13 October 2026
On the night before presenting at the European Society of Cataract and Refractive Surgeons Congress in London on 12 September, Dr Nadiia Ulianova could not sleep.
Air-raid alarms punctuate the night at regular intervals where Ulianova lives in Odesa, Ukraine. In London, the city seemed strangely quiet.
While logically, Ulianova did not need to remain alert, after four years of war, the body’s instincts can be hard to negotiate with.
“You adapt to this situation so when you travel to other places, it can be difficult,” she said.
Ulianova, alongside a delegation of other Ukrainian ophthalmologists, travelled to London to meet with colleagues from around the world and share their insight on daily practice following the Russian invasion of Ukraine in 2022.
A panel of ophthalmologists outlined how the war has changed the injuries they treat in practice, as well as the effect of the conflict on routine civilian eye care.
They also described how they have adapted to remain resilient and continue to provide eye care in the most challenging circumstances. Below, OT presents a selection of insights from the event.
Expanding the limits of what is possible
Ulianova is head of the post-traumatic ophthalmology department at the Filatov Institute of Eye Diseases and Tissue Therapy in Odesa, Ukraine.
The ophthalmologist shared with OT that her daily work changes depending on the intensity of the conflict.
“I work in a civilian hospital, but after night attacks, we receive civilian patients with blast injuries. This can be children, women and elderly patients,” she said.
“If we don’t have night attacks, then we receive more planned reconstructive surgery patients. Patients travel from different clinics within Ukraine because we are a highly specialised hospital,” Ulianova explained.
Frequent power outages can create a challenging environment to carry out surgical work – as well as the hazards of operating in a conflict zone.
“War has changed the conditions of our work. Sometimes we can be operating and suddenly bomb attacks start – but we can’t stop the surgery,” Ulianova said.
The surgical team has adapted to this challenge by creating an operating theatre in a shelter – however, other areas of the clinic are more exposed.
Ulianova shared that there has been an increase in patients who require pole to pole surgery since the outbreak of war in 2022.
She noted that as well as changing the nature of the injuries that she sees, war has altered the way that she approaches surgical care.
“We need to be ready to manage many surgical cases at the same time,” she said.
Ulianova observed that practising as an ophthalmologist during a war has meant making the best use of available resources.
“Wartime ocular trauma surgery requires creative solutions and the use of every available option,” she said.
“It has forced us to accept higher risks, but it has also expanded the limits of what is surgically possible,” she said.
Reflecting on how she remains resilient in challenging circumstances, Ulianova told OT that she tries to devote a small portion of each day to a pastime unrelated to the war. She takes time to connect with her colleagues, family and friends.
“We can’t always be in this state of stress and sadness,” she said.
“Sometimes it is the simple things like a cup of tea or coffee. After hours of surgery, a cup of coffee can be a real pleasure,” Ulianova observed.
Wartime ocular trauma surgery requires creative solutions and the use of every available option
A transformation of reality
Colonel Igor Khramov, chief ophthalmologist for the armed forces of Ukraine, shared his observations from organising ocular trauma care over the course of the war.
“From the very beginning of the full-scale invasion, we stayed in our cities and hospitals, and provided care to the wounded,” he told delegates.
Khramov highlighted that it is important to understand the psychological challenges that clinicians practising during a war experience.
He noted clinicians are anxious about the safety of their own family and friends, and face a range of distractions – including the sound of explosions and gunfire, and frequent updates about the onset of war.
“There is a transformation of reality. This involves psychological shock and severe uncertainty. People do not know what tomorrow will bring,” Khramov said.
Khramov observed that as a leader it is important to develop a clear action plan for the future with specific goals for staff.
“This reduces the level of uncertainty,” he said.
He highlighted that injuries during wartime differ “fundamentally” from peacetime injuries.
Khramov added that around three in four ocular trauma patients have concomitant injuries.
“Patients are often in a severe general condition, which dictates a completely different to surgery,” he said.
He noted that it is important to define the scope of care that will be provided when multiple casualties are being treated at the same time.
“This is critical for resources and time management. You cannot treat a single patient for too long at the expense of others,” Khramov said.
He shared with delegates that during conflict, the use of medical supplies and pharmaceuticals increases at the same time as there are disruptions in the supply chain.
“Companies may cease operations. You must quickly determine the volume of supplies required and source alternative supply routes, such as humanitarian or charitable organisations,” Khramov said.
Khramov explained that military clinicians live in the same buildings where they are working. He emphasised the importance of creating conditions where clinicians can rest.
“It is vitally important for the staff to have the opportunity to rest and reduce their psychological load,” Khramov noted.
Some military clinicians have their family and pets living with them in the hospital. Khramov shared a photograph of colleagues playing chess in a rare moment of downtime.
“It’s important to speak about good things, not just the war,” he said.
“When the war started, two of my colleagues were married,” Khramov shared.
It is vitally important for the staff to have the opportunity to rest and reduce their psychological load
The effect of war on civilian eye care
Kyiv ophthalmologist, Volodymyr Melnyk, provided delegates with insight on the effect of war on civilian eye care in Ukraine.
“War does not only create injury. It creates a second wave of blindness by disruption in access to routine care,” Melnyk highlighted.
He noted that the World Health Organization has recorded 3000 attacks on the healthcare system in Ukraine since 2022.
Melnyk shared that the number of cataract operations performed annually in Ukraine dropped from 65,000 in 2018 to 20,000 operations in 2022.
Reflecting on the reasons for this disruption, Melnyk highlighted that patients have been displaced, ophthalmic facilities have closed or been destroyed and there is a shortage of surgical staff.
Turning to glaucoma, Melnyk shared the results of a survey of 1200 Ukrainian ophthalmologists.
Three in every four survey respondents reported that patients were arriving late for routine appointments.
Sharing an example of how delays can affect care, Melnyk noted that he saw a patient in February 2022 and arranged for her to have a trabeculectomy the following month.
However, the patient was living in the Kherson region which was one of the first regions to be occupied following the invasion of Ukraine.
“I only saw her again in 2024, when she was almost blind,” Melnyk said.
“Unfortunately, we couldn’t save her vision,” he shared.
The ophthalmologist observed that the conflict has caused an increase in ocular trauma among the civilian population.
In 2021, there were 380 new cases of blindness in Ukraine caused by trauma. In 2022, this increased to 928 cases. Reflecting on this statistic, Melnyk paid tribute to the work of his colleagues in Ukraine.
“I’d like to express my gratitude for all of you because this statistic could have been much worse if you didn’t show up for work each day,” he said.
Comments (0)
You must be logged in to join the discussion. Log in