April 2020


Putting patients’ smartphones to work

by Maxine Lipner Senior Contributing Writer

Many patients have a tool that could benefit their vision care right in their pocket or purse: their smartphone. There are several free or low-cost apps that physicians could be recommending to patients.

Detecting pediatric disorders

The CRADLE (ComputeR Assisted Detector of LEukocoria) White Eye Detector app can help parents detect conditions such as retinoblastoma, cataract, refractive error, and amblyopia in their young children.
The app works in two modes. “The first mode is the app will search pictures stored on your phone for leukocoria,” said Bryan Shaw, PhD, adding that this condition makes the pupil appear white in pictures. The second is a video mode that transforms the phone into a crude ophthalmoscope. “It turns on the camera on your phone and scans every video frame in real time for leukocoria,” he said. “The White Eye Detector app works privately on your phone. You do not upload pictures to us for analysis, and you do not need internet access to scan images or faces in video mode. The software is downloaded on your device.”
Dr. Shaw created the app after his son was diagnosed with retinoblastoma as an infant. When the app detects leukocoria, it puts a red box around the eye. The app also stops working in cases where the distance from the eye is not adequate to accurately detect leukocoria, he said, adding that primary care physicians often make the mistake of getting too close to the patient when examining them for white eye.
In a study1 of use of the app in 20 children with eye disease, investigators found CRADLE beat the eventual clinical diagnosis, finding the condition in pictures on average 1.3 years earlier than it was identified by a doctor. This timing could potentially allow for sight-saving treatment. “There were 15 kids with retinoblastoma, two with Coats, one with cataract, and two with refractive error and amblyopia,” Dr. Shaw said. Two of the 20 children had their conditions detected by physical exams earlier than the app. This was due to the use of family histories, and diagnosis was made before the first week of life.

Practical patient apps

Cynthia Matossian, MD, said she routinely shares a variety of apps with her patients. For example, she suggests exercise apps for her patients with diabetes. “To minimize the risk of retinopathy, I recommend exercise to my patients with diabetes in order to maintain healthier blood sugar and hemoglobin A1c levels,” she said.
She also recommends medication compliance apps, such as Medisafe and MyMeds, to remind patients to use their medications and notify caretakers or family members if a dose has been missed.
Apps for comparative cost analysis of medications can be useful, Dr. Matossian said. She mentioned the app GoodRx, which can help consumers save money on their medications and find coupons that may further reduce cost.
For those with dry eye, there are apps to help calculate a SPEED or Ocular Surface Disease Index (OSDI) score. Filling out the questionnaires before starting a dry eye medication or undergoing a meibomian gland evacuation procedure and repeating the questionnaire later can enlighten patients about the improvement in their scores, Dr. Matossian said.
In cases of macular degeneration, Amsler grid testing apps can help patients track whether bowed or irregular lines are getting worse. “If they are, patients are advised to call their retina specialist right away and come in sooner than their scheduled appointment,” Dr. Matossian said.
There are a variety of apps that magnify text, which could be useful for low-vision patients. Be My Eyes is an app that involves sighted volunteers assisting the visually disabled via a live video connection, Dr. Matossian said. EyeNote is recommended for those who have trouble reading money; it recognizes and alerts the user as to which type of bill they have. Apps like Colorblind Helper or Color Blind Pal help users distinguish between different hues, Dr. Matossian said.

About the doctors

Cynthia Matossian, MD

Founder and medical director
Matossian Eye Associates
Doylestown, Pennsylvania, and Hopewell, New Jersey

Bryan Shaw, PhD
Associate professor of chemistry
Baylor University
Waco, Texas


1. Munson MC, et al. Autonomous early detection of eye disease in childhood photographs. Sci Adv. 2019;5:eaax6363.

Relevant disclosures

: None
Shaw: None


: Bryan_Shaw@baylor.edu
Matossian: cmatossian@matossianeye.com

Putting patients’ smartphones to work Putting patients’ smartphones to work
Ophthalmology News - EyeWorld Magazine
283 110
283 110
True, 4