ESCRS - PP12.13 - Pushing The Envelope: The Feasibility Of Using A Mailed Contrast Sensitivity Test To Prioritise Cataract Waiting Lists

Pushing The Envelope: The Feasibility Of Using A Mailed Contrast Sensitivity Test To Prioritise Cataract Waiting Lists

Published 2024 - 42nd Congress of the ESCRS

Reference: PP12.13 | Type: Poster | DOI: 10.82333/7660-mx95

Authors: Eleonora Bianchi* 1 , Peter Reddingius 2 , Mehal Rathore 2 , Dan Lindfield 1 , David P. Crabb 2 , Pete R. Jones 2

1Ophthalmology,Royal Surrey NHS Foundation Trust,Guildford,United Kingdom, 2Division of Optometry and Visual Science, School of Health Science,City, University of London,London,United Kingdom

Purpose

Cataract waiting lists are growing globally. Pragmatic, cost-effective methods are required to prioritise the most urgent cases, Whilst 'telemedicine' may provide a solution, the logistical hurdles are considerable, with it being expensive and risking digital exclusion for a subset of the most vulnerable patients that are often those most in need of cataract surgery. Here we investigate the feasibility of using a third-party pen-and-paper contrast sensitivity (CS) test (SpotChecksTM), delivered by mail, and performed by patients at home unsupervised, to assess prediction of future listing for cataract surgery, and thus assess feasibility of prioritising patients most in need of cataract surgery.

Setting

Royal Surrey County Hospital: a secondary care centre in South-East England, United Kingdom. Patients were randomly selected from those on a waiting list for a pre-surgical cataract assessment.

Methods

Test packs were prospectively mailed to 233 patients waiting for cataract assessment. The packs included 2x pen-and-paper SpotChecks CS tests (one per eye), an information sheet and consent form, a set of instructions on how to perform the test, an eye patch, and a prepaid return envelope (cross-sectional study). Response rates were tabulated (stratified by age, sex, and socioeconomic status), and test-scores analysed to see how well the home-tests predicted which eyes were listed subsequently for surgery. A subset of patients (N=39) also underwent in-person follow-up testing, to confirm the accuracy of the home data.

Results

46% of patients responded (216 eyes). No gross differences were observed between respondents and non-respondents in age, sex, socioeconomic status, or geographic location (all P > 0.05). The home-test CS scores predicted which eyes were subsequently listed for surgery, with an AUROC {± CI95%­} of 0.69 {0.61 – 0.76}. Predictive performance was further-improved when machine learning was used to combine CS scores with letter acuity, extracted from patients’ medical records (AUROC {± CI95%­} = 0.77 {0.70 – 0.83}). Among 39 patients who underwent follow-up testing, home CS scores were correlated with various measures made in clinic: biometry signal-to-noise (P = 0.032), LogMAR acuity, Pelli-Robson CS, and SpotChecks CS (all P < 0.001).

Conclusions

Mailing patients pen-and-paper CS tests may be a feasible, “low-tech” way of prioritising patients on cataract waiting lists.