclusion

Delayed presentation of urgent retinal cases during the pandemic highlights the importance of public awareness of urgent conditions that need immediate medical or surgical care. Attention to young physicians during the pandemic is crucial as they are less adherent to safety measures due to work overload.

The Impact of Covid-19 in the Follow-Up of Glaucoma Patients in a Tertiary Center: A Comparison Between Pre-Pandemic and Pandemic Periods

Purpose

To evaluate the impact of Covid-19 on the treatment and follow-up of glaucoma patients in a tertiary center.

Materials and Methods

We compared the total number of outpatient clinical visits, visual field exams, surgical procedures and medications released in the pre-pandemic period (March 2019–February 2020) and pandemic period (March 2020–February 2021). We also performed a paired analysis, which included patients who were examined in both periods, comparing the number of visits and medications.

Results

The total number of outpatients clinical visits, visual field exams, surgical procedures and medications released decreased 92.52% (7117 vs 532), 93.84% (1525 vs 94), 72.74% (682 vs 145) and 19.63% (23,259 vs 18,692), respectively, when the pre-pandemic and pandemic periods were compared. The mean number of annual clinical visits per patient (1.8 ± 0.79 vs 1.04 ± 0.18, p<0.0001) and surgical procedures per patient (1.46 ± 0.92 vs 1.13 ± 0.41, p<0.0001) decreased significantly, whereas the mean number of medications released per patient did not change significantly (28.62 ± 19.11 vs 30.34 ± 20.15, p=0.97). In the paired analysis, the mean number of visits (n=423 patients) decreased from 1.86 ± 0.76 to 1.04 ± 0.19 (p<0.0001) and the mean number of medications (n=561 patients) decreased from 33.44 ± 18.61 to 31.97 ± 19.86 in the pre-pandemic and pandemic periods, respectively (p=0.393).

Conclusion

The Covid-19 pandemic dramatically decreased the number of outpatient visits and surgical procedures, impacting the follow-up of glaucoma patients in our service. We encourage other health care units to verify the impact of the pandemic in their own population to better prepare for a possible overload of uncontrolled glaucoma patients in the future.

The Impact of the COVID-19 Pandemic on the Composition of Dietary Supplements and Functional Foods Notified in Poland

The COVID-19 pandemic has exerted a strong impact on numerous areas of everyday life. The aim of this study was to check how the pandemic influenced the composition of dietary supplements and other functional food products placed on the market till March 2021, compared to 2019. For this purpose, data concerning the registered products and reports of popularity of online searches of terms connected with vitamins and minerals were used. The results of the study made it possible to determine the group of ingredients especially popular during the pandemic. Their use in products after the announcement of the pandemic was significantly higher than in the preceding period. In conclusion, it can be shown that the pandemic changed the ingredients used in functional foods—mainly as far as vitamins and minerals are concerned. The highest proportional increase in its use in dietary supplements was noted for potassium. Personalized therapy has also become more popular, promoted by one of the manufacturers of dietary supplements active during the pandemic. Moreover, different phases of the pandemic were characterized by the popularity of different ingredients among the consumers—first, these were immunity-boosting ingredients, then those that improved psychological functions, and finally mixtures with universal health effects.

The Impact of the COVID-19 Pandemic on Ophthalmology Residents: A Narrative Review

The ongoing outbreak of the coronavirus disease 2019 (COVID-19) pandemic has drastically affected medical societies. We aim to provide an overview and summarize the information published so far concerning the impact of the COVID-19 pandemic on ophthalmology residency programs and the mental wellbeing of trainees, and to establish factors to help maintain successful residency training to ensure high-quality, specialist ophthalmic training. A literature search was conducted in October 2021 of the PubMed database for articles assessing the impact of the COVID-19 pandemic on the mental health of ophthalmology trainees and on ophthalmology residency programs. Cross-sectional survey studies, editorials, articles in scientific journals, letters to editors, and commentaries were considered; finally, 19 studies were included after excluding abstract-only publications and conference posters. The studies’ demographic details, participant characteristics, interventions, outcomes, and limitations were extracted. Our summarized information showed the alarmingly significant impact of the COVID-19 pandemic on ophthalmology trainees’ mental health and the associated considerable changes in ophthalmic training programs. Thus, in future, virtual training and surgical simulators should be permanently introduced, in addition to traditional teaching, to complete successful ophthalmology residency programs. Additionally, we emphasize the need for a widely facilitated and encouraged access to psychological support programs for healthcare workers, including ophthalmologists.