Waves of COVID-19 Pandemic: Effect on Ocular Surface Services at a Tertiary Eye Center in India.

Objective To describe the impact of lockdown and unlock phases of the coronavirus disease 2019 (COVID-19) pandemic on the ocular surface services at a tertiary eye care center in India. Methods This cross-sectional hospital-based study included 18,127 patients presenting between March 25, 2017, and July 31, 2021. A comparative analysis of the data was performed on the patients diagnosed with ocular surface disorders (allergic eye disease, cicatrizing conjunctivitis, dry eye, limbal stem cell deficiency, and ocular surface burns) and ocular surface surgeries (amniotic membrane grafting, keratoprosthesis, mucous membrane grafting, and simple limbal epithelial transplantation) presenting during the lockdown and unlock phases and the previous three years before COVID-19. Results The outpatient numbers dropped to 18.6% (172/954) and surgeries performed decreased to 2.8% (13/461) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 74% reduction in the proportion of patients requiring inter-state travel to this tertiary care referral center. There was a gradual recovery of the outpatient numbers to 70.8% (565/798) and surgeries performed to 85.8% (109/127) of pre-COVID-19 volumes by February-March 2021. This gradual incremental trend was seen across all diagnoses and surgeries except for ocular burns, which showed an initial spike in the month of May followed by another sharp increase by the month of September that coincided with the gradual ease of lockdown regulations. The proportion of patients requiring inter-state travel showed an incomplete recovery to 77.2% of pre-COVID-19 distribution by March 2021. Conclusion The first year of the COVID-19 pandemic saw a drastic reduction in the outpatient numbers and surgical volume in the lockdown phase, which gradually recovered during the unlock period. However, the impact of the second wave was significant and is showing a gradual recovery in patients accessing eye care services.