The impact of the global economic crisis on ophthalmologists in low- to middle-income countries during the COVID-19 pandemic

To the Editor, The COVID-19 pandemic severely disrupted healthcare delivery systems worldwide,[1] but its economic repercussions have been especially profound in low- to middle-income countries (LMICs). Ophthalmology was markedly challenged by the crisis, as the specialty relies on high-volume clinical workflows and close patient contact, factors that rendered it uniquely vulnerable to the effects of lockdowns and economic downturns.[2,3] We conducted a cross-sectional survey of 146 ophthalmologists from 37 LMICs to assess the impact of the pandemic-induced economic recession on ophthalmology practices, with a focus on disparities between regions. Our findings reveal a concerning reality: ophthalmologists in LMICs, particularly in the Middle East, experienced sharp reductions in clinical and surgical activity, compromised access to diagnostics and medications, and widespread financial strain. Our findings reveal a concerning picture. Approximately 69.2% of respondents reported a significant decrease in their clinical load, whereas 73.2% experienced a reduction in surgical volume. These declines were primarily attributed to patients’ fear of clinic visits (56.3%), loss of income (46.5%), prolonged lockdown measures (34%), and loss of health insurance coverage (12.5%), which impeded their ability to access care. On the provider side, financial constraints were also severe: around 24% of ophthalmologists reported having to lay off employees, and many (62.3%) cited challenges in procuring essential equipment and medications. Moreover, 82.2% of the respondents indicated that their patients faced difficulties affording out-of-pocket medications and diagnostic tests. Respondents from the Middle East were significantly more likely to report difficulties affording imaging and laboratory tests, and they demonstrated a greater reliance on generic or less expensive medications. Our data indicate that telehealth was rapidly adopted among respondents (57.6%)–with the majority using audio-based consultations (70.8%). However, technological illiteracy among patients, poor digital access, and inadequate infrastructure limited the reach and effectiveness of telehealth, particularly in underserved areas. While many high-income countries buffered their healthcare sectors with robust governmental support and subsidies, our findings suggest that ophthalmologists in LMICs were left relatively unsupported. The lack of economic safety nets, combined with the compounding effects of pre-existing healthcare inequities, rendered these systems especially vulnerable.[4,5] In light of this, our study underscores the urgent need for region-specific emergency planning that not only addresses immediate financial challenges but also strengthens long-term healthcare resilience. We advocate for policymakers to prioritize the stabilization of supply chains, the provision of financial support to healthcare workers, and the equitable expansion of telehealth infrastructure. In addition, investments in workforce training and digital literacy for both providers and patients are essential to maximize the benefits of telemedicine. Such proactive measures could mitigate the adverse effects of future global crises and ensure that even the most vulnerable regions are better equipped to maintain continuity of care. Our data reflect a broader truth: in times of global crisis, LMICs bear a disproportionate burden – even in highly specialized fields such as ophthalmology. Strengthening the resilience of these healthcare systems requires both decisive local action and coordinated international support. We hope that our findings will stimulate the necessary policy reforms and foster sustainable strategies to protect both providers and patients in economically vulnerable settings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.