Association of rural or urban status, region, and institution type with cataract surgery wait times in Ontario, Canada

Background — We examined the cataract surgery wait time (WT) disparities across Ontario regions and institution types using a data-driven, population-level, and objective method based on billing codes.

Methods — We identified 1,138,532 adults who underwent cataract surgery between 2005-2019. WT from referral to initial surgeon visit (WT1) and from surgery decision to first eye surgery (WT2) were compared between rural (population <10,000) and urban settings, LHINs, and institution types (acute care, ambulatory, or other).

Results — Median WT1 and WT2 were 70 and 81 days for rural patients and 67 and 76 days for urban patients. Overall, 18.8% and 20.8% of rural patients exceeded WT1 and WT2 provincial guidelines of 182 days, compared to 20.6% and 20.7% of urban patients. Median WT1 and WT2 were 69 and 78 days for surgeries done in acute care (n=517,511), and 73 and 84 for surgeries in ambulatory care (n=270,648) respectively. The percentage exceeding provincial guidelines in both groups ranged from 20.2% to 21.8%. Across LHINs, WT1 ranged from 36 (Erie St. Clair) to 85 days (North Simcoe Muskoka), and WT2 ranged from 44 (Erie St. Clair) to 110 (Champlain). The percentage of patients with WT1 and WT2 exceeding provincial guidelines ranged from 11.4% (Erie St. Clair) to 24.7% (Toronto Central), and from 10.7% (Erie St. Clair) to 30.4% (Champlain) respectively.

Interpretation — Though WTs were comparable between institution type, urban, and rural settings, northern LHINs experienced higher WTs than southern LHINs. More data-driven studies are needed to inform health care policies aimed at addressing access to cataract surgery.