Remote tele-ophthalmology: advice and guidance for urgent eye conditions for iPad/iPhone (children)

NHS Grampian’s Eye Health Network is a managed network involving over 150 optometrists from 58 community optometry practices. The network works alongside the hospital eye service at Aberdeen Royal Infirmary and Dr Gray’s Hospital, Elgin.

Situation

Within the NHS, the general practitioner (GP) has traditionally been the first point of contact for most patients with an eye problem. However, GPs often do not have the necessary equipment, or see a large enough volume of eye emergencies, to effectively diagnose and treat more complex acute eye conditions.

This means there are avoidable attendances where these patients go to hospital eye departments for ophthalmologists to diagnose and manage minor eye conditions. This led to increased demands on an already strained hospital eye service and recognition that many acute eye patients attending hospital could be managed in the community by primary care optometrists.

Aspiration

NHS Grampian wanted to redesign its eye health service to better meet the needs of its population and improve patient access for acute eye care. It specifically wanted to work more closely with primary care optometrists and to create strong links with secondary care for advice and guidance.

Solution and impact

The applications (apps) and website for NHS Grampian’s Eye Health Network clinical guidelines were developed in 2016 as part of the National Ophthalmology Workstream. The aim of the website and apps was to improve standardisation, accessibility, usability and currency of primary care optometry clinical guidelines and pathways, which are adapted from national guidance from the College of Optometrists and agreed by all local eye care stakeholders.

These support more management in primary care as well as better referral and advice and guidance for shared care. These can be easily accessed by primary and secondary care on computers, smartphones and tablet devices.

As part of this guidance they currently endorse the use of Kay Pictures iSight Professional app as part of home visual acuity testing on iPhone. Visual acuity is a key clinical test required to assess any eye care patient and the ability to measure remotely supports remote care and the ability of the patient to self-monitor their eye condition. Younger children have specific requirements for vision testing - checks routinely used for adults are not suitable.

Functionality

Kay Pictures iSight professional app is a smartphone-based vision check app on the Apple Store for children or adults. It allows a patient’s visual acuity to be tested with Kay pictures with the added benefit of convenience - it can be used anywhere with a smartphone. The app can also be configured for different testing environments.

Capabilities

• Measures vision (visual acuity)
• Proven to be as accurate as conventional vision tests in peer-reviewed research
• Apple iPads or iPhones
• Fast and easy to use
• Accurate and repeatable results
• Useful at all ages
• Scores are provided in standard units of Snellen (including metric 6/6 and imperial 20/20) - and LogMAR (0.0)
• Does not collect any personally-identifiable data

Scope

The app is not intended for home use, but could be used with careful advice and oversight from patients’ eye care professionals.

• Measure children’s vision accurately at home, remotely at a GP practice, on the ward or in A&E
• May also be more suitable for those with reduced mental capacity or learning disabilities
• For remote consultations or in environments where it is not possible to use a visual acuity chart

Key figures/quotes 

• Near Kay pictures on the iSight app are clinically interchangeable with the traditional printed Kay pictures
• “The best acuity app out there. The new Kay Pictures app is looking great. Ideal for clinic, school screening, bedside and domiciliary testing.” Iain Livingstone (consultant ophthalmologist)

Find out more

Read the Community Eye Care COVID-19 emergency response guidance here

Download further information about Healthcare Improvement Scotland’s service review of NHS Grampian Eye Health Network (PDF, 418 KB)

Case study on Kay Pictures iSight Professional

Researchgate website - Kay Pictures case study

iSight Test Professional vision testing app demo