African Innovation: Eye Exams With A Smartphone

Dr. Hillary Rono in collaboration with a team of technologists, eye specialists, public health doctors and product designers have designed a unique smartphone-based system for comprehensive eye testing suitable in any part of the world. The mobile phone app can serve as an alternative to an ophthalmoscope. Ophthalmoscopes tend to be difficult to transport and expensive while PEEK (portable eye examination kit), uses high quality retinal images from your phone to conduct an eye exam. Peek Acuity, the app used to test eyesight easily and affordably using a smartphone, has been found to be as accurate as traditional charts.

Dr. Hillary Rono is an ophthalmologist and zonal eye surgeon for North Rift Region in Kenya. He currently serves a population of over 1.5 million, with a range of eye health conditions, the most prevalent being trachoma and cataract and childhood blindness.  The North Rift Region, where Dr. Rono is based covers 3 counties in Kenya, made up of Tranizoia, West Pokot and Turkana.

Dr. Hillary Rono has a Master of Science (MSc) in Public Health (Eye care) from the London School of Hygiene and Tropical Medicine, a Master’s in Medicine and Surgery (Ophthalmology) from the University of Nairobi and a Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) from Moi University. He has several research publications.

How It Works

Peek Retina slips neatly over the in-built camera on your smart phone. The Peek app is held close to someone’s eye and which allows it to auto-focus and to show the examiner the retina on screen. The high quality images quality allow you to view cataracts clearly enough for treatment classification, detecting signs of glaucoma, macular degeneration, diabetic retinopathy and signs of nerve disease. In addition, other health problems such as severe high blood pressure and diabetes can also be identified with a good view of the retina. Eye exams can be carried out on both adults and children.

The app also includes a digital letter alphabet chart, which is based on the display of the letter E shape (‘the tumbling E’) that makes it simple for people to recognize. This means it doesn’t rely on someone knowing the English language, yet it is proven to give the same results as traditional tests.

The Peek SightSim™ also allows one to see a live simulation of how your patient sees the world, compared to someone with normal vision. Images and patient information can be securely stored and shared for off-site review by other medical professionals. This product is ideal for a doctor in a hospital referring cases to an ophthalmologist, or a remotely based health worker sending data to a treatment clinic hundreds of miles away. The images can be sent over the phone’s data or a Wi-Fi connection.

In the future, they hope to include a color blindness test (blue, green and red) using the high-definition of a smart phone screen and contrast tests, to evaluate the difference between shades of light and dark that people can see.

The App

Peek Acuity, the app used to test eyesight easily and affordably using a smart phone, is as accurate as traditional charts, according to a study published today. The research, published in JAMA Ophthalmology, shows that the results from the app tests carried out on 233 people in their own homes and repeated in eye clinics based in Kenya were as reliable as those from standard paper-based charts and illuminated vision boxes in an eye clinic. The app vision test is designed not to be dependent on familiarity with symbols or letters used in the English language.

Tests in patients’ homes found that Peek Acuity produced results to a clinical level equivalent to the much larger and more expensive standard electricity dependent chart – the average difference being the equivalent of less than one line on an eye chart.

Current use of PEEK in Kenya

Andrew Bastawrous recently completed a large cohort study of eye disease in Kenya, following up 5,000 people examined 6 years earlier.  The team used state of the art hospital based equipment and Peek in 100 different locations throughout the Nakuru County. The project required that they carry the fragile and expensive equipment to all the destinations to examine the study participants. The same patients who underwent comprehensive ophthalmic assessment were also separately examined by community health care workers using Peek. The results are now being compared with one another to ensure that Peek is not only effective but accurate.

Teachers in Kenya

Teachers are using Peek to identify children with visual impairment as part of a pilot study in 40 Kenyan schools. By using Peek, teachers will be able to identify pupils who need help and make sure they are referred for specialist treatment. The pilot is funded by Seeing is Believing (with Operation Eyesight Universal) and will be rolled out nationally if it proves successful.

The Portable Eye Examination Kit (Peek) is a mobile app downloaded in a smartphone and will be used to screen nearly 300,000 pupils in 400 schools in Trans Nzoia County in the next three years. The brains behind it are Dr. Hillary Rono and a team at the London School of Hygiene and Tropical Medicine. In the future, they would like to also test PEEK in other countries such as Uasin Gishu, Nandi, Elgeyo-Marakwet, West Pokot and Narok.

Peek (the Portable Eye Examination Kit) has been designed and developed through collaboration with the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, the University of Strathclyde and the NHS Glasgow Centre for Ophthalmic Research.

Some information provided by Peek Vision http://www.peekvision.org/