Smartphones are so much more than telephones. They are compact, mobile computers that have replaced so many different devices—video cameras, still cameras, music players, televisions, navigation devices, and so much more. Even in the ophthalmology world, we can use our smartphones to do intraocular lens calculations, check visual acuity, document clinical findings, review results of diagnostic tests, learn from surgical videos, orient toric intraocular lenses, and there is more to come. Future devices promise a detailed ophthalmic examination, from a corneal topography to a retinal scan, all from the convenience of your mobile phone.
A recently released device, costing just $30, allows the measurement of a patient’s refraction directly from the phone with a high degree of accuracy. With a self-done refraction and the availability of inexpensive spectacles from online vendors, does this spell the end of the need to visit a doctor, either an ophthalmologist or an optometrist, for glasses? Unfortunately, I think that some people will forgo the benefit of a full clinical examination to save the cost of the clinic visit. The makers of these at-home auto-refractors advise customers that the numbers generated from the refraction do not constitute an actual glasses prescription, but nothing prevents the consumer from ordering glasses online with the data.
But what about the people who have no access to an ophthalmologist or optometrist? Having a smartphone-enabled device to measure the refraction and some other parts of an eye examination is better than going without. As screening devices, these new apps and products could play a significant role in public health. Apps and devices that take a non-mydriatic, panoramic retinal photograph with a smartphone could be used to upload these images for reading and analysis. Even that could be done by a machine using artificial intelligence nomograms. Imagine being able identify patients with proliferative diabetic retinopathy or diabetic macular edema from screens of thousands or even millions of people.
The problem arises when consumers get a reading for the refraction and mistakenly assumes that all is well with their eyes, when in reality they could have any number of sight-threatening issues such as glaucoma, cataract, or retinal disease. We realize that these apps and devices cannot and do not take the place of a trained physician. And certainly, these diagnostic devices do not offer any intervention or therapy to treat disease. However, as ophthalmologists, we should embrace new technologies and find ways to integrate them into our practices so that we can spend more of our time treating patients who need our help.