Patient satisfaction in tele-ophthalmology: systematic review and meta-analysis

Telemedicine is rapidly expanding in eye care, yet evidence on patient satisfaction and perceived quality is limited, restricting wider clinical adoption and integration. This study aimed to: i) compare satisfaction rates in tele-ophthalmology versus in-person eye care; ii) assess overall patient satisfaction within tele-ophthalmology services. This systematic review was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews ID: CRD420251218938). We used random-effects meta-analyses to pool comparative satisfaction odds ratios (tele-ophthalmology vs. in-person care) and to calculate overall tele-ophthalmology satisfaction proportions. Heterogeneity was quantified using the I² statistic. We included 41 studies encompassing 24,595 participants. Five studies reporting patient satisfaction in telemedicine vs in-person revealed comparable satisfaction rates (OR = 0.98; 95% CI = 0.36; 2.65, p = 0.95). Across all telemedicine studies (n = 36), the pooled satisfaction rate was high 93.5% (95% CI = 90.8, 95.5) with comparable rates across different tele-ophthalmology models [( ${\chi }^2=0.99,df=2,p=0.61$ ), asynchronous (94.6%), synchronous (92.1%) and hybrid (93.8%)]. While general acceptability for telemedicine was high 92.0%, participants were more likely to recommend telemedicine service (94.9%) than to reuse it in the future (84.0%). No publication bias was found (p > 0.05). Patient satisfaction in tele-ophthalmology is high and appears to be comparable to standard in-person care. However, considerable variability between studies highlights the need for validated and standardised measures for patient satisfaction. Furthermore, lower intention rates for future use underscore the need to address potential systemic gaps, such as digital illiteracy, to sustain long-term adoption.