February 2010




Performing an eye exam? There’s an app for that

by Tony Realini, M.D.


New iTunes download for iPhone integrates a range of ophthalmology utilities

Ophthalmology is inarguably a gadget-oriented specialty. Our offices are filled with vast arrays of diagnostic and therapeutic tools. Our operating rooms are equally packed with surgical equipment of every shape and size. When on consult rounds, our pockets are jammed with more widgets than we can shake a stick at.

Imagine being able to perform many of these tasks using a single multifunctional device, from assessing near visual acuity to snapping a few fundus photos. Sound attractive? Imagine sending the results to a colleague for a second opinion with the touch of a button. Sound even better? Now imagine that it’s small enough to fit in the palm of your hand. Sound too good to be true? It isn’t. In fact, you probably already have one. It’s your iPhone (Apple, Cupertino, Calif.).

“One out of every two physicians now carries a PDA or a smartphone,” said Ken Lord, M.D., third-year resident, University of Missouri, Kansas City, Miss. “The iPhone and its smartphone counterparts are much more than a combination of a PDA and a cell phone. The iPhone can be used for performing photography and videography, internet browsing, data sharing, listening to music, and watching movies.”

Dr. Lord and his fellow ophthalmology residents at the University of Missouri recognized the value of such compact computing power. “There are a variety of software applications available for the iPhone that are ophthalmology-specific, such as the Epocrates drug guide and the Wills Eye Manual,” he said. “We downloaded and tested every ophthalmology application available for the iPhone.”

Their review of available applications left them with the sense that something was missing. “The iPhone is a multifunctional smartphone and digital camera with the ability to acquire video and obtain external photography, slit-lamp photographs of the anterior segment and fundus, as well as indirect ophthalmoscopy,” said Dr. Lord.

All that was missing was a comprehensive application that tied all of these functionalities together. So Dr. Lord and his fellow residents developed an iPhone application that integrates these and a wide variety of additional ophthalmology-specific tasks into a single interface.

“The application is called the Eye Handbook,” said Ryan Vincent, M.D., resident, University of Missouri. “It was Dr. Lord’s idea, and the work to create the app was divided among the resident staff. We made it ourselves.”

What can it do? Perhaps the better question is, what can’t it do? “With the Eye Handbook app, your iPhone can be utilized as a near vision card, an Amsler grid, color plates, an OKN [optokinetic nystagmus] drum, and a pupil size gauge in either the office or consultative settings,” said Dr. Lord.

With a little practice, said Dr. Vincent, doctors can use the Eye Handbook interface to take external photographs, slit-lamp photographs, and even perform fundus photography with an iPhone.

“These data can be wirelessly sent and received for real-time consultation or for later presentation,” said Dr. Lord. There is even a specific media-relevant consent form, which is both displayed and signed on the iPhone screen, that patients sign to authorize electronic transmission of their information and images, he said.

This virtual telemedicine feature has been useful for the resident staff. “We can take pictures of patients we see either in the emergency room or on the wards, and then send these images to our upper-level resident or attending physician when we’re on call,” said Ashley San Filippo, M.D., resident, University of Missouri, who contributed to the Eye Handbook’s development.

There are even features that allow communication with an electronic medical record. In this way, diagnostics such as computed tomography and magnetic resonance imaging images can be included in the request for consultation.

It also has applications for pediatric ophthalmology. “It will produce novel optotypes for assessing visual acuity in children and can display attention-getting pictures or videos to facilitate fixation in kids,” Dr. Lord said.

The Eye Handbook’s functionality is not limited to clinical data acquisition. “Diagrams and videos can be used to educate patients about diagnoses or contemplated procedures,” Dr. Lord said.

There are even educational applications for providers. “Studying for the written and oral boards, as well as recertification preparation, can be undertaken using the iPhone,” he said.

The whole process took several months to complete, said Dr. San Filippo, and the official launch of the application on the iTunes website took place on Oct. 21, 2009, just in time for the 2009 American Academy of Ophthalmology meeting where it was introduced.

Just how much would you expect to pay for a downloadable application that turns your iPhone into a virtual ophthalmology clinic? “It’s a free download,” said Dr. San Filippo. “We hope people use it and we hope they find it as helpful as we do at the University of Missouri.”

Editors’ note : Drs. Lord, Vincent, and San Filippo did not indicate any financial interests related to their comments.

Contact information

Lord: dr.kenlord@gmail.com
San Filippo: ashley.sanfilippo@osumc.edu
Vincent: ryandv42@hotmail.com

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