A multinational review has issued a strong warning to policymakers: without immediate and coordinated action, surgical ophthalmology services worldwide – including in Australia – will be unable to meet growing demand, leaving patients waiting longer, falling more, and losing more of their sight.1

Drawing on targeted literature searches and expert clinician interviews, the narrative review examined capacity constraints in surgical and procedure-based ophthalmology across five countries – the United Kingdom, Germany, Australia, Singapore, and India – and painted a concerning picture of healthcare sectors stretched well beyond their limits.

“The growing capacity constraints in surgical ophthalmology demand urgent policy action to prevent worsening delays and inequities in patient care,” the authors stated.

They urged policymakers, healthcare leaders, and industry stakeholders to implement “coordinated, evidence-based reforms adapted to the specific needs of each healthcare system”.

The authors proposed “proven and prospective solutions” included task shifting, technological innovations, and workflow optimisation. Additionally, they put forward scalable solutions including workforce expansion, telemedicine, artificial intelligence-assisted diagnostics, and mobile clinics.

A UNIVERSAL PROBLEM

Across all five countries studied, the review identified a consistent set of pressures: surgical workforce shortages, infrastructure limitations, inefficiencies in scheduling and resource allocation, and an increasing reliance on private sector providers. Geographic disparities are widespread, with rural and underserved populations consistently experiencing worse access to timely ophthalmic care.

The demand side of the equation shows no sign of easing. The incidence of elective surgeries is growing globally, with prevalence of cataracts, retinal disease, and macular conditions all expected to continue rising. Urgent cases routinely displace elective procedures, with individual countries employing different strategies to try to minimise the impact. In Australia, for example, emergency cases dominate daily operating lists, with elective surgeries deliberately under-booked to create space for the unexpected. In the UK, an estimated 25% of elective surgeries are postponed at least once, with rescheduling managed on a surgeon-by-surgeon basis. However, in Singapore, elective surgeries are minimally affected, particularly in private settings where emergency surgeries are performed in dedicated operating theatres.

Nursing shortages emerged as a particularly consistent theme across all countries studied. Clinicians interviewed for the review reported that in many instances, theatre space is available, but procedures cannot proceed due to the absence of appropriately trained staff. Burnout, pay erosion, and unattractive working conditions are driving experienced nurses out of eye care and into administrative roles or private practice – or out of the profession altogether.

ISSUES AT A LOCAL LEVEL

In Australia, the scale of domestic demand is significant. A nationwide database study of Australian public and private hospitals found that the total number of vitreoretinal procedures (both urgent and elective) jumped from 8,102 in 2001 to 136,430 in 2019 – a 1,584% increase. Meanwhile, waiting times for all ophthalmology surgeries in Australia have continued to lengthen. In 2016, across all ophthalmology, the longest median wait time for elective surgery nationally was 78 days, with the average time from referral to first appointment sitting at 188 days. By 2021, the median surgical wait had climbed to 118 days, extending to 30 months for some cataract patients.

These delays carry real clinical consequences. In the case of cataracts, for instance, one study found that approximately 30% of individuals awaiting surgery in Australia experienced falls during their wait, half resulting in injury. Untreated cataracts were also associated with increased rates of depression and anxiety, with cancelled appointments compounding psychological distress in patients managing ongoing conditions.

The maldistribution of Australia’s ophthalmology workforce reflects the geographic inequities seen across many of the countries reviewed. Of 965 practising ophthalmologists recorded nationally in 2019, 818 were based in major cities. In outer regional centres, just 23 ophthalmologists were in practice. Indigenous Australians are disproportionately affected, with more than 60% of the Aboriginal and Torres Strait Islander population residing in regions with little or no access to publicly funded outpatient services. Access to anti-VEGF therapy has similarly been described as a “postcode lottery”, with availability varying considerably across states.

On the nursing side, a 2024 national survey of 238 Australian nurses found that 68.6% planned to exit eye care within the next 10 years – a figure that underscores the urgency of domestic workforce retention strategies.

REASONS FOR OPTIMISM

Sydney ophthalmologist and a co-author of the study, Professor Andrew Chang AM (pictured), told mivision that the delivery of eye surgical care in Australia needs to be approached in novel ways to tackle growing demand.

“Technology is increasing our understanding of disease pathophysiology and the ability of optometrists and ophthalmologists to more accurately diagnose vision-threatening diseases, such as cataract, glaucoma, retinal disease, and diabetes. This is good news as being able to save sight is a priority. However, the more people we have referred for care, the more our healthcare system is stressed to meet demand and there is a need to increase capacity,” said Prof Chang.

While a total overhaul of the healthcare system is unlikely in the short to medium term, he said innovations are increasing access to eye care, and enabling more effective triage, which will help address wait lists for care.

“In 2025, we opened the Gadigal Clinic within Sydney Eye Hospital, and we are working on virtual models of care, which will improve access for remote communities including Indigenous and regional patients,” he said.

The review also highlighted Australian outreach programs, including Lions Outback Vision and the Griffith Base Hospital Eye Care Model, which have delivered meaningful results – the latter cutting its regional waitlist from 123 patients to just 10 within a single year by bringing metropolitan-based ophthalmologists to regional facilities.

Prof Chang said investing in succession planning with simulation labs, clinical placements, formal education, and upskilling is better preparing the next generation of surgeons and nurses for the operating theatre.

“But we still need to look at issues of sustainability. The government must ensure sustainable funding of surgical eye services in public hospitals, including resources to support patients and maintain more stringent accreditation standards.

“In many cases patients have poor health literacy – they need support to understand the required procedure and manage the consent process. This may require interpreters that are a valued and stressed resource.

“Private and public hospitals are obliged to maintain government legislated National Safety and Quality Health Service Standards. While this is extremely important, it all takes time, resources, and expertise to implement and maintain.

“But over and above all of this, we must address the specific challenges of delivering elective versus emergency eye care, often concurrently. This includes managing operating schedules for elective waitlists and ensuring the availability of medical and surgical expertise when and where it’s needed for emergency care, including ocular trauma and retinal detachment. Centres of excellence – dedicated eye hospitals such as Sydney Eye Hospital and the Royal Victorian Eye and Ear Hospital – are a logical part of the solution, but we need more networked support through integrated care to address the capacity constraints,” he said.

Reference
1. Hillier RJ, Chang A, Matse-Orere A et al. Surgical capacity in ophthalmology: the unmet need for sustainable solutions. Eye (Lond). 2025 Dec 16. doi: 10.1038/s41433-025-04153-x.