OptiCare: A Mobile Vision-Screening Application PDF

CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 1 OptiCare: A Mobile Vision-Screening Application for Teleoptometry Ellison Maurice C. Paguagan and Mon...

CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 1 OptiCare: A Mobile Vision-Screening Application for Teleoptometry Ellison Maurice C. Paguagan and Monina Gazelle Charina B. Carandang Abstract— OptiCare is a mobile vision-screening application Health (DOH) reported a high number of Filipinos with vari- designed to provide teleoptometry services to individuals who ous eye conditions: 1.1 million with cataracts, 400,000 with an have limited access to eye care services. This study presents uncorrected error of refraction, almost 300,000 with glaucoma, the development, implementation, and evaluation of OptiCare as a solution to the growing need for accessible and affordable 200,000 with maculopathy and quite an alarming number of eye care, including the use of near-visual acuity testing, central over 4 million Filipinos living with undiagnosed eye problems vision testing, and color vision testing. The usability of the that need to be addressed. Geographical disparities in application was evaluated by using the System Usability Scale accessibility and availability of health resources remain obsta- (SUS) questionnaire, which yielded an average SUS score of 87.25 cles to eye care for many Filipinos. Many community-based obtained from patients, indicating a favorable level of usability, and an average SUS score of 92.5 obtained from optometrists, health centers lack the necessary equipment for comprehensive reflecting an even higher level of usability. eye examinations, and regional hospitals face similar resource limitations. This was further worsened by the onslaught Index Terms— eye care, digitized eye exams, mobile application of the recent Coronavirus-19 (COVID-19) pandemic, a global catastrophe that forced countries around the world to undergo lockdown , which heavily impacted healthcare systems I. I NTRODUCTION around the world ,. As the Philippines went through A. Background of the Study various stages of quarantine and classifications of alert levels, Eye care is an integral part of our health care. Taking it for physical distancing was implemented and public gatherings granted could lead to further profound impacts if not given were restricted, making the routine practice of optometry in enough attention. That is why just like any other medical an office setting with face-to-face interactions difficult. The professional, eye doctors, also known as Optometrists, recom- COVID-19 pandemic forced healthcare providers, including mend that patients undergo regular examinations, generally at eyecare professionals, to find ways to reduce the risk of in- least once a year. When determining your ocular health office exposure while still providing high-quality care. This and visual ability, Optometrists use specialized clinical and includes de-prioritization of eye health, with health facilities diagnostic techniques and tests. By using these tests, an prioritizing treating COVID-19 patients and increasing vac- Optometrist can assess if you need glasses and identify any cination rates; non-COVID patients avoided hospitals out of eye conditions, ensuring that you have optimal vision. The fear of contracting the disease; and there were not enough most basic and manual method of having a comprehensive eye educators to communicate and promote eye health, particularly exam, which is also often practiced by non-specialists and op- in rural areas. In spite of that, with the advancement and ticians locally, involves the assessment of the reading capacity accessibility of technology comes the opportunity to utilize it of eyes from a given distance. These manual methods use in the medical context in the form of telemedicine. several instruments that resemble printed handouts or texts, to Vision and technology have, in a sense, always gotten along. be viewed and read by the patient. The patient is instructed to Humans are constantly looking for new methods to leverage read aloud a text of various font sizes while keeping both eyes the power of technology to enhance their visual abilities, from open and covering one eye at a time. The Optometrist keeps electron microscopes to camera phones to the Hubble tele- experimenting with lens combinations until the suitable power scope. Telemedicine allows healthcare professionals to evalu- is found based on how easily the alphabet and characters can ate, diagnose and treat patients at a distance using telecom- be read. munications technology. Technology for telemedicine has According to the World Health Organization (WHO), at been available since the mid-20th century. Its potential to least 2.2 billion people have near or distance vision impairment improve healthcare access has been recognized for several around the world, and 1 billion people, or almost half of these decades; however, the much-awaited increase in its utilization cases, vision impairment could have been prevented or has is yet to be observed. In the field of optometry, telemedicine yet to be addressed. In the Philippines, The Department of is considered among the most promising solutions to address inadequate access to eye care practitioners, especially in rural Presented to the Faculty of the Institute of Computer Science, University communities. Concurrently, the need for telemedicine services of the Philippines Los Baños in partial fulfillment of the requirements for the Degree of Bachelor of Science