According to vitreoretinal surgeon Dr. Ashish Ahuja, the brain can be trained to be innovative. Dr. Ahuja recently shared his insights and ideas about this interesting topic at the All India Ophthalmology Society-Young Ophthalmologists Society of India (AIOS-YOSI) forum in New Delhi, India.
“I was working in a government hospital where a resident doctor often forgot to switch off the slit lamp light,” he explained. “This incidence made me think, how can we build a sensor which can automatically turn off the light after three to five minutes?”
This kind of “innovation” – that is, finding simple solutions to improve aspects of both clinical practice and patient care – can sometimes be right in front of us. For example, in another instance, he saw the need for a sensor to track the body posture of a patient who needed to maintain a face down position after vitrectomy surgery for 24 hours. As a result, the post-vitrectomy recovery device-sensor was born.
Dr. Ahuja notes that ophthal-mologists can also look at other subspecialties for inspiration.
“Charles Kelman revolutionized cataract surgery by using a dental instrument. We should go through the atlases of other subspecialties, like orthopedic, gynecology, cardiac surgery instruments . . . and ask ourselves: How can we use it [the instrument] in another way for eye care?” he said.
“Another way to be innovative is to question everything you see,” said Dr. Ahuja. “Can we use the instrument in a different way? Can a particular thing be made with a lower cost? Can we use some other material?”
“It is important to prepare for failures and persist,” he added. “Focus on one project at a time and surround yourself with inspiration. It’s also important to discuss your ideas with others. Some people fear that their ideas might get stolen, but to the contrary, the idea gets more refined . . . and you will get a better outcome with teamwork,” he added.
From idea to innovation . . .
Dr. Ahuja is also an advisor for a digital healthcare startup that is working on an artificial intelligence (AI) platform for screening retinal diseases. Here, he shares some his personal experience and work, some of which has been published.
His first development is a smartphone-based clip lens which provides 30 times magnification of the ocular surface1 – an idea that came to him when he read an article where researchers analyzed the blood constituents (red and white blood cells) using a smartphone.
And smartphone-based technologies are increasingly being used and developed. Dr. Ahuja noted a few examples that have caught his eye, including: Smartphone Slit Illumination Imaging (by Chinese company MediWorks); Smartphone Autorefractor and the Smartphone Lensmeter (by Eyenetra), both of which are commercially available; smartphone-based thermal imaging; and a wide-angle smartphone lens with that is in development in Hong Kong.
His second innovation is the DIY Reduced Eye Model for Fundus Examination2 which consists of a stack of three lenses – one 18D and two 20D lenses (making 58D) attached together. These are taped to the Reti Eye plastic model at one end, and a piece of cardboard is placed in front of the lenses and the plastic film with a 6mm opening in the center, representing the pupil. This reduced eye model can be attached to the slit-lamp headrest with tape and viewed with a 90D or 78D lens or with the indirect ophthalmoscope. It is a low-cost model which would be helpful for training purposes as it will decrease the learning curve of the fundus examination.
Dr. Ahuja’s third innovation is the low-cost video indirect ophthalmoscope (IO)3 made using an IO, telephoto lens and small spy camera (which is 1-2mm in size and has an antenna with battery), mounted to the side of the IO. Dr Ahuja is currently working with engineers to refine the model. Another technology rapidly gaining steam is AI. “Aiseon Healthcare is developing the diabetic retinopathy screening using artificial intelligence. Computer generated algorithms marks out the images and aneurysms and gives a printed report whether the disease is referable or not. This technology will really pick up in the next five years,” he said.
Also, Dr. Ahuja highlighted that 3D printing technology is gaining momentum – this is because printing 3D components can reduce the cost of vitreoretinal surgery. He shared his experience with 3D printing from the Moscon Hackathon 2018, which is the annual conference of the Maharashtra Ophthalmological Society. At this event, a team of doctors, mentors and engineers successfully developed a smartphone based gonioscope imaging device with the use of 3D printed mold and lenses in just two days – a feat which would have required months to accomplish without teamwork.
“Teamwork is crucial for exponential innovation. With teamwork from experts consisting of electronic, mechanical, optic and biomedical engineers; 3D printing experts; artificial intelligence experts and virtual reality app developers; and with funding, more and more low-cost devices can be invented, ultimately benefitting the ophthalmology industry which is heavily dependent on gadgets,” explained Dr. Ahuja.
With hope for a future where healthcare is accessible and affordable, he concluded: “A group of UK researches has developed an ultrasound probe prototype which costs about three to four-thousand rupees ($43 to 57 USD), so it is really possible to make innovative low-cost devices.”
Editor’s Note: The AIOS-YOSI’s “Young Ophthalmologist – The Way Ahead” Forum was held on 25 November 2018 in New Delhi, India. Reporting for this story also took place at the AIOS-YOSI Forum.
References:
1 Ahuja AA, Kohli P, Lomte S. Novel technique of smartphone-based high magnification imaging ocular surface. Indian J Ophthalmol. 2017; 65(10): 1015–1016.
2 Ahuja AA, Adenuga OO, Ahuja AS. Do it yourself: Reduced eye for fundus examination. J Clin Ophthalmol Res. 2018;6:35.3 Ahuja AA, Kamble A. Commentary: Change in trends of imaging the retina. Indian J Ophthalmol. 2018; 66(11): 1620–1621.
