A good reference tool is necessary for ophthalmologists, especially when facing ophthalmic emergencies. Eye Emergency Manual made by Agency for Clinical Innovation is exactly that, and even more, broadening its scope to grasp almost everything in ophthalmology, from general terms to more specific, concerning emergency cases.
Although its creators state that the app is specifically designed to help medical practitioners in New South Wales, Eye Emergency Manual is an app that is actually useful worldwide.
Keep in mind that this is not a diagnostic app, it's just a reference tool since the information provided inside is not strictly evidence-based.
The design of the app is clean and simple. It's mostly textual based, with a lot of useful pictures and diagrams, that back up the information really well.
Introduction screen is the first thing you see upon starting up the app. It offers the basic information about the manual provided within the app, and how it's been structured.
As we could see from the introduction, the manual is subdivided into basic ophthalmic diagnostic techniques and treatments, and management of common eye conditions, supported by high graphic content. Each of the conditions is further subdivided into the following sections: Immediate action (if necessary), History, Examination, Treatment, and Follow-up. Each section has red flag points to indicate urgency or to increase triage weighting based on Australasian Triage Scale (ATS).
Finally, at the bottom of the Introduction screen, you'll find a link that leads you to the ACI website for further information.
You'll also notice that there are just two tabs beside Introduction: Emergency and Reference. While it doesn't look like that, the app actually offers a lot. There's a plenty of 'fancy' apps we saw and reviewed that actually failed to deliver what's necessary – reference and guidance. On the other side, Eye Emergency Manual may look simple, but it offers a lot more than many apps that pay more attention to interface than information.
You'll see this is true when you tap on the Emergency tab. There are three options available: Trauma, Acute Red Eye and Acute visual disturbance/Sudden loss of vision. Tapping on each option expands the list of conditions related to the main diagnose.
Trauma lists main eye presentations based on the type of trauma, such as lid laceration, ocular trauma (blunt and sharp), corneal foreign body, chemical and flash burns, blow-out fracture, and unexplained non-accidental injury, which offers the least information, i.e. brief advice on children exams.
Each condition has a designated category, which depends on the severity of trauma, and also suggests an urgency of treatment. There are five categories in total. Category 1 requires urgent treatment, Category 2 – treatment within 10 minutes, Category 3 – 30 minutes, Category 4 – 60 minutes and finally Category 5 requires ophthalmologist's response within two hours. Conditions listed under Trauma section mostly require Category 2-4 treatments.
As said previously, each condition follows similar pattern consisted of History, Examination, Treatment, and Follow-up sections, with optional description and advice on an immediate action (if necessary).
History is basically a set of questions that should help confirm initial diagnosis and gain knowledge about the cause of trauma and its severity, for example, which eye is injured, when and how injury happened, the origin of foreign body, velocity of impact, type of chemical that caused the burn, and so on. Answering those questions helps ophthalmologist gain more knowledge about the trauma and its severity, and decide on further actions.
The examination consists of standard techniques, which however depends on type and severity of trauma. This section suggests a range of techniques from visual acuity, slit lamp, superficial and fundus examination, etc.
Treatment is suggested next, depending on examination results. Type of trauma also defines how each treatment would be conducted. Sometimes, a further investigation is required, such as CT scans (axial and coronal), which are suggested in case of ocular trauma or blow-out fractures.
A follow-up is required for any type of trauma, so the next section lists follow-up and referral steps depending on trauma type and severity, as well as initial treatment results.
The following section of the Eye Emergency Manual app is Acute Red Eye, listing a variety conditions causing a red eye, depending on presence or absence of pain. There's also and useful chart made by Dr. Weng Sehu that gives a better insight how these conditions are sorted.
Although, less severe than traumas, red eye condition also require urgent attention, from 30 to 120 minutes, depending on severity category, which is in the case of these conditions from 3-5.
Guidance for these conditions doesn't go as deep as in Trauma section, offering only a visual presentation of the condition, type of treatment and suggestion on follow-up or further investigation.
The last section of this app offers guidance for acute visual disturbances, i.e. sudden vision loss, whether they are transient such as Transient Ischaemic Attack, or persistent, such as vaso-occlusive disorders, optic nerve disorders or retinal detachment.
All conditions in this section belong to Category 3, requiring a response within 30 minutes. You'll get the list of sign and symptoms for each condition, along with visual presentation and investigation/management guidance.
Finally, Reference tab offers a couple of useful features, from visual anatomy, detailed steps in ophthalmic workup (including various exam techniques and types of medications), to useful links and emergency contact, which is useful only if you're 'down under.'
Nevertheless, this app offers a lot of useful information for ophthalmologists worldwide, as well as all medical providers facing some type of eye emergency.
The only objection we have is a lack of interactivity, which would make this type of app even better. Also, a navigation could be better implemented, because if there’s no Back button, users wouldn’t know where they are.
Benefit: A definite reference guide for ophthalmologists and medical providers facing some type of eye emergency.