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Published on: February 11, 2014
Web-based telemonitoring of visual function and self-reported postoperative outcomes in cataract care: international
Janneau L J Claessens1, Joukje C Wanten, Noël J C Bauer
1From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Imhof, Wisse); University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands (Wanten, Bauer, Nuijts); Oogcentrum Noordholland, Heerhugowaard, the Netherlands (Vrijman, Selek, Wouters); Department of Ophthalmology, Amphia Hospital, Breda, the Netherlands (Reus, van Dorst); Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Findl, Ruiss); Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany (Boden); Mount Saint Peter Eye Clinic, Trier, Germany (Januschowski).
Purpose:
To compare 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 patients with cataract were randomized into 2 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- to 6-week postoperative 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 with conventional Early Treatment Diabetic Retinopathy Study 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 in spherical equivalent 0.15 ± 0.67 diopters), resulting in a poorer corrected distance VA compared with subjective refraction (mean 0.1 vs -0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROM questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and National Eye Institute Visual Function Questionnaire-25) improved postoperatively (mean improvement -0.80 and 16.70, respectively) and did not significantly differ between the 2 groups.
Conclusions:
The patients with cataract in this study effectively provided postoperative outcome data using 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.
