IMPACT OF THE COVID-19 PANDEMIC ON OPHTHALMOLOGY OUTPATIENT ATTENDANCE AND SURGICAL VOLUME: A RETROSPECTIVE COMPARATIVE STUDY AT A TERTIARY-CARE TEACHING HOSPITAL IN UTTARAKHAND
Main Article Content
Keywords
COVID-19; ophthalmology outpatient; surgical volume; tele-ophthalmology; delayed presentation; Uttarakhand; health-service research.
Abstract
Background: The national COVID-19 lockdown imposed on 24 March 2020 fundamentally disrupted outpatient and surgical ophthalmic services across India. Tertiary-care institutions had to reconfigure workflow, triage, and follow-up within days. Region-specific data quantifying this disruption — and the emerging pattern of delayed presentation — remain limited for Uttarakhand, a hill state with a substantial rural catchment.
Objectives: To quantify the change in ophthalmology OPD attendance, elective and emergency surgical volume, and case-mix at SMIH / SGRRIMHS between January and June 2020 relative to the same period in 2019; and to identify patient-level factors associated with review non-attendance during the lockdown and early-unlock phases.
Methodology: A retrospective comparative analysis of hospital information system records for January–June 2020 was undertaken, with corresponding 2019 data as historical control. OPD attendance was tallied weekly; surgical volume monthly; case-mix and presenting-severity parameters by sub-speciality. A binary logistic regression model identified predictors of non-attendance among 1,842 scheduled reviews during April–June 2020. Analyses were performed in SPSS v22.0 with two-sided α = 0.05. The study was approved by the Institutional Ethics Committee (SU/SGRR/IEC/2020/07-B).
Results: Total OPD attendance fell from 24,696 in 2019 to 15,317 in 2020 (–38.0%, p < 0.001), with a weekly trough of 68 visits (a 93% drop versus the corresponding 2019 week). Elective surgeries fell by 52.0% (1,483 → 712) and cataract surgeries by 61.8%, while emergency surgical volume declined only marginally (–12.5%, p = 0.184). Ocular-trauma and emergency presentations rose from 8.2% to 25.4% of the 2020 case-mix. Presenting LogMAR BCVA worsened from 0.42 to 0.68 and hypermature cataract at first visit rose from 21.5% to 38.6%. A new tele-ophthalmology service delivered 1,926 consultations. On multivariable analysis, residence outside Dehradun district (aOR 2.94), containment-zone residence (aOR 3.08) and age ≥ 60 years (aOR 2.41) were independent predictors of review non-attendance (all p < 0.001); model AUC 0.82.
Conclusion: The first pandemic wave caused a severe and asymmetric contraction of ophthalmology services: electives collapsed, emergencies persisted, and patients presented later and with more advanced disease. Tele-ophthalmology provided meaningful but partial mitigation. The findings support investment in hybrid tele-clinic pathways and region-specific outreach for hill districts in any future public-health emergency.
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Dr. Chauhan Mitaben Vaibhavkumar
Associate Professor, Department of Ophthalmology, SGRRIM&HS, Dehradun, Uttarakhand, India
Dr. Pradip Mohanbhai Poriya
Assistant Professor, Department of Ophthalmology, Adesh Medical College & Hospital, Mohri, Shahabad, Haryana, India
