Teleophthalmology and Remote Eye Care: A Bibliometric Analysis of the 50 Most Highly Cited Articles From 2000 to 2025

Teleophthalmology has emerged as an evidence-based strategy to improve access to ophthalmic care and reduce preventable visual impairment, particularly in underserved settings where specialist shortages are acute. This study presents a bibliometric analysis of the 50 most-cited articles in teleophthalmology and remote eye care to characterize publication trends, journal distribution, geographic contribution, evidence levels, study designs, and major thematic areas. A structured literature search of the Web of Science Core Collection was executed to identify remote eye care publications spanning 2000 to 2025. The top 50 cited peer-reviewed articles were screened, extracted, and analyzed using descriptive bibliometric methods and keyword co-occurrence network mapping via VOSviewer (version 1.6.20; Leiden University, Leiden, The Netherlands). The 50 articles accumulated 10,621 total citations (mean: 212.4; median: 166.5), with the top 10 accounting for 44.1% of citations - indicating a broad rather than highly concentrated scholarly influence. The 2010s contributed 62.0% of the articles, representing the most productive decade. Publications were highly concentrated in JAMA Ophthalmology (n = 9), Ophthalmology (n = 8), and the British Journal of Ophthalmology (n = 5), originating predominantly from North America (44.0%), Asia (24.0%), and Europe (18.0%). Observational studies (26.0%) and diagnostic validation studies (24.0%) dominated the study design profile. Only one randomized controlled trial (2.0%) appeared in the top 50, while diabetic retinopathy screening and artificial intelligence emerged as the primary leading thematic clusters. Teleophthalmology has developed into a clinically relevant field supported by a distributed base of highly cited work. However, the predominance of non-randomized Level IIb and Level III evidence (54.0%), severe underrepresentation of low-resource settings, and a stark scarcity of randomized controlled trials (2.0%) highlight critical systemic gaps. Future research must prioritize prospective multicenter trials, standardized validation frameworks, and equity-focused implementation studies in underserved regions.