OBJECTIVES: Pre-operative work-up for cataract surgery is an intensive and complex process and ensuring accuracy is crucial to avoid IOL implantation errors and/or poor refractive outcomes. A literature review was conducted to understand the burden of transcription errors in ophthalmology and the impact of recent digital technologies.

METHODS: MEDLINE was searched without language restriction from Jan-01-2001 to Sept-30-2021 using terms related to digital solutions (artificial intelligence [AI], cloud, telemedicine) and errors. Grey literature was also scanned.

RESULTS:

Of 417 sources screened, 9 reported on transcription errors and 17 were related to digital solutions in ophthalmology. Transcription errors leading to wrong IOL implantation were most commonly reported for IOL selection and power calculation, followed by visual acuity measurements. Other root-cause errors included illegible handwriting, using data from the wrong eye or patient, and printing/faxing errors. Wrong IOL implants were associated with an average liability of $57,514 USD, causing moderate-to-severe harm in 33% (United Kingdom), and permanent injury in 11% of analyzed cases (United States). Examples of automation and AI currently in use in ophthalmic practice included tele-screening (ocular pathologies, post-operative follow-up), AI-informed surgical annotation software, and algorithms to automate IOL power calculations. Several ophthalmic societies and reviews recommended digital solutions, including software to improve calculation accuracy, and cloud technology to reduce the opportunity for human error.

CONCLUSIONS: Transcription errors remain an important cause of wrong IOL implants, but digital technologies may support improved accuracy through optimization and error reduction. Future studies are warranted to understand how technological advancements can best address unmet needs.