Mobile phones for retina care

Mobile, smartphone-based out of office monitoring combined with a fully integrated electronic health record will revolutionise the delivery of ophthalmic care, according to Mark S Blumenkranz MD, MMS. Dr Blumenkranz focused primarily on the use of personal portable devices to monitor visual function in patients with age-related macular degeneration (AMD). However, he noted the potential for much broader utility. “This approach provides an opportunity to extend our reach and scope,” said Dr. Blumenkranz, H J Smead Professor of Ophthalmology, Stanford University School of Medicine, Stanford, USA. “The availability of real-time high frequency patient outcomes data will give us another window into disease activity, and it will also create a very robust database that can be easily shared for patient care, clinical research, public health purposes, and marketing analytics. On top of all of that, the technology establishes a link for physicians to communicate with our patients over time and distance, and it may be a means for decreasing the burdens associated with in-office care.” The feasibility of mobile monitoring in patients with ophthalmic diseases is supported by the high penetration of smartphones in the older adult population and findings from initial studies investigating the performance of smartphone-based systems. As an example, Dr Blumenkranz reported that evaluations of one smartphone-based vision testing application showed that it could provide reproducible near visual acuity measurements and that the data correlated well with results of standard in-office tests. “There was only a short learning curve for patients using the application. The reliability of the data was quite high after the first two or three measurements,” he said. Dr Blumenkranz also presented several real world cases that showed how the smartphone-based monitoring data provided an alert of a change in disease status leading to treatment modification and illustrating how the data from high-frequency measurements could be extremely informative for identifying and understanding patterns and fluctuations. He noted that in addition to obtaining functional measurements, smartphones equipped with relatively inexpensive attachments could be used to take high quality anterior and posterior segment images. “In a trial evaluating the potential for diabetic retinopathy screening, masked graders rated the quality of the smartphone-obtained fundus images as comparable to those acquired with a nonmydriatic fundus camera,” Dr Blumenkranz said. “Because of their low cost and portability, these systems are now being used around the world to improve public health capabilities. In the near future, I expect that the technology will also include IOP measurements and OCT.” ENDS