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From Selfies to Saving Sight Smartphone Imaging System Provides Accessible and Affordable Eye Health Screening

“India is challenged by the burden of diabetes and its complications. Blindness due to diabetes is preventable, and early detection and treatment is the key,” Dr. Rajalakshmi explained. “Easy-to-use, lower-cost devices would overcome barriers to [allow patients to receive] regular diabetic retinopathy screening in lower and middle-income countries like India.”



PostAug09_3Link to Pie Magazine

India’s medical devices startups grabbing the world’s attention with advanced and affordable technologies

In an industry dominated by global giants, medical devices startups are making inroads with technology that’s advanced, affordable and more accessible.




India’s medical devices industry is growing at about 15% annually and is expected to reach at least $25-30 billion (Rs 1.65-1.98 lakh crore) by 2025, according to a report in March by Deloitte Touche Tohmatsu India, driven by indigenous manufacturing, exports and local innovation.


But the industry is fragmented, price-sensitive and faces constraints such as erratic power supply, low doctor-patient ratio and a shortage of trained personnel to handle complex devices, pain areas startups are trying to tide over to achieve market acceptance.


The affordability and increased reach that these startups bring are also particularly crucial. Medical technology contributes significantly to healthcare delivery costs in India, with medical devices and diagnostics accounting for 20%-25% of the cost of medical services, according to Deloitte. “We are seeing Indian medical devices startups being able to innovate and bring products to the market faster than their western counterparts at a price point that is very attractive,” said Barath Shankar Subramanian, vice president at venture capital firm Accel Partners


Remidio, which makes eye-care diagnostics technology, has so far commercially launched two products smartphone-based Fundus on Phone and Angio on Touch diagnostic imaging system. While obtaining a complete image of the retina would require a wide-field imaging camera that costs about Rs 65 lakh, Remidio’s Fundus on Phone, priced Rs 1.8 lakh, can connect to a mobile phone camera to take pictures of the central part of the retina. It is highly useful in early detection of diabetic retinopathy. “This is a marathon, not a sprint,” said Anand Sivaraman, CEO at Remidio, an IIT-Kharagpur alumnus who previously worked at General Electric and biotechnology firm ReaMetrix. The startup has achieved 300 installations across hospitals and private opthalmologist clinics in the past 22 months.


Link to News Article in The Economic Times

Validation of Smartphone Based Retinal Photography for Diabetic Retinopathy Screening



To evaluate the sensitivity and specificity of “fundus on phone’ (FOP) camera, a smartphone based retinal imaging system, as a screening tool for diabetic retinopathy (DR) detection and DR severity in comparison with 7-standard field digital retinal photography.


Single-site, prospective, comparative, instrument validation study.


301 patients (602 eyes) with type 2 diabetes underwent standard seven-field digital fundus photography with both Carl Zeiss fundus camera and indigenous FOP at a tertiary care diabetes centre in South India. Grading of DR was performed by two independent retina specialists using modified Early Treatment of Diabetic Retinopathy Study grading system. Sight threatening DR (STDR) was defined by the presence of proliferative DR(PDR) or diabetic macular edema. The sensitivity, specificity and image quality were assessed.


The mean age of the participants was 53.5 ±9.6 years and mean duration of diabetes 12.5±7.3 years. The Zeiss camera showed that 43.9% had non-proliferative DR(NPDR) and 15.3% had PDR while the FOP camera showed that 40.2% had NPDR and 15.3% had PDR. The sensitivity and specificity for detecting any DR by FOP was 92.7% (95%CI 87.8–96.1) and 98.4% (95%CI 94.3–99.8) respectively and the kappa (ĸ) agreement was 0.90 (95%CI-0.85–0.95 p<0.001) while for STDR, the sensitivity was 87.9% (95%CI 83.2–92.9), specificity 94.9% (95%CI 89.7–98.2) and ĸ agreement was 0.80 (95%CI 0.71–0.89 p<0.001), compared to conventional photography.


Retinal photography using FOP camera is effective for screening and diagnosis of DR and STDR with high sensitivity and specificity and has substantial agreement with conventional retinal photography.


Link to Scientific Publication in PLOSOne

Remidio Innovative Solutions: A startup providing cure for Retinopathy


BENGALURU: Anand Sivaraman met Anand Vinekar in a train coming from Coimbatore to Bengaluru, where they both lived. Sivaraman, a PhD in chemical engineering, was working with biotech firm ReaMetrix. Vinekar was a pediatric ophthalmologist with Narayana Netralaya. Vinekar told him about his work, and the problems he faced due to high costs of imaging equipment. Sivaraman, who knew a thing or two about optical imaging, immediately spotted an opportunity.

