Remote Postoperative Visual Exam Tool Shows Promise, But Could Use Tweaks 

A remote visual exam for cataract surgery follow up can, with a few adjustments, be appropriate for the right patients.

A remote postoperative visual exam tool could save surgeons and patients time, with a few adjustments, according to an investigation published in the Journal of Cataract and Refractive Surgery. Although patients report an overall good experience with the system, more specific instructions, automated confirmation that tests were performed correctly, and patient education on the quality of telemedical care can all bolster patients’ willingness to embrace the test.  

Researchers conducted in-depth interviews with 12 out of 22 patients who underwent  surgery and follow-up using the remote postoperative visual exam tool. All participants were first-time users of the web-based eye exam system. The study was embedded into a prospective clinical trial, the Cataract Online Refraction Evaluation, a Randomized Controlled Trial (CORE-RCT; NCT04809402). 

Researchers compiled responses to the patient interviews and identified 4 overarching themes in the interviews. 

  • First, participants were “inventive in overcoming practical barriers encountered” while self-administering the remote postoperative visual exam, with the prime practical barrier being controlling the smartphone during the test. Patients were inventive in their use of implements or calling in family for assistance. 
  • Second, participants complained that a presentation of Snellen scores upon completion of the vision exam did not clearly interpret the findings in a way they could understand.
  • Third, some patients reported that the remote postoperative visual exam gave them a sense of playing an ‘active’ role in their visual improvement, as compared with a passive role when being assessed at a hospital. In fact, several reported they were interested in continued home-monitoring using this approach.
  • Fourth, the majority of participants wished to maintain the option to contact their surgeon or another eye health specialist to discuss potential postoperative symptoms. 

While these reports show a positive response to the technology, patients identified several barriers to care as well. For one, the remote postoperative visual exam provided feedback only when requested. All patients opted for the feedback, indicating that patients had insecurities about whether they performed the test correctly. Also, as the exam provided only a numerical score, without additional interpretation, participants reported confusion that may have left them without motivation to participate in follow-up care. 

There is a group of patients whose low digital literacy may restrict them from using this web-based test.

The researchers identified that age of the average cataract surgery patient may also be a barrier to engaging with telemedicine, as patients of older age groups may be more likely to be dissuaded by telemedical care such as the remote postoperative visual exam.

“Even when the aforementioned barriers are adequately overcome, it should be noted that human interaction remains important,” the study shows. “There is a group of patients whose low digital literacy may restrict them from using this web-based test.”

Even so, the technology may eventually offer options to patients with limited mobility, according to the study.

The researchers explain that future iterations of any remote postoperative visual exam should provide live feedback (perhaps guided by artificial intelligence), careful selection of patients with strong digital literacy, and a safety guard to ensure patients with alarming symptoms can be promptly guided to a physician’s care.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Claessens JLJ, Maats EPE, Iacob ME, Wisse RPL, Jongsma KR. Introducing e-health technology to routine cataract care: patient perspectives on a web-based eye test for postoperative telemonitoring. J Cataract Refract Surg. Published online April 3, 2023. doi:10.1097/j.jcrs.0000000000001189