Need an eye test or worried you’re going deaf? Apps to use now

During my last eye test I paid £10 extra for anOptical Coherence Tomography scan. This takes detailed pictures of the rear of the eye, which can be used to spot early signs of diabetes, macular degeneration and multiple sclerosis.

But do I still need to go all the way to an optician? MyReaderNumber, a recently published app, makes it possible to assess eyesight using just a smartphone. It’s simple. You pay £2.49 to download the app (you will need an iPhone 11 or later) and then create an account. After that you answer a few basic questions and take the tests.

There are two. The first is for your near-distance reading prescription (a book, for example). Take your smartphone away from your eyes until you can comfortably read some text on the screen, then press the “measure” tab in much the same way you’d take a selfie. There is a second measurement to establish your mid-distance sight, eg reading a computer screen.

For most people the MyReaderNumber prescription you receive at the end of the process is at least good enough for buying reading glasses at a pharmacy. I could use it to order lenses online. After answering an online questionnaire from a company called Lensology I was offered a pair of varifocal lenses for £48.25 (they cost me more than £100 at Specsavers). I also found a pair of frames I liked at glassesdirect.com for £65 (including a second pair).

I am always losing or accidentally sitting on my glasses so using this DIY process I could be saving myself a lot of money.

There are other self-test visual acuity apps with more functions too. Verana Health’s vision test app is free and comes with an added function: an Amsler grid that can help detect signs of macular degeneration (the macula is the central part of the retina responsible for central, colour and detailed vision). Staring at a dot in the centre of the Amsler grid, seeing any or missing or distorted squares might suggest I had a problem.

I came through that test with flying colours. No, not actual flying colours. Floaters and flashes can be a sign of retinal detachment, which is also a very serious problem.

So should I really be entrusting my eyesight to a smartphone app? In 2019 the journal Nature reviewed 42 “visual acuity” apps and found that, although they displayed “potential”, the overall verdict was quite muted.

“The validity and reliability has not been established,” the journal harrumphed, although there is surely a place for them where proper ophthalmic care is hard to find. In 2013 Andrew Bastawrous, a British former NHS ophthalmologist, developed Peek (portable eye examination kit), another smartphone eye-test app, and trialled it in Kenya.

Since then it has helped thousands of people in Kenya, Botswana, Tanzania and India who might otherwise have gone blind to find their way to better care. The World Health Organization (WHO) estimates there are a billion people worldwide with preventable vision impairment.

Louise Gow is a doctor of optometry and specialist lead for eye health at the Royal National Institute of Blind People. For those of us lucky enough to have access to proper ophthalmic care she thinks an eye test once every two years is in order, more in some cases.

“Fifty per cent of eyesight loss is avoidable, so if a smartphone app makes you take an interest, fine,’’ Gow says. “But these tests cannot replace a proper eye test, which will not only assess visual acuity but can also offer early warning signs of high blood pressure, glaucoma, diabetes, multiple sclerosis, even strokes.”

The pandemic has been bad for our eyes. Working via Zoom and endless “doomscrolling” on smartphones has been a huge challenge for our eyeballs.

“While there is no evidence screen light impairs vision permanently, we know that the blue screen light can disrupt sleep patterns and cause digital eye strain,” Gow says. “The latter isn’t permanent but leads to tired eyes, reduced blink rate and dry eyes. The rule for any sort of screen time is 20/20/20. Every 20 minutes look away from your screen for 20 seconds, preferably extending your gaze for 20 yards. The other things known to damage eyesight are smoking and doing DIY without adequate eye protection, both of which were quite popular during the pandemic too.”

With your eyesight sorted, you can also use your smartphone to self-test for hearing impairment. This is important since, in many ways, the implications of hearing loss are even more serious than sight loss.

According to WHO statistics, almost 50 per cent of teenagers and young adults aged 12 to 35 are at risk of hearing impairment as a result of exposure to loud music on smartphones or powerful modern PA systems. In older people hearing impairment can be a factor in social isolation and contribute to the onset of dementia.

And yet, despite many years at rock concerts and listening to Spotify on powerful headphones, I have never undergone a hearing test.

My first test is on the Royal National Institute For the Deaf (RNID) website. You find a quiet spot and take its “noise and digit” test. A woman reads a series of three digits numbers in what sounds like the hiss and static of a torrential downpour. You type the numbers you hear into a keypad.

With each round, the background noise becomes louder and her voice less distinct. By the end I was craning into my phone speaker like a member of the resistance straining to hear a crucial radio message. Unsurprisingly, after three minutes of this, I received the gloomy information: “Your results suggest you may have hearing loss.”

Officially the RNID suggests I see an audiologist but first I decide to try the Mimi hearing test app. After downloading it onto my smartphone I am offered two assessments: the quietest sound I can hear at four different frequencies (between 500Hz and 4KHz) and the quietest sound I can hear in a noisy environment. The results were then collated and measured against WHO guidelines for normal hearing.

I found the tests, one for each ear, a bit fiddly, but at the end the app produced an audiogram for me. The hearing loss, although not great, was slightly worse in my left ear than my right. That baffled me. I put it down to 20 years of children nagging me about pocket money and me learning not to listen to what they are saying from the passenger seat of my car.

Jesal Vishnuram, the technology adviser to the RNID, says that while adults ought to think about testing their hearing regularly from about the age of 45, youngsters are beginning to show more awareness of the noisy world they inhabit.

“Even the electronics giant Apple is itself conducting the Apple Hearing Study, collecting data directly from its millions of smartphone users,” she says.

According to Apple’s hearing tests, 20 per cent of participants have experienced hearing loss by WHO standards. “The odd thing is while eye tests and dental check-ups are taken seriously, going to an audiologist is not,” Vishnuram says. “An app can be a useful starting point but you really need a professional examination too.”

Although often overlooked, audiology tests are free on the NHS, as are a range of hi-tech hearing aids often enabled with Bluetooth (they allow wearers to stream music, podcasts and TV sound straight from a smartphone).

“The world has never been noisier, especially for young people exposed to high decibel sounds through headphones on a daily basis,” Vishnuram says. “My advice is: take your hearing as seriously as your eyesight.”

The idea that a smartphone can offer immediate triage on a number of medical conditions can be addictive. After testing sight and hearing I found myself exploring an app called Elbow Decide that diagnoses common elbow ailments in 3D.

I was also rather taken with MDacne, which asks you to take a photo of your skin before diagnosing and suggesting treatments for acne. Pregnant women might be interested in the Ovia Health app allowing them to track the growth of their foetus in real-time. The app will compare it to the size of different fruit or even a dessert.

According to Nature there are more than 350,000 e-health apps on the market with about 200 new ones published each day. Messing about with them might be harmless but never assume they are ready to replace your GP, optician or audiologist just yet.

“They can be a starting point,” Gow says. “But when it comes to proper diagnosis, a professional with all the equipment, lateral thinking and intuition they bring is still the best.”