At 3.5 million a year, India has the largest share of premature births in the world, twice as much as China, the next highest. Retinopathy – damaged retina – is quite common among premature infants. “About 47% of premature babies develop retinopathy,” said Vinekar. Unless detected early, these children become blind.


A complete image of the retina needs a wide-field imaging camera, costing around $100,000 (about Rs 65 lakh). Not many hospitals can afford it, and so the problem goes undiagnosed till it is too late. Sivaraman roped in Pramod Kummaya, a colleague at ReaMetrix and a product designer.


Remidio Innovative Solutions was set up in 2010, with Rs 5 lakh from the promoters and two friends. It got Rs 15 lakh soon from IKP Knowledge Park in Hyderabad. By the end of that year, it showed an imaging device prototype to Wellcome Trust. The UK-based organisation liked the idea but did not quite trust the product. Could Remidio bring out a fully engineered version soon? Wellcome Trust gave the company Rs 1 crore and one year to do so. The fully engineered version was ready by the end of 2011.   Within a month, Remidio got Rs 4 crore and three more years from Wellcome Trust, and last year it launched the device. It is useful to detect diabetic retinopathy early,” said Sivaraman.


Link to News Article in The Economic Times

Smartphones – there is more to them than meets the Eye

hinduCHENNAI: Cameras in smart phones have a wide range of use than to just click selfies and other pictures to be shared on social media platforms. Doctors are saying there is more to it than meets the eye when it comes to smart phones. Increasingly they are using them to detect and diagnose eye ailments.

There are a number of devices and techniques that have been used by smart phones to detect eye conditions, but very few studies have been made on their efficiency, say physicians. For instance when it comes to diabetic retinopathy, accuracy plays a major role. To screen patients said to be having the condition, Dr. Mohan’s Diabetes Specialities Centre has been conducting studies using a device called ‘Fundus on Phone Camera’. In their latest study, they have made use of the new device for taking colour photographs of the fundus (interior of the eye). These photos were validated against the photos of the retina that were taken using a conventional retinal camera.

“This procedure would thus help detect a number of diseases on the fundus, including diabetic retinopathy,” V. Mohan, founder, Dr. Mohan’s Diabetes Specialities Centre, says. The cost of this camera is one tenth that of the traditional camera and can be used by untrained professionals. “Patients with type 2 diabetes will have to check their vision every year from the day they are detected. Using a cheaper, smaller piece of equipment would help to screen more people for diabetes-related eye diseases,” he said.


Link to News Article in The Hindu

Smart phones to the rescue: Detecting the warning signs of blindness in India

WellcomeBlogLONDON: In a country with over 60 million diabetics, and a doctor-patient ratio of only 1:8300, how do you ensure that each patient gets the early screening needed to help prevent vision loss?


In India, scientists hope to be able to counter the growing problem of preventable blindness thanks to a new ultra-portable lightweight device that is able to detect any early signs of sight deterioration.


Developed by Remidio Innovative Solutions in Bangalore, the Fundus on Phone (FOP) device is able to ‘piggyback’ onto a regular smartphone and take high resolution images of the back of the eye.   Designed with simplicity in mind, the images can be taken by local health workers in the field, before being sent electronically by WhatsApp and Gmail to ophthalmologists many thousands of miles away to look for early warning signs.


Funded by the Wellcome Trust under the Affordable Healthcare in India scheme, the idea for the innovative device actually came after a chance meeting with an ophthalmologist on a train. Founder and Director of Remidio Dr Anand Sivaraman explained how the ophthalmologist talked of the problems of preventable vision loss and that despite the treatment costing only $30-50, the instruments needed to detect it can cost up to $100,000.


Pilot programs have already shown the potential public health impact this technology could have.  Over the past 18 months over 3800 diabetics in Maharashtra were screened using FOP by women volunteers with no prior knowledge of retinal imaging, under the clinical guidance of Dr Salil Gadkari of Vision India Foundation.  Of these, 507 patients were found to have sight-threatening retinal conditions that they were not even aware of, which means that 13% of the screened diabetics were potentially saved from permanent blindness due to a simple retinal image taken on a smartphone.


Dr Sivaraman says: “Early detection is key in the war against preventable blindness caused by chronic conditions such as Diabetic Retinopathy, ARMD and Glaucoma. Large scale screening requires devices that are not only affordable, but also simple to use, easy to maintain and reliable.  Given its simplicity, affordability and ease of use, FOP has the potential to significantly impact preventable blindness programs, through tele-ophthalmology-based screening, globally.”


