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. 2024 Dec 18;12(24):2550.
doi: 10.3390/healthcare12242550.

User-Centred Design and Development of a Smartphone Application (OverSight) for Digital Phenotyping in Ophthalmology

Kishan Devraj  1 , Lee Jones  1 , Bethany Higgins  1 , Peter B M Thomas  1   2 , Mariya Moosajee  1   2   3
Affiliations

User-Centred Design and Development of a Smartphone Application (OverSight) for Digital Phenotyping in Ophthalmology

Kishan Devraj et al. Healthcare (Basel). .

Abstract

Background: Visual impairment can significantly impact an individual's daily activities. Patients require regular monitoring, typically occurring within hospital eye services. Capacity constraints have necessitated innovative solutions to improve patient care. Existing digital solutions rely on task-based digital home monitoring such as visual acuity testing. These require active involvement from patients and do not typically offer an indication of quality of life. Digital phenotyping refers to the use of personal digital devices to quantify passive behaviour for detecting clinically significant changes in vision and act as biomarkers for disease. Its uniqueness lies in the ability to detect changes passively. The objective was to co-design an accessible smartphone app (OverSight) for the purposes of digital phenotyping in people with sight impairment.

Methods: Development of OverSight included stakeholder consultations following principles of user-centred design. Apple iOS software frameworks (HealthKit, ResearchKit, and SensorKit) and a SwiftUI developer toolkit were used to enable the collection of active and passive data streams. Accessibility and usability were assessed using the System Usability Scale (SUS) and feedback following a 3-month pilot study. Consultations with patients informed the design of OverSight, including preferred survey scheduling and the relevancy of patient support resources.

Results: Twenty visually impaired participants (mean age 42 ± 19 years) were recruited to the pilot study. The average score on the SUS was 76.8 (±8.9), indicating good usability. There was a statistically significant moderate negative correlation between SUS scores and visual acuity in both the better (r = -0.494; p ≤ 0.001) and worse eye (r = -0.421; p ≤ 0.001).

Conclusions: OverSight offers promising potential for collecting patient-generated health data for the purposes of digital phenotyping in patients with eye disease. Through further testing and validation, this novel approach to patient care may ultimately provide opportunities for remote monitoring in ophthalmology.

Keywords: digital health; digital phenotyping; ophthalmology; remote sensing; software development.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
An illustration of the tech stack used to create the OverSight app. (A) Apple software frameworks. (B) OverSight app front end. (C) Cloud infrastructure.
Figure 2
Figure 2
Improved accessibility of surveys. (A) Survey developed using the ResearchKit framework, where the user is required to perform multiple actions to submit a response. (B) Survey developed using the SwiftUI toolkit, where fewer actions are required by the user and there is enhanced VoiceOver accessibility.
Figure 3
Figure 3
Scatterplot showing the relationship between better eye visual acuity (BEVA) in logMAR and scores on the System Usability Scale (SUS). Each point represents an individual participant. The grey-shaded area represents the normative 50th percentile for the SUS, which is considered the threshold for good usability. The majority of data points (n = 15) lie above this area, indicating most participants rated OverSight as having better than average usability.
See this image and copyright information in PMC

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