Virtual follow-up after cataract surgery: systematic review

Author: Hanna A, Martinez DL, Popovic M, Ahmed IIK, Teichman J.

Geographical coverage: United Kingdom, Brazil, the Netherlands, New Zealand, Singapore and the United States

Sector: Service delivery

Sub-sector: Access, virtual follow-up

Equity focus:  Not reported

Study population: Patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background:

Cataract is the principal cause of blindness worldwide and is associated with reduced quality of life and shorter life expectancy. Cataract surgery is among the most frequently performed operations globally and is generally safe thanks to advances in phacoemulsification. Short-term complications, however, still occur: intra-ocular pressure (IOP) elevation (2.3 %–8.9 %), corneal oedema (0.62 %), cystoid macular oedema (0.1 %–2.35 %) and uveitis (1.6 %). Serious events such as endophthalmitis and toxic anterior segment syndrome have been reported in up to 0.22 % of cases. Early detection and management rely on timely post-operative review, yet guidelines differ: some countries recommend an early visit only for high-risk patients. In this context, virtual follow-up (e.g. telephone or video consultation) is being explored as a more accessible alternative to face-to-face appointments.

Objective:

To examine the association between virtual post-operative follow-up and patient outcomes after cataract surgery.

Main findings:

Seven studies (five full papers, two conference abstracts) published between 2004 and 2020 were included, encompassing 2 113 cataract operations in 1 994 patients. One was a randomised controlled trial (RCT); the remainder were observational (three prospective, three retrospective). Two studies were from the UK and one each from Brazil, the Netherlands, New Zealand, Singapore and the USA.

• Mode and timing of follow-up: All studies used telephone calls; none employed video platforms. Calls were made on post-operative day 1 (POD1) in three studies, week 1 in two, and week 2 in one.
• Safety: Complication rates did not differ significantly between virtual and in-person groups (p = 0.22). Elevated IOP, cystoid macular oedema and iritis were detected with similar frequency by both methods. No study reported serious adverse events, even when virtual reviews replaced face-to-face visits on POD1, week 1 or week 2.
• Visual outcomes: Visual acuity was comparable between groups (p = 0.28); in one study, 80.5 % of patients reviewed virtually on POD1 achieved corrected distance visual acuity of 20/40 or better.
• Patient preference: Where surveyed, more than 70 % of participants favoured telephone follow-up because of convenience and reduced travel.
• Risk of bias: The RCT had an intermediate risk of bias; observational studies scored a mean 6.5/9 on the Newcastle–Ottawa Scale.

Overall, low- to moderate-quality evidence suggests that telephone follow-up after uncomplicated cataract surgery is as safe and effective as traditional in-person review, and highly acceptable to patients.

Methodology:

MEDLINE, Embase and CINAHL were searched to October 2023 for studies using virtual follow-up (telephone or video) after cataract surgery and reporting clinical outcomes. Reference lists of included articles were also screened. Two reviewers independently screened titles, abstracts and full texts, extracted data and appraised quality with the Newcastle–Ottawa Scale; disagreements were resolved by discussion. Findings were synthesised narratively.

Applicability / external validity:

Most participants were low-risk patients with uneventful surgery, limiting applicability to those at higher risk of complications. All studies relied on telephone reviews; evidence for video-based telemedicine is lacking. Variation in follow-up timing and provider (nurse or technician) may also affect generalisability. Socio-economic, cultural and health-system factors could influence outcomes, so local pilot testing is advisable before widespread adoption.

Geographic focus:

United Kingdom, Brazil, the Netherlands, New Zealand, Singapore and the United States; no geographical restrictions were applied.

Summary of quality assessment:

There is medium confidence in the review’s conclusion. Searches covered three major databases; inclusion criteria were explicit; dual-reviewer processes were used for screening, extraction and quality appraisal; and study characteristics were clearly reported. Limitations include English-language restriction, absence of an excluded-studies list and reliance on predominantly observational evidence.