Projects funded by Seeing is Believing | Innovation Fund Phase Three
Tackling childhood blindness through technology
Organisation: London School of Hygiene & Tropical Medicine, International Centre for Eye Health
Early identification of congenital cataracts and retinoblastoma in children dramatically improves the chances of avoiding blindness, and in the case of retinoblastoma, death. The best way of detecting these early is called red reflex screening. However, the traditional method of red reflex screening using a direct ophthalmoscope is both difficult and expensive.
- This project aims to train and equip primary health workers (who already come into contact with around 90 per cent of children in the target age group as part of their regular, successful immunization programmes) to screen children for these two eye conditions alongside using two new, simpler tools, arclight and I-cam, for red reflex screening.
In addition to supplying the equipment and training, mobile phones are used not only to trace children identified at screening and follow up with their carers if they don’t attend their hospital appointment, but also to transfer money to the carer to pay for the cost of getting to hospital via the M-Pesa mobile payment system. These innovations together present a cost-effective way of preventing a lifetime of blindness and dependency for children suffering from these two conditions.
“I’ve been trying for years to get African children access to cataract surgery at a younger age when there is more chance to save their sight. It has been great to see the success of the immunization programmes in Africa and the high coverage achieved. This early contact with a health professional provides a great opportunity for earlier detection of cataract but in order to tap into this we need to motivate and equip the nurses by providing them with a simple way of looking into the eye and assessing the ‘red reflex’. Traditional tools have been expensive and difficult to use. This partnership and innovative technology offers a real opportunity to begin to achieve that.”
[Richard Bowman, Consultant Ophthalmologist, and Senior Lecturer, London School of Hygiene and Tropical Medicine]
Improving vision to empower female factory workers in Vietnam
Organisation: Fred Hollows Foundation
In Vietnam, there are approximately 2.1 million people working in the manufacturing industry, with women making up 70-90 per cent of the workforce. These workers are particularly vulnerable to eye health issues, as eye strain caused by up-close, repetitive work in poorly-lit conditions can lead to refractive error and severe visual impairment.
While occupational health and safety regulations for factory workers exist, there are currently no specific policies concerning eye heath.
Within three factory sites of two major manufacturers, this project will pilot a model that provides eye health services to workers and aims to increase women’s health-seeking behaviours; as well as working with factory management to reduce occupational eye health risks. Manufacturers will benefit from greater staff engagement and productivity, and the Foundation will use evidence generated by this pilot to advocate for the model’s adoption nation-wide.
“The Vietnam Factory Workers Project is an innovative partnership with the manufacturing industry of Viet Nam, which harnesses a unique opportunity to improve occupational eye health for a large number of vulnerable women. Within three factory sites of two major manufacturers, the project will pilot a model that provides eye health services and increases women’s health seeking behaviours; as well as working with factory management to reduce occupational eye health risks. The partnership between Seeing is Believing, Fred Hollows Foundation, and the factory sites and manufacturers ensures that this pilot project is able to go ahead, improving the eye health for large numbers of factory workers in Vietnam”
[Anh Pham Quoc – Country Manager – Vietnam, International Programs, Fred Hollows Foundation.]
Low cost, simple cameras to screen premature babies at risk of blindness
Organisation: The Peek Vision Foundation
The Peek ROP project aims to develop a portable, low cost camera to help reduce vision loss in premature babies. Across the world, advances in the care of premature babies have led to dramatically improved survival rates. However, a consequence of the life-saving interventions required is a blinding eye disease called Retinopathy of Prematurity (ROP). ROP is a leading cause of avoidable childhood blindness worldwide, with some 184,700 preterm infants estimated to develop the disease per year, of which 20,000 are left severely visually impaired for the rest of their lives.
Effective screening and timely laser treatment has been shown to be highly effective in reducing vision loss from ROP. Currently, babies are screened either by nurses using very expensive digital imaging equipment or by specialist eye doctors using a highly specialist technique and in many parts of the world, there is limited access to costly equipment or highly skilled ophthalmologists. Peek is acquiring a portable, low cost camera technology developed at the Department of Biomedical Engineering of the University of Strathclyde, and aims to make it available to neonatal nurses to perform the initial screening, which can then be assessed remotely by specialist ophthalmologists.
Not only will this remove the need for ophthalmologists to travel between healthcare facilities, but the lower cost of the unit should greatly lower the barriers to eye care for preterm infants and increase the number who can be helped to see better from the start of their lives.
