Have you ever heard of a newly emerging technology in ophthalmology and optometry called telehealth? It is the newest addition to any discerning clinician’s repertoire that … okay, okay, do not worry or adjust your eyeglasses — we know you haven’t been living under a rock for the last year.
We will spare you the full explainer on telehealth, but will just emphasize how popular it has become since the start of the COVID-19 pandemic. It has become pervasive and patients are generally supportive, recognizing it can make their medical experience easier and more comfortable. No surprise, therefore, that several interesting new technologies are emerging specifically designed for telehealth in optometry.
For example, Moorfields Eye Hospital in London (U.K.) has developed the Home Vision Monitor, a smartphone app designed for patients to remotely test and monitor changes in their vision at home.¹ The app is focused on conditions that affect the macula, like age-related macular degeneration (AMD). It uses a “shape discrimination” test where multiple shapes are displayed on a screen with one target shape being different, and the user must identify this shape.
Dispel any image in your mind of wee old dearies struggling to use the app to find the shape — it has proven popular. More than 90% of patients who used the app found it easy to use, and 85% used it at least once or twice a week, the minimum amount required. Moorfields Eye Hospital said that apps help clinicians decide on the right course of action and can significantly improve outcomes, especially at early stages of disease progression.
There is Something in the Water
Detecting intraocular pressure (IOP) is also a crucial matter for patients and clinicians alike as this constitutes an early warning system for glaucoma and other conditions. The difficulty of properly checking and monitoring IOP with isolated patients is obvious, yet three researchers from the University of Birmingham in England have postulated a solution. They propose using smartphones to transmit sound waves as a mobile measurement method for IOP.
Dr. Khamis Essa, one of the researchers in the study, said his team has discovered a relationship between the internal pressure of an object and its acoustic reflection coefficient. His study concluded that there is a clear link between the internal pressure of an object and its acoustic reflection; while the internal pressure of an object increases, the reflection coefficient increases at a rate of approximately 1.80 RC mmHg−1 through the range 0.100−0.200 m through water.² While recognizing more research is required, the University of Birmingham reports this water test shows the promise of using soundwaves to monitor IOP.
Now, new telehealth technology is not always smartphone-based and in fact, some even adopt a somewhat low-tech approach. The humble eye chart was adopted by a group of English researchers to create the Home Acuity Test (HAT). A study into this test was carried out from May 11 to 22, 2020 with 50 control participants and 100 adult ophthalmology outpatients who reported subjectively stable vision.
The researchers found that there was “good agreement in the visual impairment category for ophthalmology outpatients (Cohen κ = 0.77 [95% CI, 0.74-0.81]) and control participants (Cohen κ = 0.88 [95% CI, 0.88-0.88]), and the mean (SD) difference in visual acuity was -0.10.”¹ Based on these findings, the researchers concluded that the HAT can be used to measure visual acuity by telephone. The trick will of course be ensuring patients can access printing technology, especially if lockdowns are in place.
- Crossland MD, Dekker TM, Hancox J, et al. Evaluation of a Home-Printable Vision Screening Test for Telemedicine. JAMA Ophthalmol. 2021;139(3):271-277.
- Essa K, Soanes M, Butt H. Testing the Viability of Measuring Intraocular Pressure Using Soundwaves from a Smartphone. Engineering Reports. 2021;e12355.