Eye Screening? There’s an App for that!

John Davis Akkara, MD, is an ophthalmologist at Westend Eye Hospital in Cochin, India. But before he committed to medicine, he was fascinated by computers and technology. 

“Even while in medical school, I learned mobile software programming and developed a few apps,” he said. “During ophthalmology residency and fellowship, I continued to merge my passion for ophthalmology and technology to develop a few ophthalmology apps as well.” 

Since then, he’s developed numerous smartphone apps for both ophthalmologists and optometrists to assist with screening, diagnosis and more. Among them are the 3D Atlas of Ophthalmology (for stereoscopic atlas of eye conditions); Eye Grader (for grading systems in ophthalmology); Eye Know Tamil (a local language helper app for eye care specialists); and iDoctor JD (a vision testing app). These are currently available in the App Stores for Android and iPhone.

And now, with the COVID-19 pandemic making access to eye care more difficult worldwide, telemedicine and apps such as these can contribute to the effort to avoid preventable blindness and provide continued medical care. Below, Dr. Akkara discusses the different apps available to eye care professionals and their patients — as well as their potential impact in eye care.

Riding the Tech Wave

“Smartphones are now an essential part of modern daily life and the medical field is no exception,” began Dr. Akkara. “With the simple phrase, ‘there’s an app for that,’ many problems of modern life have been solved — even in eye care for doctors and patients.”

In fact, smartphones have driven most of the recent innovations in ophthalmology, noted Dr. Akkara in a 2018 paper called Innovative Smartphone Apps for Ophthalmologists.¹

He shared that there are some apps (such as the Eye Handbook), which do a variety of things like comprehensive patient vision assessment, ophthalmic calculations, international classification of diseases and more — while many other apps are specialized in one or a few tasks only.

“[There are] apps for vision testing including acuity, contrast, color vision and stereo acuity. There are also apps to test optokinetic nystagmus, to do optometric calculations, to do virtual perimetry and grade various ophthalmic signs,” said Dr. Akkara.

He continued that there are several innovative apps that enable easy, affordable and portable vision testing via smartphone. “Other apps may be useful for a quick reference (EyeGrader), learning (3D Atlas of Ophthalmology) or smartphone fundus photography (HopeScope, Ullmann Indirect & MIIretcam),” explained Dr. Akkara. 

Apps that assess near and distance visual acuity (VA) have been found to be reliable in an emergency setting, although there is still some standardization needed in the brightness and contrast of the smartphones and optotype sizes.

Dr. Akkara said there are also apps that help patients: There are now several apps where can set a medication schedule to ring an alarm and remind the patient to follow the correct dosing of medications. These are especially useful in chronic diseases like glaucoma. There are also apps that stimulate vision in cataract, glaucoma, diabetic retinopathy patients, and in different types of intraocular lenses (IOLs).

“Patients also get the benefits from faster and affordable eye care,” he said, adding that patients may also find medication reminder apps very useful. 

Further, in 2019, Dr. Akkara authored another paper on Smartphone Apps for Visually Impaired Persons.²  These apps can help with daily tasks, with talking clocks, calculators and camera functions, but there are also apps that can help patients identify objects, recognize people, identify currency, and read signs and text.

“Smartphones can also be easily used as magnifiers and contrast enhancing low vision aids with free apps,” he said. “One innovative app is Be My Eyes, in which sighted volunteers can help the visually impaired in identifying anything with their smartphone camera.”

The ‘Smart’ Future of Eye Care

Worldwide, there is still a huge disparity in access to eye care. Dr. Akkara suggests some of these apps could help bridge that gap for patients in rural or underserved communities. 

“One of the biggest advantages of these apps is that they increase healthcare access by improving availability and reducing the cost of care. Smartphones are becoming very affordable and these apps and techniques definitely help to bridge the gap in access to healthcare, not just eye care,” he shared.

And fortunately, for doctors and patients alike, the momentum continues to build. Dr. Akkara shared that there are several interesting innovations already in use: “Smartphones can be used to take anterior and posterior segment photographs via small and low cost adapters with image clarity rivalling that from conventional expensive cameras,” he said, adding that smartphone gonioscopy, corneal topography, and imaging of endothelial cells have also been demonstrated. 

“As technology progresses and becomes more affordable, we should try to find ways to help each other using these. Technology should not divide us, but rather unite us as humanity. 

“We see a lot of disease and ill-health as a consequence of inequitable distribution of wealth and technology, and much of this can be easily improved by careful redistribution of available resources with no disadvantage to anyone,” concluded Dr. Akkara.

Dr. Akkara’s Top 5 Apps 

Most are available in the iPhone and Android App Stores

Eye HandBook is a free (but ad-supported) multipurpose ophthalmic app with multiple vision tests including near vision, color vision, optokinetic nystagmus drum, Amsler grid, contrast sensitivity and Worth 4-dot test. It also has multiple optometric calculators such as a glaucoma risk calculator, visual acuity convertor and IOL power calculators. In addition there is ICD coding, forums, videos, eye atlas and references for patient education. “Truly an essential app for eye care specialists,” said Dr. Akkara.

Peek Acuity is a free app from Peek Vision that allows for rapidly distance VA measurement using an E chart with built-in calibration. “The innovative swiping and shaking method allows quick and accurate VA measurement and there is also a simulator showing the blurred vision experienced at different visual acuities,” he shared.

Eye Chart Pro & Remote are a pair of apps for iPad and iPhone that work as a remote-controlled and calibrated VA chart with multiple optotype options, and additional charts such as Amsler grid and Duochrome test. The app is free, with the option to purchase for more advanced features.

Eye Grader is a free app developed by Dr. Akkara for clinical grading of several ophthalmic signs, symptoms and findings, including approximately 70 grading systems, which are searchable and also can be browsed by topic. “A few examples include cataract (LOCS), gonioscopy (Spaeth, Scheie, Shaffer, RP Centre), bleb (Moorfields, Indiana) and so on.”

visualFields easy is free iPad-based software that tests suprathreshold visual fields easily. “This technology has rapidly evolved in the past few years to make portable, accurate, affordable, virtual reality perimetry possible,” said Dr. Akkara.

References