Assessing Quality of Vision in Cataract Surgery: A Randomized Trial of Digital vs. Paper-Based Questionnaires

Abstract

Purpose: To introduce a newly developed digital platform and compare its reliability and agreement with paper-based questionnaires for assessing quality of vision before and after cataract surgery. Setting: University-affiliated ophthalmology department and private clinic. Design: Prospective, randomized trial with parallel design of 1:1 allocation ratio without masking. Methods: Between 11/2021 and 6/2023, patients from a preoperative cataract clinic, aged ≥21 years, with cataracts in both eyes and internet access were randomly assigned by "ALEA"software to complete Catquest-9SF and Quality-of-Vision (QoV) questionnaires before surgery and after second eye surgery via paper or a newly developed digital European Registry of Quality Outcomes in Cataract and Refractive Surgery (EUREQUO) platform. Statistical analyses evaluated agreement between methods, and validation was by Rasch analysis. Results: Half (183/364, 50.3%) of the enrolled patients were allocated to digital questionnaires. After exclusion due to technical issues, missing questions, and withdrawal, 307/364 patients remained, of whom 159 (51.8%) filled in digital questionnaires. Half of all patients (n=154) underwent sequential surgeries on both eyes after a minimum one-month interval. Seventy-two (72/154, 46.8%) completed postoperative questionnaires. Comparative analysis found no significant differences between paper and digital methods. Catquest-9SF and QoV questionnaires demonstrated good precision and reliability (Rasch analysis). Postoperative vision improved at an average of 2.82 logits. Conclusion: The newly developed digital EUREQUO platform for patient assessment of quality of vision before and after cataract surgery with the Catquest-9SF and QoV questionnaires, offers a reliable alternative to traditional paper-based questionnaires, enhancing convenience for patients and providers.