It doesn’t matter if you’re in India, Indiana or Italy, rural populations are underserved in eyecare. If you live in Iqaluit in Nunavut, Canada (home to the Northern Territories’ only paved street), you’re not going anywhere by road until winter comes – as it’s only then that that the ice roads over the Arctic Ocean can be driven across. It’s helicopter or nothing there. So if you’re not able to get to a well-equipped and staffed hospital with an eye department, you’re not going to do as well as your counterparts in closer proximity. There’s an unmet medical need for better eyecare there. What can be done? Miniaturization has been a blessing here. If you think about electroretinography – what used to require a big box in a laboratory now needs a battery-powered handheld device. A number of manufacturers make OCT instruments that guide a user through the process of performing the scan – although there’s often regulatory reasons to prohibit it, I’ve seen two instruments on the show floors that essentially allows users to perform the OCT imaging themselves. I certainly could. There are now handheld fundus cameras and tonometers that you can give patients to take home with them and monitor their own IOP, and €5 durable, portable ophthalmoscopes (1). If you look at the smartphone app stores, there are any number of eye test and information apps there – and although many aren’t validated, some are (2). Then there are the bespoke apps: we’ve covered a few over the years, including Gobiquity’s GoCheckKids Amblyopia (and strabismus) screening app (3), and Krista Kelly and her colleagues’ iPad game for treating it (4). The endgame is clearly something similar to what Alex Walsh and Pearse Keane described: all-in-one diagnostic binoculars with OCT and screens that are cheap enough to give to patients for their own use at home.
Smartphone retinal imaging has come a long way from the days of holding a phone at just the right distance from a Volk 20 D lens (6)! I’ve followed the story of Peek Retina since noticing it on the crowdfunding website, IndieGoGo, in 2013 (I was an early backer and got mine earlier this year). The quality is great: good enough for optic disc imaging and grading (7). Happily, there’s now a trend toward longer-acting formulations – the Ozurdexes, Iluviens and the bimatoprost-eluting periocular rings, plus everything else that’s in development. So what it comes down to is cost. ‘Rural’ often means ‘poor’. The diagnostics are getting cheaper and more available to those with the greatest unmet needs. Let’s hope the therapies do too.
Mark Hillen
Editor
References
- R Steer, “Briging the Idea to Life”, The Ophthalmologist, 41, 16–21 (2017). Available at: top.txp.to/issues/0517/401 J Vaughan, D Huang, “Two-Tap Amblyopia Screening”, The Ophthalmologist, 9, 26–28 (2014). Available at: top.txp.to/issues/0614/401 R McGuigan, “The App That Cuts Clinic Queues”, The Ophthalmologist, R Steer, “Amblyopia: Game On”, The Ophthalmologist, 36, 11 (2016). Available at: top.txp.to/issues/1116/204 P Keane, A Walsh, “The Eye Exam’s Quantum Leap”, 26, 20–27 (2016). Available at: top.txp.to/issues/0116/301 M Hillen, “Smart(phone) Ophthalmoscopy”, The Ophthalmologist, 3, 12 (2013). Available at: top.txp.to/issues/0313/203 A Bastawrous et al., “Clinical Validation of a Smartphone-Based Adapter for Optic Disc Imaging in Kenya”, JAMA Ophthalmol, 134, 151–158 (2016). PMID: 26606110.
