medwireNews: A randomized clinical trial suggests that families of children undergoing surgery for congenital ectopia lentis (CEL) are more than twice as likely to attend their 3-month postoperative follow-up when they receive phone reminders and health education via a smartphone-based social media application.
“Timely surgical intervention and a rigorous follow-up schedule are essential for the management of CEL,” write the study authors in JAMA Ophthalmology, but “patients with CEL often exhibit suboptimal follow-up attendance rates, leading to impaired visual development and the progression of systemic complications.”
Recognizing that the 3-month follow-up is “a critical period for essential post-operative interventions,” Guangming Jin, from Sun Yat-sen University in Guangzhou, China, and colleagues assessed whether appointment reminders and health education communicated via WeChat, a cost-free, smartphone application, could improve attendance at this follow-up.
A total of 110 children (mean age 7.1 years; 58.2% males) undergoing surgery for CEL were randomly assigned to receive either the social media-based intervention (n=55) or standard postoperative care (n=55).
The intervention involved the children’s parents (mean age 36.7 years) being personally reminded by staff via the smartphone application 4 days and 24 hours before each of the three scheduled follow-up visits, at 1 week, 1 month, and 3 months post-surgery, the researchers explain.
In addition, structured health education messages were sent 4 days before each appointment, comprising essential information about CEL and its treatment, the risks of associated systemic comorbidities, and the importance of managing postoperative complications. This accompanied the standard information on the importance of timely follow-up to achieve optimal surgical outcomes and a follow-up appointment schedule that was received by the other children.
“Attendance rates in the social media intervention group remained consistently higher than those in the standard-care group across all 3 postoperative follow-ups,” state the authors. Children in the intervention group were more than twice as likely to attend their 3-month postoperative follow-up as those receiving standard postoperative care, at rates of 83.6% versus 41.8%. Attendance was also greater in the intervention group at the earlier 1-week (92.7 vs 87.3%) and 1-month (81.8 vs 58.2%) timepoints.
In addition to improved follow-up adherence, secondary outcome measures showed greater accuracy in the parents’ knowledge of CEL with the intervention. This was measured using an informal questionnaire covering CEL diagnosis, comorbidities, and treatment, with scores ranging from 0 to 14 points and higher scores indicating better knowledge.
In the intervention group, there was an average 14.9 percentage point gain in accuracy of knowledge at 3 months compared with baseline (73.1 vs 58.2%). This compared with a 3.8 percentage point gain in the standard care group (63.8 vs 60.0%) – giving an adjusted, significant between-group difference of 10.6%.
The initiation of amblyopia treatment was also a significant 2.4-fold more frequent in the intervention group, occurring in 38.2% of children versus 14.5% of those in the standard care group.
The researchers observe that regression analysis suggested that in addition to the social media intervention, having parents with higher education, annual incomes, and baseline CEL knowledge also improved the children’s attendance at the 3-month follow-up, although the confidence intervals were wide, and the findings did not meet thresholds for strong inference.
The authors stress that all the secondary outcomes should be interpreted as hypothesis-generating, although they note that “they may inform a more focused approach to identify and support patients at risk of poor follow-up compliance.”
In an accompanying commentary, Raymond Kraker, from the Jaeb Center for Health Research in Tampa, Florida, USA, acknowledges the success of the intervention but cautions: “While the study did demonstrate that phone reminders using WeChat could improve short-term follow-up visit completion and education after surgery, whether or not phone-based contacts translate into longer-term improvements in follow-up and subsequent management of systemic disease was not answered by the study.”
The study authors also acknowledge the short 3-month follow-up period as a study limitation, along with the labor-intensive nature of delivering personalized reminders. They propose that “automated reminder systems enhanced by artificial intelligence” could offer a more scalable solution.
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JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2025.0526
JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2025.0588