Principal Investigator (PI): Dr. Simon Arunga, Ophthalmologist, Lecturer, Mbarara University of Science and Technology (MUST), PhD Alumnus, Assistant Professor (Hon) at the London School of Hygiene and Tropical Medicine.
Co-Investigators:Dr. Daniel Atwine, Biostatistician, Executive Director of Soar Research Foundation (SRF) and SRF Research and Training centers.
Dr. Viola Ninsiima, Medical doctor, Public Health Specialist, Head of Cataract Outreach Program
Study Coordinator: Dr. Apap Jocef, Ophthalmologist, Mbarara University of Science and Technology
Project background
Follow-up after cataract surgery is a core part of quality eye care. It enables eye care teams to detect and manage postoperative complications early, optimize vision through refraction and glasses, and collect outcome data for continuous quality improvement. Although there is no single global follow-up schedule, expert consensus recommends three postoperative reviews, with the final visit at 12 weeks or later. The World Health Organization sets clear benchmarks: over 80% of patients should achieve good visual outcomes, and fewer than 5% should have poor outcomes at 12 weeks.
Across Africa, however, follow-up after cataract surgery remains very low. In Uganda, audits from high-volume eye centers show that only about 50% of patients attend the first follow-up visit, 30% the second, and just 15% the third. These gaps limit timely management of complications, undermine final visual outcomes, and weaken quality monitoring. Common barriers include long travel distances, low perceived need for review once vision improves, fatigue from repeated visits, and other logistical challenges.
While studies from high-income countries suggest that fewer in-person visits may be sufficient for routine cases, these models do not easily translate to African contexts. Uganda, however, has mobile phone coverage exceeding 80%. Mobile health approaches using SMS and voice calls have already improved follow-up in maternal health, chronic disease care, and eye services.
Aim: This study proposes to leverage mobile phone technology to develop and test a Telephone Assisted Cataract Tool (TACT) to guide home-based postoperative follow-up after routine cataract surgery in an African setting.
Research questions:
- Is home follow up after cataract surgery possible and safe in an African setting?
- Can a telephone assisted home based decision tool be used to guide post-operative review visits after routine cataract surgery in an African setting?
Study overarching objective: To develop and evaluate a Telephone Assisted Cataract Tool (TACT) to guide safe and effective post-operative follow-up for patients undergoing routine cataract surgery in an African setting.
Study Methods: This study will be conducted in three phases.
Phase 1 will involve development of a Telephone Assisted Home Based Decision Tool (TACT) using a scoping review of post-operative cataract complications in Africa, followed by a multi-round online expert Delphi process and focused group discussions to contextualize symptom wording.
Phase 2 will use a cohort sensitivity and specificity study design to validate the TACT against a clinical gold standard among patients who have undergone routine cataract surgery.
Phase 3 will be an open-label, parallel, randomized controlled non-inferiority clinical trial comparing TACT-guided post-operative follow-up with the standard face-to-face follow-up protocol. This will be done in the second stage of the project.
The study will be conducted at the Mbarara University and Referral Hospital Eye Centre and the Kabarole Lions SightFirst Secondary Eye Centre in Uganda. The target population will include adult patients (18 years and above) undergoing routine cataract surgery at the participating centres, ophthalmologists, optometrists, ophthalmic clinical officers and nurses participating in the Delphi process, and post-operative cataract patients participating in focused group discussions.
Funding: SightFirst Research Grant Program
Partners: MURHEC, KALSEC, Soar Research Foundation (SRF), SRF Research and Training Centres, Lions Club International Foundation (LCIF), Dr Arunga's Eye Hospital
Total duration: 24 months
Current status: Ongoing implementation
Contact Persons: Dr. Simon Arunga and Dr. Daniel Atwine
Expected completion year: 2027