• Enormous increase in year-long waits for cataract surgeries
  • Experts say backlog could take more than two years to clear under traditional ways of working.
  • Trusts are adapting services to COVID-19 and opening green sites to tackle long wait lists.

Delays due to the covid-19 crisis have created tens of thousands of year-long waiters for ophthalmology treatment, and a surgery backlog which experts say may never be recovered.

NHS England provisional data shows the number of people waiting 52 weeks or longer for ophthalmology treatment increased to more than 23,000 in December, up 57,580 per cent on just 40 the year before. 

Experts say ophthalmology procedures have been hit particularly hard by the cancellation of elective work due to covid-19 pressures. On average, roughly 130,000 ophthalmology patients completed treatment per month in England in 2019, most of which would likely have been cataract surgeries.

Royal College of Ophthalmologists professional standards chair Melanie Hingorani reported that many in the discipline feared “traditional” ways of working were too “fragmented” to address the size of the challenge. She said that without a “much more innovative” approach it would be “really difficult” to deal with the surgery backlog on ophthalmology and that clearing it could take “two years, maybe longer”.

There remained a danger, however, that: “maybe we never catch up”. 

Dr Hingorani said: “Even before covid-19, we already had backlogs because there was so much demand and not enough eye doctors.” She also noted that, even as ophthalmologists return from covid-19 redeployments, infection control measures continue to constrain day-to-day capacity.

Dr Hingorani added that, although cataracts typically remain treatable after many months of delay, long waits can make surgeries more complicated and prolong the temporary sight loss associated with untreated cataracts. This puts patients at a higher risk of falls and mental health problems and prevents many of them from performing everyday activities, like driving and shopping.

She said, “This kind of sight reduction has a real impact on people’s lives and people’s general health.”

Ophthalmology had the highest increase in 52+ week waiters by proportion for any speciality. Other disciplines, including trauma and orthopaedics, also had tens of thousands of patients waiting more than a year for treatments in the same month.

Specialities with the biggest increase in year-long waiters

Biggest increase by %*Biggest increase by raw number 
Ophthalmology57,580 %Trauma and Ortho45,070
Ear, Nose and Throat51,638 %Other34,046
Dermatology36,675 %Ear, Nose and Throat25,819
Neurology24,267 %General Surgery21,923
Oral Surgery20,612 %Ophthalmology20,032

* geriatric medicine, general medicine and rheumatology excluded because of comparatively low overall patient numbers.

New service models

Trusts with the highest numbers of year-long waiters for ophthalmology told HSJ they had implemented measures to bring down waiting lists as covid-19 patient numbers begin to fall.

A spokeswoman from Newcastle Upon Tyne Foundation Trust — which, at 1,252, had the highest number of year-long waiters in England in December said it was introducing a new service model to “dramatically reduce” its backlog within a year.

The spokeswoman for the trust, which runs a regional cataract service in the North East, said: “The covid-19 pandemic has meant many people have had to wait longer to access cataract surgery although we do ensure that patient care and subsequent treatment is kept under constant review.

“[The new model] includes a significant investment in additional purpose-built theatres which will enable ‘high volume’ day case lists for first and second eye procedures.”

Mike Adams, consultant ophthalmologist at Buckinghamshire Healthcare Trust, which had 1,116 year-long ophthalmology waiters, said the organisation was the first to restart elective cataract surgery, and has been treating patients from across the region in a covid-19 free cataract unit since November. The organisation has taken on extra ophthalmology staff and is now running daily cataract clinics at two sites.

He added that the trust serves a high number of people over 70, many of whom decided to delay treatment during the pandemic. 

“It is vital that these patients do not get lost in the system, which is why they remain on our waiting list. To reassure patients and encourage them to attend their appointments we recently released a walk-through video highlighting all the COVID-19-safe measures in place,” he said.