Efficacy of Remote Care in Cataract Surgery: a Systematic Review.

Topic: To evaluate the efficacy of currently available digital and remote care applications for postoperative cataract management compared to traditional methods for postoperative clinical measurements.

Clinical relevance: With the increasing demand for ophthalmological services and an anticipated shortage of professionals, innovative approaches are needed to optimize care. Cataract surgery, characterized by its high safety profile and turnover rate, is well-suited for digital and remote care solutions, which could enhance the postoperative patient pathway, potentially leading to substantial time and cost savings.

Methods: A systematic search was performed in Ovid Embase, Ovid MEDLINE, KSR Evidence, CINAHL, and Cochrane CENTRAL Library for randomized controlled trials (RCTs) and observational studies on digital tools, telemedicine or remote care in postoperative cataract management. Reported outcomes included patient reported outcomes (PROMs), visual acuity, refraction, intraocular pressure, slitlamp and fundus examination, or complication prevalence. The risk of bias was evaluated using the Cochrane Risk-of-Bias Assessment Tool (version 2) and Joanna Briggs Institute Critical appraisal checklists. Data extraction included both qualitative and quantitative information. The protocol was registered at PROSPERO (CRD42024505933).

Results: The search identified 11,319 studies, of which 14 were included. These comprised 4 RCTs and 10 observational studies involving 2681 patients. Interventions were categorized into telephone consultation, messaging, automated phone calls, and mobile applications/software. Telephone consultations were effective for follow-up screening, and automated phone calls also showed promising results. Messaging was suggested to improve adherence in the early postoperative period. Visual acuity assessment tools showed potential as screening methods, but exhibited variability compared to conventional methods and had wide 95% limits of agreement. All types of interventions were well-accepted by patients.

Conclusion: Early evidence supports a positive impact of implementing digital and remote care tools in the postoperative cataract management pathway, particularly for screening purposes. However, further research is needed to define their roles and develop clinical practice guidelines.