Studying blindness – There’s an App for that…
Everything is hazy; I can’t even see my glasses. I keep my eyes closed; it doesn’t seem to make much difference opening them. My hand clumsily feels around the bedside table, knocking my mobile phone to the floor till eventually I come across my glasses. On they go, I can see again. Those brief few seconds as I awake in the morning serve as a continual reminder to me of how much I value my sight.
Losing sight is the sense most people fear losing most. I am fortunate to have perfect vision when wearing corrective glasses or contact lenses and privileged to be in a profession (ophthalmology) where centuries of research and practice have brought us to a time when so much of blindness is now curable or preventable. There is no feeling like it: when the eye patch comes off someone who hasn’t seen for years, the sheer wonder as they take in their surroundings and their anticipation to see faces that have become voices and places that have become memories.
Incredibly, despite 80% of blindness being curable or preventable, the majority of blind people with treatable eye conditions live in developing countries and have no access to suitable healthcare. Africa has the greatest disparity in numbers needing treatment and specialists available to provide it. In the UK we have 3,600 ophthalmologists compared to only 86 in Kenya where we now live.
There are many factors that can lead to blindness, and many complexities that lead to a society unable to deal with the burden that comes with a disability. Although each individual goes blind very much alone, there are shared stories and features, the understanding of which can enable prevention or access to curative treatment. Some of the major questions include knowing how many people are blind? Who are they? Where do they live? Why are they blind?
Gathering this type of information is known as epidemiological research, it is a method of describing the characteristics of a population. This information is then used in practice to inform policy makers and health workers to benefit individuals on a large scale.
Performing such a study can be a logistical nightmare, it is also extremely time consuming and expensive. My study involves the retracing and examination of 5,000 people across a district in Kenya known as Nakuru. Taking what is effectively a fully staffed eye hospital (team of 15 people), fully equipped (over £100,000 worth of heavy and fragile equipment) to remote villages, many of which have no road access or electricity supply is extremely challenging yet absolutely vital if provision to prevent needless blindness is to be put in place.
As I’ve pondered and planned for the challenges that lay ahead, I’ve had the continual thought that there must be an easier way to gather this information, a way that is less expensive, less resource hungry and therefore could be used on a much wider scale. Then it dawned on me… I use my smartphone for everything nowadays, from checking train times, navigating in the car, taking and sharing photos, not to mention using it as a phone and speaking to people. This has led me to develop a set of gadgets and applications making it possible to use a modified smartphone (We call it the “Portable Eye Examination Kit – Peek”) to measure someone’s vision, take photos of the back of the eye for diseases such as diabetic retinopathy, macula degeneration and glaucoma and check for the presence of a cataract. All the data is then stored on the phone and can be shared with specialists anywhere in the world to provide expert diagnosis and treatment plans in even the most remote locations. Individuals are locatable on an interactive Google Map, and can be retraced and contacted to arrange treatment or follow up.
It is important to check the new device works and doesn’t miss people who need help. To see how accurate the new device is, I will test the phone on the same 5,000 individuals undergoing the detailed examinations that use the gold-standard state-of-the-art hospital equipment. We will then be able to compare the two methods and see how many of the study population we would have correctly picked up as having sight loss (as well as the reasons why) and if we would have missed anyone.
At one-fiftieth of the price and only one non-specialist needed to perform the test, the examiner can go to the patient rather than the patient waiting for someone to never come. It could be that those in remote and resource-poor places, silently losing their sight, could be a text message away from help.
This essay explaining the project was printed in the Metro Newspaper on the 24th September, 2012
Visit the Peek website at: http://www.peekvision.org