There is a growing abundance of mobile applications (apps) designed for the medical field—about 6,000, by one estimate—many of which are related specifically to ophthalmology. These apps are available in a multitude of languages and can be used in a variety of situations; their capabilities can benefit patients at home and in the clinic, facilitate the work of the surgeon and the practice staff, and improve the doctor-patient relationship.
PATIENT APPS
Home education and vision testing. Thanks to advances in mobile technology, today’s patients can take a more active role in their health and eye care. Using their smartphones and tablets, patients can gain instant access to information about their surgeon or surgical center. They can also read books and other educational materials dedicated to ophthalmology-related problems prior to their arrival at our office.
Additionally, there are a number of apps that patients can use to check and monitor their vision at home (Figure 1; see Apps for At-Home Vision Testing). These include the Eye Meter (developed by Jamie Gutierrez Martin); iOcchio (developed by Stefano Zanghi); EyeSnellen (developed by Steve Colley); Eye Chart Pro (Dok LLC); and Color Blindness Test (EnChroma).
In the waiting room. Mobile technology is also a useful tool for patients in the waiting room, both to improve the patient experience and to facilitate the workflow. At Centro Ambrosiano Oftalmico, we provide Wi-Fi in our waiting room so that patients can use the Internet during the periods between tests or procedures. Patients can watch animated film clips of their scheduled surgery or access reading material, for example.
While the patient is in the waiting room, we also collect his or her personal data using an iPad and then transfer that information to the office data management system. The iPad allows the patient to read informed consent forms relative to the visit and the surgery and add his or her electronic signature.
Tools for the visually impaired. The use of smartphones and tablets can also yield benefits for individuals with low vision. These devices can magnify images and text, adapting the content to suit the user’s visual requirements. Some apps are also geared specifically toward this patient group, such as EyeNote (US Bureau of Engraving and Printing). With EyeNote, individuals who are blind or visually impaired can scan US currency using their smartphone; then an electronic reader identifies the denomination and communicates it to the user.
DOCTOR APPS
A resource for exams. Mobile devices offer a range of advantages to doctors and staff in the clinic. Of particular benefit is the camera feature available on many devices. For example, suppose you have a patient who traveled to your practice to undergo a procedure, and, 2 weeks postoperatively, he or she calls complaining of a red, irritated eye. Rather than requiring the patient to return to the practice, the surgeon can instruct the patient to use his or her smartphone to capture a photo of the eye and send it to the surgeon for immediate review. These remotely acquired images can be used to determine the nature of any potential emergency. In the clinic, ophthalmologists can use their smartphones to take external photographs of a patient’s eyes; there are also mounting devices available to attach a smartphone to the slit lamp to capture images of the anterior segment (Figure 2). After patients have returned to a distant home, or if they are traveling abroad, remote images can again be requested to record and observe the evolution of any pathology identified in the office.
An app I have found particularly useful in the clinic is EyeVisPod (Farotech; Figure 3), an innovative system for assessing a patient’s visual performance. EyeVisPod provides a score of the patient’s visual performance by simulating common visual tasks and by processing data from a series of optical tests. The system then creates a functional score of the patient’s pre- and postoperative near and intermediate visual quality. Optical assessments that can be performed with EyeVisPod include near visual acuity measurement, automatically measured reading speed, a comprehension test, social reading quality-of-vision measurement for near and intermediate distance using real-life dimension images, a photic phenomena test, and a defocus analyzer.
With the aid of the Palm Scan (Micro Medical Devices), an accessory that attaches to an iPhone (Apple), ophthalmologists can acquire pachymetric measurements, measure the length of the eye (A-scan), calculate IOL power, and perform echography (B-scan). For more on frequently used ophthalmology apps, see Apps Commonly Used by Ophthalmologists.
Doctors can also use mobile devices to view information relative to the patient’s clinical situation. For instance, when a technician performs a test (eg, topography, optical coherence tomography), the results can be sent to the central computer and then be accessed by the doctor on his smartphone during the visit. Smartphones or tablets can also be used to present educational videos or images to patients to illustrate ocular diseases and available treatment options.
Operating room advantages. My team and I at Centro Ambrosiano Oftalmico are currently developing an app that surgeons and the operating room staff may find useful. This app is integrated with Google Glass and can be used by nurses and technicians to read barcodes on IOLs and other surgical products, providing real-time information on expiration dates, lens powers, and details from manufacturers for increased safety in the operating room.
There are other uses for Google Glass (Figure 4) in the operating room setting. By preloading information relevant to a procedure and recalling it in Google Glass, the surgeon can compare the astigmatism measured preoperatively with the real condition and position encountered during surgery. Using voice commands, the surgeon can visualize images, topographic maps, and other preoperative tests.
Consultation and productivity. There are multiple additional medical uses of mobile technology. Scientific publications, journals, and textbooks can by consulted on the fly using a smartphone or tablet. Cloud storage programs such as DropBox, One Drive, and iCloud can be used to download and save documents and images. The physician can then access and update these files on any mobile device during the patient’s visit. Notepad and calendar features are also helpful for checking one’s schedule of visits, surgeries, and personal engagements.
Mobile technologies can also be used for surgery simulations and training to improve a specific technique. The cataractMobile app (George Kong softwares), an animation simulator for phacoemulsification and capsulorrhexis techniques, is extremely useful for surgeons in training and those looking to improve their skills. With cataractMobile, users can track the time and success of their phaco and capsulorrhexis techniques and save images of their work for consultation with colleagues and mentors.
Industry can also capitalize on these technologies to demonstrate to physicians how a particular instrument or system works and how to transfer information from a device to an application.
FUTURE DIRECTION
A digital revolution is taking place before our eyes. Mobile technology is a fascinating field, and these are exciting times. Whether we like it or not, smartphone and tablet devices will undoubtedly play an important role in the future of medicine, so it is necessary for ophthalmologists to join the movement.
- Lucio Buratto, MD, is Director of the Centro Ambrosiano Oftalmico in Milan, Italy. Dr. Buratto states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +39 026361191; e-mail: office@buratto.com.
