Using technology to bridge eye care inequalities

University of Strathclyde academic, Dr Mario Giardini, outlined how smartphones and digital displays can be harnessed to deliver more care outside hospital settings in his talk at 100% Optical (ExCeL London, 24–26 February).

During his presentation, Task shifting from secondary care to the community, Giardini presented a map of the world that was rescaled in proportion to the number of ophthalmologists per head of population in each country.

He shared that in Kenya in 2012 there were 84 ophthalmologists for a population of 80 million people.

“My work has been directed towards healthcare equality – making sure that healthcare gets to the people who need it,” Giardini said.

It is not just low-income countries that are struggling to meet eye care needs, he added.

Giardini shared that the ratio of ophthalmologists per head of population is declining across the world.

“We need to identify patients who are at risk of disease directly in the community,” he said.

Giardini shared that his aim in developing technology to be used outside the hospital was to create a device that was relatively simple to use.

Giardini added that the ophthalmoscope has been nicknamed ‘the guessing stick’, while only 45% of doctors in hospitals report being confident using it.

“We all know what it is like to look at a retina through an ophthalmoscope. It is like looking at a landscape through a keyhole. This is not an instrument to put in the hands of community operators,” he said.

Alongside Peek Vision, Giardini developed six generations of the Peek ophthalmoscope. The technology then went through a dormant period before it was revived during COVID-19 and a seventh-generation device was created.

Giardini explained that during the pandemic, ophthalmology services were reorganised in Scotland so that there was one Emergency Eyecare Treatment Centre per 100,000 people.

The seventh-generation device, a retinal camera capable of being mounted on a smartphone, enabled an optometrist to show an ophthalmologist video of the patient’s eye in real-time.

Giardini shared that there was a positive response to the technology.

“We were filtering patients in the community. The patients were overwhelmingly accepting of this technology – it avoided a hospital appointment,” he said.

Giardini outlined some of the advantages that digital displays have over paper eye charts that have traditionally been used in optometry.

“What we find is that, on average, tablet displays have better compliance with all of the normative requirements,” he said.

Using the example of paediatric acuity tests, Giardini shared that standard tests that incorporate grating have differences in the level of reflectance.

“The average colour of the grating is the colour of ambient light,” he said.

A digital display has its own light source so the reflectance is flat.

“To a certain extent, digital displays are much better suited to these types of tests,” Giardini emphasised.