Staying Current With Apps

The media through which we communicate have inspired a whole new vocabulary. Now we do not write or call; we tweet, post, blog, tag, scroll news feeds, read e-books, and use apps. One addition to the medical industry’s vocabulary is mobile health, or mHealth. Yetisen AK, Martinez-Hurtado JL, da Cruz Vasconcellos F, et al. The regulation of mobile medical applications. Lab Chip. 2014;14(5):833–840.,Cortez NG, Cohen IG, Kesselheim AS. FDA regulation of mobile health technologies. N Engl J Med. 2014;371(4):372–379. Mobile and wireless devices, such as smartphones and iPads, when used for medical information transfer on behalf of patients, practitioners, and pharmaceutical companies, fall under the umbrella of mHealth. Through mobile software applications, or apps, all parties have access to revolutionized, real-time updates of health status.

Need to combine four pictures into a collage? There’s an app for that. Want to find out what song is playing on your radio? There’s an app for that, too. Apple’s ubiquitous tagline “There’s an app for that” holds true across even the most improbable digital venues, and the world of ophthalmology does not disappoint. A quick search in the iTunes App Store yielded nearly 5000 apps with the search term “eye;” more specific terms such as “eye care,” “visual acuity,” “ocular,” and “fundus” yielded smaller lists. This issue’s installment of Innovations in Retina touches on some of what is out there in the app world by looking at applications for those interested in the back of the eye.

VISUAL ACUITY AND IMAGING

Tallying 76 results in the iTunes App Store search, visual acuity apps appear to be popular for mHealth users. The apps vary in price and design, ranging from virtual Snellen tests to more in-depth exams. One application, SightBook (DigiSight Technologies), offers 10 standard vision tests, including visual acuity, inverse acuity, color acuity, and the Amsler grid. After downloading the app, users are encouraged to join the DigiSight Network, where they can connect with their physicians and share results. Patients can also use the app as their own personal electronic health record by recording treatments and documenting past or upcoming appointments.

Earlier this year, Vital Art and Science built upon the first ophthalmic app cleared by the US Food and Drug Administration (FDA), updating the company’s myVisionTrack Vision Monitor and rebranding it the mVT Service. Available only by prescription, the mVT Service, which includes the app and the Physician Portal, can be used on any Apple smartphone or tablet and is designed to track the progression of disease in patients with maculopathy. Patients are able to self-test on a physician-prescribed schedule; results are delivered to the Physician Portal for review by the patient’s prescribing doctor. The test, which takes less than 10 minutes, requires patients to hold the screen at arm’s length and identify a distorted circle that appears alongside three regularly shaped circles. The use of four circles is an improvement over the previous version, as it reduces the chance of the user guessing the correct circle. An additional improvement is the 10-digit Rx code supplied by the prescribing physician that heightens security.

Use of smartphones as clinical imaging devices is also on the rise. Traditional fundus photography, although an integral element of retina practice, requires the use of expensive cameras that are not portable. Retina doctors interested in telehealth initiatives have developed protocols for physicians using fundus photography apps. Haddock LJ, Kim DY, Mukai S. Simple, inexpensive technique for high-quality smartphone fundus photography in human and animal eyes. J Ophthalmol. 2013;2013:518479. The iExaminer system is an FDA-cleared option for

At a Glance

  • Smartphone and tablet applications now offer retina specialists access to a number of helpful tools.
  • Fundus photography apps often require small adjunctive equipment but can produce high-quality fundus photographs.
  • The more experience retina specialists have with retina apps, the more easily they can integrate them into practice.

capturing photos of the fundus and retinal nerve. With a combination of the PanOptic Ophthalmoscope, the iExaminer adapter, and the iExaminer app, retina specialists can use the iPhone 4 or 4S on the go to generate immediate images. Welch Allyn iExaminer receives 510(k) clearance from the United States Food and Drug Administration [press release]. Skaneateles Falls, NY: Welch Allyn; January 22, 2013. Free in the Apple App Store, the iExaminer app allows physicians to save images and upload them to a patient’s file. Physicians can also e-mail images or print the images for on-site viewing.

Peek Vision is also making waves in both the smartphone- based imaging and visual acuity testing arenas. Peek, the name of which derives from the use of a portable eye examination kit, is a network of apps and utilizes a specialized clip-on camera adaptor for imaging the back of the eye. The clip-on equipment slides over the smartphone’s camera lens. In May, results of the Peek validation study were published in JAMA Ophthalmology. Bastawrous A, Rono HK, Livingstone IT, et al. Development and validation of a smartphone-based visual acuity test (Peek acuity) for clinical practice and community-based fieldwork [published online ahead of print May 28, 2015]. JAMA Opthalmol. doi:10.1001/jamaophthalmol.2015.1468. The study, which enrolled 233 adults at least 55 years old in central Kenya, was designed to assess the Peek Acuity app compared with traditional Snellen and ETDRS logMAR charts. Researchers concluded that the app tests were as accurate and reliable as those standard tests. Ongoing studies aim to reproduce these results, possibly expanding Peek use in additional patient populations.

REFERENCE APPS

Instead of scouring through the thousands of pages in a textbook, retina specialists are now using apps to help them make informed medical decisions. Epocrates is one such medical reference app. It allows doctors to research treatment options, check for drug interactions, look up drug monographs, and review safety information. There are also several apps that cater specifically to ophthalmologists and other eye care professionals. For example, Eye Handbook, the result of collaboration in 2009 between Cloud 9 Development and the University of Missouri, Kansas City, provides users with an eye atlas and comprehensive directories of ocular medications, coding instructions, and digested reference materials and e-books.

For many retina patients, appointments with their doctor can be overwhelming. In addition to the fear of new diagnoses, they may also be trying to sift through medical jargon to understand their disease and treatment. The app Sight Selector, available on mobile devices and computers, holds a library of 3-D images and narrated videos designed specifically to be presented to a patient by a physician. The preview library catalogues videos explaining a variety of ophthalmic diseases, including retina-specific diseases such as macular degeneration and diabetic retinopathy, along with a wide range of ophthalmic procedures.

DON’T GET LEFT BEHIND

The mHealth evolution is exciting, and a product of innovative and thoughtful scientists, researchers, and physicians. It is important to keep pace with the changes in technology and take advantage of the opportunity to improve the care of patients and identify changes in visual function that occur in real time. Doctors in the retina space should begin to pilot these new apps on their own devices to become familiar with their offerings and identify how best to implement them in clinical practice.

Aron Shaprio is vice president of retina at Ora in Andover, Massachusetts.