Eyeworld

58 | EYEWORLD | DECEMBER 2020 ATARACT C Contact Keenan: Jeremy.Keenan@ucsf.edu Mamalis: nick.mamalis@hsc.utah.edu Opere: CatherineOpere@creighton.edu References 1. Heruye SH, et al. Current trends in the pharmacotherapy of cat- aracts. Pharmaceuticals (Basel). 2020;13:15. 2. Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309:2005–2015. 3. Srinivasan M, et al. Antiox- idant vitamins for cataracts: 15-year follow-up of a ran- domized trial. Ophthalmology. 2020;127:986–987. Relevant disclosures Keenan: None Mamalis: None Opere: None Dr. Opere is hopeful that a pharmacological approach could someday be successful. "I think we have to go back to the drawing board and figure out why this is not translating and what we should do differently," she said. "There's a lot of potential. I think we shouldn't give up." treat animals at a relatively young age, whereas in humans, cataract development is lifelong, though often does not become visually signif- icant until age 60 or 70. Dr. Mamalis said any in-human study would need to show that flexi- bility and clarity are maintained long term. continued from page 56 Modeling Medicare cataract surgery volume in 2020 and estimating pandemic-related backlog The impact of the COVID-19 pandemic on ophthalmic practices has been significant, but just how the shutdown in the spring will affect overall 2020 cataract surgical volumes has yet to be realized. An epidemiologic study published in the Journal of Cataract & Refractive Surgery (JCRS) sought to model cataract surgery volume in 2020 with the impact of the pandemic in mind. It also sought to estimate the backlog of surgeries that was created when most stopped performing elective surgery throughout the country. Using data from 2008–2018, the study authors first estimated an overall Medicare cataract surgery volume for 2020—3.7 million cases—assuming the pandemic shutdown didn't happen. They then assumed that cataract surgery volume was normal and 100% in January and February 2020. They used practice patterns from Shruti Aggarwal, MD, first author of the study, to establish the volume between March and April and assumed that elective surgeries restarted in May. The return of elective surgeries was below typical volume, and the researchers modeled this using a stochastic Monte Carlo simulation of a Gompertz function, which they wrote "is a sigmoid curve with a rapid accel- eration phase followed by a plateau phase." They forecasted post-shutdown volumes under an optimistic (90% growth velocity) and pessimistic (50% growth velocity) scenario. The authors were primarily interested in determining how many surgeries would need to be performed to reach 90% pre-pandemic volume estimates. The backlog estimate was created by adding the number of cases that were deferred in the shutdown to those that were created during the post-shutdown ramp-up period. The authors wrote that higher ramp-up velocities in general might be possible in ophthalmology but noted the impact and variability different state regulations would have. Even with a significant ramp-up speed, the authors estimated a significant residual backlog. "In both scenarios, the size of the surgical cataract case backlog at 2-year post-suspension (May 2022) would be tremendous: 1,080,000 cases in the optimistic scenario, and 1,550,000 cases in the pessimistic scenario," the study authors wrote. "Our analysis reveals that even under optimistic conditions, the backlog would be greater than 1 million surgical cataract cases at 2 years post-suspension," they wrote later in the conclusion. "Even in the backlog minimization sensitivity analysis with all ideal conditions, it would take 9 months to catch up on the backlog." The authors detailed how getting through this backlog would require increased surgery levels beyond pre-pandemic rates, which they said puts an emphasis on the need for efficiency in rela- tionships with medical colleagues, surgical planning, postop visits, and considering immediately sequential bilateral cataract surgery. Reference Aggarwal S, et al. COVID-19 and cataract surgery backlog in Medicare beneficiaries. J Cataract Refract Surg. 2020;46:1530–1533. From JCRS

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