Ahmed El Ashry, Mahmoud El Ashry, Sujin Kang, Sotiria Palioura, Allister Gibbons, Jose Miguel Mora Correa, Zubair A Ansari, Despoina Theotoka, Sonia H Yoo, Tamarra R Biekman, Stephen G Schwartz, Guillermo Amescua, Jaime D Martinez
Cataract surgery requires precise coordination of multimodal processes delivered across decentralized multi-site tertiary healthcare systems. Investigating the logistical orchestration required for geographically distributed healthcare networks, this review describes an operational framework from a multi-satellite tertiary academic referral center operating a hub-and-spoke model across South Florida handling approximately 21,000 annual surgeries. To address multi-site care fragmentation, the institute introduced the "digital spine" framework, which integrates cloud-based diagnostic platforms, coordinated scheduling, and centralized surgical planning. This cloud-integrated system asynchronously bridges diagnostic hubs up to 116 miles apart, sending centralized surgical plans directly to operating room microscopes and feeding post-operative refractive data back into predictive algorithms. Within this network, cataract surgery accounts for approximately 8000 cases annually. Providers, imaging technicians, surgical coordinators, and nurses seamlessly establish collaborative care pathways. This system plays a critical role in maintaining efficiency, while a tiered referral protocol routes high-risk and complex cases to the central hub where multidisciplinary support is available. The present review fills the literature gap by providing a scalable blueprint for multi-site ophthalmic networks seeking to integrate decentralized diagnostics with centralized surgical execution. However, further quantitative studies are needed to evaluate clinical and cost-effectiveness outcomes.