Developing New Pathways for Eye Care Services & Reduction of Blindness in the wake of Covid-19.

Since the onset of the Covid-19 pandemic in March 2020, it is estimated that thousands of cataract surgeries have been cancelled, delayed or put on hold throughout the world.[i] As a result, many persons are at risk of permanent vision loss due to delayed review or treatment. This is something that all ophthalmologists and public health administrators should be worried about.


Today, globally, at least 2.2 billion people are living with vision impairment or blindness, of whom at least 1 billion have vision impairment that could have been prevented or is yet to be addressed. [ii]


A recent study done in the UK [iii] showed that prior to Covid-19, the average wait time for cataract surgery in the public system was 18 weeks. This was considered a reasonable time to ensure patient review and treatment. Today, as we extended into more than 2 years of partial lockdowns and limited health service provisions, the wait time for eye surgeries has soared exponentially and can stretch up to 12 months or more right here in Trinidad & Tobago.


This is a growing concern among the patient community who are suffering from visual impairment and blindness due to cataract. The United Nations is emphasizing the need to reduce the socio-economic cost of blindness across the globe.[iv]


When persons lose their eyesight, they lose their social status, their livelihood, their self-esteem and often, they suffer from premature mortality. This is the story of many vulnerable people in our community who may have serious cataracts. If left unmanaged, cataract surgery backlogs can have a crippling and long-term impact on society and significantly reduce our ability to reach our sustainable development goals. Conservative assessments based on the latest vision loss prevalence figures for 2020 suggest that annual global productivity loss from vision impairment is approximately $410.7billion purchasing power parity.[v]


At a country level a response is crucial, and at the universal healthcare planning level, it should be a high priority. The health management agenda must be shifted to re-engineer the way eyecare is delivered, making it more accessible to everyone who needs it.

In private eyecare institutions, such as CVRS, we have seen the severe impact on these staggering levels of patients who cannot afford eyecare on their own. They lose their sight, their income, their independence, and tumble into a spiral of economic hardship. Last year, there was a 96% increase in the number of patients who could not afford the full price for cataract surgery at CVRS (See fig 1). This is an alarming statistic for private eyecare providers. We can only imagine how many more are undetected among our population and carry on living with severe vision loss as a result.


A large number of patients show up at our clinics unnecessarily blind from cataracts. Instead of hundreds, this number has turned into thousands having visual problems untreated due to the pandemic. The resulting economic downturn has caused the number of cases on our subsidized cataract surgery program and our charity surgery lists to double. Some people suffer in silence.


Blindness prevention needs all hands on deck, working together to alleviate the impact across the country. In 2022 we want to open the doors for public and private eyecare providers to collaborate and collectively increase our capacity to lessen the threat of sight loss for so many in Trinidad & Tobago.


We believe there is value in generating more discussion with key stakeholders on the following:


· Data capture and knowledge sharing within both the public and private eye health care systems

· Eye Health Education

· Public/Private Partnerships for patient review and treatment

· Public Health System Sponsorship for patients to receive timely care within both the public and private systems.


The global situation calls for a global response and Trinidad and Tobago should not be left behind. We must do more to prevent and reduce sight loss.


June 2022, is the month dedicated to Global Cataract Awareness. CVRS will host an open forum virtual meeting to discuss new pathways to reduce vision impairment due to cataracts. All who are part of the health and eyecare industry are invited to attend. Visit our website at www.trinidadeyehospital.org to learn more about participating in this forum.


Patients Choosing Subsidised Price Options for Cataract Surgery at CVRS (Figure 1)

[i] Darren Shu Jeng Ting, Rashmi Deshmukh, Dalia G. Said, and Harminder S. Dua. "The impact of COVID-19 pandemic on ophthalmology services: are we ready for the aftermath?" Therapeutic advances in ophthalmology 12 (2020). [ii] World Health Organization. "World report on vision." 2019. World Health Organization. January 2022. <https://apps.who.int/iris/handle/10665/328717> . [iii] Darren Shu Jeng Ting, Rashmi Deshmukh, Dalia G. Said, and Harminder S. Dua. "The impact of COVID-19 pandemic on ophthalmology services: are we ready for the aftermath?" Therapeutic advances in ophthalmology 12 (2020). [iv] Integrated people-centred eye care, including preventable vision impairment and blindness, 73rd World Health Assembly, Agenda Item 12, (2020) [v] The Lancet Global Health. "The Lancet Global Health Commission on Global Eye Health: vision beyond 2020." The Lancet Global Health Commission 16 February 2021. January 2022. <https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30488-5/fulltext#seccestitle10> .





Dr. Ronnie Bhola, CEO & Eye Surgeon at Caribbean Vitreous & Retina Surgery Ltd (CVRS) & Chairman of Trinidad Eye Hospital (TEH) Contact: ronnie.bhola@trinidadeyehospital.org