EyeSpy Consults: A decision-support app to improve neuro-ophthalmology consult confidence

The problem

The first time I became aware of the training gap in neuro‑ophthalmology was during my neurology residency. Even though we had more dedicated neuro‑ophthalmology time than many neurology programs, the field still felt somewhat esoteric to a lot of us as neurology trainees. Later, during my neuro-ophthalmology fellowship, I saw similar uncertainty among ophthalmology residents when they were asked to evaluate patients with neuro-ophthalmic issues. In both settings, I saw how often trainees were being asked to navigate neuro-ophthalmology without a built-in structure for how to think through these cases, even though a solid neuro-ophthalmology foundation is essential for anyone who wants to be a well-rounded neurologist or ophthalmologist.

Background

My experiences reflected a broader educational gap that has been documented in studies examining neuro-ophthalmology training among both neurology and ophthalmology residents. Prior studies have demonstrated that residents often have limited exposure to neuro-ophthalmology during training, and many report lower confidence when they are asked to evaluate such cases.^1,2 Across programs, neuro‑ophthalmology exposure is highly variable and frequently shaped by faculty availability and institutional resources.² Recent medical education studies suggest that interactive, case‑based approaches can improve engagement, diagnostic reasoning, confidence, and knowledge retention.^3,4 Digital tools can further support trainees by improving accessibility and enabling “just‑in‑time learning” at the point of care.⁵ Structured diagnostic frameworks and stepwise reasoning models have also been described as useful for organizing information and reinforcing systematic clinical reasoning.⁶ Despite these advances, relatively few structured, interactive tools currently exist within neuro‑ophthalmology.

Study hypothesis

This knowledge led me to co-create a project, EyeSpy Consults, that seeks to close that gap. It is an interactive app-based guide that helps trainees think through neuro-ophthalmology consults step by step, building both confidence and clinical reasoning. I partnered with John Payne, BS, in information technology, who is a cloud engineer with experience in app development, to facilitate the technical aspects. Nurhan Torun, MD, chief of the division of ophthalmology at Beth Israel Deaconess Medical Center in Boston, MA is my faculty sponsor.

The tool is modeled loosely after AMBOSS, a comprehensive, AI-powered digital medical knowledge platform and question bank for students and clinicians worldwide to study, prepare for exams, and support clinical decisions. However, EyeSpy Consults provides a tighter focus on how trainees should think through consults in real time. The goal is to help them reason the way a neuro-ophthalmologist does: step by step, organized, and intentional.

My colleagues and I hypothesized that EyeSpy Consults would help trainees feel more confident and develop a structured, step-wise approach to neuro-ophthalmology consults. By strengthening foundational knowledge and clinical reasoning, the tool aims to enhance consult quality by helping trainees ask better questions, focus their exams, and recognize when a neuro-ophthalmic issue truly warrants subspecialty input.

The target study population will include neurology and ophthalmology residents.

The intervention

The app will be organized around 3 main entry points: by symptom, by suspected diagnosis, or by exam finding. Under “symptoms,” users can start with common presentations such as vision loss, diplopia, ptosis, or anisocoria. For example, selecting vision loss will branch into transient versus persistent, then unilateral versus bilateral. From there, it will walk the user through the key questions to ask and explain why those questions matter. Each branch will also include “do-not-miss” prompts to highlight details that separate urgent from non-urgent cases. The figure shows an example of a path through the app.

If the trainee already has a suspected diagnosis in mind, they can navigate to focused sections on conditions like optic neuritis, giant cell arteritis, myasthenia gravis, central retinal artery occlusion, Graves orbitopathy, and non-arteritic anterior ischemic optic neuropathy. Each includes brief summaries, recommended testing, and management pearls.

The exam findings section will cover key ocular signs such as optic disc edema and anisocoria, providing structured guidance on how to interpret and approach these findings during a consult.

Each topic includes short expandable links for background reading, and every pathway ends with what tests or imaging to order, when to order them, and when to call neuro-ophthalmology urgently versus when outpatient follow-up is appropriate.

The tool will be piloted with neurology and ophthalmology residents during their consult rotations. Trainees will use the app during consults and complete pre- and post-use surveys assessing their confidence, comfort with approach, and overall usability. Qualitative feedback from trainees also will facilitate ongoing refinement of the app during the timeline of intervention.

This project will be long-term, continuing into my attendance. Though the app is created, its decision trees will undergo rigorous review to ensure accuracy, flexibility (as not all cases are straightforward), and usability (eg, how many clicks will get the trainee to the top differentials when that trainee has a busy emergency department day). The current goal is for the most common consults (specifically to not miss diagnoses) before we aim for an expanded comprehensive approach.

Outcome variables

The primary outcomes will be changes in trainee confidence and comfort when approaching neuro-ophthalmology consults, measured through pre- and post-intervention surveys using a 5-point Likert scale. Secondary outcomes will include improvement in trainees’ ability to describe a structured approach to common consults and identify key “do-not-miss” features, as well as the perceived usefulness and usability of the app in real clinical settings.

It is iPhone-based but will be available for Android use. My hope overall is that it will make neuro-ophthalmic consults a little less scary for trainees and help them understand the beauty of neuro-ophthalmology.

References

1. Lee AG, Volpe NJ, Eggenberger ER, et al. Neuro-ophthalmology education in neurology residency training programs. J Neuro-Ophthalmol. 2021;41:e414-e419.

2. Kirkman MA, Moss HE, Lee AG. Variability in neuro-ophthalmology training within ophthalmology residency programs. Eye. 2020;34:1545-1550.

3. Sun M, Reddy RM, Erwin PJ, et al. Simulation and case-based learning in neurology education: a systematic review. Neurology. 2020;95:e304-e312.

4. Dhar R, El-Sourady M, Ramani S, et al. Case-based and simulation-based learning improve clinical reasoning and learner confidence in graduate medical education. Acad Med. 2022;97:1018-1025.

5. Lin DS, Patel RM, Kiang S, et al. Just-in-time mobile learning in clinical education: a systematic review. BMC Med Edu. 2021;21:82.

6. Patel VL, Groen GJ. Knowledge based solution strategies in medical reasoning. Cogn Sci. 1986;10:91-116.