FP1638 : Review of Smartphone APPs in Ophthalmology

Dr. John Davis Akkara, A19733, Dr. Davis J Akkara, Dr. Anju Kuriakose, Dr. Swati Upadhyaya

Abstract

Smartphones have become ubiquitous and almost everyone has one. Smartphone apps¹ have been developed which can be used to document visual acuity, contrast sensitivity, color vision² and central vision. They can even test optokinetic nystagmus, near vision, diplopia, stereo acuity. There are apps to calculate IOL power, transpositions, corrected IOP, glaucoma risk, toric calculations and convert between Snellens and LogMAR visual acuity. There are Patient teaching apps and Doctor teaching apps, apps for Medical eBooks and Journals, apps for reminding patients³ of medication schedule⁴. Electronic Medical Records are now capable of running on a smartphone. Wireless networks can be made on the field with a smartphone, thus allowing an entire paperless eye camp to be run using a few smartphones and basic instruments. Not to forget smartphone fundus⁵and slitlamp photography. He we review some useful apps for ophthalmologists which will greatly improve our efficiency and skills.

Key Words

smartphone, apps, Play Store, App Store, vision testing, color vision, stereopsis, optokinetic nystagmus,

 

Body of the Manuscript

Introduction

Technology has been rapidly advancing in the past decade, and more importantly, it has become accessible to a lot more people at lower costs. Smartphones and Internet have become almost an essential item of daily life. There have been several attempts at making low cost digital technology to replace expensive and bulky equipment². Smartphone apps can do this to some extent and are better than the standard of care in some cases⁶. There are many types of apps for ophthalmologists⁷ includingPatient Testing Apps, Ophthalmic Calculators, Patient Education Apps, Ophthalmologist Education Apps, Ophthalmologist Reference Apps, eBook Apps, Electronic Medical Record Apps,Toric Marker App, Capsulorhexis training app and more. Here we looked at the available patient testing apps. The tests include Visual Acuity – Distant and Near, Contrast Sensitivity, Color Vision – Isihara’s chart & Farnsworth Munsell 15/100 hue tests, Pediatricoptotypes, Pediatric fixation targets, Duochrome test, Astigmatism fan, Optokinetic drum, Worth 4 dot test, Visual Field Charting, Amsler grid, Pupil gauge and Torchlight. Some additional things that can be done include Pupillary reactions recording, Nystagmus recording, Anterior Segment and Posterior Segment Photography, Electronic Medical Record Appsand Self Refraction Apps.

Methods

We evaluated apps from Android and iPhone platforms for their features and their relevance in ophthalmic practice. Of the few operating systems(OS) for mobile phones, only Android and iOSare in common usage now, so we have covered apps made for those platforms.

Apps were downloaded from the Google Play Store for Android and App store for iPhone. They were tested to see what features they had. Advantages and shortcomings were noted and possible modifications were discussed.

Apps evaluated were iDoctorJD, EyeHandbook, IOL Calculator, Toric IOL Calculator, LOCS III, EyeTouch, Eye Chart Pro, Dr Hue, Color Blind test, Adjustable OKN, Park’s 3 step test, StereoTAB, StereoAcuity Test – Cardboard, VisionC, ClinicCSF, visualFields easy, OCT browser, MyEyeDrops, eyeDROPS, RxmindMe, Glaucoma, iAssist, IOL Vision Simulator, VR Human Eye and Medical Drug Info.

Results

Smartphone apps are a very low cost method for certain eye testing procedures, in addition to being useful for learning and teaching as well. Several free smartphone apps and also paid apps were found that were useful for ophthalmologists⁸. Several apps were available for visual acuity and color vision testing, and some specialized apps for other tests including stereoacuity testing on smartphone.

There were also apps that help the doctor⁹ in learning ophthalmology, reading eBooks, simulating anatomy and surgery. There were also apps for patient management and Electronic Medical Records.

Discussion

Many smartphone apps are expected to come up in the coming few years which can help reduce the costs, help in learning, visualize patient data effectively, encourage patient adherence to medication³, make hospital appointments¹⁰ convenient and even allow tele-follow-up of patients adding to their convenience and safety.

The number and quality of smartphone apps for doctors and patients are expected to grow rapidly in the coming years as smartphone become more capable and usage and acceptance of smartphone technology continues to grow.

References

1. Lord K, Shah VA, Krishna R. The Eye Handbook: a mobile app in ophthalmic medicine. Mo Med. 2013 Feb;110(1):49–51.
2. Campbell TG, Lehn A, Blum S, Airey C, Brown H. iPad colour vision apps for dyschromatopsia screening. J ClinNeurosciOff J NeurosurgSocAustralas. 2016 Jul;29:92–4.
3. Santo K, Richtering SS, Chalmers J, Thiagalingam A, Chow CK, Redfern J. Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps. JMIR MHealthUHealth. 2016 Dec 2;4(4):e132.
4. Santo K, Chow CK, Thiagalingam A, Rogers K, Chalmers J, Redfern J. MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: a randomised controlled trial protocol. BMJ Open. 2017 Oct 8;7(10):e017540.
5. Raju B, Raju NSD, Akkara JD, Pathengay A. Do it yourself smartphone fundus camera – DIYretCAM. Indian J Ophthalmol. 2016 Sep;64(9):663–7.
6. Pathipati AS, Wood EH, Lam CK, Sáles CS, Moshfeghi DM. Visual acuity measured with a smartphone app is more accurate than Snellen testing by emergency department providers. Graefes Arch ClinExpOphthalmol Albrecht Von Graefes Arch KlinExpOphthalmol. 2016 Jun;254(6):1175–80.
7. De la Torre-Díez I, Martínez-Pérez B, López-Coronado M, Díaz JR, López MM. Decision support systems and applications in ophthalmology: literature and commercial review focused on mobile apps. J Med Syst. 2015 Jan;39(1):174.
8. Meyer CH. [Smart ophthalmologists : Smartphones for nothing and the Apps for free?]. Ophthalmol Z DtschOphthalmolGes. 2012 Jan;109(1):6–7.
9. Stanzel BV, Meyer CH. [Smartphones in ophthalmology : Relief or toys for physicians?]. Ophthalmol Z DtschOphthalmolGes. 2012 Jan;109(1):8–20.
10. Tsui I, Drexler A, Stanton AL, Kageyama J, Ngo E, Straatsma BR. Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist. J Diabetes Sci Technol. 2014 Jul;8(4):845–9.