Tele-refraction in tele-eye care settings.

Refraction is an important part of a comprehensive eye examination, and when performed remotely through information and communication technology or when its results are transmitted for remote analysis, this procedure is called tele-refraction. Uncorrected refractive errors are the main reason for consultation in primary eye care, and an increasing number of eye care providers offer tele-refraction services in response to the global demand. Even so, very little literature exists on how the correction of refractive errors can be managed through tele-eye care. The objectives of this review are to examine the integration of tele-refraction in different eye care models and to report the existing findings regarding patient satisfaction towards tele-refraction and the efficacy of tele-refraction. Searches were undertaken on Medline, Embase, EBM Reviews, CINAHL and Web of Science to identify relevant articles. All original studies describing a clinical tele-refraction service and its outcomes were included. Out of 1322 articles, 15 were retained for analysis and have shown that tele-refraction has been provided for general eye care (n = 10; 67%), refractive-only examinations (n = 3; 20%) or disease-specific screening (n = 2; 13%). Ten (67%) had a hybrid telemedicine modality. Given the small number of included studies and the lack of outcomes comparing refractive errors between face-to-face and remote refraction, it is concluded that the current scientific literature does not reflect the increasing availability of tele-refraction in clinical practice. More studies on remote refraction should be conducted to better understand its efficacy, cost-effectiveness and impacts on patient satisfaction and management.