Implementing RetCAT™ Across Three Singapore Tertiary Centres: A 2024–2025 Multi-Site Deployment Study

Collecting quality-of-life (QoL) information in patients undergoing treatment for diabetic eye disease is important but often difficult to implement at scale due to operational and technical barriers. Patient uptake can be limited when questionnaires are lengthy, repetitive, and poorly integrated into clinical workflows.

PROMinsight’s diabetic eye disease quality-of-life Computer Adaptive Test system (RetCAT™) was designed to deliver time-efficient, clinically relevant assessment across domains including visual functioning, emotional well-being, and patient concerns.

Over a 12-month implementation study conducted between 2024 and 2025, RetCAT™ was deployed across retinal clinics at the Singapore National Eye Centre (SNEC), Tan Tock Seng Hospital (TTSH), and National University Hospital (NUH) to evaluate feasibility and patient uptake in individuals receiving intravitreal injections for diabetic macular edema.

Two implementation models were evaluated:

At SNEC, RetCAT™ was delivered using an automated secure weblink via WhatsApp prior to the clinic appointment, allowing patients to complete the assessment remotely. This workflow was enabled in collaboration with our Patient Engagement Partner, BotMD. Patients who did not complete the assessment remotely were identified via dashboard monitoring and offered in-clinic tablet completion immediately before treatment or consultation.

At TTSH and NUH, RetCAT™ was administered in-clinic only on the day of the patient’s visit.

Over 700 patients completed RetCAT™ during the 12-month period. Outcomes exceeded expectations. Uptake was greater than 85% using the hybrid remote and in-clinic model at SNEC, and between 73–88% using the in-clinic-only model at TTSH and NUH.

Patients reported a positive experience using RetCAT™:

“The questionnaire asked about things my doctor doesn’t usually ask, like coping with daily vision problems. This is what is lacking right now in the current clinical situation.” (Retinal patient)

Clinicians also found value in having QoL scores integrated into the EMR to support clinical management:

“… Understanding patient’s disease burden is crucial, yet with brief consultations we often miss how their condition and treatment affect daily life. Having background information on their attitudes and how their disease and treatment impact them helps us identify and address barriers…this would be good to address so that they keep on their treatment and get the best outcomes they can.” (Assoc Prof Anna Tan, Senior Retinal Consultant)

This multi-centre study provides an implementation blueprint for sustainable use of CAT technology in routine retinal care and demonstrates the feasibility of collecting high-quality patient-reported outcomes in patients with diabetic eye disease.