in Computer Science has dramatically increased in response to the necessity to continue providing important optometry services during the COVID-19 epidemic, and the field has moved quickly toward © 2023 ICS University of the Philippines Los Baños CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 2 the adoption and implementation of teleoptometry, a form of II. R EVIEW OF R ELATED L ITERATURE healthcare technology that allows patients to receive eye care The role of Optometrists in telemedicine is quickly evolv- services remotely using telecommunication and information ing with great potential. Teleoptometry, as defined by the technologies. Federation of Optometric Regulatory Authorities of Canada (FORAC), is the provision of vision and eye health services B. Statement of the Problem that are delivered within the scope of practice of optometry us- As a result of the urgent need to continue offering vi- ing electronic health information, medical and communication tal optometry services during the pandemic, demand for technologies, and where the provider and patient are separated telemedicine services has sharply increased. Moreover, there by remote distance. It is a feasible supplement to the is still a lack of access to eyecare for individuals in remote or delivery of eye care, or a replacement for in-person optometric underserved areas. Even for those who do have access to eye- services when necessary. The feasibility of teleoptometry as care, the process of scheduling and traveling to appointments an auxiliary to face-to-face optometric care via telemedicine can be time-consuming and inconvenient. was observed in a study conducted by Massie, Block, and Morjaria (2022). Furthermore, Optometrists’ participation in delivering eye care services via telemedicine provides C. Significance of the Study significant value for many people, including the elderly, those The teleoptometry application aims to assist Optometrists in with disabilities, and people living in rural areas. providing high-quality eye care and to provide accessible and In the Philippines, healthcare delivery was already evolving affordable eye care services to individuals who have limited at a rapid pace, but the COVID-19 crisis has further accelerated access to such services by digitizing standardized eye exams this transformation. Healthcare for Filipinos is now more eas- and implementing the concept of teleoptometry. ily available with the introduction of mWell, the nation’s first fully integrated health and wellness mobile app. mWell D. Objectives of the Study is a high-performance mobile app supported by a powerhouse of top names in the healthcare, wellness, and IT industries, The general objective of this study is to develop a mobile including CareSpan, LotusFlare, Ping An, TELUS, Phicare, vision-screening application for teleoptometry. Specifically, Keralty, and Paymaya. Users of the mWell app may the application aims: get online teleconsultations from a network of specialists in- 1) To keep track and manage both Optometrist and pa- cluding dermatologists, gastroenterologists, internal medicine tient information and examination data via a clinic experts, gynecologists, pediatricians, and psychiatrists from administrator-side module; anywhere in the country. Additionally, users get access to 2) To facilitate digitized eye exams between patients and wellness, parenting, and fitness programs, as well as nutrition Optometrists, including near-visual acuity testing, central and family health management services. Similar apps and vision testing, and color vision testing, and to provide telemedicine services in the Philippines have also started to accurate and reliable results that can be used to diagnose rise. AIDE, Medgate, KonsultaMD, Kitika, and DockoTo, to and manage eye conditions via an optometrist-side and name a few. In spite of these, data and telemedicine patient-side module; and that focus specifically on teleoptometry are scarce. One study 3) To evaluate the usability and effectiveness of the user-side by Chan (2021) revealed that local eye centers/institutes of the vision-screening mobile application. are increasing the utilization of teleophthalmology during this present pandemic. Moreover, a recent online nationwide E. Scope and Limitations of the Study survey by Azarcon, et al. involving 327 trainee and consultant The application may not be able to diagnose or treat ophthalmologists revealed that the COVID-19 pandemic has refractive errors and more complex or rare eye conditions, spurred an increase in teleophthalmology utilization with an which would still require in-person examination and care from increased willingness to engage in virtual consultations from an Optometrist. Another limitation of the application would pre-pandemic (53%) to during (90%) the pandemic. be that it may not be able to accurately test for all types of There have been several implementations in the develop- vision problems, such as visual field defects and visual acuity ment of vision-screening applications as an effort to implement errors, which may require specialized equipment and testing. digital teleoptomery applications. In 2021, Satgunam et al. Additionally, the application may not be suitable for use in conducted a study on identifying and validating smart- certain populations, such as very young children, people who phone based vision-screening apps that can be used in teleoph- have visual problems but without prescription, and individuals thalmology. One of the applications was SmartOptometry, with cognitive or physical impairments, who