A retrospective population-based analysis of wait times for cataract surgery in Ontario, Canada

**Background:** Cataract surgery is one of the most common surgeries in Canada, with volumes expected to more than double over 25 years. In Ontario, wait times are publicly reported via the Wait Time Information System (WTIS), but these are self-reported by surgeons and may be inaccurate due to inconsistent administrative policies. Long wait times are associated with visual loss and reduced quality of life. This study aimed to use objective administrative health data to estimate cataract surgery wait times and the proportion of patients meeting provincial targets.

**Methods:** This retrospective population-based analysis used Ontario health administrative data from ICES for all adults (≥18 years) who underwent cataract surgery between January 1, 2005 and December 31, 2019. The cohort included 1,138,532 patients after exclusions (e.g., no referral, no preoperative visit within 2 years). Wait time 1 was defined as days from referral to first visit with the cataract surgeon; wait time 2 as days from the decision for surgery (second-last preoperative visit) to surgery date. The primary analysis used a ranking method for referral source: optometrist first, then ophthalmologist, then family physician. Sensitivity analyses used the earliest and latest potential referral dates. Outcomes included median wait times, proportions waiting <3, <6, <12 months, and proportion not meeting the 182-day provincial target (priority 4). Subgroup analyses by referral source, single vs. multiple referrals, and age were performed.

**Key Results:** The cohort was 57.3% female and 79.0% aged ≥65 years. In the primary analysis, median wait time 1 was 67 days (IQR 29–147); 54.1% waited <3 months, 78.5% <6 months, 91.7% <12 months; 19.3% did not meet the 182-day target. Median wait time 2 was 77 days (IQR 37–155); 49.5% waited <3 months, 77.1% <6 months, 93.3% <12 months; 20.5% did not meet the target. Overall, 35.0% of patients did not meet the target for either wait time. Sensitivity analyses showed wide variation for wait time 1 (earliest referral: median 173 days; latest: 49 days) but similar results for wait time 2. Stratified by referral source, median wait time 1 was shortest for optometrist referrals (65 days) and longest for family physician referrals (144 days). Wait time 2 was similar across sources (69–77 days). Patients aged 20–64 had slightly shorter wait times than those ≥65. The highest proportion not meeting targets occurred in 2005 and 2017–2019.

**Clinical Implications:** This study demonstrates that administrative health data can provide objective, reproducible estimates of cataract surgery wait times, with wait time 2 showing greater consistency than wait time 1. The finding that 35.0% of patients did not meet the 182-day target suggests substantial delays in access to care, which may lead to visual loss and reduced quality of life. The method allows identification of regions with longest waits, enabling targeted resource allocation. However, limitations include inability to capture the exact referral date (especially for optometrist referrals in younger patients who pay out-of-pocket), potential misclassification of referral source, and inability to account for patient or system factors that delay surgery (e.g., preoperative consultations, patient hesitancy). The authors recommend creating new billing codes at the time of referral to improve accuracy of wait time 1 estimates. Overall, this data-driven approach could be applied to other ambulatory surgeries to improve wait time reporting and policy decisions.