Asynchronous Remote Clinic Telemedicine for the Monitoring of Keratoconus: Patient Perspectives

PURPOSE: To evaluate patient satisfaction and experiences in an asynchronous remote clinic telemedicine pathway for keratoconus monitoring, treating satisfaction as a primary quality indicator and exploring factors associated with patient perceptions. METHODS: A cross-sectional survey was conducted at The Royal Liverpool University Hospital between October 2023 and August 2025. Patients with keratoconus who attended asynchronous remote clinic telemedicine follow-up monitoring appointments completed an anonymous online questionnaire. Quantitative outcomes (visit history, waiting time before the appointment, comparison with face-to-face care, overall quality, and willingness to recommend) were analyzed descriptively, and free-text comments underwent thematic analysis. Ordinal logistic regression assessed associations with age, sex, ethnicity, and travel distance. RESULTS: A total of 385 patients completed the survey. Most were first-time attendees (304, 79.0%), and the most commonly reported waiting time before the visit was 30 to 60 minutes (194/385, 50.4%). Compared with face-to-face care, 201 (52.2%) rated the experience as equivalent, 124 (32.2%) as better, and 44 (11.4%) as worse. Overall, 310 patients (80.5%) rated clinic quality as high or very high, and 242 (62.9%) would recommend it to others. Greater travel distance was associated with lower satisfaction and willingness to recommend (odds ratios per 10 minutes 0.93, 95% confidence intervals 0.87-0.99). CONCLUSIONS: Patient satisfaction with the asynchronous remote clinic telemedicine follow-up monitoring visits was high, supporting its feasibility for routine care. Longer travel distances reduced satisfaction, highlighting the need for decentralized, patient-centered service models to optimize accessibility and experience. Future refinement should prioritize patient-centered elements to secure both efficiency and quality of care.