Clinical pathway
Post-cataract follow-up cadence with the conversational triage agent operating asynchronously between scheduled visits.
Clinical Pathway: Post-Cataract Follow-Up
The clinical evidence supports a structured five-touchpoint post-cataract pathway anchored by the AAO PPP 2021 routine cadence (day 1, week 1, week 4). The validated bottleneck is between scheduled visits: most acute complications surface in the first 1–2 weeks (aao-ppp-2021 §Complications p.33), and asymptomatic structural complications can surface at week 4 (wanten-2025 §limitations). A conversational triage agent operating asynchronously between visits, grounded in the Wanten 5-symptom set and 4-way classification, can catch the cases that would otherwise wait until the next scheduled visit. The validation evidence (meinert-2024 reports sens ~93.8%, spec ~86.3% in the published study) supports the screening role. The data spine is the symptom interview transcript: the same patient-reported symptom record drives the system's escalate/no-escalate decision AND drives the clinician's pre-read for the next visit if escalation occurs.
Section 1: Provider Workflow
Six phases from referral through end-of-cadence. Each phase identifies clinical actions, the device data touchpoint where applicable, and the decision criteria for progression.
Phase 1: Referral & Pre-Op Education
Objective: Confirm cataract diagnosis warrants surgery, complete pre-op workup, set patient expectations.
Clinical actions:
- Confirm visually significant cataract (best-corrected visual acuity, lens opacity grading)
- Biometry for IOL power calculation
- IOL selection discussion: monofocal vs. multifocal/EDOF, target refraction, patient priorities
- Pre-op educational content delivered (patient-facing app evidence base: pmc11015376)
- Surgical consent
Device data touchpoint: [Pre-op education completion + comprehension check] — a digital pre-op education module (categorically supported by pmc11015376) records completion and prompts a short comprehension self-check before the surgery date. Not a comprehension exam — a self-attestation that the patient knows what to expect and what to call about.
Decision criteria → Phase 2: Surgery scheduled, IOL selected, patient confirms understanding of post-op course expectations.
Phase 2: Day of Surgery
Objective: Safe surgical execution with patient-participatory pre-incision verification.
Clinical actions:
- Pre-incision time-out per AAO PPP Appendix 4 p.65: patient identity, surgical site, intended IOL verification
- Standard phacoemulsification + IOL placement
- Post-procedure exam (immediate)
- Day-1 follow-up scheduled
- Patient discharged with topical antibiotic + anti-inflammatory drop schedule and written symptom-watch instructions
Device data touchpoint: [Patient-led safety checklist] — the patient confirms the surgical site and intended IOL on a digital checklist app at check-in (stolk-vos-2018 §methods). Adds a redundant verification channel; does not replace the surgeon's time-out.
Decision criteria → Phase 3: Surgery completed without intraoperative complication. Patient understands drop schedule. Day-1 visit on calendar.
Phase 3: Day 1 Follow-Up (in person)
Objective: Detect immediate post-op complications, confirm IOL position, confirm patient compliance with drops.
Clinical actions:
- Visual acuity check
- Slit-lamp exam: anterior chamber clarity, IOL position, corneal clarity
- IOP measurement
- Symptom interview: redness, pain, vision, flashes, floaters (wanten-2025 5-symptom set; moustafa-2019 question set)
- Drop schedule confirmed
- Day-1 to week-1 conversational triage agent activated
Device data touchpoint: [Triage agent activation] — the conversational triage agent (the system under evaluation in this artifact) is enabled at the end of the day-1 visit. The patient receives instructions to engage the agent if any new or worsening symptom occurs, or on a fixed cadence (e.g., daily check-in option) per clinic preference.
Decision criteria → Phase 4: No day-1 complication. Patient leaves with active triage agent + clear escalation path for the inter-visit period.
Phase 4: Day 2–Week 1 (asynchronous triage)
Objective: Catch acute complications (endophthalmitis, IOL malposition, persistent inflammation) between scheduled visits. This is the highest-acuity inter-visit window.
Clinical actions:
- Triage agent runs the 5-symptom interview on patient initiation or scheduled cadence
- Agent classifies each symptom (4-way) and applies the cautious-default escalation rule
- On escalate: clinician receives the conversation transcript + system decision rationale, contacts patient within target SLA (clinic-dependent, typically same-day for present-with-significance findings)
- On no_escalate: patient continues; no clinical action triggered
Device data touchpoint: [Triage transcript + escalation queue] — every triage interaction produces a transcript captured to the eval JSON (data/results/eval-latest.json in this project). Escalations flow to a clinician-facing queue with the transcript pre-loaded so the in-person follow-up starts with the patient's actual words, not re-elicited from a blank state.
