Web-based Telemonitoring of Visual Function and Self-reported Postoperative Outcomes in Cataract Care: an International Multicenter RCT.

PURPOSE: Comparing web-based, self-administered follow-up after cataract surgery to conventional face-to-face follow-up. SETTING: Eye clinics in the Netherlands, Austria and Germany. DESIGN: Randomized controlled trial with an embedded method comparison study [ClinicalTrials.gov: NCT04809402]. METHODS: Routine cataract patients were randomized into two groups: the 'telemonitoring' group undertook web-based vision self-assessments and questionnaires from home, while the 'usual care' group received conventional care. All participants had a 4-6 week post-surgery clinic visit for safety and validation purposes. Outcomes included: the web-test's accuracy for assessing postoperative visual acuity (VA) and refractive error; adverse event rates; and patient reported outcome measurements (PROMs). RESULTS: 94 participants (188 eyes) were enrolled. Web-based uncorrected distance VA testing demonstrated a negligible mean difference (-0.03±0.14 logMAR) when compared to conventional ETDRS chart testing, with 95% limits-of-agreement ranging from -0.30 to 0.24 logMAR. The web-based refraction assessment overestimated the postoperative refractive error (mean difference 0.15±0.67 diopters), resulting in a poorer corrected distance VA compared to subjective refraction (mean 0.1 vs. -0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROMs questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and NEI-VFQ-25) improved after surgery (mean improvement -0.80 and 16.70 respectively) and did not significantly differ between the two groups. CONCLUSION: The cataract patients in this study effectively provided postoperative outcome data via a web-interface. Both conventional and web-based follow-ups yielded similar PROMs and adverse event rates. Future developments should reduce the variability in the web-based VA test and yield representative refraction outcomes.

Evaluation of a visual acuity eHealth tool in patients with cataract.

PURPOSE: To validate the Easee web-based tool for the assessment of visual acuity in patients who underwent cataract surgery. SETTING: University Eye Clinic Maastricht, Maastricht, the Netherlands. DESIGN: Prospective method comparison study. METHODS: Subjects aged between 18 and 69 years who underwent cataract surgery on 1 or both eyes at the Maastricht University Medical Center+ were eligible to participate in this study. The uncorrected (UDVA) and corrected distance visual acuity (CDVA) assessments were performed using the web-based tool (index test) and conventional ETDRS and Snellen charts (reference tests). The outcomes of the different tests were expressed in logMAR, and a difference of <0.15 logMAR was considered clinically acceptable. RESULTS: 46 subjects with 75 operated eyes were included in this study. The difference of the UDVA between the web-based tool and ETDRS or Snellen was -0.05 ± 0.10 logMAR ( P < .001 [0.15; -0.26]) and -0.04 ± 0.15 logMAR ( P = .018 [0.24; -0.33]), respectively. For the CDVA, these differences were -0.04 ± 0.08 logMAR ( P < .001 [0.13; -0.21]) and -0.07 ± 0.10 logMAR ( P < .001 [0.13; -0.27]), respectively. The Pearson correlation coefficients between the web-based tool and ETDRS were maximally 0.94 and compared with Snellen 0.92. In total, 73% to 88% of the visual acuity measurement differences were within 0.15 logMAR. CONCLUSIONS: The web-based tool was validated for the assessment of visual acuity in patients who underwent cataract surgery and showed clinically acceptable outcomes in up to 88% of patients. Most of the participants had a positive attitude toward the web-based tool, which requires basic digital skills.

Remote follow-up after cataract surgery (CORE-RCT): study protocol of a randomized controlled trial.

BACKGROUND: Cataract surgery has become one of the most performed surgical procedures worldwide. Postoperative management consists of routine clinical examinations to assess post-operative visual function and detect possible adverse events. Due to the low incidence of complications, the majority of clinic visits after cataract surgery are uneventful. Nonetheless, valuable time and hospital resources are consumed. We hypothesize that remote post-operative follow-up involving teleconsultations and self-assessments of visual function and health status, could be a valid alternative to face-to-face clinical examinations in selected patient groups. The practice of remote follow-up after cataract surgery has not yet been evaluated. The aim of this study is to investigate the validity, safety and cost-effectiveness of remote cataract surgery follow-up, and to report on the patients' experiences with remotely self-assessing visual function. METHODS: This study is a multicenter, open-label, randomized controlled trial. Patients planned for cataract surgery on both eyes, without ocular comorbidities, are eligible for participation. Participants will be allocated (1:1) into one of the two study groups: 'telemonitoring' or 'usual care'. Participants in the 'telemonitoring' group will perform in-home assessments after cataract surgery (remote web-based eye exams and digital questionnaires on their own devices). Participants in the 'usual care' group will have regular post-operative consultations, according to the study site's regular practice. Outcome measures include accuracy of the web-based eye exam for assessing visual acuity and refraction, patient-reported outcome measures (visual function and quality of life), adverse events, and cost aspects. DISCUSSION: Investigating remote follow-up after cataract surgery fits the current trends of digitization of health care. We believe that remote self-care can be a promising avenue to comply with the increasing demands of cataract care. This randomized controlled trial provides scientific evidence on this unmet need and delivers the desired insights on (cost)effectiveness of remote follow-up after cataract surgery. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04809402. Date of registration: March 22, 2021.