may not be able which specializes in measuring near-vision acuity. The results to accurately complete the vision tests. Finally, the application showed that the majority (90%) of the participants use Android may also be limited by the availability and quality of the platform, and the instructions or testing was also reasonably device’s display, which could potentially affect the accuracy clear to both clinical and non-clinical staff. Moreover, it was of the test results. also found that SmartOptometry can be used for patients being followed up with disease conditions (e.g., age-related macular degeneration) that affect near-visual acuity. Another CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 3 application that was tested was Peek Acuity, which specializes 2) Optometrist in measuring distance visual acuity. The study showed that The Optometrist can view their schedule and availabil- neither age nor refractive error significantly affected distance ity within the app. visual acuity measurement by using the application. Moreover, The Optometrist can manage their availability by mark- based on the results carried out by Bastawrous et al. (2015) ing specific time slots as available or unavailable for which aimed to validate Peek Acuity to be used for clin- appointments. ical practice and community-based fieldwork, the smartphone The Optometrist can cancel appointments if needed, app was equally reliable as the standard paper-based charts notifying the patient about the cancellation. and the illuminated vision box in an eye clinic. The study The Optometrist can access and review digitized eye conducted by Bhaskaran et al. (2022) also concluded that exams for their patients within the app. the smartphone application-based visual acuity (EyeChart and The Optometrist can send a copy of the patient’s eye Peek Acuity) compared with traditional visual acuity showed exam results through the app. no statistically significant difference observed. This means that 3) Patient they are still comparable and within the acceptable range, and The patient is required to register within the application can be used as an effective, reliable, and feasible alternative to access its features. to assess visual acuity in tele-opthalmology, especially during The patient can view a list of available optometrists pandemic times. Overall, the study by Satgunam et al. and can schedule appointments with any available concluded that the said apps have the potential to play an optometrist. important role in televisual acuity testing as they were feasible The patient can select a preferred timeslot from the and reasonably accurate to use for estimating distance and available options and automatically secure the appoint- near- visual acuity. ment if it’s available. III. M ETHODOLOGY The patient can cancel their appointments, notifying the Optometrist about the cancellation. A. Development Tools The patient will only gain access to the digitized eye A laptop with the following specifications was used in exams once they have checked in to their scheduled developing the mobile vision-screening application: appointment with the optometrist. Operating System: Windows 10 64-bit Processor: Intel® Core™ i5-9300H CPU @ 2.40GHz C. Features Memory: 16 GB DDR4 The following software development tools and technologies This section is divided into four parts: clinic administrator, were used in developing the mobile vision-screening applica- optometrist, patient, and application-aided eye exams. tion: 1) Clinic Administrator Visual Studio Code Log in A source-code editor that served as the environment for Clinic administrators can log in to the application using developing the application. their provided account credentials. Cloud Firestore Create Optometrist Accounts A flexible, scalable NoSQL cloud database that served as Clinic administrators have the ability to create accounts the database. for the optometrists working under their clinic. Neces- React Native sary information is needed as input, such as : An open-source UI software framework that was used to a. Email develop the mobile application. b. Password Firebase c. Name A backend-as-a-service platform that served as the sys- d. Contact Number tem’s backend. e. Professional Regulation Commission (PRC) Pro- fessional Identification Card B. Types of Users View Optometrists The use case diagram is shown in Fig. 1. The following are Clinic administrators can access a list of optometrists the different types of users that use the application: working under their clinic. They can view their basic 1) Clinic Administrator information and scheduled patient appointments. The clinic administrator has exclusive access to view View Patients the contents of the database. Clinic administrators have the privilege to view pa- The clinic administrator can create user accounts for tients’ information and examination data associated the optometrists working under the clinic. with their clinic, including accessing patients’ basic in- The clinic administrator has the ability to view and formation, details of eye exam results, and any relevant manage the information of both optometrists and pa- information related to the patients’ eye health. tients, including their personal details and examination 2) Optometrist data within the app. CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 4 View Account Information View history of medical records Optometrists can access, view, and modify their ac- Patients can access their electronic medical records on count information. the application, providing a historical record of