Phone check-ups for cataract

The Straits Times

Nov 5, 2011

By Fiona Low

Patients recovering from cataract surgery could be given follow-up consultations over the telephone under an initiative by Tan Tock Seng Hospital. Its eye centre is exploring ways to cut the number of return visits by those who have had the operation.

The idea is to make life more convenient for patients, who will be spared a journey, and free up doctors to focus on more complicated cases. Only patients whose surgery had gone without a hitch and who are deemed to be at low risk of complications are eligible for phone consultations.

Trained nurses will call them and go through a list of eight questions designed to check they are recovering smoothly and are free of problems such as infections. The initiative follows a successful pilot study in 2009. Phone consultations have been used to follow up cataract surgery in places such as the United States and Europe. However, this is the first time the system has been implemented here.

Patients who undergo the operation normally have to return to the hospital for three follow-up visits. The first is the day after surgery, the next is a week later and the third is a month after that. The phone consultations replace only the first visit. Dr Wong Hon Tym, head of the hospital’s ophthalmology department, said the questionnaire used by nurses is a safe way to pick up complications because they are usually easy to identify. Signs include obvious pain, blurry vision and redness in the eye.

Cataracts occur when the crystalline lens in the eye becomes cloudy, blurring the patient’s vision. The surgery involves removing it and replacing it with an artificial lens. Seven of the hospital’s 26 consultants routinely use phone consultations with their patients, and there are plans for all to do so eventually. Cataract surgery is the most commonly performed operation in the department. It is carried out on between 4,000 and 6,000 patients a year.

By the time the programme is implemented fully, about 1,000 10-minute clinic slots will be saved in a year. The eye centre is also looking into using telemedicine to reduce the number of follow-up visits by cataract patients. 

This means that instead of returning to the hospital, they can go to an optometrist at a polyclinic instead. Pictures and videos are taken of the eye and sent to the consultant at the hospital, who then conducts the check remotely.

Findings from a pilot study of the technique this year have been encouraging. It found that advances in technology mean the transmitted images are nearly as clear as if the doctor was examining the patient in the flesh. Telemonitoring is intended to be used with the patient’s third follow-up visit. Dr Wong said that although larger studies are needed, the promising data indicates that in future, post-operation visits will be carried out in a non-hospital setting.

fionalow@sph.com.sg