A portable robotic eye-testing device could provide care for people in remote communities who currently face obstacles to treatment.
Difficulties with transport, childcare and general costs can all get in the way of people receiving the care they need.
A trial of the prototype machine – made from a 3D printer and with a specialised camera – is now underway in Northland. Specialists can hold a consultation with the patient remotely while they are having the test.
The trial is being run by iwi health provider Te Hau Ora o Ngāpuhi. Its chief executive Tia Ashby said eye health is crucial to the hauora of the whānau and, ultimately, those with chronic health conditions.
Ashby said: “For example, type 2 diabetes, every year they’re meant to have an annual eye check, and that’s not the case. They either can’t book in or they have personal barriers that are hindering them from monitoring their eye health.”
She said a wide range of barriers exist for whānau in the north which involve transportation issues, petrol cost and the cost associated with the appointment itself. Other barriers include the appointment time and length of time to be seen.
“Baby sitting is also a barrier, so if you got a solo parent with multiple children, often that’s a deterrent from following through with that appointment.”
She said the machine is an efficient solution to addressing many of the barriers, ensuring whānau access the care they need, and allows early screening for early intervention and access to treatment.
“It could lead the way for other emerging technology, and a faster way to actually be seen by a specialist, because all it is… is that it’s a robotic system that takes retinal pictures of the eye and the specialist is sitting remotely in the cloud and can make a diagnosis remotely.”
The trial
There are two phases to the research, the first part is the trial with the device, built by a research team from Auckland University’s engineering department. The second phase will involve AI technology to help enable diagnosis from the pictures.
Ashby said they put a notice out to their client base for 30 people to participate in the first phase, but in two days there were “50 lining up”.
“There are many more waiting because it’s promising, this type of technology, it’s offering hope that not all is lost, and we are doing something about it.
“We are exploring emerging technology, we are looking at efficiency in the way healthcare is delivered. The answer isn’t always ‘bring in more doctors, more nurses’.”
Kaumātua and iwi leader Hone Sadler is taking part in the trial and can see the benefit of this kind of technology in the north, especially for the many whānau who live remotely in ‘te puihi’ (the bush).
“He nui te utu te haereere. He mataara te tawhiti raini te haere, e kore e taea te haere i te kaha nui o te utu.”
(“Travel is expensive, and the distance doesn’t help either. You just can’t afford to go.”)
The prototype device
Danny Su helped to develop the latest version of the prototype. It is made from a 3D printer “flipped to its side”, with other components – including a specialised portable camera from oDocs – added to the machine.
Participants are taken through the details of the trial and the process involved with the test. They are told to sit in front of the device and look down the barrel of the camera to focus on a green light.
The camera can be controlled remotely, and it’s connected to a phone where the patient can speak to the specialist.
“We’ve created this device alongside software application, and this device can be placed in clinics, any clinic throughout New Zealand, and the specialist on the other side – who can be in the city – can operate the camera and provide consultations and screening in real time.”
He said a specialist can monitor all the devices at the same time to expand their reach and provide care remotely.
“[The machine is] pretty simple actually, there’s not really too much inside, so it just means that it’s very cost effective as it’s very cheap to manufacture and replicate for many rural communities.”
The project
Dr Jaspreet Dhupia and Dr Renoh Johnson Chalakkal are two lead researchers for the project.
Dr Dhupia, a senior lecturer at Auckland University in mechanical and mechatronics engineering, said for many rural communities their GP is the first point of contact who will then refer them to an eye specialist. “But that appointment can take up to six months.”
He said depending on the eye condition, people can risk permanent vision loss or symptoms can worsen.
“New Zealand only have like 35 ophthalmologists… in the rural locations, the rest of them being in the urban locations.
“So [a] machine like this where a patient could go to the pharmacy and get an eye check done remotely, and the pictures can be diagnosed by a doctor – and a more precise diagnosis can help a lot.”
He said they have successfully trialled the latest version of the prototype in Dargaville, Kaikohe, and overseas in India.
“We were trying to make this device cost effective, but also portable and easy to operate over internet.”
“Diabetes is a silent killer,” said Dr Chalakkal, director of research at oDocs Eyecare, manufacturers of the retinal device used in the prototype.
“If you are able to screen it at an early stage it is really useful. It usually progresses quickly and if it is detected early, we can prevent blindness that is associated with later stage.”
He said the current version of the prototype looks at the back of the eye to help identify any irregularities in the macular region that can indicate an issue.
Ultimately, the end goal is to prevent preventable blindness and make eye care accessible to everyone, he said.
The future
The work will continue to refine the prototype, build a few more and trial them in different locations, said Dr Dhupia. They are also looking into an automated system for ease of operation by clinicians.
For Te Hau Ora o Ngāpuhi, the technology opens doors to better serve their community. Ashby said pending safety considerations and signing off the technology, they would love to provide the service for their clients.
“We know that there’s a need for Māori to get access – Māori and everyone in the community – to get access to eye specialists and to look after their eye health.”
