Study: Patient-oriented mobile applications in ophthalmology.

Fascinating little abstract in "Clinical and Experimental Optometry". This caught my eye for three reasons:

1. I disagreed with the very first sentence, at least at first glance.

2. Dry eye is highlighted... unsurprisingly... as having the highest download rate for applications related to this disease group.

3. I'm an aspiring software developer. I have (casting modesty aside briefly) mind-blowing ideas about database and software applications that can be helpful to chronic dry eye disease patients and their doctors, and anything about mobile applications in ophthalmology was bound to catch my eye.

This abstract starts off with the statement:

"Mobile solutions will improve patient care only if they are equally valued by physicians and their patients".

I read that and said to myself: "That's not background information. That's a hypothesis. And for dry eye, I think it's wrong!"

Of course, they're not wrong, and the study authors' whole point is they want ophthalmologists to pay attention and get involved in software development so that applications will be developed that they consider to be useful. But the whole thing reminded me of why I feel mobile apps are critical for progress in raising the standard of care in dry eye, and why I myself am heading down the software development path.

So let's take OSDI, the little 12-question survey instrument for dry eye symptoms that has been used in most major dry eye clinical trials (such as for Restasis' original FDA approval). OSDI has a simple smartphone app - which is, in fact, a key reason why I recommend this particular symptom survey to virtually every dry eye patient, for the purpose of quantifying their symptom frequency and severity in a way that can be helpful for communication with their doctors. You can keep a history to view on-screen and you can export the data. (Note: Some dry eye specialists routinely ask patients to complete some kind of symptom questionnaire at each visit, but they are a small minority of eye doctors.)

Suppose a dry eye patient begins scoring themselves now and then on OSDI.

The first thing that is going to happen is that they will get in the habit of seeing their symptoms as DATA, i.e. numbers, as opposed to "complaints" (either in the medical or lay sense of the word). This is a significant shift in thinking: they are moving from the purely subjective to the quantifiable. That patient is already going to be much better equipped to communicate with their doctor in the doctor's own language, which has a high probability of making their next eye doctor visit proceed differently from previous ones.

Now let's go back to the data: What if they score themselves on their OSDI smartphone app at regular intervals. Every week, say. That means that before long, they will have, not just numbers, but patterns. That in turn means they know more about their symptoms than they did before, because no one is going to accurately remember how they felt for that long. It also means that they have a chronology. They can take that data, if they want, and put it on a timeline alongside the timeline of the treatment(s) they are on. Did their symptoms change while on this treatment? That's important data, and it's much more reliable than just thinking you are or aren't feeling better now than you were three months ago.

Then suppose the patient proceeds to the next step and communicates those scores to their doctor, in print or electronic copy so that it can become part of their medical record. That's potentially game-changing. Suddenly we have numbers, not just complaints, and we have a history of numbers, which can be lined up against a history of treatments and remedies, and these numbers are every bit as important as any other numbers, whether osmolarity or meibography or staining or Schirmer. Bear in mind that patient priorities for dry eye outcomes are dramatically different from doctors' priorities, as Saldanha et al recently demonstrated in JAMA Ophthalmology. Patients don't really care about their osmolarity or their meibography if their symptoms are better. Among many other things, having credible numbers to quantity the outcomes that WE want to modify is crucial for getting buy-in from doctors to pursue primarily the treatments that will improve those outcomes. And mobile applications are the way that will be accomplished.

Here's the abstract:

Clin Exp Optom. 2018 Aug 30. doi: 10.1111/cxo.12830. [Epub ahead of print]
Patient-oriented mobile applications in ophthalmology.
Skrzypecki J1,2, Stańska K1, Grabska-Liberek I2.
Author information

"Abstract
BACKGROUND:
Mobile solutions will improve patient care only if they are equally valued by physicians and their patients. Although mobile applications are gaining acceptance among ophthalmologists and optometrists, little is known about their adoption among patients. Therefore, this study was designed to analyse the market for patient-oriented mobile applications in ophthalmology.
METHODS:
Search engines of Google Play and App Store were utilised to find patient-oriented mobile applications. All applications were divided into seven subspecialties; dry eye, strabismus and amblyopia, macular degeneration, cataract, glaucoma, diabetic retinopathy and general ophthalmology. Subsequently, number of downloads, average patient rating, year of release and source of clinical information provided in the application were collected. Furthermore, in order to evaluate whether development of software responds to epidemiological demand, number of applications in each subspecialty was correlated with the prevalence of particular diseases.
RESULTS:
Fifty-six applications that met established criteria were found. The overall number of downloads was estimated at the level of 1.5 million, whereas the weighted average rating for all applications was 4.21/5. The number of applications by subspecialty did not correlate with the prevalence of particular eye disorder. The dry eye was the most frequently downloaded and best rated subspecialty.
CONCLUSIONS:
The overall number of patient-oriented applications in ophthalmology is low. Subspecialties are not equally equipped with patient-oriented mobile solutions. Furthermore, the number of applications or downloads in each subspecialty does not correlate with the number of potential users such as patients with particular eye disorders. Finally, ophthalmologists should encourage software developers to meet future demand for mobile solutions in eye disorders."
 

