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TED2014

Andrew Bastawrous: Get your next eye exam on a smartphone

March 17, 2014

Thirty-nine million people in the world are blind, and the majority lost their sight due to curable and preventable diseases. But how do you test and treat people who live in remote areas, where expensive, bulky eye equipment is hard to come by? TED Fellow Andrew Bastawrous demos a smartphone app and cheap hardware that might help.

Andrew Bastawrous - Eye surgeon, inventor
Andrew Bastawrous studies eye health -- and builds accessible new tools to bring eye health to more people. He is a 2014 TED Fellow. Full bio

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There are 39 million people in the world
00:13
who are blind.
00:16
Eighty percent of them
00:17
are living in low-income countries such as Kenya,
00:20
and the absolute majority
00:22
do not need to be blind.
00:24
They are blind from diseases
00:26
that are either completely curable or preventable.
00:28
Knowing this, with my young family,
00:32
we moved to Kenya.
00:34
We secured equipment,
00:35
funds, vehicles, we trained a team,
00:37
we set up a hundred clinics throughout
00:41
the Great Rift Valley
00:43
to try and understand a single question:
00:45
why are people going blind,
00:48
and what can we do?
00:50
The challenges were great.
00:53
When we got to where we were going,
00:56
we set up our high-tech equipment.
00:58
Power was rarely available.
01:00
We'd have to run our equipment
01:03
from petrol power generators.
01:03
And then something occurred to me:
01:06
There has to be an easier way,
01:08
because it's the patients who are the most in need
01:11
of access to eye care
01:13
who are the least likely to get it.
01:14
More people in Kenya,
01:17
and in sub-Saharan Africa,
01:18
have access to a mobile phone
01:20
than they do clean running water.
01:21
So we said, could we harness
01:24
the power of mobile technology
01:25
to deliver eye care in a new way?
01:27
And so we developed Peek,
01:29
a smartphone [system] that enables
01:31
community healthcare workers
01:33
and empowers them to deliver eye care everywhere.
01:35
We set about replacing
traditional hospital equipment,
01:39
which is bulky, expensive and fragile,
01:41
with smartphone apps and hardware
01:44
that make it possible to test anyone
01:46
in any language and of any age.
01:48
Here we have a demonstration
01:51
of a three-month-old having their vision
01:53
accurately tested using an app and an eye tracker.
01:55
We've got many trials going on
02:03
in the community and in schools,
02:05
and through the lessons that
we've learned in the field,
02:07
we've realized it's extremely important
02:09
to share the data in non-medical jargon
02:11
so that people understand
02:13
what we're examining and what that means to them.
02:15
So here, for example,
02:18
we use our sight sim application,
02:19
once your vision has been measured,
02:21
to show carers and teachers
02:23
what the visual world is like for that person,
02:25
so they can empathize with them and help them.
02:28
Once we've discovered somebody has low vision,
02:31
the next big challenge is to work out why,
02:34
and to be able to do that,
02:36
we need to have access to the inside of the eye.
02:37
Traditionally, this requires expensive equipment
02:40
to examine an area called the retina.
02:42
The retina is the single part of the eye that has
02:45
huge amounts of information about the body
02:47
and its health.
02:49
We've developed 3D-printed,
02:51
low-cost hardware
02:53
that comes in at less than five dollars to produce,
02:54
which can then be clipped onto a smartphone
02:57
and makes it possible to get views
03:00
of the back of the eye
03:01
of a very high quality.
03:02
And the beauty is, anybody can do it.
03:04
In our trials on over two and half thousand people,
03:07
the smartphone with the add-on clip
03:10
is comparable to a camera
03:12
that is hugely more expensive
03:14
and hugely more difficult to transport.
03:16
When we first moved to Kenya,
03:19
we went with 150,000 dollars of equipment,
03:21
a team of 15 people,
03:24
and that was what was
needed to deliver health care.
03:26
Now, all that's needed
03:29
is a single person
