Teleophthalmology Satisfaction Comparable to In-Person Eye Care

Patient satisfaction with teleophthalmology was comparable to in-person eye care, but fewer patients plan to use it again, according to a meta-analysis of 41 studies published in Eye.¹ However, a gap between patients' willingness to recommend teleophthalmology and their intention to use it again suggests that high satisfaction alone may not sustain long-term adoption.

Demand for eye care is rising as populations age and chronic eye disease becomes more common, but ophthalmologists remain in short supply. Teleophthalmology has moved from a niche tool to a mainstream care model, particularly since the COVID-19 pandemic. Still, the authors noted that evidence on how patients perceive these services has been fragmented, which has limited broader clinical adoption.

High Satisfaction Across Care Models

The researchers searched 4 databases through November 2025 and included 41 studies with 24,595 participants, most conducted in the US and the UK. Before 2020, teleophthalmology focused largely on asynchronous diabetic retinopathy screening in underserved areas. After the pandemic began, it shifted toward real-time emergency triage and virtual clinics. The analysis showed 5 studies directly compared teleophthalmology with in-person care and found no significant difference in satisfaction (OR, 0.98; 95% CI, 0.36-2.65; P = .95). Across 36 studies including 22,903 participants, the pooled satisfaction rate for teleophthalmology was 93.5% (95% CI, 90.8%-95.5%).

Satisfaction was similar across delivery models:

• Asynchronous, or store-and-forward: 94.6%
• Synchronous, via real-time video or telephone: 92.1%
• Hybrid: 93.8%

Rates were also comparable across community and optometry practices, hospitals, and remote or mobile services, as well as between new and follow-up patients. Teleophthalmology in the 3 most common subspecialties (emergency care, glaucoma, and medical retina) all exceeded 92% patient satisfaction when the study was conducted. The authors noted that comparable satisfaction with asynchronous care should ease concerns that store-and-forward models lack direct communication.

Why Patients Recommend TeleOphthalmology but May Not Use It Again

Among 19 studies reporting acceptability, 94.9% of participants said they would recommend teleophthalmology, but only 84.0% intended to use it again. The authors suggested that patients may view remote eye care as a good community service but still return to in-person visits because of disease progression or barriers such as low digital literacy and older age.

Access gaps also extend beyond technology. In a 2022 interview with The American Journal of Managed Care^® (AJMC^®), Parisa Emami-Naeini, MD, MPH, of UC Davis, said teleophthalmology reimbursement was lower for beneficiaries aged 65 years and older, those in Medicare Advantage plans, lower-income enrollees, and Black patients. Yet, older individuals and racial minorities stand to benefit most from the services.² Separately, a recent study of California Medicare beneficiaries found that every additional 100 miles of travel lowered the odds of receiving cataract surgery by 14%. The study authors recommended expanding teleophthalmology triage sites as one remedy.³

Limitations and the Need for Standardized Satisfaction Measures

Heterogeneity across studies was substantial (I ² = 95%) and persisted after subgroup analyses, which the authors said may reflect the lack of standardized satisfaction instruments. The comparative analysis included only 5 studies, which limits how far those results can be generalized. The authors also cautioned that pooling results from different questionnaire scales introduces measurement bias and that pandemic-era conditions may have inflated satisfaction, although their meta-regression found no significant effect of time. They concluded that standardized satisfaction measures are needed to guide policymakers and that closing the gap in intention to reuse will require addressing digital literacy and disease-specific needs.¹

References

1. Al-Nosairy KO, Stolle F, Choritz L, et al. Patient satisfaction in tele-ophthalmology: systematic review and meta-analysis. Eye. Published online September 7, 2026. doi:10.1038/s41433-026-04831-4
2. Joszt L. Teleophthalmology is here today, but insurance coverage, reimbursement will change. AJMC. August 17, 2022. Accessed September 30, 2026. https://www.ajmc.com/view/teleophthalmology-is-here-today-but-insurance-coverage-reimbursement-will-change
3. Atta H. Geographic barriers limit access to cataract surgery. AJMC. August 29, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/geographic-barriers-limit-access-to-cataract-surgery