Smartphones in Ophthalmology: Potential Uses of the Smartphone in Your Practice

By Vinay A. Shah, MD, Ron K. Lord, MD and Ashley N. San Filippo, MD

Physicians appear to be embracing mobile technology at a faster rate than the general population, and ophthalmologists are no exception. Currently, smartphones are being utilized by 64% of U.S. physicians, and this number is projected to reach 81% in 2012. As ophthalmologists, we have the ability to use smartphones in countless areas of practice and education. We believe potential functions of smartphones in ophthalmology can be divided into the following broad categories:

1. Testing Tools
2. Patient Education Tools
3. Physician Reference Tools
4. Physician Education Tools
5. Calculators and Other Office-Based Tools

In the following article, we will discuss the potential for using your smartphone as a testing tool. Examining a patient for the first time in the emergency room or hospital setting can be a hassle, especially with the limited availability of ophthalmologic equipment in these settings. The smartphone has the potential to combine many commonly used clinical evaluation tools into one easy to use interface. No longer do you need to fumble through your overly-stuffed white coat pockets to find your bent, faded near vision card—it’s there at the touch of a button on your smartphone. Forgot your penlight in the emergency room? There’s no need to search the halls for a working flashlight—there’s a suitable alternative right in your pocket. While these tools may not replace office-based testing under ideal conditions, with appropriate standardization and acceptance of some testing variability, they can be especially valuable during inpatient consults and emergency room visits.

The following are some of the tools that are currently available, or have the potential to be used with your smartphone:

Near Vision Cards


This tool can be used as described above in situations where other tests of visual acuity are not readily available. In addition, they could potentially be used in the office as a substitute for your typical near vision card testing.

Color Vision Plates


Similarly to the near vision cards, these could be used in emergency or inpatient settings. Since it is unlikely that most ophthalmologists carry color plates with them in these situations, this tool may add value to your clinical evaluation. Also, since this tool is on your smartphone, it will not undergo the usual “aging” of color plates with faded colors and potentially inaccurate results.

Pupil Gauge and Measuring Ruler


These tools allow quick access to measuring devices and can be used in any exam setting.

Fluorescein Light & Pen light


These tools, again, will have most of their utility in non-ideal patient exam situations. They may be extremely valuable in the diagnosis of corneal surface disease when a slit lamp is unavailable, or when patients are unable to be examined at the slit lamp.

Pediatric Fixation Targets


These tools can also be accompanied by motion and sound to entertain pediatric patients while you examine them.

Worth 4 Dot & Accomodation Targets


Again, these can be used in office or non-office based testing situations.

Amsler Grids


These can be beneficial in quickly evaulating a patient with suspected macular disease.

Pediatric Optotypes


This tool, like the near vision cards, can be used in an emergency and inpatient settings, but can be used in pediatric patients and patients who are unable to read numbers or the English alphabet.

Red Desaturation Test

This tool allows for comparison of nasal and temporal fields in the same eye:



And for comparison of red desaturation between two eyes:

Several new testing tool applications for smartphones have and are being developed. Eye Test, Eye Chart, EyeChart RandomEyes, Eye2Phone, and Fast Acuity Life are just a few examples. Our new application for the iPhone is called the “Eye Handbook” (Available on iTunes – for free or at www.eyehandbook.com). This application is one of the most comprehensive ophthalmology applications available and provides most of the above-mentioned examination tools.

Smartphones have a number of useful applications for any medical professional, but ophthalmology uniquely requires several testing tools for a basic patient exam. In addition to being a power-packed communication device and having all of the features available in a PDA, smartphones with testing tools such as those mentioned above offer the ability of increased ease and efficiency in ophthalmology exams, especially those conducted under non-ideal testing circumstances. . Smartphone applications in ophthalmology have great functionality and have vast potential for future growth.

References

1. Eye Handbook: Free iPhone application for eye care professionals. http://www.eyehandbook.com/


2. http://www.manhattanresearch.com/newsroom/Press_Releases/physician-smartphones-2012.aspx


3. Gillingham W, Holt A, Gillies J. Hand-held computers in healthcare: what software programs are available. N Z Med J. 2002 Sep 27; 115(1162):U185


4. Low DK, Pittaway AP. The Iphone induction – a novel use for the iPhone. Pediatric Anaesth. 2008 Jun;18(6):573-4. Epub 2008 Feb 2

Disclaimer: Please note that all the testing tools are not standardized and should be used by the eye care professional in proper testing conditions, using their professional judgment.