Surgical capacity in ophthalmology: the unmet need for sustainable solutions

The increasing prevalence of eye diseases is placing significant pressure on surgical and procedure-based ophthalmology services worldwide. Delays in surgical care can lead to poorer patient outcomes and reduced treatment efficacy, highlighting the urgent need for healthcare systems to address these challenges. This narrative review provides a broad overview of surgical and procedure-based ophthalmology capacity constraints across five countries (UK, Germany, Australia, Singapore, and India) to identify cross-cutting, system-level challenges that transcend individual diseases or interventions, thereby informing policy and investment strategies. It examines contributing factors from patient, clinician, and healthcare system perspectives, focusing on workforce shortages, operating theatre limitations, and scheduling conflicts, while also addressing diagnostic and medical challenges affecting surgical pathways, preoperative preparation, and postoperative care. Key insights were derived from targeted literature searches and supplemented by qualitative expert interviews. The searches revealed themes including the rising prevalence of retinal diseases, workforce gaps, and the impact of capacity constraints on clinical outcomes. Expert interviews provided nuanced, qualitative perspectives from ophthalmic surgeons on local challenges and opportunities for improvement. Proven and prospective solutions were identified, including task shifting, technological innovations, and workflow optimisation. Examples such as AI-assisted diagnostics, mobile clinics, and telemedicine have successfully mitigated capacity constraints in various healthcare systems. By identifying actionable strategies, this review serves as a call-to-action to healthcare policy makers to improve surgical and procedure-based service capacity, enhance patient access to care, and ultimately optimise clinical outcomes.