Development of a digital care program for the management of patients with strabismus: a pilot study on pre-operative evaluation

Background: Telemedicine has rapidly evolved as a strategic tool for improving healthcare delivery, particularly following the Covid-19 pandemic. In ophthalmology, remote assessment—known as teleophthalmology—has demonstrated significant advantages in screening and follow-up for chronic diseases. However, its feasibility in the surgical management of strabismus remains poorly investigated. Methods: This prospective study, conducted at the Ophthalmology Unit of IRCCS Policlinico Sant’Orsola (Bologna, Italy), evaluated the reliability of remote pre-operative assessments for strabismus surgery compared with standard in-person evaluations. Between January and July 2025, 70 patients underwent a two-step evaluation: first, a telemedicine-based review of demographic, clinical, photographic, and video data; second, an in-person consultation with a strabismus specialist. Agreement between remote and in-person findings in terms of diagnosis and surgical planning was statistically analyzed. Results: Diagnostic agreement between remote and in-person evaluations was confirmed in 80% of cases, while surgical planning required modification in 35.7% (p = 0.004). Errors in diagnosis were significantly associated with incorrect surgical planning (p < 0.001). Younger age and mixed or complex strabismus types reduced diagnostic accuracy (p = 0.029). Image quality also emerged as a practical limitation, leading to patient exclusion in 8.5% of cases. Conclusions: Telemedicine can reliably support diagnostic triage and patient selection in strabismus surgery but remains insufficient for definitive surgical planning. Its integration within a hybrid care model—combining remote screening with in-person evaluation—may optimize waiting lists and resource allocation. Future research should focus on AI-assisted image analysis and standardized tele-strabismus protocols to enhance diagnostic precision and reproducibility.