The Impact of Virtual Follow-ups

For uncomplicated cataract surgery, follow-up telephone calls to patients appear to be a safe alternative to in-office visits. Virtual follow-up benefits may include greater convenience and access for patients, according to a literature review.

“The patient doesn’t have to go to the clinic, which can be a really huge advantage, depending on where you are in the world,” said Angelica Hanna. “Some have mobility issues, or they may require a caregiver to take them.”

In addition, phone calls are easier for clinic staff, who don’t have to prepare patients. They also free up office space—not to mention valuable clinician time, added Hanna, a medical student who conducted the review.

The findings are important because guidance on follow-up after uncomplicated cataract surgery varies. For example, the American Academy of Ophthalmology suggests low-risk patients can be seen within 48 hours, whereas the Royal College of Ophthalmologists advises patients with no high-risk ocular comorbidities should not be asked to be seen in clinic following uncomplicated cataract surgery. There is no guidance on the use of virtual follow-up, according to the review.

Diverse study group

Altogether, the review included 7 studies examining virtual follow-up after uncomplicated cataract surgery that contained clinical outcome data. Winnowed from more than 1,700 citations, the studies meeting the screening criteria included 2,113 eyes of 1,994 patients. They came from all over the world, including the Netherlands, the UK, New Zealand, Singapore, the US, and Brazil. Publication dates ranged from 2004 to 2023, with 6 after 2014.

Postoperative follow-up was done through calls from a clinic staff member. These varied from study to study and included clinical assistants, surgeons, trainees, and nurses, Hanna said. Calls were placed between one day and two weeks after surgery, with most within 24 or 48 hours. No other virtual follow-up methods, such as video chats or AI-powered systems, were examined.

Call content varied from study to study, Hanna said. Most included screening questions, asking about the presence of pain and redness, flashes and floaters, and headache or vomiting that might suggest an intraocular pressure spike.

“Patients were advised to call in to be seen in person early if they had any concerns.”

Patient education content—such as reminding patients to take their eye drops on schedule and not take showers— was included in one study, which examined nursing calls. This study found faster recovery among patients receiving the education.

Similar outcomes

Outcomes were similar between telephone follow-up patients and those seen in person. No significant differences were seen in visual acuity or complication rates. No serious adverse events were seen in any of the studies, and rates of emergency room and ophthalmic clinic visits after surgery were also similar, Hanna noted. However, the study does not rule out possible risks, and she cautioned the sample size may not have been large enough to detect them.

One theme that emerged from all the studies was patients preferred the calls and found them more convenient than in-person visits. Telephone follow-up may also make care more accessible for seniors, the review concluded.

Hanna presented a poster at ARVO 2024 in Seattle, US. Poster co-authors included Joshua Teichman MD, and Iqbal ‘Ike’ K Ahmed MD.

Angelica Hanna is a medical student at the University of Toronto, Canada. angelica.hanna@mail.utoronto.ca

Joshua C Teichman MD, MPH, FRCSC is an ophthalmologist at Prism Eye Institute and Trillium Health Partners, and an assistant professor at the University of Toronto, Canada.

Iqbal ‘Ike’ K Ahmed MD, FRCSC is an ophthalmologist at Prism Eye Institute and Trillium Health Partners, director of the University of Toronto Glaucoma and Advanced Anterior Segment Surgery, Toronto, Canada, and a professor at John A Moran Eye Center, University of Utah, Salt Lake City, US.