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Novel Uses of Smartphones in Ophthalmology

2010; Elsevier BV; Volume: 117; Issue: 6 Linguagem: Inglês

10.1016/j.ophtha.2010.01.001

1549-4713

Ron K. Lord, Vinay Shah, Ashley N. San Filippo, Rohit Krishna,

Retinal and Optic Conditions

We believe that smartphones are valuable tools in the field of ophthalmology. It is estimated that 1 out of every 2 physicians uses a personal digital assistant (PDA) or smartphone, and this number is expected to rise.1More Physicians Use Smartphones, PDAs in Clinical Care.http://www.ihealthbeat.org/Articles/2009/1/6/More-Physicians-Use-Smartphones-PDAs-in-Clinical-Care.aspxGoogle Scholar While smartphones have been used for some time as electronic references, these devices have evolved over recent years and are now far more than a simple combination of a PDA and a cellular phone.2Gillingham W. Holt A. Gillies J. Hand-held computers in healthcare: what software programs are available?.N Z Med J. 2002; 115: U185PubMed Google Scholar We believe that all smartphones have great utility in the field of ophthalmology. However, the iPhone (Apple Inc, Cupertino, CA) stands out among other phones because of its unique interface and its vast supply of third-party add-on software. We would like to present various uses of smartphones, as well as their applicability in virtually every part of the ophthalmologic examination. Smartphones can combine many commonly used clinical evaluation and educational tools into one easy to use, portable interface. A near vision card, Amsler grid, Ishihara color plates, and a pupil gauge are some examples of simple to use applications that are readily accessible on a smartphone. While these tools will not replace office-based testing under ideal conditions, with appropriate standardization and acceptance of some testing variability, these tools can be particularly useful, especially in the setting of inpatient consults and emergency room visits. The smartphone can also display educational videos, diagrams, and clinical photographs that provide a convenient way to instruct patients and their families about various ophthalmic conditions and treatment options (Figure 1, available at http://aaojournal.org). As students, residents, educators and speakers, ophthalmologists often present clinical cases in conferences. The smartphone allows collection of acceptable quality presentation images for this purpose. In non-ideal clinical settings, such as in the emergency room, a smartphone can be used to document external photographs of the eye, slit-lamp pictures of the anterior segment, fundus biomicroscopy, and indirect ophthalmoscopy findings (Figure 2, Figure 3, available at http://aaojournal.org). We have also been successful in taking presentation-quality images and videos of surgical procedures through the operating microscope (Fig 4, available at http://aaojournal.org). In addition, the smartphone will display suitable images of magnetic resonance imaging and computed tomography scans directly from a liquid crystal display computer monitor (Figure 2). Most smartphones also have the ability to capture video. As mobile devices continue to integrate into ophthalmology, special consideration should be given to the Health Insurance Portability and Accountability act of 1996 (HIPAA) and patient confidentiality. While e-mail messages containing patient information and clinical photos can be sent securely with encryption, appropriate documentation of patient consent must be obtained. It should always be remembered that patient information must be protected and established guidelines adhered to.Figure 3Technique to capture slit-lamp pictures on the iPhone.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Image captured on the iPhone through operating microscope.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Many digital references (e.g., Epocrates [San Mateo, CA], Lexi-Comp [Hudson, OH], Taber's Medical Dictionary [Unbound Medicine, Inc., Charlottesville, VA])2Gillingham W. Holt A. Gillies J. Hand-held computers in healthcare: what software programs are available?.N Z Med J. 2002; 115: U185PubMed Google Scholar and diagnostic tools that have been available through other electronic devices are now available for smartphones. In addition, ophthalmologic-specific applications like “The Wills Eye Manual” and “Optics Clinical Calculator” are available. These phones also have transcription capability through third-party software. There has already been the development of an electronic medical record for the iPhone,3Allscripts Introduces iPhone MR.http://medgadget.com/archives/2009/04/allscripts_introduces_iphone_emr.htmlGoogle Scholar and novel devices like microscope and ultrasound attachments are being developed.4Fitzpatrick T. Ultrasound imaging now possible with a smartphone Imaging device fits in the palm of a hand.http://news-info.wustl.edu/tips/page/normal/13928.htmlGoogle Scholar, 5Low D.K. Pittaway A.P. The ‘iPhone' induction – a novel use for the Apple iPhone.Paediatr Anaesthes. 2008; 18 ([Epub 2008 Feb 2]): 573-574Crossref PubMed Scopus (30) Google Scholar The iPhone already has many uses and its ophthalmologic utility, as well as that of other comparable smartphones will continue to develop with time. The authors were able to facilitate the performance of an yttrium aluminum garnet (YAG) laser capsulotomy in a 2-year-old child using a video displayed on the iPhone as a fixation target. In addition, other medical specialties are finding novel uses for the iPhone and utilizing them to enhance patient care.5Low D.K. Pittaway A.P. The ‘iPhone' induction – a novel use for the Apple iPhone.Paediatr Anaesthes. 2008; 18 ([Epub 2008 Feb 2]): 573-574Crossref PubMed Scopus (30) Google Scholar We recently developed a free ophthalmology iPhone application called the “Eye Handbook.” This application includes international classification of diseases (ICD) 9 codes, an ophthalmic picture atlas, an ophthalmic dictionary, clinical studies reference list, ophthalmic instrument references, various ophthalmic study materials, and an ophthalmic English-Spanish translational guide (www.eyehandbook.com; Accessed November 19, 2009). Smartphones, like the iPhone, have many useful applications for any medical profession, especially ophthalmology. In addition to being a power-packed communication device and having all of the features available in a PDA, the smartphone's programs, and digital photography are altering the educational environment for ophthalmology residents at the University of Missouri-Kansas City. This dynamic interface has great functionality at present, and it has great potential for future growth in the field of ophthalmology. Vinay Shah and Ken Lord are equity owners in Company Digital Medicine LLC. Smartphone FundoscopyOphthalmologyVol. 119Issue 2PreviewMore ophthalmologists than ever carry a smartphone with them on a daily basis. There are many ophthalmic applications (apps) and reference texts available on a variety of platforms. Full-Text PDF