Diabetes
Diabetes screening
To achieve wider screening , health systems need to address three key challenges . The first is to make screening affordable in health systems where tests are done out of pocket , as is the case in about 95 percent of the developing world .
and maculopathy is no longer the leading cause of certifiable blindness in the working age group as a result of screening done in general physician clinics ,” he said . “ The problem that you have is when you think of what ’ s been done in England and start asking if this can this be replicated elsewhere .”
To achieve wider screening , health systems need to address three key challenges . The first is to make screening affordable in health systems where tests are done out of pocket , as is the case in about 95 percent of the developing world .
Secondly , the device used for screening must be extremely simple to use by non-specialists . And thirdly , a tele-ophthalmology model needs to be adopted with so-called graders who are trained to determine the level of disease present in the retina .
“ The problem that you have in most developing nations is that all three of these present significant challenges because you don ’ t have quality certified programmes yet at scale in many of these places ,” Dr Anand said .
His decade-old startup has set out to reduce the cost of these devices and make them easier to use by introducing a smartphone imaging platform that allows a nurse practitioner or healthcare worker to take highquality pictures of the retina .
To address the need for specialist graders , Fundus On Phone uses artificial intelligence instead of ophthalmologists .
“ In a place like India , we have only 15,000-20,000 ophthalmologists for a total population of a billion . It made a lot more sense for us to start asking the question , ‘ Is it possible to look at AI as a means to be able to grade for referable diabetic retinopathy ?’” said Dr Anand . “ We have scaled the hardware and the AI globally and have been able to impact so far 7.5 million patients across the world .”
While the developing world , with its lack of resources and personnel and fast rising population of diabetics , may be an obvious market for a startup in this field , the issues encountered in developed markets like America are not so remote .
“ Why we exist is because diabetes is the leading cause of blindness here in the United States . Ninetyfive percent of it is completely preventable through early detection and treatment ,” said Steve Martin , chief executive of Intelligent Retinal Systems ( IRIS ), at Medical Festival Asia .
IRIS ’ mission is to end preventable blindness through the development and deployment of retinal diagnostic services at surgeries and clinics .
“ All of the quality metrics here recommend that a diabetic gets screened annually , yet fewer than 40 percent actually get it done ,” he said .
He ascribes the reason to the “ inconvenience ” a diabetic faces when seeing their GP , of being told to have separate eye screening done at an ophthalmology centre .
That is “ where the process breaks down ”, as the patient may be forced to take another day off work and have someone drive them to and from their appointment .
“ We need to go where the diabetics are . If they ’ re at home , at work , or going somewhere to do something , whether they ’ re seeing their primary care physician or perhaps going to a pharmacy to get their medicine filled – all of those places ,” Martin added .
To help overcome these challenges , Florida-based IRIS entered into a partnership with Remidio to bring Fundus on Phone to the American market in 2019 . Under their agreement , IRIS couples its software and services platform with Remidio ’ s handheld camera to allow more service providers to adopt telemedicine programmes in their practices to examine , detect , and diagnose retinal disease in diabetic patients . These are also now available in novel locations like drugstores and at patients ’ homes .
Since a credentialed and licenced ophthalmologist is needed to analyse retinal scans , images taken using Fundus cameras at clinics , pharmacies , or at home are uploaded to IRIS ’ platform .
IRIS then enhances the image and sends it to an ophthalmologist to look at both the original and enhanced image to assess the pathology .
“ One of the challenges that you ’ ll see is that you ’ ve got a varying degree of technical expertise of individuals taking these images out in the field . Also ,
50 APRIL 2021 GlobalHealthAsiaPacific . com