Patient-Reported Outcome Measures For Cataract Surgery At The Oxford Eye Hospital

Patient-reported outcome measures (PROMs) are ideally suited to symptomatic diseases like cataracts. The key deciding factor to determine whether to proceed with cataract surgery relates to the patient's visual-related quality of life (QoL). Currently our pre-operative assessment and post-operative outcomes are largely based on objective visual acuity and refraction alone which does not assess how a patient’s vision-related QoL has been impacted by their treatment. By routinely collecting PROMs for cataract surgery we can better assess the impact of cataract surgery at both an individual and a service level and will provide valuable information for commissioning cataract surgery.

The Oxford Eye Hospital (OEH) uses the artificial intelligence clinical assistant ‘Dora' (Ufonia, Oxford, UK) to provide automated phone calls for patients pre and post cataract surgery. Since May 2023 Dora has conducted a conversation that collects PROMs data. Patients listed for cataract surgery receive a pre-operative PROMs telephone call within 1 week of surgery and again 12 weeks post-operatively. Dora collects responses to the 5 questions in CAT-PROM5 regarding vision-related QoL. 

We included patients at the OEH between May 24th - Sept 28th 2023 who had completed both the pre-operative and post-operative PROMs call. Patients were eligible for a call with Dora if they had uncomplicated cataract surgery and were able to have a conversation in English. PROMs data was collected on the call with Dora and summary reports were generated. Demographic and clinical characteristics were collected from Medisoft medical records. Standard conversion of the raw CAT-PROM5 score to a 0-100 scale was applied as per Sparrow et al., 2018. 

133 participants (83(62%) female) with a mean age of 75yrs (SD 9.36) were included. 72 (54%) were 1st eye patients. 36 (27%) had existing ocular comorbidities, most commonly age-related macular degeneration (9 (7%)). The mean pre-operative CAT-PROM5 score was 48.19 (SD 16.0 and post-operative 65.97 (SD 20.2) with a change in mean scores of 17.78 (SD 21.7). 105/133 (79.0%) of patients had an improvement in their visual QoL after surgery. 21/133 (15.8%) experienced worsening vision-related QoL. Patients having 2nd eye surgery had a greater improvement in PROM score than 1st eye patients (23.22 vs 13.16, p<0.05), but there was no statistically significant difference between patients with and without ocular comorbidity (12.16 vs 19.9, p=0.12).

UK guidelines (NICE and RCOphth) state that PROMs should be routinely collected. No published studies demonstrate pre- and post-operative PROMS in routine UK clinical practice; perhaps due to collection barriers or concerns for staff workload. Telephone automation with Dora provides a practical and effective method for collecting this data. The majority of patients in our analysis had an improvement in their visual QoL following cataract surgery (79%). This data can be used at an individual level to inform the consent process prior to surgery and to identify patients with potential post-operative issues. At the population level data can be used to compare different surgical centres and inform commissioning decisions.