Assessing quality of vision in cataract surgery: randomized trial of digital vs paper-based questionnaires

Purpose: To introduce a newly developed digital platform and compare its reliability and agreement with paper-based questionnaires for assessing quality of vision (QoV) 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 November 2021 and June 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 QoV questionnaires before surgery and after second-eye surgery through 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 of 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 1-month interval. 72 (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. Conclusions: The newly developed digital EUREQUO platform for patient assessment of QoV 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.