To develop an objective, standardized and efficient diagnostic tool and reporting system for Ice test and Neostigmine test for the diagnosis of Myasthenia Gravis by way of a smart phone App (Myasthenia -Dx).

Myasthenia gravis (MG) is a rare autoimmune neurological disorder affecting neuromuscular junction causing fluctuating muscle weakness and fatigue.  It has two major forms, Ocular Myasthenia Gravis (OMG) and Generalized Myasthenia Gravis (GMG). In OMG symptoms are restricted to the eye muscles, causing ptosis and diplopia whereas in GMG, symptoms are more generalized. More than 50% of patients of MG have ocular presentation. Ice test and Neostigmine test are simple yet high value bed side diagnostic tool for MG, however, objective and structured methods of reporting is lacking, and no smart phone-based diagnostic-application exists as of date.

Suspected patients of MG with ocular features are taken for Ice Test first then subsequently Neostigmine Test using Myasthenia-Dx App.  The app integrates two key diagnostic procedures into a guided workflow (vide QR code), allowing clinicians to systematically document patient demographics and clinical findings, capture standardized facial photographs at intervals, record objective clinical measurements viz. Palpebral Fissure, MRD and automatically generate structured reports facilitating quick bedside diagnosis. If margin reflex distance (MRD) or mid-pupillary diameter of Palpebral fissure increases by 2 mm or more, test is reported positive otherwise negative.

 Ice test is highly sensitive (86-92%) and specific (79-100%) for MG, making it the fastest, simplest and the most risk-free clinical test, whereas Neostigmine test has a sensitivity approx. 85% and specificity 84-100%.  However, false negative and false positive results can occur.