their View calendar of appointments eye exam results over time. Optometrists can access their own calendar within the 4) Application-aided eye exams app, which displays scheduled patient appointments. a) Comprehensive Eye Exam Overview Manage availability The application-aided eye exams provide users with a Optometrists can mark specific time slots as available concise yet informative description of the eye exami- or unavailable for appointments, indicating their avail- nation, offering key details about its purpose, method- ability for patient bookings. ology, and the specific areas of the eye being assessed. Receive notifications b) Guide instructions Optometrists receive notifications about upcoming and The application-aided eye exams begin with pre-exam cancelled appointments. instructional guidance, where users are provided with View Patients intuitive, on-screen instructions that offer step-by-step Optometrists can view a list of their patients along with guidance for each eye exam. their basic information and medical records. c) Diagnostic report generation Grant access to eye exams The application-aided eye exams generate detailed re- Optometrists can grant access to digitized eye exams ports summarizing the eye exam results and diagnoses for their patients by checking-in to the scheduled provided by the Optometrist. appointment. d) Near-visual acuity test Send eye exam results The application-aided eye exams can conduct a near- Optometrists can send a copy of their patient’s eye visual acuity test using the Jaeger’s Card which con- exam results through the app. tains letters or paragraphs of text of increasing text 3) Patient sizes. Register e) Central vision test Patients are required to register within the application The application-aided eye exams can conduct a central to access its features. Necessary information is needed vision test using the Amsler Grid, a square-shaped grid as input, such as: resembling a checkerboard, and a dot in the middle a. Email ,. b. Password f) Color vision test c. Name The application-aided eye exams can conduct a color d. Sex vision test using the Ishihara Test which consists of a e. Birthday set of plates with dots of different colors and sizes that f. Occupation form shapes or one- or two-digit numbers. g. Contact Number h. Address i. Medical Case History View Account Information Patients can access, view, and modify their account information. View Optometrists Patients can view a list of available optometrists within the app and have the flexibility to schedule appoint- ments with any optometrist who is available. Schedule Appointments Patients can select a preferred timeslot from the avail- able options and automatically secure the appointment if it’s available. Receive notifications Patients can receive notifications about their upcoming and cancelled appointments, and eye exam results. Receive and view eye exam results Patients can receive and view a copy of their eye exam results within the application. Additionally, patients have the option to download the eye exam results, allowing them to save a local copy for their records or further analysis. CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 5 Fig. 1. Use Case Diagram for OptiCare: Vision-Screening Application D. Database Design The database design consists of five entities: Clinic Administrator, Optometrist, Patient, Schedule, and Medical Record. Each entity has a unique ID. The unified modeling language diagram is shown in Fig. 2. Fig. 2. Unified Modeling Language (UML) diagram for the Vision-Screening Application CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 6 E. Flowchart The flowchart of the vision-screening process is shown in Fig. 3. Fig. 3. Flowchart of the Vision Screening Process CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 7 IV. R ESULTS AND D ISCUSSION administrator has full access to view and manage the per- A. Development Stage sonal information and examination data of both optometrists and patients. This includes details such as profiles, contact During the development stage of the project, Firebase information, and relevant records. Screenshots of the clinic proved to be an invaluable resource, offering a range of administrator-side module are shown on Fig. 9 to 12. services and tools that facilitated the implementation of cru- cial features within the application. The free Spark Plan of Firebase was utilized, which provided a solid foundation for C. Optometrist-side Module development but came with certain limitations that needed to The Optometrist-side module of the app offers a seamless be considered. experience for optometrists, starting with the creation and Firebase Authentication, with its email verification feature, verification of their accounts. Clinic administrators create played a vital role in ensuring secure user registration and optometrist accounts and send registration verification links to login processes. The email verification functionality helped the optometrists’ emails. Firebase Email and Password-based establish trust and security within the application. However, Authentication was used for this feature. it is important to note that the free Spark Plan of Firebase Once successfully verified, optometrists can log in to the imposes limitations on certain resources. Under the Spark app and will be greeted with three main screens available Plan, there are specific limitations for Firebase Authentication. in the bottom tab navigator: Schedule, Medical Records, and New account creation is restricted to 100 accounts per IP Profile. The optometrist-side