Eyeworld

92 | EYEWORLD | APRIL 2020 Contact Shaw: Bryan_Shaw@baylor.edu Matossian: cmatossian@matossianeye.com by Maxine Lipner Senior Contributing Writer M any 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 recommend- ing to patients. Detecting pediatric disorders The CRADLE (ComputeR Assisted Detector of LEukocoria) White Eye Detector app can help parents detect conditions such as retino- blastoma, cataract, refractive error, and amblyo- pia 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 work- ing 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 study 1 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 treat- ment. "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 compli- ance 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 med- ications 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 Dis- ease Index (OSDI) score. Filling out the ques- tionnaires 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 wheth- er 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. Matos- sian said. There are a variety of apps that magni- fy 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. I NSIDE THE PRACTICE Putting patients' smartphones to work 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 Reference 1. Munson MC, et al. Autonomous early detection of eye disease in childhood photographs. Sci Adv. 2019;5:eaax6363. Relevant disclosures Matossian: None Shaw: None

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