Digital Cataract Clinic Versus Face-To-Face Clinics – Do They Have An Impact On Patient Reported Outcomes Measures (Proms) Of Cataract Surgery?

The pandemic has had a major impact on the cataract services. Self-isolation rules and safety concerns have made listing patients for surgery difficult. This has contributed to longer waiting times and more severe pathology at presentation. To combat this, we piloted a novel digital cataract service, where patients were listed for surgery following a video consultation. A traditional slit lamp examination was replaced with imaging (anterior and posterior segment OCT). The purpose of this study was to evaluate the digital service and ensure patient-measured cataract outcomes were at least as effective as the standard face-to-face service. If so, could there be a permanent place for the digital cataract service in the future?

The study design included all patients from Moorfields at Croydon. The digital cataract service was set up virtually via a digital platform, DrDoctor. Patients were seen remotely via a video consultation. The face-to-face cataract service was set in the Moorfields Croydon clinic area. Patients were seen physically in a clinic room and their eyes were examined under a slit lamp. Patients proceeded on the same pathway following the decision to list them for surgery – irrespective of the service.

Patients seen and listed from the digital and face-to-face services between September 2021 and March 2022 were sent a patient reported outcome measures (PROMs) questionnaire. The PROMs questionnaire was based on the international Catquest-9SF and comprised 8 items assessing daily visual difficulties. The questionnaires were sent digitally via the DrDoctor platform, at the time of listing (i.e., prior to surgery) and following completion of the surgery. The mean change in visual outcomes between the two services – digital and face-to-face – was compared. Further information was gathered from Medisoft to better understand the results. This included the complexity of the cataract, comorbidities, guarded prognoses and surgical complications.

A total of 37 patients completed two PROMs questionnaires each – one before and one after their cataract operation. These 37 patients were stratified into two cohorts. 26 of them were from the face-to face service and 11 were from the digital cataract service.

For those from the digital cataract service, the results showed that 82% (n=9) saw an overall improvement in patient measured visual outcomes and 18% (n=2) saw an overall worsening under the same metrics.

In comparison, the results from the face-to-face service showed that 73% (n=19) saw an overall improvement in patient measured visual outcomes, 14% (n=4) saw an overall worsening under the same metric, and 12% (n=3) felt there was no overall change in the outcome.

The digital cataract service had a higher proportion of patients who reported an overall improvement in their visual outcome at 82% compared to only 73% in the face-to-face patient cohort.

To conclude, the digital cataract service is as effective, if not more effective than the face-to-face service according to the PROMs. It is unclear why the outcomes are better in the digital service. Perhaps patients are being seen quicker or feel more comfortable with remote consultations. This may require further qualitative research and analysis.

However, the conclusion does highlight the question we began with – could there be a bigger, more permanent space for the digital cataract service in the UK and worldwide?