Physicians appear to be embracing mobile technology at a faster rate than the general population, and ophthalmologists are no exception. Two out of every three physicians utilizes a personal digital assistant or smartphone, and it is estimated that 81% of physicians will be using these devices in their practices by 2012.1 This boom can be attributed to the proliferation of medical software applications, also known as apps, and the inherently portable nature of the content they hold. Keeping up with medical knowledge and its growing sources can be daunting, but an app that serves as a portal for all of this information assembles the data in a cohesive manner. It allows for more efficient use of an ophthalmologist's time. This article will explore the features of the Eye Handbook (Cloud Nine Development, LLC, Overland Park, KS), a free app that is available for download on iTunes for the iPhone, iPod Touch, and iPad (all from Apple Inc., Cupertino, CA). The Eye Handbook has applicability in virtually every part of ophthalmic care, and it combines many commonly used tools for clinical evaluation and education into one easy-to-use, portable interface (Figure 1A).
EVALUATIVE AND EDUCATIONAL TOOLS
Testing Tools
The Eye Handbook's testing tools include near vision
cards, color vision plates, a pupil gauge and ruler, a fluorescein
light, a pen light, pediatric fixation targets, a
Worth 4 Dot Test and accommodation targets, an
Amsler grid, a red desaturation test, and an optokinetic
nystagmus drum simulator (Figure 1B). Although these
tools will not replace office-based testing under ideal
conditions, they can be particularly useful during inpatient
consultations and ER visits.
Patient Education Tools
Tools for educating patients such as the eye diagram
and eye movie offer high-resolution images that explain
anatomy and pathology as well as various treatment procedures
and options. The eye movie provides a threedimensional
rendering of a rotating eyeball with which
the physician can delineate specific anatomical considerations
in medical or surgical disease management. The
most common is a list of various disease processes that
are encountered day to day in an ophthalmic practice.
The list includes a brief description of a topic and an
index of relevant and credible Web sites where patients can access more information about their
diagnosis. A wonderfully designed aspect
of this app is that an ophthalmologist
can e-mail specific information to the
patient from the smartphone while
speaking with the patient in the office
(Figure 2A and B).
Physician Reference Tools
Classifications and grading systems
such as angle anatomy, iritis severity, diabetic
retinopathy, optic nerve edema,
melanoma, and macular holes are helpful
reference tools. The Eye Handbook also
contains a useful section on definitions,
differential diagnosis, Spanish translations
of commonly used ophthalmic terminology,
and Department of Motor
Vehicles and legal blindness standards
for each state as well as workups for
common ocular diseases.
Physician Education Tools
The Eye Handbook provides a list of diagnoses not to
miss, a color-coded diagram of retinal drawings, questionnaires
for commonly encountered ophthalmic diseases,
and a summary of benchmark studies in ophthalmology,
including the Collaborative Initial Glaucoma
Treatment Study (CIGTS), the Normal Tension
Glaucoma (NTG) Study, the Advanced Glaucoma
Intervention Study (AGIS), the Early Manifest Glaucoma
Trial (EMGT), and the Ocular Hypertension Treatment
Study (OHTS).
Calculators and Other Office-Based Tools
Useful calculators include a glaucoma risk calculator
and an IOL power calculator. A section on ophthalmic
coding allows the user to search various CPT and ICD
codes. Another section reviews modifiers and explains
when to use them.
The app can be used to obtain media consent from a patient; the patient's digital signature can be transferred to an electronic health record at a later date. The Eye Handbook's new 2.2 version allows content such as lectures, video presentations, movies, and flashcards to be downloaded. Recently added icons include links to the Web sites of major journals and periodicals and links to ophthalmic societies such as the American Academy of Ophthalmology (AAO), American Glaucoma Society, American Society of Cataract and Refractive Surgery, and the Association for Research in Vision and Ophthalmology.
COLLABORATIONS
Through an upcoming collaboration with the AAO,
the Eye Handbook will feature educational videos and
summary benchmarks. An interface to EyeWiki, the
AAO's collaborative online encyclopedia, will also be
enabled.
CONCLUSION
The Eye Handbook has been well received and has
frequently been listed in the iTunes store as one of the
top 100 medical apps available. It has been downloaded
more than 70,000 times, and that number is growing
rapidly. The app is used worldwide, with about 50% of
downloads in North America, 20% in Europe, and 10%
in Australia and Asia.2 This dynamic interface has great
functionality at present, and it has vast potential for
future growth in the field of ophthalmology.
Rohit Krishna, MD, is associate professor of ophthalmology and director of glaucoma at the University of Missouri, Kansas City School of Medicine. He holds a financial interest in Cloud Nine Development, LLC. Dr. Krishna may be reached at krishnar@sabateseye.com.
