Trends in Cataract Surgery volumes before and after the COVID pandemic

Author Block: Isra Hussein, Matthew B. Schlenker, Shalu Bains, Laura Rosella2, Nirmal Summan2, Casey Chu2, Iqbal Ike K. Ahmed

Disclosure Block: Isra Hussein: Not Current  Matthew Schlenker: Not Current  Shalu Bains: Not Current  Laura Rosella: Not Current  Nirmal Summan: Not Current  Casey Chu: Not Current  Iqbal Ike Ahmed: Not Current

Abstract Body:  The deficit in cataract surgery since the COVID-19 pandemic has been well documented, but it has not been evaluated from an equity lens. This study aimed to examine cataract surgery volumes according to area-based socioeconomic status (SES), before and after the pandemic, from a large academic hospital in Ontario.  Study Design:  Single-centre, retrospective cohort study  Methods:  Patients who received cataract surgery at one of three hospital sites in Ontario between April 2019 and December 2021 were included. SES was assigned by postal code according to neighbourhood-level characteristics captured in the material deprivation index of Ontario Marginalization Index Quintiles (Q1=least deprived;Q5=most deprived). To compare surgical volumes for patients from the most socioeconomically deprived areas and least socioeconomically deprived areas, relative index of inequality (RII) and slope index of inequality (SII) were calculated. RII and SII are summary measures of inequality that use the full population distribution. Surgical volumes were also compared by age and sex. All comparisons were made between fiscal years (FY), as defined by the hospital (April 1-March 31) (FY 2019-2020, 2020-2021, and 2021-2022 to December included).  Results:  The cataract surgery volume decreased from 6,004 in FY 2019-2020 (pre-pandemic) to 3,332 in FY 2020-2021 (during pandemic, heightened phase), representing a decrease of 46%. During this time, patients 70-79 years had the highest decrease in volume by 1,200 cases (-46%), while patients 80-89 years had the greatest relative decrease (-56%). Sex had no effect on the relative decrease in cases. These trends were maintained to December of FY 2021-2022 
(post-pandemic). Surgical volumes were consistently lower among the most deprived group (FY 2019-2020, n=619;FY 2021-2022, n=321) compared to least deprived group (FY 2019-2020, n=972;FY 2021-2022, n=528), but the relative decrease was similar.  Corresponding SII and RII values indicated higher volumes among less deprived areas, but there was a decrease in SII and RII, from 481 to 268 and 1.70 to 1.63, respectively, when comparing pre- and post-pandemic years.  Conclusions:  Overall, there was a decrease in cataract surgical volumes since the pandemic, and the relative decrease was similar across deprivation areas. However, surgical volumes were consistently lower among the most deprived areas compared to the least deprived areas, with inequity in surgical volumes maintained from pre- to post-pandemic years. With increasing attention on surgical volumes to address the deficit, there is an opportunity to approach post-pandemic recovery with an equity-based lens to further close the gap between least and most deprived.