Remote Monitoring Using Smartphone May Be Safe And Effective For Patients In The Week Following Dmek – A Feasibility Pilot

To ascertain if it is safe and feasible for patients to perform virtual review after DMEK.

Descemet Membrane Endothelial Keratoplasty (DMEK) has been shown to provide quicker recovery times, better visual outcomes, higher patient satisfaction and reduced rates of graft rejection compared to thicker endothelial grafts.

15 patients were consented to take part in the pilot. Photos and videos were obtained at day 1 or day 7 follow- up using a Doctor's smartphone (iPhone 6S or iPhone 11 Pro). Sixteen photos and videos were randomly amalgamated into a slideshow questionnaire and sent to four Consultant Ophthalmologists for review. We asked each clinician to record whether they could see a bubble present in each photo or video. Reponses were recorded and returned to an independent reviewer for comparison.

The mean patient age was 64 years, and 14 out of 15 (93%) owned a smart phone. 9 patients (60%) said they would be happy for remote monitoring if it was an option. 2 patients (13%) stated a strong preference for remote monitoring, while 4 (27%) preferred to be seen face-to-face. Four proformas were recovered, showing 100% concordance between clinicians.

There was full interobserver agreement between clinicians regarding bubble presence. One Consultant
felt confident enough estimate percentage bubble size compared to post-operative size, and two Consultants commented on the same video that the bubble was too small to be effective. These results provide proof-of-concept that it is possible for experienced Ophthalmologists to detect bubble size reliably on smartphone images.
The majority of patients own and are happy using a smartphone to send media to clinicians, for which the potential advantages are numerous; patients are spared the cost and difficulty of a hospital trip, the cost to service is reduced, and most importantly patients spend more time supine, aiding graft attachment.