Decision criteria → Phase 5: Week-1 in-person visit scheduled. Any escalation during this window has been clinically resolved.
Phase 5: Week 1 Follow-Up (in person)
Objective: Confirm normal early post-op course; detect any complication missed by the triage screen.
Clinical actions:
- Visual acuity check
- Slit-lamp exam (anterior segment + IOL position)
- IOP measurement
- Drop taper instructions
- Review of any inter-visit triage escalations (cross-check the agent's calls against the clinical picture)
- Triage agent continues for week 1 → week 4 interval
Device data touchpoint: [Inter-visit triage review] — clinician reviews the triage transcript queue for the prior week, even for no_escalate interactions. This is the human-in-the-loop quality signal — clinicians see what the agent saw and can flag mis-classifications for retraining (out of MVP scope, but the data is captured).
Decision criteria → Phase 6: No week-1 complication. Drop taper initiated. Week-4 visit on calendar.
Phase 6: Week 4 Follow-Up (in person, end-of-cadence)
Objective: Detect delayed or structural complications (posterior capsular opacification, cystoid macular edema, peripheral retinal detachment). This visit catches the documented Wanten asymptomatic-structural failure mode (wanten-2025 §limitations).
Clinical actions:
- Visual acuity check
- Dilated slit-lamp + fundus exam (this is the irreplaceable step)
- IOP measurement
- Refraction (final post-op refractive endpoint)
- Triage agent deactivated (or transitioned to long-term follow-up cadence per clinic policy)
Device data touchpoint: [End-of-cadence triage summary] — the clinician reviews the cumulative triage transcript across the full 4-week post-op window before the week-4 exam. The summary supplements but does not replace the dilated exam.
Decision criteria → discharge: Post-op course complete. Patient transitioned to routine eye-care cadence.
Section 2: Patient Journey
Six touchpoints from the patient's perspective. Same five phases as the provider workflow, framed by what the patient sees and does.
Touchpoint 1: Pre-op preparation
The patient learns about cataract surgery via the clinic's pre-op education module (pmc11015376). They confirm they understand the procedure, the recovery cadence, and the symptoms that warrant calling the clinic. The IOL conversation with their surgeon happens before surgery is scheduled.
Touchpoint 2: Day of surgery
The patient checks in, confirms the surgical site and IOL choice on a patient-led safety checklist app (stolk-vos-2018), undergoes surgery, and leaves with explicit written drop instructions and the day-1 visit scheduled. They install the post-op triage app on their phone (or receive an SMS-based equivalent).
Touchpoint 3: Day 1 check
The patient returns for the day-1 in-person follow-up. The clinician confirms the eye looks good, reviews the drop schedule, and activates the triage agent. The patient receives a brief tutorial on how to engage the agent if symptoms occur.
Touchpoint 4: Day 2 to Week 1 — the home recovery window
This is where the patient experiences most of the post-op course. Drops on schedule, eye gradually clearing. If anything feels wrong — new redness, new pain, vision change, flashes, floaters — the patient opens the triage agent. The agent asks the 5-symptom interview (wanten-2025 §methods), classifies each response, and either tells the patient "this sounds like part of normal recovery, but call us if it worsens" (no_escalate) or "we want a clinician to see you today" (escalate). When the agent escalates, the clinic calls the patient — typically within the same day — with the conversation transcript pre-read.
Touchpoint 5: Week 1 check
The patient returns for the week-1 in-person visit. The clinician examines the eye, adjusts the drop taper, and shares any feedback on the triage interactions from the prior week. The patient feels heard — the clinician has read the conversation, not just glanced at a chart note.
Touchpoint 6: Week 4 check
End of the standard post-op cadence. The patient returns for the dilated exam — the one structural-imaging step that the at-home triage agent could not replace. The clinician confirms the eye has healed appropriately, finalizes the refraction, and discharges the patient back to routine eye care.
Data spine
The triage transcript is the spine that connects the two workflows. The provider sees the same patient-reported symptom record that the patient generated; the system's classifications are visible to both. When the system escalates, the clinician's first action — calling the patient — starts from the patient's own words rather than a blank intake form. When the system does not escalate, the transcript is still captured for clinician review at the next in-person visit, so nothing the patient said is invisible to the clinician.
This is why the symptom-text interview is the right granularity for the device touchpoint: it's the artifact that makes both the agent's reasoning and the clinician's pre-read share the same source of truth.