03:32
on a bike with a smartphone.
03:33
And it costs just 500 dollars.
03:37
The issue of power supply
03:41
is overcome by harnessing the power of solar.
03:43
Our healthcare workers travel
03:45
with a solar-powered rucksack
03:46
which keeps the phone charged and backed up.
03:48
Now we go to the patient
03:50
rather than waiting for the patient never to come.
03:53
We go to them in their homes
03:55
and we give them the most comprehensive,
03:57
high-tech, accurate examination,
03:59
which can be delivered by
anyone with minimal training.
04:01
We can link global experts
04:05
with people in the most rural,
04:08
difficult-to-reach places
04:09
that are beyond the end of the road,
04:11
effectively putting those experts in their homes,
04:12
allowing us to make diagnoses
04:15
and make plans for treatment.
04:17
Project managers, hospital directors,
04:20
are able to search on our interface
04:22
by any parameter they may be interested in.
04:24
Here in Nakuru, where I've been living,
04:26
we can search for people
04:28
by whatever condition.
04:30
Here are people who are blind
04:31
from a curable condition cataract.
04:32
Each red pin depicts somebody
04:35
who is blind from a disease that is curable
04:37
and treatable, and they're locatable.
04:40
We can use bulk text messaging services
04:42
to explain that we're coming to arrange a treatment.
04:44
What's more, we've learned that this is something
04:47
that we haven't built just for the community
04:50
but with the community.
04:52
Those blue pins that drop represent
04:53
elders, or local leaders,
04:55
that are connected to those people
04:58
who can ensure that we can find them
04:59
and arrange treatment.
05:00
So for patients like Mama Wangari,
05:02
who have been blind for over 10 years
05:05
and never seen her grandchildren,
05:07
for less than 40 dollars, we can restore her eyesight.
05:08
This is something that has to happen.
05:12
It's only in statistics
05:18
that people go blind by the millions.
05:19
The reality is everyone goes blind on their own.
05:22
But now, they might just be
05:26
a text message away from help.
05:28
(Applause)
05:30
And now because live demos are always a bad idea,
05:37
we're going to try a live demo.
05:39
(Laughter)
05:41
So here we have the Peek Vision app.
05:42
Okay, and what we're looking at here,
05:51
this is Sam's optic nerve,
05:54
which is a direct extension of her brain,
05:56
so I'm actually looking at her brain as we look there.
05:58
We can see all parts of the retina.
06:01
It makes it possible to pick up diseases
06:04
of the eye and of the body
06:07
that would not be possible without access to the eye,
06:09
and that clip-on device can be manufactured
06:11
for just a few dollars,
06:13
and people can be cured of blindness,
06:15
and I think it says a lot about us as a human race
06:16
if we've developed cures and we don't deliver them.
06:20
But now we can.
06:22
Thank you.
06:23
(Applause)
06:26

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Andrew Bastawrous - Eye surgeon, inventor
Andrew Bastawrous studies eye health -- and builds accessible new tools to bring eye health to more people. He is a 2014 TED Fellow.

Why you should listen

Andrew Bastawrous is a Kenya-based ophthalmologist who co-founded PEEK, a low-cost smartphone ophthalmic tool. PEEK was built to deliver eye care in some of the world's most challenging places, to those who need it most. Bastawrous is a research fellow at the International Centre for Eye Health.

Andrew has worked in Sierra Leone, Peru, Belize, Sri Lanka, Madagascar and Uganda and is based in Kenya working on the collaborative development and testing of Peek. In 2011, Andrew was awarded a Medical Research Council (MRC) and Fight for Sight Fellowship to undertake the first longitudinal population-based study (follow-up study) of eye disease in Africa and the challenges he faced inspired the idea of a smartphone-based ophthalmic tool. He has published some 25 peer-reviewed articles focusing on international eye health and mobile technology in healthcare and has co-authored four book chapters. Andrew was awarded the MRC Max Perutz Science writing Award in 2012 and is a TED Fellow.

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