Glaucoma is a leading cause of irreversible blindness, affecting over 7.5 million people globally. With ageing populations worldwide, the burden of disease is projected to increase substantially. Beyond visual impairment, glaucoma impacts patients’ physical functioning, emotional well-being, and independence, while imposing significant long-term economic costs associated with medications, surgeries, and ongoing care.
Improving patient health outcomes requires systematic capture of patient-reported outcome measures (PROMs). However, widespread implementation of PROMs into routine clinical care has historically faced several barriers, including reliance on lengthy paper-based questionnaires, operational challenges associated with large-scale data collection, and lack of real-time integration with electronic medical records.
To address these challenges, the PROMinsight team conducted a large clinical implementation study at the Singapore National Eye Centre (SNEC), working alongside public health experts, implementation scientists, and glaucoma clinicians. The study evaluated the feasibility and effectiveness of integrating our glaucoma-specific quality-of-life Computer Adaptive Test for Asian populations, GlauCAT™-Asian, into routine glaucoma care.
Patients scheduled for glaucoma surgery were sent secure CAT links via WhatsApp prior to their clinic appointments, with in-clinic tablet completion available for those who had not responded remotely.
Patients completed five GlauCAT™-Asian QoL tests assessing:
Ocular comfort – unwanted sensations such as pain, stinging, and dryness
Activity limitation – difficulties with daily activities including reading and self-care
Mobility – challenges with independent movement such as using stairs and crossing streets
Concerns – worries about safety, vision deterioration, and loss of independence
Emotional well-being – emotional reactions including frustration and helplessness
Glaucoma management – issues related to treatment administration and regimen changes
CAT reports were integrated in real-time into the electronic medical record, making results immediately available for clinician review during consultation.
Over 300 patients agreed to participate, representing a 74.4% acceptance rate. Three-quarters of patients completed GlauCAT™-Asian remotely on their own smart devices.
Patient-reported acceptability, satisfaction, and usability were high, with average ratings exceeding 3.5 out of 5. Patients valued the opportunity to discuss their GlauCAT™-Asian results with their doctor:
“The questions were quite nice because people rarely ask you about these kind of things. So, having a questionnaire that asks these questions helped me feel a bit more seen.” (Glaucoma patient)
Clinicians also reported value in having structured QoL metrics available during consultation:
“… the main thing for the CAT test is it gets the patients to, just more systematically respond to the questions … gives us a metric … to quantify what our subjective performance is in the clinic. So that’s very helpful to have because especially if there’s a mismatch between what we see structurally and what patients tell us.” (Glaucoma clinician)
This hybrid CAT implementation model achieved strong adoption and positive user experience, demonstrating a scalable and practical framework for integrating patient perspectives into glaucoma care at a tertiary centre level.