Feasibility Of A Digital-First Pathway For Postoperative Cataract Outcome Data Collection: Remote Patient Reported Outcome Measures And Visual Acuity Assessment

Postoperative outcome data following cataract surgery is essential for quality improvement and audit. UK guidance recommends discharge of uncomplicated cataract patients to community optometrists rather than hospital follow-up. While this improves efficiency, outcome data collected in the community often does not return to hospital records, creating gaps in audit datasets. The most recent UK national audit reported inconsistent capture of visual acuity, refraction, and patient-reported outcome measures. This feasibility evaluation examined whether a digital-first pathway combining automated telephone follow-up (Dora) for PROMs collection and self-testing of postoperative distance visual acuity (DigiVis DVA) could bridge this gap.

Three-site mixed methods feasibility evaluation conducted at Royal Berkshire Hospital NHS Foundation Trust (RBFT), UK, over four weeks (December 2024–January 2025). At RBFT, patients with uncomplicated cataract surgery do not routinely return to hospital; they continue with routine community optometrist sight tests. Previously, postoperative contact relied on patient initiation; now Dora proactively contacts patients to identify concerns and VA can be tested at home.

All patients scheduled for Dora-based postoperative follow-up during the evaluation period were included. Dora collected Cat-PROM5 questionnaire responses and performed complication screening via automated telephone calls. DigiVis DVA enabled self-testing of VA on patients' own digital devices; patients received SMS invitation to testing without additional training, support or expectation. Primary outcomes were completion rates for each pathway element and patient satisfaction measured using Customer Satisfaction (CSAT) scores. Secondary outcomes examined variation by age and gender. Free-text comments (n=120) underwent thematic analysis.

Among 218 patients (mean age 75 years, 58% female), 78% completed the post-operative Dora call and 74% completed post-operative PROMs. Of the 14% of patients who started the DigiVis DVA test, 31/32 (97%) completed testing in the operated eye, giving informative post-operative VA results. Overall, 85% had at least one post-operative outcome recorded. Patient satisfaction was high (mean CSAT 4.69/5; 91.9% rated ≥4/5). Completion rates were consistent across age groups: patients aged 70-79 achieved 77% Dora call completion and 73% PROM completion. Thematic analysis identified "therapeutic reassurance" as an emergent theme-  patients valued that automated follow-up addressed their concerns.

A digital-first pathway achieved 85% postoperative outcome capture with excellent patient acceptability. Automated telephone follow-up demonstrated high completion rates across all age groups, challenging assumptions about older patients' engagement with digital tools. Home VA testing had lower uptake, yet 97% who opened the link completed their assessment- suggesting barriers relate to initiation rather than technology. This underscores the need for verifying digital access, pre-operative familiarisation, and ensuring patients expect a vision test SMS. Combined, these approaches offer a scalable model for postoperative care. Further work should explore drivers and barriers to inform interventions.