Peek Vision's portable eye examination kit

Dr Andrew Bastawrous talks to us about Peek Vision's portable eye examination kit.

You may recall our report on the recent Tech4Good Awards in the July edition of Connections. Peek Vision was the proud winner of the digital health award which recognises its pioneering work in developing eye care exams that can be carried out, using just a smartphone, anywhere in the world.

Dr Andrew Bastawrous is the co-founder of Peek and a research fellow in International Eye Health at the London School of Hygiene & Tropical Medicine. Here he explains more about the innovative portable eye examination kit and what it means for the future of eye care.

Peek is a Portable Eye Examination Kit which enables health workers anywhere in the world to carry out professional eye exams.

Peek provides an easy to use and affordable alternative to traditional equipment which is bulky, expensive and difficult to use.

It features a unique clip-on camera adapter to capture images of the retina and complementary apps to test vision and enable images to be stored and shared.

The Peek team share a mission to increase access to high-quality eye care and empower health workers around the world to reach the people who need it most.

As well as working to prevent blindness in low-income countries, Peek will be a valuable tool in high-income countries – increasing the potential for ophthalmic examination beyond dedicated eye clinics, for example in general practice.

Peek can test for visual impairment, cataracts, glaucoma, macular degeneration, diabetic retinopathy and other retinal and optic nerve diseases, as well as crucial indicators of other health problems such as high blood pressure and diabetes. The system stores contact information and GPS data for each patient. Google Maps integration allows a novel way to follow-up and treat patients. More broadly, such technology allows co-ordination of services, to target mass treatment campaigns to the regions of greatest need.

Peek was developed as a collaboration between the London School of Hygiene & Tropical Medicine, the University of Strathclyde and the NHS Glasgow Centre for Ophthalmic Research.

In 2012 I was working on a follow-up eye health study of 2,000 people in Nakuru, Kenya, as part of my PhD at the London School of Hygiene & Tropical Medicine's International Centre for Eye Health (funded by MRC/Fight for Sight).

We faced a daily struggle to actually get out to remote villages to examine study participants' eyes. It was a logistical nightmare trying to manoeuvre lots of very bulky, expensive equipment in vans along dirt tracks. I am a tech fan and use my smartphone for everything (I get lost frequently unless I have Google Maps running). I started to explore whether we could do the same tests I was needing to do in the field with hospital-based equipment but, instead, using a smartphone.

I teamed up with my Peek co-founders (Stewart Jordan, Dr Mario Giardini and Dr Iain Livingstone) to turn that idea into a reality. With early stage apps and a prototype clip-on adapter, our field team in Kenya could use Peek on the people in the study to collect data from each participant who were also being tested with the traditional equipment. This enables like-for-like comparison.

I returned to London from Kenya with my family at the beginning of the year to analyse the results, which will be published at a later date. At the same time I have been working with the Peek team on further tests and development of the Peek system to ensure it is rigorously designed as a high-quality alternative to equipment such as vision charts and ophthalmoscopes.

There are many incredibly hard working eye health workers who are transforming eye care. By providing unique, high-quality eye care tools on a smartphone, we are hoping to make it possible for those living in the most remote and challenging areas to have access to those health workers. If community health workers can identify that someone has a problem, the data can be referred for diagnosis and subsequent treatment can be arranged and managed.

A low-cost operation that takes just minutes could restore sight in many cases – but for the majority, going blind is part of life and those who can provide treatment struggle to reach them. For example, 39 million people worldwide are blind, 80 per cent of blindness is avoidable and 90 per cent of blind people live in low-income countries.

In the areas of greatest need, patients do not have access to diagnostics or treatment. In developing countries, more people have access to mobile phones than running water.

Those most in need are often the most difficult to reach. Peek helps by providing the tools to connect those most in need with those who can help.

It is also exciting to think that Peek can benefit high-income settings, with doctors, medical students and clinics able to use innovative and effective smartphone tools to provide a comprehensive eye examination.

The first Kenya cohort study data collection is complete and I am now working with colleagues on the data analysis and writing up the results.

Partners in Kenya are currently leading a trial in schools in Kenya to test if teachers can use Peek to pick up eye problems among their students. Poor eyesight is a major factor in under-achievement at school so if you can identify a problem and get it treated at an early stage, learning potential can be maximised. This trial is funded by Operation Eyesight Universal (Seeing is Believing).

We are in the process of setting up or planning a number of other trials in Kenya, Mali, Botswana, Tanzania and the UK over the next five years thanks to funding from the Queen Elizabeth Diamond Jubilee Trust. These will investigate Peek in the community, hospitals and for specific conditions such as diabetic retinopathy and malaria retinopathy.

We would love to make Peek available to everyone who needs it as soon as possible and will be working hard to make that happen. Ultimately we want to make sure no one is blind if they don't need to be. We hope Peek can help get closer to that point.

In the short-term we will continue to analyse our data, carry out further research and work on developing Peek's tools and capabilities to ensure they meet required standards, and take steps to get Peek to those who need it.

Next steps for Peek include further research to test and develop the software and hardware, and work to make the system widely available.

We were honoured to win the prestigious Tech4Good Digital Health Award. We were very pleased and it has led to a number of new contacts and networks. We are very grateful for the support.

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