Nigel Bolster, contributed to the development of the camera at Strathclyde, as part of a group led by Dr Mario Giardini and is now ROP co-Investigator and Evidence Lead for Peek. He said: “We know that if Retinopathy of Prematurity is spotted and treated in time, it greatly increases the chances of a baby not going blind from the condition so it is extremely sad that so many children cannot be helped at the moment. At Peek we are focused on increasing access to eye care by creating solutions which break down barriers. Peek ROP is an exciting opportunity to develop a portable and affordable solution which does not require a specialist to use and we are very grateful to Seeing is Believing for funding this project.”
Tackling trachoma through smart phones
Organisation: Johns Hopkins University
As we move towards a world free of trachoma, monitoring the disease is vitally important. Essential to this monitoring are population-based prevalence surveys, which measure the impact of programmes and confirm that trachoma hasn’t re-emerged. It is estimated that over 2,500 surveys will be required, between now and the global elimination of trachoma; however, the low rates of trachoma mean that there aren’t enough examples of trachoma left to train the number of people required to carry out these surveys.
Trainee graders are required to travel increasingly further away to access the areas with enough trachoma remaining for training. And in places where trachoma may have been gone for years, graders may not be available or may be out of practice, and need re-standardization.
This project aims to develop and test an image capture and processing system that uses smartphone VR technology, cloud storage and crowdsourcing to acquire good quality images of the upper conjunctiva that can be stored and graded in a virtual reading centre for signs of trachoma. This system could ease the burden of relying on quality trained trachoma graders and ensure that the thousands of planned trachoma surveys in low prevalence areas can be completed.
“The development and application of new technology to help rid the world of Neglected Tropical Diseases like trachoma is an exciting trend and we are grateful for funders who have the vision to be part of that trend”
[Dr Sheila West, Principal Investigator of the team leading the new initiative]
Training surgeons to use innovative technology to treat cataracts
Cataract is the major cause of blindness for developing countries. To treat it, surgery to remove the cataract is required, but whereas the western world’s standard method is Phacoemulsification (Phaco) – a very small incision with minimal recovery time – the operations performed in low resource settings still involve a large incision, inducing astigmatism and delaying full visual recovery.
In Phase 2 of the Innovation Fund, this project developed ‘The Hummingbird’, a light, portable device capable of performing Phaco surgeries, improving outcomes for patients and allowing them to resume their normal routine in just a few days.
With the technology in place, this project now aims to establish two training centres to enable surgeons to learn how to conduct Phaco surgery utilising the new Hummingbird technology. The centres will be established where there are a high number of surgeries happening to maximise training opportunities for surgeons. In addition, trainees will be able to learn in a ‘wet-lab’ practice environment without risking patient’s eyes, with a video library also established to help trainees handle complex cases.
“Building upon the Hummingbird innovation, the inception of Phaco training centres that utilize this machine would be helping a great deal in reaching out to the unmet need of low income populations. A machine is only one part of the challenge, as surgeons need to understand how to use the machine effectively to have a positive societal impact. We believe this program, which emphasizes hands-on experience and close mentoring, equips ophthalmologists with the superior skills, knowledge and judgment to successfully contribute to those in need.”
[Sriram Ravilla, Joint Managing Director – Aurolab]
Creating a sustainability toolkit for eye healthcare
Organisation: The Centre for Sustainable Healthcare
While climate change is recognised as a global priority within the UN Sustainable Development Goals, a 2016 survey of over 3500 IAPB members demonstrated a lack of awareness of sustainability. In addition, there was limited understanding of strategies to optimise social value while minimising the economic and environmental impact of accessible eye care.
This project is the first attempt to develop a globally-accessible audit tool, enabling surgeons, eye units, governments and NGO’s to capture data associated with the cataract services they provide. This data will allow the surgical units to view their own service in terms of productivity, costs, carbon-emissions, and resource consumption over time, and to benchmark these against other users.
The initial incentive for participating in the project will be to cut costs and improve productivity. But, the environmental impact data will provide a new ‘lens’ through which services can view themselves, enabling them to redesign pathways and services to ones which are more community oriented, and which minimise environmental damage.
“This exciting project will help to inform eye health practitioners, governments and NGOs how best to increase and sustain capacity and quality of services at affordable cost whilst considering the environmental impact.”
[David Lewis OAM, CBM Focal Point for ‘Environmental Sustainability’ and ‘Inclusion in Eye Health’]
Preventing blindness from glaucoma through laser treatment
Glaucoma is a common cause of irreversible blindness in Africa. People often only seek assistance when it is too late, as glaucoma has no symptoms in its early stages, and primary eye care is almost non-existent. In addition, treatment has its difficulties, with patients required to undergo surgery or use eye drops daily for life.
Trans-scleral diode cyclophotoablation (TSDL) laser treatment has been shown to be an effective tool in the fight against glaucoma. It can be a one-off treatment that is easy to deliver, can be repeated if it fails and which only requires local anaesthesia. The diode laser is portable, low maintenance, and can be used to treat other conditions such as diabetic retinopathy.
