Smartphone-based ophthalmology for low-income countries:

Peek – the Portable Eye Examination Kit NES Optometry Annual Conference 26 October 2014

mario.giardini@strath.ac.uk

39 million people are blind 80% of blindness is avoidable 90% of blind people live in low-income countries

Image courtesy of Andrew Bastawrous – also see BJO (2012) 96:1357-1358

Blindness

Image courtesy of Andrew Bastawrous – also see BJO (2012) 96:1357-1358

Ophthalmologists

Kenya, 2012-2014

Kenya, 2012-2014

Kenya, 2012-2014

Kenya, 2012-2014

Kenya, 2012-2014

Kenya, 2012-2014

Smartphones for medicine

Comprehensive phone-based diagnostics A full pocket-size ophthalmology department

A comprehensive tool • Patient record with Geo-tagging • Visual Acuity • Visual field testing • Colour Vision Testing • Contrast Sensitivity Testing • Lens imaging for cataract • Retinal Imaging • Image grading

Kenya, 2012-2014

Visual acuity

Visual acuity

Visual acuity

Video: Andrew Bastawrous

Visual acuity

Retinal imaging

Looking at the retina

The direct ophthalmoscope

Images: Millodot, Dictionary of Optometry and Visual Science

Looking at the retina

The direct ophthalmoscope • Charles Babbage, 1847

• A light source • A method to reflect the light coaxially into the eye • (An optical means of correcting the sharpness of the image of the fundus…)

Image: Optometry in Practice 4 (2003) 137-145

The direct ophthalmoscope • 1851:Herman von Helmoltz, der Augenspiegel • 1879: the light bulb ( 1885) • 89 models collected by Landolt and Snellen in 1880 • 200 models by 1913 • 1915: the battery handle

• Very limited field (5 deg) • Still today, a “guessing stick”

Image: Optometry in Practice 4 (2003) 137-145, & Welch Allyn

The direct ophthalmoscope

The guessing stick • It is difficult to use !!!

• Requires very close proximity between doctor and patient

• Only ~45% of hospital doctors feel confident with it

(Roberts et al , Postgrad Med J 1999;75:282–284)

• Attempted in only ~20% of headache/stroke/seizure patients presenting at an A&E in the UK (Dalay S et al, Clin Teacher 2013; 10: 103–106)

Image: Welch Allyn

Image source: ArcLight

The indirect ophthalmoscope

Images: Millodot, Dictionary of Optometry and Visual Science, & Mayo Clinic

Looking at the retina

Image: Willows Veterinary Centre

Looking at the retina

Image: Andrew Bastawrous

Looking at the retina

Images: Journal MTM 3:1:9-15, 2014 - doi:10.7309/jmtm.3.1.3

The indirect ophthalmoscope

Images: USPTO, Canon

The PanOptic™ configuration

Images: Welch Allyn

Looking at the retina

Images: Br J Ophthalmol 2014;98(4):438-441

iExaminer™

MK 0.1

Peek Mk 0.I

MK 0.1

The Peek ophthalmoscope MkII

The Peek ophthalmoscope MkII

The Peek ophthalmoscope MkII

• Field of view adaptation • Field of illumination adaptation • Co-centering between view and illumination • Flare suppression • Focussing

The Peek ophthalmoscope

Comparison with fundus camera

Topcon TRC-50EX Peek Ophthalmoscope

Comparison with fundus camera

Peek Ophthalmoscope Topcon TRC-50EX

The Peek ophthalmoscope

Minimum Maximum Mean Std. deviation

DRS+ 0.200 0.900 0.396 0.141

Peek 0.200 0.900 0.429 0.153

Cup-to-disk ratio

The Peek ophthalmoscope

Geotagging

In the field

Peek in the field • Kenya

• Traditional examinations and, separately, Peek used by community healthcare workers

• Antarctica • Assessing the participants to The Coldest Journey

(www.thecoldestjourney.org) • Teachers test Peek

• Pilot in 30 Kenyan schools • Funded by Seeing is Believing (Operation Eyesight Universal)

• Mali • Assessment of cerebral malaria (Medecins sans Frontieres)

• Botswana, …

Peek grows

Paediatric visual acuity I

Paediatric visual acuity II

Kudos • Design of the Year Award 2014 – Digital Section • Tech4Good Award – Digital Health Award • TED

Acknowledgments

Peek is a collaboration: • London School of Hygiene and Tropical Medicine • University of Strathclyde • Glasgow Centre for Ophthalmic Research

www.peekvision.org