Digital Cataract Service : Modernising The Oldest Eye Disease Management Pathway

Moorfields at Croydon initiated a digital cataract service in response to the pandemic. The traditionally 100% face-to-face service was redesigned into a telemedicine based model to continue cataract care pathway delivery during lockdowns.  Remote consultation coupled with imaging supported clinics was deployed using existing technology and personnel.  This enabled rapid deployment of a novel, safe and efficient service that not only benefited patients during the pandemic, grew into the new normal; and has become a stepping stone for us to further innovate and modernise the care pathway of the oldest eye disease, in the age of the medical digital revolution. 

Cataract surgery is the most commonly performed operation UK, it was the first elective service halted and last recovered during the pandemic;  Digital cataract service (DCS) was rapidly deployed to enablecataract clinics during lockdown.  Utilising the concept of the minimal viable product, we devised a strategy to replace any avoidable face-to-face consultation with teleconsultation and reduce any unavoidable clinician-patient interaction eye examination time utilising imaging technology.

 We reviewed the existing process and mapped out the minimal clinical requirements for safe cataract management.  Utilising the concept of the minimal viable product, the multidisciplinary team devised a strategy to replace any avoidable face-to-face surgeon consultation with teleconsultation and reduce any unavoidable clinician-patient interaction eye examination time by utilising imaging technology.  DCS was assessed against key performance indices set by the Royal College of Ophthalmologists (National Ophthalmology Database -NOD) that benchmarks cataract service standards in:   safety, efficacy, efficiency, user experience ( patient and clinician) and digital exclusion

409 patients were in the pilot.  DCS has demonstrated:  96% of patients reported improvement of vision post-surgery(NOD standards of 95%).  4% patients had intraoperative complications (NOD standards of 4.64%). 4% of patients had post-op complications (NOD standards of 14%).  DCS had a higher conversion to surgery rate at 82% compared to the national average of 74%.  Overall DCS assessment time was 1.5 hours compared to a 3-4 hour face-to-face clinic. 95% patients satisfied with care, 57% preferred the video clinic. 24% of patients with demographics traditionally assumed may be digitally excluded group were able to access the service by proxy or with digital aid provided by the service.

The DCS not only demonstrated itself as non-inferior to current face-to-face pathways in safety, but also its superioriority in conversion rate, efficiency, user preference.  The linearity of DCS involves less clinical space and staff to deliver the same volume of patient care.   Its now a sustained new way of working but also serving as a stepping stone and test ground for further digital innovations.  Til this submission, it has introduced electronic patient reported outcome (ePROMS), e-consent, remote pre-op and patient education initiatives.  Lastly DCS is reduces carbon footprint as 82% patients would have attended a face-to-face clinic via a carbon-emitting mode of transport, 60% by car, similarly with staff.