Article

WEB EXCLUSIVE: Apps for Glaucoma Management

Options abound for education and calculations.

The smartphone has revolutionized care for physicians and patients in ways that aren’t necessarily specific to glaucoma. Text messaging or other secure messaging platforms can allow communication with patients or with colleagues. The phone camera can facilitate documentation; for example, an ophthalmologist might take a picture of a cornea perforation or other ophthalmic pathology and align it perfectly at a subsequent visit (Figure 1). And, of course, there are HIPAA-compliant platforms to do any of these things if a physician wants that information to be part of a medical record. There are also glaucoma-specific technologies that can help both physician and patient. For example, Varadaraj et al recently conducted a study of 100 patients who used an electronic health record to get reminders for glaucoma medications and found that 74% of patients found the reminders useful.1 We will discuss some of the ophthalmology-specific and glaucoma-specific apps in this article.

Figure 1. A photo of a tube sandwiched between two IOLs taken with a smartphone.
PHOTO COURTESY OF NATHAN M. RADCLIFFE, MD

Physician Resources

There are many helpful educational resources for physicians, including audio books and podcasts. There is a tremendous amount of ophthalmology-related content now available for free through a variety of different podcasts. One example is “As Seen From Here,” which is an ophthalmology podcast by Joshua A Young, MD. “Ophthalmology Off the Grid” is hosted by Gary Wortz, MD. Robert Schertzer, MD, hosts a glaucoma podcast called, “Talking About Glaucoma.” The American Glaucoma Society website is also a helpful tool for ophthalmologists, as is the ASCRS EyeConnect365, which is a forum that includes a glaucoma section.

Patient Resources

There are apps patients can use, and these can be very straightforward, such as a variety of magnifying apps, including Pocket Glasses Pro, and other reading aids. You can also teach patients how to use the flashlight on their phone to have better illumination. The Glaucoma Research Foundation also offers a glaucoma podcast for patients.

The Glaucoma Notebook app allows patients to set alarms on their own phone to remind them to take their drops. It also enables them to make notes from their visits. Some physicians, including myself, don’t encourage using this type of app; many glaucoma physicians prefer to maintain control over monitoring IOP so the patient does not have to worry as much about it. But glaucoma specialists should know about these apps; many patients will want to use glaucoma apps because they can give patients a feeling of ownership over and involvement in their care.

An app called EyeDropAlarm has the names of various drops already entered so the patients can just select their drop and apply it. Similar to apps that set alarms on the phone, patients can also use any of the various virtual assistants from Siri to Alexa to Google to set alarms to take drops.

A very good educational glaucoma app is called Glaucoma From Wills Eye (Figure 2). It offers videos with educational content on glaucoma from Wills Eye Hospital glaucoma experts Jonathan Myers, MD, L. Jay Katz, MD, and others. It provides information about drops, laser, visual fields, and surgery. It also allows patients to track and record their history, pressure, and drops.

Figure 2. Screen capture from Wills Eye Hospital's Glaucoma From Wills Eye app.

Linking Clinic and Home

The Icare Home app works with the Icare Home tonometer. This allows patients to sync their Icare tonometer with the app. Self-tonometry with the Icare Home is designed for the patient to gather additional IOP. The app does not give patients their eye pressure, but it allows them to bring the app into the doctor’s office to sync up and provide the doctor with measurements like 24-hour pressure curves. The Icare Home tonometer records IOP, date, time, eye, and a quality score, which is not displayed to the patient. The data is retrieved by a health care provider via the Icare Clinic software.

The Icare Home app also has helpful information on how the iCare works and to guide patients regarding its use. Some ophthalmologists feel it is not appropriate to give patients access to their pressures 24 hours a day. However, this app seems to do this in a way that respects the practice and quailty of life of the treating ophthalmologists by not bombarding them with pressure measurements every few hours.

MDbackline is a web-based app that helps physicians to evaluate patient compliance, elicit common medication side effects, teach how to use drops, and educate patients about surgical options in glaucoma. It meets MACRA/MIPS mandates, and it drives online reviews from happy patients. It is an automated app powered by artificial intelligence.

Calculating Targets

There are some apps that are blurring the line between the physician’s care and technology, and glaucoma specialists have varying opinions on these. There’s an app that will help calculate the target intraocular pressure. There is an app that can calculate the ocular hypertension risk score and therefore gives a 5-year likelihood of developing glaucoma. Again, some ophthalmologists would prefer to retain control of these measurements for continuity of care.

In my opinion, IOL calculation apps can be invaluable. Every surgeon will from time to time have a patient with biometry that’s not quite ideal. Surgeons could decide a different lens would be useful, and they may not be able to get into the office to reprint scans from the biometry, but if they have the A constant and the keratometry, using an app like IOLcalc can help, for example, if the Hoffer Q wasn’t calculated but surgeons realize that’s what they would like to use. The LRI Calc app is also great for femto-relaxing incisions. It can help surgeons decide where and how big to make an arcuate. Of course, surgeons doing this will want to talk to experienced surgeons because manual and LRI calculations done by femto are a little different. But, at the same time, surgeons should know how to translate between the two.

Conclusion

Technology enhances health care. There are many different options available for ophthalmologists and patients alike when it comes to apps and technology - for health care in general and glaucoma management specifically. Mostly these apps leverage the incredible power of the supercomputers that we call our cell phones. There are sure to be more developments for glaucoma care as time marches forward. GP

References

  1. Varadaraj V, Friedman DS, Boland MV. Association of an electronic health record-linked glaucoma medical reminder with patient satisfaction. JAMA Ophthalmol. 2018 Dec 13. [Epub ahead of print]