JMIR Publications

ABSTRACT

Background:

Cataract eye surgery is the most frequently performed surgery worldwide, crucial for restoring sight in millions. The COVID-19 pandemic and an aging population have increased barriers to timely surgery. Missed preoperative instructions and poor adherence to postoperative care contribute to surgery cancellations, delays, and potential complications, adversely affecting health care efficiency and patient outcomes. Mobile digital health interventions could enhance adherence and reduce cancellations.

Objective:

The intent of this study was to assess the effectiveness of the Sharp Health Companion smartphone app, built using the CareKit health platform. The study aimed to compare this digital intervention with traditional printed instructions to determine its impact on medication adherence after cataract eye surgery, surgery cancellations and delays, vision outcomes, and the overall patient experience for older adults undergoing the full cataract surgery process.

Methods:

In this randomized controlled trial, 200 patients aged 39–86 years (mean 70 years) were enrolled from a high-volume ophthalmology practice between December 2022 and January 2024. Participants were randomly assigned to Group 1 (printed instructions with phone reminders) or Group 2 (Sharp Health Companion app). Each participant underwent their first cataract surgery on the eye with the most severe cataract. Both groups received identical perioperative care instructions and post-surgery eye medications. Data collected included patient demographics, preoperative and postoperative visual acuity, medication adherence (self-reported checklists and objective bottle weight measurements), surgery cancellations and delays, and patient satisfaction at pre-surgery, 1-day post-surgery, and 1-month post-surgery intervals. Statistical analyses included independent t-tests and chi-square tests, with significance set at P<.05.

Results:

Surgery completion rates were similar between the printed instruction Group 1 and the Sharp Health Companion App Group 2, indicating both methods effectively supported perioperative preparation for cataract surgery. Participants using the Sharp Health Companion app experienced significantly fewer same-day surgery delays (1.0%) compared to those using printed instructions (9.6%; P=.02), while surgery cancellation rates were similar between groups (P=.48). Both groups reported high preparedness and satisfaction, with no significant differences in preparedness (P=.39). Self-reported postoperative medication adherence was higher in Group 1 (97%) than in Group 2 (74.95%), though objective measures using eye drop medication bottle weights showed better antibiotic adherence in Group 2 (P<.05). Both groups experienced improved visual acuity and low complication rates after surgery.

Conclusions:

The Sharp Health Companion app effectively supported perioperative care by significantly reducing same-day surgery delays and objectively improving medication adherence among older adults undergoing cataract eye surgery. These findings highlight the potential for mobile health interventions to enhance health care delivery, operational efficiency, and patient outcomes, even among traditionally less technology-oriented populations. Future research should explore broader applications of these digital tools to improve outcomes and accessibility in other surgical disciplines. Clinical Trial: ClinicalTrials.gov NCT07028359; retrospectively registered.