Complexity Of Cataract Cases Before And After The Pandemic At A Tertiary Referral Center

Cataract services have been impacted by the pandemic with delays in patients presenting to clinics and restrictions on theater availability. While the Royal London catered to a significant proportion of patients affected by COVID, we explore here the impact on cataract service provision and future direction of service recovery.

An audit of the electronic patient database for cataract cases complexity at Royal London Hospital was undertaken. 

Data was gathered comparing cases from Aug 2018 to July 2019 (pre pandemic) and Aug 2020 to July 2021 (after the first wave). We used the Royal College of Ophthalmologists cataract risk stratification tool (outlined in Guidance on the Resumption of Cataract Services during COVID) for the purpose. 

Total cases operated in the 12 month period dropped from 1984 (pre pandemic) to 557 (post pandemic). Average age of the patient increased from 67.4 year to 71.2 year in the post pandemic cohort. Category 1 patients (no risk factors) declined from 65% to 55% after the pandemic which was statistically significant. There was an increase in category 2 (from 28% to 35%) & category 3 (5% to 8%). The proportion of category 4 cases remained stable at 2%. Average time on the waiting list for patients also increased from 58 days to 67 days after the pandemic.

As ophthalmology services aim to re-establish pre pandemic capacity for cataract surgery, consideration must be given to increasing complexity of cases. Operating lists would need modifications to include a proportionate number of uncomplicated (category 1) cases to provide adequate training opportunities.