module provides an overview address per hour. The number of address verification emails of the optometrist’s calendar, displaying scheduled patient that can be sent is limited to 1000 emails per day, while the appointments. Optometrists can manage their availability by maximum number of address verification links that can be sent marking specific dates and time slots as either available or un- is 10,000 emails per day. Additionally, the free plan allows for available for patient bookings. They also receive notifications a maximum of 150 password reset emails and 1500 password regarding upcoming or cancelled appointments. The module reset links to be sent per day. also enables optometrists to check in to the appointment, Cloud Storage for Firebase offered reliable storage for file granting access to digitized eye exams for their patients. uploads such as the user profile pictures and Optometrists’ During an ongoing appointment, optometrists can monitor the Professional Regulation Commission (PRC) IDs. However, it progress of the patient’s eye exams through the Status Progress has certain limitations that should be considered under the screen. This allows them to track in real-time which exams the Spark Plan. The storage capacity is limited to 5GB, which patient is currently answering, which exams are pending, and includes both the original files and any derived versions (such which ones are completed. Once the patient completes the eye as thumbnails or resized images). The number of operations exams, optometrists can review and analyze the results. They per day is limited to 20,000 reads and 50,000 writes. are required to input their diagnosis and recommendations Firebase Cloud Messaging (FCM) played a vital role in for the patient. The module facilitates the transmission of enabling push notifications within the application. However, the eye exam results to the patient. Optometrists can also it is important to note that the free Spark Plan of Firebase access their list of patients, view their past medical records comes with certain limitations in terms of FCM usage. The and appointments, ensuring comprehensive and convenient daily quota for sending messages is limited to 500 notifications management. Additionally, optometrists can view and edit per day. Additionally, the number of registered devices allowed their own profile, updating necessary information as needed. for receiving messages is limited to 1000 devices. Screenshots of the optometrist-side module are shown on Fig. React Native with Expo served as the development frame- 13 to 17. work for building the mobile application, offering several advantages. Expo’s streamlined workflow and hot-reloading D. Patient-side Module feature enabled rapid prototyping and faster development cycles. The extensive collection of pre-built components and The Patient-side module of the app offers a user-friendly APIs simplified UI implementation and data handling. Expo’s and comprehensive experience for patients seeking eye care cloud-based infrastructure simplified the build and deployment services. To begin, patients are required to register an account process, making it easy to publish the app to the Android using their email and password, along with essential personal platform. Additionally, Expo’s build service allowed for easy information. After signing up, users receive a registration creation of test versions of the application, enabling efficient verification link via email, ensuring the security and validity distribution and testing on multiple devices. of their account. Firebase Email and Password-based Au- thentication was utilized for this feature. Furthermore, the patient-side module enables patients to view a list of available B. Clinic Administrator-side Module optometrists within the app, giving them the flexibility to The Clinic Administrator account is pre-existing and does schedule appointments with any available optometrist. Patients not require registration. The administrator account is assigned can select a preferred timeslot from the available options and to the clinic owner or authorized personnel responsible for automatically secure the appointment if it is still available. managing the app. This module empowers the clinic admin- They also receive notifications about cancelled appointments, istrator to create and register user accounts specifically for ensuring timely updates. the optometrists associated with the clinic. Additionally, the CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 8 Once the account is verified, patients can log in and ac- based on the responses to the SUS. The scores were then cess the app. Upon entering, patients are greeted with three used to calculate the mean score, which provides an overall main screens located in the bottom tab navigator: Schedule, assessment of the application’s usability. Medical Certificates, and Profile. The patient-side module Based on the average SUS score of 87.25 for patients and allows patients to view their calendar of scheduled appoint- 92.5 for optometrists, the application can be classified as ments, providing a clear overview of their upcoming eye excellent in terms of usability for both user groups. care consultations. Once the scheduled appointment begins, For patients, the highest scores were given to statements patients gain access to digitized eye exams by checking in with S5, S6, and S8, all receiving a translated score of 3.7. their designated optometrist. The module presents patients These positive responses indicate that patients appreciated the with three eye exams: