Industry profile

Independent service providers: reducing cataract waiting lists, market shifts, and the impact of COVID-19

CEO of Optegra, Dr Peter Byloos, told OT  about the trend for outsourcing cataract surgery, and market shifts in independent eye care provision

Optegra ophthalmic kit

The year of 2019–2020 was challenging for Optegra, as for every medical provider. COVID-19 had a big impact on our lives, healthcare, and how we treat our cataract patients. We standardised our pathways and reopened relatively quickly. We started doing a lot of virtual consultations and pre-operation assessments by telephone.

The pandemic had a massive impact on the waiting list for cataract procedures. It is the number one elective procedure in terms of patients who have been on the waiting list for more than one year in the UK. There has been a trend of outsourcing to independent service providers, and now there are three or four national chains providing cataract surgery within a relatively short window of time.

The NHS has been struggling to cope with the demand, in dealing with very sick COVID-19 patients, and elective cataract surgery can be done very easily in a day care setting. Sometimes, independent service providers like us, who specialise in ophthalmology, are better positioned to do that.

There has been a shift in the market. The Royal College of Ophthalmologists has found that almost 50% of the market was outsourced during COVID-19, and in Europe, most elective cataract surgery is outsourced. The UK is a large market, the second largest in Europe, and it is now a market that is going to be largely outsourced. I think that is here to stay. A very complex Trust hospital is not built for simple elective surgery. It’s not that we are cherry-picking one cataract and not another, but in general, most cataract surgery can be done with the patient in a day care setting.

The pandemic had a massive impact on the waiting list for cataract procedures


The private market has been very turbulent with COVID-19. After the closure for six to eight weeks of our sites, we saw the younger patients who wanted to have vision correction coming back very quickly, while we saw that elderly patients who wanted to have their cataract surgery were very concerned about COVID-19 and were not coming back as quickly.

Worldwide, the vision correction market has had a stellar 2021. Having built up some savings, people are preferring to have their eyes ‘done’ than take a flight with the risk of COVID-19.

We will see what happens with the private market in the future. On the one hand, you have high waiting lists that are going to be influencing the private market, encouraging patients to find different solutions. On the other hand, how is the current situation in Ukraine, as well as energy prices, going to affect our spendable income, lifestyles, and how much we are going to spend on our eyes?

We won’t be going back to the old days with some of the ways we’ve had to adapt and learn during the pandemic. We hold a virtual clinic for every self-pay and refractive patient, and will continue to. The patients love it. It means they come to the hospital prepared and knowing what to expect. There is a high degree of patient satisfaction.

For cataract patients, we have pre-operation assessments with a clinical team once they are booked in. We will continue to do that so the patient is better prepared and so we can triage better.

I think it is very important to work with the optometrists in the community. We try to host as many webinars as we can. A recent one was attended by more than 1000 optometrists. It’s important to make sure that the relationship with the optometrists is very good, and that we can refer patients back. We are very good at performing the day care surgery but we are not necessarily best-positioned to have that patient interaction day-to-day afterwards, such as in ordering the prescription for glasses after cataract surgery. That is where the relationship with the optometrist is very important, and the NHS is facilitating this too.

With the ageing population, it’s going to be important to continue having our patients served well, and the more we can do that at a local setting, the better


Being able to restore people’s sight is a critical opportunity. With the ageing population, it’s going to be important to continue having our patients served well, and the more we can do that in a local setting, the better.

I think that vertical integration between High Street optometrists, as well as ophthalmic providers, specialty providers and community centres, is important, so the patient gets a really great experience.

OT toured Optegra’s flagship facility in Queen Anne Street, London. Watch the video here.