TeleGlaukos: A Clinician-Led Adaptive Telemonitoring Platform for Hybrid Glaucoma Care

Glaucoma requires continuous surveillance, sustained treatment adherence, and timely recognition of postoperative or treatment-related complications. Conventional outpatient follow-up provides structured clinical assessment but offers limited visibility of symptoms between appointments. This study describes TeleGlaukos, a clinician-led adaptive telemonitoring platform designed for hybrid perioperative and therapeutic glaucoma care. Its principal innovation is a configurable protocol engine that transforms static symptom forms into patient-specific workflows through conditional questions, symptom-triggered branching, medication reminders, rule-based alerts, and bidirectional clinician-patient communication. The platform was implemented as a Progressive Web App connected to a modular Django backend through RESTful APIs and WebSocket-enabled communication. The clinical pilot cohort comprised 30 glaucoma patients followed between May 2025 and April 2026. The wider platform environment contained 95 registered accounts: 30 glaucoma patients, 10 ophthalmologists, 10 research or administrative users, 20 development and testing accounts, and 25 non-pilot registered users. Across the platform, 737 engaged sessions, 1329 events, 30 bidirectional messages, and 186 questionnaire responses were recorded. Structured monitoring identified suspected treatment-related adverse reactions in two patients, prompting earlier clinical reassessment and treatment adjustment. Usability was assessed in 22 respondents (18 patients and 4 ophthalmologists), yielding a mean System Usability Scale score of 79.43 ± 17.98 (95% CI: 71.46-87.40), corresponding to a Good adjective rating and an Acceptable usability range; internal consistency was high (Cronbach's alpha = 0.882). The artificial intelligence-assisted module remained exploratory and was not evaluated as an autonomous clinical component. TeleGlaukos demonstrated technical feasibility, favourable perceived usability, and the capacity of adaptive symptom workflows to surface clinically relevant signals between visits. Larger multicentre studies are required to evaluate effectiveness, safety, adherence, workflow burden, and cost-effectiveness.