For those of you, who like me, have a teenager or pre-teen (or both!) in your house, the sight of a child absentmindedly performing household tasks with eyes glued to a phone will be a familiar one. I have to admit, I’m often guilty of the same faux pas; in this digital age of constant online access, I spend way too much time answering emails, checking the latest headlines, and yes, occasionally catching up on the latest celebrity gossip.
The world of medical practice has changed dramatically with the advent of smartphones. For one thing, patients now have a wealth of information at their fingertips. While there are clear advantages to providing countless, often free, resources for patient education, the information provided can also be misleading and sometimes even dangerous for naïve patients who may not know how to filter out scientific fact from fiction.
As physicians, the way we practice medicine has also evolved. The latest journal articles and preferred practice guidelines are readily and immediately available for my perusal. With the touch of a fingertip, I can pull up images of diseases that are rare in my practice, such as Zika virus chorioretinitis, to compare to findings in a patient I am currently seeing in clinic. For the more common end of the disease spectrum, I have friends who keep the standard reference photographs from the Early Treatment of Diabetic Retinopathy Study handy on their phones to help them grade diabetic retinopathy severity on a daily basis.
Over time, both patient and physician use of smartphone technology has become increasingly interactive. These days, we use our phones not just to access information but to improve access to timely care for patients. Multiple groups have focused on developing phone-based retinal imaging apps that may be used as platforms for telemedicine approaches to screen for diabetic retinopathy and other intraocular pathology. On a much smaller scale, fellows occasionally text me images from the emergency room or a patient’s bedside so we can quickly triage cases and develop an initial management plan. I receive some subpar images, but it is astonishing to me to see how good the quality of a fundus photograph can be when taken with a handheld phone camera through a 20-diopter lens. Patients are also quick to use smartphone tools to improve their care. Several of my patients with age-related macular degeneration check for metamorphopsia using Amsler grids stored on their cell phones and message my office for appointments as needed in between their regular follow-ups.
Smartphones can also have a substantial, although fortunately fleeting, adverse impact on visual function for some individuals. The newly described entity of “transient smartphone blindness” was first reported in 2 young patients who presented with episodic monocular vision loss that occurred after smartphone viewing in the dark and resolved after several minutes. A detailed history revealed that each of these patients experienced symptoms in the eye contralateral to the side on which they were lying while viewing their phone. The authors postulated that that the transient “blindness” in one eye was due to differential bleaching of the retinal photoreceptors in the light-adapted eye as compared with the other eye, which remained dark adapted due to being inadvertently covered by a pillow.
The highly specific phenomenon of transient smartphone blindness is unlikely to persuade anyone to curtail their phone use anytime soon. Overall, the age of the smartphone has been a boon to both patients and retinal physicians. Future advances in smartphone technology will increase processing speed, decrease cost, and heighten the sophistication of approaches to improving retinal care.