Jaeger’s Card Test, Amsler Grid Test, seamless integration of functions and found the system to be and Ishihara Test. Each exam is accompanied by a concise straightforward. On the other hand, the lowest scores were yet informative description, providing key details about its given to statements S9 and S10, receiving translated scores purpose, instructions, and specific areas of the eye being of 3.3 and 3.5, respectively. These lower scores suggest that assessed. After completing the eye exams, the optometrist patients felt less confident in their ability to use the system reviews and analyzes the results. The app sends a notification without additional learning or support, potentially indicating to the patient once the test results have been released by a need for clearer instructions or more intuitive features. the optometrist. Patients can access their electronic medical Similarly, for optometrists, the highest scores were given certificates within the application, offering a comprehensive to statements S1 and S7, both receiving a translated score of summary of their eye exam results over time. Additionally, 4. These positive responses indicate that optometrists found the module allows patients to generate a medical certificate in the system appealing, and user-friendly, and expected it to be the form of a detailed PDF report. Screenshots of the patient- quickly adaptable for most users. In contrast, the lowest scores side module are shown on Fig. 18 to 25. were given to statements S9 and S10, receiving a translated score of 3.6 and 2.8, respectively. These lower scores suggest E. Testing that optometrists expressed a slightly lower level of confidence in using the system, perceiving a need for more initial learning The usability of the OptiCare application was evaluated before feeling proficient. through the participation of 10 patients and 5 optometrists as During the survey, respondents were also given the oppor- respondents who were carefully selected from Quiapo, Manila. tunity to provide optional suggestions for improvements, as Quiapo, with its diverse population and numerous optometric well as share their commendations about the application. care facilities, was chosen as a significant hub for optometry, Patients expressed their appreciation for the ease of manag- ensuring that the sample represented the broader optometry ing appointments and navigating through the application. They community. The System Usability Scale (SUS) question- found the app to be intuitive and user-friendly, enhancing their naire was utilized to assess the usability of the application overall experience. Some patients also suggested enhancing from the perspective of these user groups. The SUS consisted the user interface to make it even more visually appealing of statements evaluating the usability of the application. Each and intuitive. Additionally, there was a recommendation to respondent rated the statements on a five-point scale, ranging implement a validation step during registration to ensure the from ”Strongly Disagree” to ”Strongly Agree.” The average accuracy and existence of email addresses before sending the SUS score obtained for patients was 87.25, indicating a verification link. favorable level of usability. For optometrists, the average SUS Optometrists also commended the application for its ease of score was 92.5, reflecting an even higher level of usability. The use and convenience. They found it beneficial for enhancing individual scores for patients and optometrists are depicted in eye care accessibility. In fact, some optometrists went further Figure 4 and 5, respectively. The following statements were and recommended the application to their colleagues and included: patients, recognizing its potential in improving eye care ac- 1) I think that I would like to use this system frequently. cessibility and convenience for both optometrists and patients. 2) I found the system unnecessarily complex. These results demonstrate the positive usability of the 3) I thought the system was easy to use. application, while also highlighting areas where improvements 4) I think that I would need the support of a technical person can be made to enhance usability and user confidence and to be able to use this system. address specific concerns. By incorporating user feedback and 5) I found the various functions in this system were well suggestions, the application can further enhance its usability integrated. and overall user experience for both patients and optometrists. 6) I thought there was too much inconsistency in this system. 7) I would imagine that most people would learn to use this system very quickly. 8) I found the system very awkward to use. 9) I felt very confident using the system. 