Following successful trials in Phase 1 of the Innovation Fund, this project is now scaling up TSDL treatment in Nigeria. A key component of this next stage will be designing training programmes to enable more ophthalmologists to use the equipment, ultimately resulting in some of those consultants becoming trainers themselves.
“The ambition of the project is that laser treatment becomes an accepted treatment for glaucoma in Africa. Findings from this project will be used for advocacy with organisations developing curricula for ophthalmology residents, Ministries of Health, and NGOs. We are excited to be able to scale up this project thanks to Seeing is Believing.”
[Dr Mohammed Abdull, Chief ophthalmologist, ATBU Teaching Hospital Bauchi]
Supporting retinal laser treatment through training
Organisation: Gloucestershire Hospitals NHS Foundation Trust
While laser treatment is now a recognised method of treating diabetic retinopathy (DR), it requires investment in both equipment and training to be successful. In many areas across Asia and Africa, there remains a significant risk of blindness through inadequate laser treatment for DR, despite successful screening and detection.
This project builds on a pilot project funded in Phase 2, to develop an on-line application to support retinal laser treatment, as well as developing practical, hands on laser treatment training which includes the use of model eyes to enable the trainees to develop practical skills.
In addition, existing resources will be made available via DVD as well as online, and the online software will be developed so that the supervision of trainees can be decentralised and therefore expanded.
“We are delighted to be working with the Seeing is Believing Innovation Fund in this important area to prevent blindness due to diabetic retinopathy. Population based diabetic eye screening programmes and timely treatment have reduced blindness in the UK so that diabetic retinopathy is no longer the leading cause of blindness in the working age group. An important component is the quality of laser treatment which is of major importance in the countries that we are working with who are having to cope with the worldwide epidemic of diabetes. Many people in these countries can be prevented from blindness.”
[Professor Peter Scanlon, Consultant Ophthalmologist]
Improving grading and laser treatment in Diabetic Retinopathy in China
Organisation: Gloucestershire Hospitals NHS Foundation Trust
China has the world’s largest diabetes epidemic, with 11.6 per cent of Chinese adults affected. However, most local eye doctors are not trained in diabetic retinopathy (DR) and laser treatment, despite being the first point of contact for most patients.
In Phase 2 of the Innovation Fund, this project was supported in developing and piloting a Chinese Diabetic Eye Screening and Grading course, with 10 Chinese doctors successfully completing the course in summer 2017.
To get the maximum benefit of this learning breakthrough, this training in diabetic eye screening, grading, testing and training, with the addition of training in quality laser treatment will be made be accessible to a wider community of Chinese doctors.
This project aims to build on the pilot project, training an additional 40 eye doctors over the next 18 months, while also adding training in laser treatment, expanding and upgrading learning materials, and establishing a ‘knowledge bank’ for students to access learning materials even if their internet capability prevents them.
“We are delighted to be working with the Seeing is Believing Innovation Fund in this important area to prevent blindness due to diabetic retinopathy in China. China has the world’s largest diabetes epidemic, with over 11.6% of Chinese adults – that’s 114 million people. The subsequent epidemic of blindness due to diabetic retinopathy is beginning to develop. We are providing education and support for the Lifeline Express Charity and other organisations developing screening programmes in China for sight threatening diabetic retinopathy and we are also providing laser training.
All of this is being provided in Chinese. We believe that by providing this support we can enable the Chinese doctors to make a major impact on levels of blindness in China due to diabetic retinopathy.”
[Professor Peter Scanlon, Consultant Ophthalmologist]
Giving cataract treatment a BOOST
Organisation: Fred Hollows Foundation
Despite proven, cost-effective treatment being available, cataracts remain the most common cause of blindness in the world.
Poor surgical outcomes and inadequate access to surgery remain major challenges. While training new surgeons can address both issues, success depends on monitoring surgical quality, which has often been difficult to do.
In Phase 2 of the Innovation Fund, this project developed BOOST, a free, simple-to-use app for computers and smartphones which guides users and hospital administrators in recording, analysing and benchmarking their surgical results against those of global users in the cloud.
Now, the project aims to improve the way that administrators can access data within the app, create a simple video to introduce BOOST and its capabilities to organisations, and add social-media style functionality to the app. In addition, a dedicated China-based data server will be brought online to meet new government regulations on data protection.
“Following the success of the development of the BOOST App, it is exciting to be able to further utilise the app in order to allow medical professionals to more easily access surgery results, data, and to monitor results to further improve the eyesight of those who have previously had surgery. The app is an exciting way to improve analysis of surgery results, and enables greater access to eye care”.
[Beatrice Varga, Research Manager]