Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic

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.

Stress and cataract surgery: A nationwide study evaluating surgeon burnout

BACKGROUND

We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem.

METHODS

A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains.

RESULTS

A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity.

CONCLUSION

The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.

Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006-2020 Health and Retirement Study

BACKGROUND

The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age.

METHODS

Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006-2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services ("Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?" and "What type of care did you delay") using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data.

RESULTS

Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60-70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays.

CONCLUSION

Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.