10) I needed to learn a lot of things before I could get going with this system. In the evaluation phase, individual scores were computed CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 9 Individual more guidance or clarification during the remote examination S10 S1 S2 S3 S4 S5 S6 S7 S8 S9 Resp. Score process. Moreover, it is recommended to expand the features of the 1 4 2 4 3 4 2 4 2 4 2 72.5 application to include more diagnostic techniques and tests 2 4 2 4 1 5 2 4 2 5 1 85 that can be done remotely. Specifically, the inclusion of tests such as the Farnsworth-Munsell 100 Hue Test (FM100) would 3 5 1 5 1 5 1 5 1 4 1 97.5 enhance the application’s ability to assess color discrimination 4 4 2 4 1 5 1 4 1 5 1 90 and identify color vision deficiencies. It is a color-arrangement test that consists of four rows of similar color hues, each 5 4 1 5 1 5 1 4 1 5 1 95 containing 25 variations, where observers adjust the hue tiles 6 5 1 5 1 5 1 5 1 5 1 100 between fixed anchor points to assess their ability to discern color differences. This will require collaboration with 7 5 2 4 3 5 1 4 1 3 3 77.5 other medical professionals to ensure that all necessary tests 8 4 2 4 2 5 1 5 1 4 2 85 are included in the application. Additionally, it is highly recommended to make the applica- 9 5 1 5 2 4 1 4 1 4 2 87.5 tion color-blind-friendly. This involves considering the specific 10 4 2 4 1 4 2 5 2 4 1 82.5 needs and requirements of color-blind individuals to ensure that they can comfortably use the application. Implementing Mean 87.25 color-blind-friendly features such as alternative color palettes Fig. 4. Individual Scores Table for Patients or additional visual cues will enhance the accessibility and usability of the application for color-blind users. Furthermore, it is recommended to make the application Individual available on iOS devices, as it is currently limited to Android. S10 S1 S2 S3 S4 S5 S6 S7 S8 S9 Resp. Expanding the platform compatibility will broaden the reach Score and accessibility of the application, allowing a larger user base 1 5 1 5 2 4 2 5 1 5 2 90 to benefit from remote vision screening. 2 5 1 5 1 5 1 5 1 5 2 97.5 Finally, further studies can be conducted to evaluate the long-term effectiveness of using the application in managing 3 5 1 4 1 5 1 5 2 4 2 90 eye conditions. This will involve monitoring patients who have 4 5 1 5 1 5 1 5 1 5 3 95 used the application over an extended period to determine if there are any improvements in their eye health outcomes 5 5 1 5 3 5 1 5 1 4 2 90 compared to those who received traditional in-person eye Mean 92.5 exams. With these improvements, OptiCare can become an even Fig. 5. Individual Scores Table for Optometrists more powerful tool for remote vision screening application for teleoptometry. Additionally, as telemedicine becomes more V. C ONCLUSION AND F UTURE W ORK widely adopted in healthcare, it can serve as a model for The study was able to successfully develop a mobile vision- other similar applications that aim to provide high-quality care screening application for teleoptometry to address the need for remotely. a more convenient and accessible way of having regular eye exams. The application has achieved its objectives of keeping track and managing both optometrist and patient information and examination data, facilitating digitized eye exams between patients and optometrists, and evaluating the usability and effectiveness of the user-side of the vision-screening mobile application. For future work, improving the user experience of the application is recommended. To be more specific, consid- ering the feedback from patients and optometrists express- ing less confidence in their ability to use the application, it is recommended to explore the implementation of open cameras during consultation appointments. Allowing open cameras would enable a real-time visual connection between patients and optometrists, potentially improving communica- tion, addressing any concerns or questions, and enhancing the overall teleoptometry experience. This feature could provide additional support and reassurance to users who may require CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 10 A PPENDIX I S CREENSHOTS OF THE A PPLICATION A. Clinic Administrator-side Module Fig. 8. Patient List Screen Fig. 6. View Users Screen Fig. 9. Register an Optometrist Screen Fig. 7. Optometrist List Screen CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 11 B. Optometrist-side Module Fig. 12. Eye Exam Status Progress Screen Fig. 10. Scheduled Appointments Screen Fig. 11. Set Available Date and Time Slots Screen Screen CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 12 Fig. 14. Patient Medical Records Screen C. Patient-side Module Fig. 13. Eye Exam Results Screen Fig. 15. Scheduled Appointments Screen CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 13 Fig. 16. Select Available Optometrist Screen Fig. 18. Eye Exams Screen Fig. 17. Select Available Date and Time slots Screen Fig. 19. Jaeger’s Card Test CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 14 Fig. 20. Amsler Grid Test Fig. 22. Medical Records Screen D. Common Screens Fig. 21. Ishihara Test Fig. 23. Medical Record CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 15 Fig. 24. Medical Certificate Fig. 26. Edit Profile Screen Fig. 25. Profile Screen Fig. 27. Notifications Dropdown CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 16 A. Arghittu, M. Dettori, E. Dempsey, et al., “Health Communication in COVID-19 Era: Experiences from the Italian VaccinarSı̀ Network Websites,” International Journal of Environmental Research and Public Health, vol. 18, no. 11, p. 5642, Jan. 2021, number: 11 Publisher: Multidisciplinary Digital Publishing Institute. [Online]. Available: https://www.mdpi.com/1660-4601/18/11/5642 C. R. Wells and A. P. Galvani, “Impact of the COVID-19 pandemic on cancer incidence and mortality,” The Lancet Public Health, vol. 7, no. 6, pp. e490–e491, June 2022, publisher: Elsevier. [Online]. Available: https://www.thelancet.com/journals/lanpub/article/PIIS2468- 2667(22)00111-6/fulltext “Study Confirms Validity of At-Home Visual Acuity Tests,” Apr. 2022. [Online]. Available: https://www.reviewofoptometry.com/article/study- confirms-validity-of-athome-visual-acuity-tests “Indonesia, Philippines & Vietnam: Building on lessons learned to enhance eyecare services beyond COVID-19,” Jan. 2022. [Online]. Available: https://www.novartis.com/ph-en/news/media- releases/indonesia-philippines-vietnam-building-lessons-learned- enhance-eyecare-services-beyond-covid-19 “What is Telemedicine? | Telemedicine System.” [Online]. Available: https://chironhealth.com/telemedicine/what-is-telemedicine/ J. Massie, S. S. Block, and P. Morjaria, “The Role of Optometry in the Delivery of Eye Care via Telehealth: A Systematic Literature Review,” Telemedicine and e-Health, May 2022, publisher: Mary Ann Liebert, Inc., publishers 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA. [Online]. Available: https://www.liebertpub.com/doi/ 10.1089/tmj.2021.0537 “Teleoptometry During COVID- 19: A Guide | The Canadian Association of Optometrists,” Apr. 2020. [Online]. Available: https: //opto.ca/teleoptometry-during-covid-19-a-guide A. Hani, “Philippine Healthcare Expands with Health and Fig. 28. Sidebar Drawer Wellness Mobile App - OpenGov Asia,” Aug. 2021, section: Healthtech. [Online]. Available: https://opengovasia.com/philippine- healthcare-expanded-with-its-first-health-and-wellness-mobile-app/ ACKNOWLEDGMENT J. Castillo, “mWell rolls out first nationwide Virtual Medical Mission,” I would like to express my heartfelt gratitude to my Special Aug. 2021, section: Tech News. [Online]. Available: https://mb.com.ph/ 2021/08/09/mwell-rolls-out-first-nationwide-virtual-medical-mission/ Problem adviser, Prof. Monina Gazelle Charina B. Carandang, D. Chan and P. Ronque, “The digital footprint of Philippine eye care for her guidance, wisdom, and support throughout my re- centres in the onset of the COVID-19 pandemic,” Future Healthc J, search. My gratitude also goes to the UPLB Computer Science vol. 8, no. 2, pp. e331–e332, July 2021. C. P. Azarcon, F. K. T. Ranche, and D. E. Santiago, “Tele- Society for providing me with opportunities to learn, grow Ophthalmology Practices and Attitudes in the Philippines in Light and explore my interests in computer science. Finally, I would of the COVID-19 Pandemic: A Survey,” Clinical Ophthalmology, like to express my gratitude to my family and closest friends vol. 15, pp. 1239–1247, Mar. 2021, publisher: Dove Press. [Online]. Available: https://www.dovepress.com/tele-ophthalmology-practices- for their unconditional love and support which have been the and-attitudes-in-the-philippines-in-light-peer-reviewed-fulltext-article- driving force behind my academic achievements. OPTH P. Satgunam, M. Thankur, V. Sachdeva, S. Reddy, and P. K. Rani, “Validation of visual acuity applications for teleophthalmology during R EFERENCES COVID-19,” Indian J Ophthalmol, vol. 69, no. 2, pp. 385–390, Feb. “The Importance of an Annual Visit with an Eye Doctor,” Apr. 2020, 2021. section: Eye Doctor. [Online]. Available: https://www.carmieyecare. A. Bastawrous, H. K. Rono, I. A. T. Livingstone, H. A. com/blog/the-importance-of-an-annual-visit-with-an-eye-doctor/ Weiss, S. Jordan, H. Kuper, and M. J. Burton, “Development H. Patel, “Importance of Regular Eye Checks and the and Validation of a Smartphone-Based Visual Acuity Test (Peek Check-up Procedure,” Sept. 2018, section: Health. [Online]. Acuity) for Clinical Practice and Community-Based Fieldwork,” Available: https://www.news-medical.net/health/Importance-of-Regular- JAMA Ophthalmology, vol. 133, no. 8, pp. 930–937, Aug. Eye-Checks-Procedure.aspx 2015, eprint: https://jamanetwork.com/journals/jamaophthalmology/ World Health Organization, “Vision impairment and blindness.” articlepdf/2296911/eoi150043.pdf. [Online]. Available: https://doi.org/ [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/ 10.1001/jamaophthalmol.2015.1468 blindness-and-visual-impairment A. Bhaskaran, M. Babu, B. Abhilash, N. A. Sudhakar, and V. Dixitha, G. H. Romualdez, “Four million Filipinos have undiagnosed eye “Comparison of smartphone application-based visual acuity with tradi- problems,” Nov. 2019, section: Health & Fitness. [Online]. 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Heiting, “Eye Tests, the Eye Chart and 20/20 Vision https://apps.who.int/iris/handle/10665/275436 Explained.” [Online]. Available: https://www.allaboutvision.com/eye- L. Forchette, W. Sebastian, and T. Liu, “A Comprehensive Review of test/free-eye-chart/ COVID-19 Virology, Vaccines, Variants, and Therapeutics,” Current M. C. Stoppler, “Medical Definition of Amsler grid,” Mar. 2021. Medical Science, vol. 41, no. 6, pp. 1037–1051, Dec. 2021. [Online]. [Online]. Available: https://www.rxlist.com/amsler grid/definition.htm Available: https://doi.org/10.1007/s11596-021-2395-1 K. Boyd and R. Janigian Jr, “Have AMD? Save Your Sight with an Amsler Grid - American Academy of Ophthalmology,” May 2020. [Online]. Available: https://www.aao.org/eye-health/tips- prevention/facts-about-amsler-grid-daily-vision-test CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 17 D. Brennan, “Color Blind Test: 5 Types of Tests For Color Blindness,” Jan. 2022. [Online]. Available: https://www.webmd.com/eye-health/ what-you-need-to-know-about-color-blindness-tests J. Brooke, “Sus: A quick and dirty usability scale,” Usability Eval. Ind., vol. 189, 11 1995. M. B. Cranwell, B. Pearce, C. Loveridge, and A. C. Hurlbert, “Performance on the Farnsworth-Munsell 100-Hue Test Is Significantly Related to Nonverbal IQ,” Investigative Ophthalmology Visual Science, vol. 56, no. 5, pp. 3171–3178, 05 2015. [Online]. Available: https://doi.org/10.1167/iovs.14-16094 Ellison Maurice C. Paguagan is a Computer Sci- ence student from the University of the Philippines Los Baños. He served as the Membership Committee Head (A.Y. 2021-2022) of the UPLB Computer Science Society.