Telemedicine is rapidly expanding in eye care, yet evidence on patient satisfaction and perceived quality is limited, restricting wider clinical adoption and integration. This study aimed to: i) compare satisfaction rates in tele-ophthalmology versus in-person eye care; ii) assess overall patient satisfaction within tele-ophthalmology services. This systematic review was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews ID: CRD420251218938). We used random-effects meta-analyses to pool comparative satisfaction odds ratios (tele-ophthalmology vs. in-person care) and to calculate overall tele-ophthalmology satisfaction proportions. Heterogeneity was quantified using the I2 statistic. We included 41 studies encompassing 24,595 participants. Five studies reporting patient satisfaction in telemedicine vs in-person revealed comparable satisfaction rates (OR = 0.98; 95% CI = 0.36; 2.65, p = 0.95). Across all telemedicine studies (n = 36), the pooled satisfaction rate was high 93.5% (95% CI = 90.8, 95.5) with comparable rates across different tele-ophthalmology models [( χ 2 = 0.99 , d f = 2 , p = 0.61 ), asynchronous (94.6%), synchronous (92.1%) and hybrid (93.8%)]. While general acceptability for telemedicine was high 92.0%, participants were more likely to recommend telemedicine service (94.9%) than to reuse it in the future (84.0%). No publication bias was found (p > 0.05). Patient satisfaction in tele-ophthalmology is high and appears to be comparable to standard in-person care. However, considerable variability between studies highlights the need for validated and standardised measures for patient satisfaction. Furthermore, lower intention rates for future use underscore the need to address potential systemic gaps, such as digital illiteracy, to sustain long-term adoption.
BACKGROUND:Voretigene neparvovec (VN) improves retinal sensitivity in biallelic RPE65-associated inherited retinal dystrophy (IRD), with greater best-corrected visual acuity (BCVA) gains reported in children. METHODS:We describe a 13-year-old male with biallelic RPE65-IRD who underwent bilateral VN treatment without subretinal foveal detachment at the Manchester Royal Eye Hospital. RESULTS:Six weeks post-treatment, BCVA improved by four lines to 0.20 logMAR in the right eye and by three lines to 0.30 logMAR in the left eye. White full-field stimulus threshold (FST) testing showed maximal gains of -37.8 dB in the right eye and -39.1 dB in the left eye. Approximately four years later, the patient presented with marked BCVA decline (0.68 logMAR in the right eye; 0.90 logMAR in the left eye) and FST deterioration to -18.2 dB and -22.8 dB, respectively. Fundoscopy revealed chorioretinal atrophy (CRA) along the vascular arcade, and optical coherence tomography (OCT) showed foveal outer retinal atrophy with relatively preserved perifoveal layers and choroidal hyperreflective foci within the CRA. The rapid BCVA decline, foveal atrophy pattern, and presence of choroidal hyperreflective foci suggest VN-related effects or an inflammatory response as the most likely contributors to CRA development. CONCLUSIONS:These findings underscore the need for long-term follow-up after VN treatment to detect potential late deterioration despite early visual gains. Additionally, patients who exhibit pronounced early FST improvements may benefit from modified or extended immunosuppression to reduce the risk of CRA development.
Choroidal, optic disc and crystalline lens colobomas are rare ophthalmological conditions, but they can (either directly or by association) present with retinal detachments that are difficult to manage. Due to their rarity and variability of presentation, evidence of different approaches to treatment strategies is mainly found in case reports or small case series. This article reviews the basic pathogenesis of these conditions and the authors’ experience in how various treatment options address the underlying mechanisms. Sub-categories of retinal detachments complicating choroidal coloboma and management strategies are discussed—principally those where retinal detachment is secondary to choroidal coloboma and those where the management of retinal detachment is complicated by the co-existence of choroidal coloboma. The pathogenesis, natural history and management strategies for retinal detachment associated with optic disc pit are reviewed together with the additional challenges posed by lens and zonular coloboma in the management of retinal detachment.
