According to a new pilot study, patients with diabetes are adherent to -- and even enthusiastic about -- self-monitoring their vision with a mobile app, but the study was not able to quantitatively demonstrate a health effect from the intervention. Diabetic retinopathy, a degradation of vision that can lead to blindness, is one of the most common complications of diabetes.
"General findings are that diabetic patients, even though they have a lot on their plate — checking their sugar regularly, etc. — they enjoy using the mobile app because it simplifies this aspect of their healthcare," Dr. Irena Tsui, the lead investigator on the study, told MobiHealthNews. "Without it we would tell patients, 'If you notice a change in your vision please call us.' So that’s kind of a big thing. This is something concrete that patients can do at home."
Doctors at the Jules Stein Eye Institute at UCLA enrolled 60 patients with type 1 and 2 diabetes in the trial, instructing them to download and use the app to monitor their vision and report changes to a physician. Doctors, including both the patient's primary care physician and their vision specialist -- could log onto the back-end and see the results of the tests.
Tsui said the hope for the study was that constant engagement with the app would improve their control over their blood sugar. But the patients enrolled in the study were, for the most part, already well controlled. Researchers also found that because not all diabetes patients develop immediate vision problems, even when they have diabetic retinopathy, the app should be combined with other mobile means of monitoring diabetes, such as connected glucometers. Physicians also found it hard to fit a separate back-end into their workflow. Tsui hopes future iterations of the app can be incorporated into electronic health records.
Some individual patients benefitted greatly from the intervention, Tsui said, and she may write up a case study based on one particular patient.
"There were a few patients [who] had diabetic macular edema, and that does present vision changes on a pretty acute basis," she said. "One woman in particular, she’s a doctor, she would check on a weekly basis, and if she noticed a change she would come in. We would repeat the eye exam, take an X-Ray scan, and oftentimes it was right. The visual acuity at home would correlate with new swelling in her retina, and she would come in and get a shot."
The app used in the study, SightBook, is an iPhone, iPad, and iPod Touch app by DigiSight Technologies, a company led by Mark S. Blumenkranz, MD, a Professor and Chairman of the Byers Eye Institute and the Department of Ophthalmology at Stanford University. Within the app, patients can take a number of vision tests modified for the device: a visual acuity test, an Amsel Grid test for macular disease, and several additional contrast and acuity tests. Results are stored in an online account where they can also be accessed by a user's physician. The app also has organizational tools for managing scheduled appointments and logging treatments and office visits.
SightBook is not FDA-cleared; DigiSight writes on its website: "[O]ur Products and Services are not intended to diagnose, treat, cure or prevent any disease, but to serve as a preventative tool for you and/or your physician to use in support of your general health and wellbeing. The information on this Website or in emails or materials distributed to you by DigiSight, are designed for informational purposes only and are not intended to be a substitute for informed medical advice or care."
At least one iPhone vision test app has been cleared by the FDA, but only for prescription use. Texas-based Vital Art and Science is currently pursuing avenues to distribute MyVisionTrack via pharmaceutical companies as an adherence tool for medications and for clinical trials.
Tsui has a few visions for future versions of the study. One is simply to repeat it with a population that is at high risk for poor glycemic control, to see if the app can really move the needle on behavior change. She also sees great potential to combine the app with low-cost iPhone-enabled optical cameras recently developed at Stanford to help with vision screening for diabetic retinopathy in developing countries like Mexico.