Study: Dry eye relationship to depression, anxiety and stress in 16-35 year olds

I am longing to get my hands on the full study... but I decided I was too impatient and wanted to go ahead and post this. I can always blog about it again when I learn more. This study actually was the first thing in a long time to motivate me to dust off my LinkedIn password in hopes of being able to connect with the lead author.

Thoughtful analysis of the mental health impact of dry eye disease always catches my eye, and this one had the added attraction of specifically addressing young people.

The authors studied 211 subjects aged 16-35 (mean age 21) and found that while OSDI scores did not correlate with clinical signs of dry eye (as we know, that correlation is elusive!), they sure did correlate with quality of life, depression, anxiety and stress. Furthermore, the severity of dry eye symptoms picked up in those OSDI scores had more of an impact on depression than the other mental health aspects studied. 

Eye Contact Lens. 2018 Aug 20. doi: 10.1097/ICL.0000000000000550. [Epub ahead of print]
Impact of Dry Eye on Psychosomatic Symptoms and Quality of Life in a Healthy Youthful Clinical Sample.
Asiedu K1, Dzasimatu SK, Kyei S.

Abstract
OBJECTIVE:
To determine the impact of dry eye on quality of life, depression, anxiety, and stress in a healthy youthful clinical sample.

METHODS:
This was a clinic-based cross-sectional study. Subjects were patients visiting the University of Cape Coast Eye Clinic for comprehensive eye examination. The age range for recruitment into the study was 16 to 35 years. Eligible participants completed three questionnaires namely the Ocular Surface Disease Index (OSDI), short version of the depression, anxiety, and stress scale (DASS-21), dry eye quality of life score (DEQS) questionnaire. All eligible participants underwent clinical assessment including meibomian gland expressibility, corneal staining, tear breakup time, and Schirmer 1 test. The Spearman correlation coefficient was used to determine the relationship between variables. Univariate and multivariate analyses of variance were used to determine the impact of the OSDI score on DASS-21 subscales scores and the dry eye quality of life scores.

RESULTS:
All 211 subjects who met the inclusion criteria were included in the analysis. The mean age for the entire sample was 21.6±3.0 years with a range of (17-31) years. Spearman correlation coefficient showed a statistically significant association between OSDI scores and DEQSs (P<0.001), anxiety scores (P<0.001), depression scores (P<0.001), and stress scores (P<0.001). Spearman correlation coefficient showed no statistically significant association between clinical test results and quality of life scores (P>0.05), DASS-21 subscales scores (P>0.05), except anxiety subscale and meibomian gland expressibility score (P=0.026). There were no statistically significant association between clinical test results and OSDI scores (P>0.05) except for the tear breakup time (P=0.018). Using Pillai's trace in the multivariate analysis of variance (MANOVA), there was a significant effect of OSDI severity classification on depression, anxiety, and stress subscales scores of the DASS-21, V=0.37, F(3, 207)=9.67, P<0.001. Furthermore, separate univariate analyses of variances on the outcome variables revealed a significant effect of OSDI severity classification on depression F(3, 207)=35.24, P<0.001, anxiety F(3, 207)=25.27, P<0.001, and stress F(3, 207)=13.08, P<0.001. The MANOVA was followed up with a discriminant analysis, which revealed three discriminant functions. When subjects were classified according to the OSDI grading of severity, there were a statistically significant difference between all levels of severity dry eye symptoms for the DEQSs (F(3, 207) = 63.9.3 P<0.001, η=0.48).

CONCLUSION:
The study showed that the severity of dry eye symptoms impacted on psychosomatic symptoms and quality of life. The study also revealed that the severity of dry eye symptoms impacted more on the depressive symptoms compared with other psychosomatic symptoms in this youthful clinical sample.