According to the World Health Organization (WHO), there are nearly 285 million visually impaired people worldwide – and 80 percent of those cases could have been avoided with early detection. In addition, 90 percent of those affected live in low-income areas. These statistics illustrate why effective, accessible and affordable screening strategies are critical for early detection of disease and overall eye health.
Dr. Ramachandran Rajalakshmi, the Head of Medical Retina at Dr. Mohan’s Diabetes Specialities Centre in Chennai, India, recognizes the importance of preventative screening.
“India is challenged by the burden of diabetes and its complications. Blindness due to diabetes is preventable, and early detection and treatment is the key,” Dr. Rajalakshmi explained. “Easy-to-use, lower-cost devices would overcome barriers to [allow patients to receive] regular diabetic retinopathy screening in lower and middle-income countries like India.”
So, how can we provide more accessible and affordable screening instruments to patients in need? Thankfully, the answer lies in our pockets (or purses): our smartphones. We’ve long known that these devices are more than simple telephones – and they have the ability to do things we have yet to imagine. Now thanks to Remidio Innovative Solutions, our smartphones have one more use: preventing eye disease and visual impairment.
Remidio Innovative Solutions (Bengaluru, Karnataka, India) has developed the world’s first and the only smartphone-based non-mydriatic (no pupillary dilation required) retinal imaging system, the Fundus On Phone (FOP NM-10). With its cutting-edge optical design and simplicity of use, the device can be applied to screen for a variety of ocular conditions including: diabetic retinopathy, macular edema, vitreous hemorrhages and anterior segment diseases. In addition, the compact optical design allows for extremely low flash intensities, which means there is no pupil dilation required, resulting in lower patient stress and discomfort.
This puts Remidio in a unique position to make a huge impact on the visual health of diabetics, and others suffering from vision loss, around the globe. Remidio’s R&D team hails from the Massachusetts Institute of Technology (MIT) in Cambridge, Mass., USA. These engineers are using technological innovations to improve the imaging capabilities of the smartphone-based fundus camera. The company utilizes hardware that has been developed for more than half a decade, and is well-recognized for delivering unmatched quality in terms of image acquisition without requiring pupillary dilatation. The camera is easy to use, portable, low-cost, relatively lightweight, and is based on simple point-and-shoot technology. These features enable technicians in clinics, and the in field, to be easily trained to acquire excellent images.
Additionally, Remidio has established a reading center of highly skilled retina specialists trained from reputable national and international centers such as Sankara Nethralaya (Chennai, India) and Johns Hopkins Medicine (Baltimore, Maryland, USA). These retina specialists provide “real time” grading of retinal images via telemedicine solutions.
According to Dr. Sabyasachi Sengupta, an ophthalmologist, retina specialist and head of Sengupta’s Research Academy, based in Mumbai, India, “The addition of the Remidio FOP and the ‘software’ – which can provide instant grading of images by retinal specialists obtained over cloud based software – makes this DR screening solution a complete package. It can be easily employed by ophthalmologists, diabetologists and other health care organizations on a large scale to achieve the mission of preventing blindness due to diabetic retinopathy.”
Dr. Sengupta has no financial interest in the technology, but has been very involved in validating the FOP NM-10. “We imaged more than 200 eyes with various severity of DR using the FOP as well as the gold standard Topcon fundus camera and found that the FOP was more than 90% sensitive and specific for detecting all forms of DR,” he shared.
“Mobile phones offer connectivity. Images obtained can be instantly sent to an esteemed colleague and the best opinion sought for patients, irrespective of geographic barriers. Hence, I see tremendous potential in mobile phone based screening solutions for timely and early DR detection,” he added.
Dr. Rajalakshmi and colleagues at Dr. Mohan’s Diabetes Specialities Centre have been extensively using the Remidio FOP, and feel that the device is both sensitive and specific in detecting retinopathy of varying severity which provides sharp image quality both in the mydriatic and the non-mydriatic versions.
They previously published a study in the journal PLoS One*, comparing the Remidio FOP to a traditional Zeiss FF450 desktop imaging system and found the clinical sensitivity to be 93% and specificity to be 98%.
“The combination of affordability, portability of the device, easy transmission of images and other features of this Fundus On Phone system provides a platform not only for physician’s in-clinic use, but it’s also invaluable for teleophthalmology purposes. Remidio FOP is a good option for cost-effective regular repetitive retinal assessment in people with diabetes,” shared Dr. Rajalakshmi. Remidio has installed more than 500 of the FOP units in the Asia-Pacific region, including India, SAARC region, Southeast Asia, Australia and some initial units in the US market. The technology is protected with patents granted in the US, Europe, China and South Africa. The device is CE marked, TGA registered, HSA (Singapore) approved and USFDA registered.
Rajalakshmi R, Arulmalar S, Usha M, et al. Validation of Smartphone Based Retinal Photography for Diabetic Retinopathy Screening. PLoS One. 2015; 10(9): e0138285.