The authors of a recent study found that emergent ophthalmic surgical care at one eye surgery center dropped to about 10% of its 2019 level for the same month thanks to the COVID-19 pandemic.1

“What was happening with surgical volumes during the pandemic? We were concerned about lack of access to surgical care people needed,” says Zubair Ansari, MD, assistant professor and medical director of outreach, cataract, comprehensive, and global ophthalmology at Bascom Palmer Eye Institute, part of the University of Miami (FL) Health System.

When comparing data from April 2019 to data from April 2020, Ansari and colleagues found 1,107 procedures occurred in April 2019 vs. only 117 in April 2020.

They also found the type of eye surgeries performed also varied significantly. Before the COVID-19 pandemic, the investigators found cataract surgery was the top eye procedure, accounting for 47.3% of all such surgeries. In 2020, the most dominant procedure, at 31.6% of cases, was retinal detachment surgery, Ansari reports.1 “We were one of the few institutions open during the height of the pandemic, so we found that many referrals from the emergency department were emergency cases,” he says.

Lower surgery case numbers were expected because the pandemic forced many to pause elective procedures. But what happened to surgical procedure caseloads once operating rooms reopened nationwide?

“It would be interesting to look at what happened to caseloads when Florida got hit with COVID-19 in the summer,” Ansari says. “This would be all anecdotal, but I think those trends, in terms of volume decrease, were not as pronounced in the summer as they were in March and April.”

Heading into the fall, Ansari says the surgery center from his study was starting to rebound as the rate of COVID-19 cases began to fall in Florida. Nevertheless, he reports that some patients who delayed scheduled March and April cataract removal procedures still have not rescheduled those dates.

“We know cataracts have an effect on quality of life for patients,” Ansari says. “People with cataracts in both eyes are at risk of other types of medical issues.”

Surgeons should think about how they will deliver care to patients as the COVID-19 pandemic continues and how they will prepare for future crises. “It’s a challenge taking care of patients who we feel are at significant risk as a result of cataracts,” Ansari says.

For example, if patients are not returning because it is challenging to schedule the appointment, then surgery centers should direct coordinators to contact patients and try to see what the center can do to fit those patients into the schedule, he suggests.

“I look through my patient logs and see which patients have significant limitation due to cataract blindness to see if we can squeeze them in earlier,” Ansari says. “We do outreach presentations in the local community.”

Bascom Palmer Eye Institute leaders inform citizens about infection control protocols and how the center screens everyone who comes in. They discuss telemedicine options for high-risk patients, and they talk about how they comply with regulations and guidelines.

“Cataract surgery, as compared to other major surgical procedures, is one of the most successful and quickest procedures you can go through,” Ansari says.

Ansari and colleagues also observed other interesting trends. They found the mean age of surgeons performing eye procedures declined from April 2019 to April 2020 (48.4 years vs. 42.3 years). The same was true for the average age of patients (59 years in April 2019 vs. 50 years in April 2020).

Ansari attributes these trends to the likelihood that older surgeons and patients may have been more hesitant about working in or receiving treatment in a surgery center during a pandemic. “We didn’t gather data on nurses or technicians, but I would guess that trend would be observed in that group, as well,” he adds.

As the COVID-19 crisis continues, surgery center leaders must ensure the continued well-being of not just patients, but also their staff. For Ansari, learning new information about the virus each day, along with gradual improvements in the personal protective equipment supply chain, alleviated anxiety among his staff.

It also helped when the surgery center instituted rigorous screening and testing programs. “Most of our staff were assuaged by those guidelines,” Ansari says. “Still, Miami-Dade was hit harder than most other areas of the United States. We couldn’t let our guard down, and we need to do whatever has to be done to take care of our patients.”

REFERENCE

  1. Al-Khersan H, Kalavar MA, Tanenbaum R, et al. Emergent ophthalmic surgical care at a tertiary referral center during the COVID-19 pandemic. Am J Ophthalmol 2020; Sep 1:S0002-9394(20)30481-5. doi: 10.1016/j.ajo.2020.08.044. [Online ahead of print].