Advanced Teleophthalmology to Improve Cataract Referral Attendance From ECCs to Base Hospital

NCT07697014 | Not Yet Recruiting

• 1 other identifier: BEH_PRASHO_2026
• Study Type: interventional
• Target: 396
• Locations: 0 countries
• Sites: N/A

Brief Summary

Although cataract remains the leading cause of avoidable blindness in Nepal, completion of referral from peripheral Eye Care Centers (ECCs) to Bharatpur Eye Hospital (BEH) for cataract surgery remains very low, with only about 3% of referred patients attending the hospital. Poor referral completion is influenced by barriers such as long travel distances, transportation costs, inadequate counselling, fear of surgery, and limited communication between peripheral eye care providers and ophthalmologists. This study aims to evaluate whether an enhanced tele-ophthalmology model improves cataract referral completion compared with the existing referral system. A stratified matched-cluster quasi-experimental study will be conducted in 12 satellite ECCs of Bharatpur Eye Hospital, comprising six intervention ECCs and six matched control ECCs. Adults aged 40 years or older diagnosed with visually significant cataract or other conditions requiring ophthalmological consultation will be enrolled. Participants in intervention ECCs will receive real-time tele-ophthalmology consultation using slit lamp-mounted anterior segment cameras, allowing ophthalmologists to remotely examine patients, confirm the diagnosis, provide counselling, and support referral planning. Control ECCs will continue the existing standard referral process without real-time ophthalmologist-patient interaction. The primary outcome is referral completion, defined as attendance at Bharatpur Eye Hospital or a designated secondary hospital within 12 weeks of referral. Secondary outcomes include patient-reported barriers to referral completion, time to hospital attendance, acceptance of tele-ophthalmology, and diagnostic confidence among ECC staff. A total of 396 participants (198 per group) will be enrolled. Referral completion rates between groups will be compared to determine whether enhanced tele-ophthalmology improves access to cataract surgical services and strengthens referral systems in rural Nepal.

Conditions

Health Services

Keywords

Teleophthalmology; Eye care Centre; Cataract surgery; Referral

Outcome Measures

Primary Outcomes (1)

• ECC referrals

  The number of referred patients from ECCs through teleconsultation attending base hospital or secondary hospital within the window period of 12weeks±1 weeks.

  3 months

Secondary Outcomes (1)

• Barriers to referrals

  3 months

Study Arms (2)

Advanced teleophthalmology with referral tracking

EXPERIMENTAL

Other: Advanced teleophthalmology

Existing teleophthalmology

NO INTERVENTION

Interventions

Advanced teleophthalmology OTHER

Advanced teleophthalmology that includes real time video consultation with ophthalmologist at base hospital using slit lamp mounted anterior segment camera with referral support and tracking.

Advanced teleophthalmology with referral tracking

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged ≥40 years
• Diagnosed with visually significant cataract or other ocular conditions requiring Ophthalmological consultation by ECC staff
• Provided a referral slip to BEH for cataract surgery

You may not qualify if:

• Patients requiring urgent referral for other ocular comorbidities
• Patients already under follow-up at BEH
• Patients unable to participate in tele-consultation due to hearing, communication, or cognitive limitations when companion-assisted consultation is not feasible

Sponsors & Collaborators

• Seva Canada Society: lead
• Bhartapur Eye Hospital: collaborator
• Pragyaan Sustainable Health Outcomes Foundation: collaborator

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 6, 2026
• First Posted: July 10, 2026
• Study Start: August 1, 2026
• Primary Completion (Estimated): March 31, 2027
• Study Completion (Estimated): July 31, 2027
• Last Updated: July 10, 2026

Record last verified: 2026-07