Link to Wellcome Trust Blog


Image credit: © Remidio Innovative Solutions Pvt Ltd

The ‘Smart’ way to Prevent Blindness

Dr Mohan

CHENNAI: A large number of conditions such as congenital blindness and diabetic retinopathy can now be diagnosed without expensive diagnostic aids.  It can be done with a simple imaging system that works with your average high-end smartphone, after which the images are WhatsApped to an optometrist for a quick consult.


A large portion of India’s preventable blindness burden is because people don’t get diagnosed or treated on time. “We were shocked to find that some patients were completely blind and they don’t know it,”  said diabetologist Dr V Mohan.


So far,  a hundred of these mini telescope like devices called Fundus on Phone have been sold to clinics across the country, but the true potential of this device is largely untapped, according to its developer Dr Anand Sivaraman of Remidio Innovative Solutions.


“Fundus on Phone was developed indigenously in 2010 and it’s built in such a way that it can be carried anywhere easily, so there will be plenty of rural applications here. All it needs is a smartphone mounted on it and practically anybody can capture images of the patient’s eye for diagnosis,” he said.  After devices like Peek made their debut, using smartphones to try and diagnose a variety of eye conditions are in vogue. But just how effective these methods are have never been scientifically verified until researchers at the Madras Diabetes Research Foundation (MDRF) decided to put the device called the Fundus on Phone to the test. “So, we did a study on 301 patients using this technique and what we found was that the images produced were stunningly effective in diagnosing retinopathy.  The effectiveness was as high as 94 percent which is amazing because in patients of this nature anything over 70 percent is acceptable,” said Dr R M Anjana, diabetologist and researcher.


All of Dr Mohan’s centres will have one of these devices and ordinary technicians will man these stations to ensure the diabetics who troop through aren’t in the 18 percent slab that develops retinopathy.


Link to News Article in The New Indian Express

The Pune Diabetic Retinopathy Awareness and Screening Model


Background: Diabetic retinopathy has become a serious public health problem.


Aim: To evolve a reliable and scalable model of diabetic retinopathy screening and awareness usable at the national level.


Setting and Design: Community-based cross-sectional observational study.


Materials and Methods: The model was used in Pune and surrounding districts in 25 locations, between March to November 2014. It involved the local communities to arrange, enrol attendees, and disseminate information about the mission before and after the program. This was done through a women’s self-help group “Tanishka” with over 70,000 volunteer members distributed throughout Maharashtra. Screening was done by telemedicine using an indigenous low-cost portable retinal camera, with a remote reporting capability. All programs were reported by the vernacular press to ensure a force multiplier effect by conveying the message to its entire readership.


Results and Conclusion: A total of 25 programs were held and attended by 2,965 persons. One thousand four hundred and eighteen diabetics patients were screened out of which 193 were found to have retinopathy requiring further investigation and treatment. Repeated press coverage over an extended period ensured high reader uptake. Creating awareness and screening were used simultaneously and to complement each other. Local participation, affordable indigenous technology, and awareness through the press were the three pillars of this model. The model was found to be viable, reliable, reproducible, and scalable. It can be expanded to function at a national level.


Link to Scientific Publication in JCOR

Retina check among Diabetics goes Smarter & Cuts down on Costs


PUNE: Opthalmologists can now rely on indigenous technology to screen diabetic patients in rural India sitting in their clinic through smartphones. ‘Fundus on Phone’, a portable, battery-operated device, can be used through the smartphone to take pictures of the back of the eye, the light sensitive layer called retina. A medical technician carries the device to the village, checks the eyes of the diabetic patients and sends the images to the doctor’s phone through WhatsApp.


The doctor studies the laser sharp images to decide whether the patient needs further intervention. Vision India Foundation is using the technology to hold free screening camps in Junnar, Manchar, Satara, Talegaon and Nashik. “Signs of retinopathy in a diabetic patients are visible well before the onset of the ailment. It starts developing in the periphery of the retina so the patient doesn’t know that he is losing his vision till the centre of the retina is affected. Early detection is the key and Fundus on Phone helps us do that with efficiency and economy,” said Quresh Muskati, president of All-India Opthalmological Society.


Opthalmologists agree that the state government has good medical infrastructure and resources for treating patients with eye ailments. Besides, there are NGOs active in the health sector. “With early detection, we can help save hundreds of diabetic patients from permanent blindness,” concluded Gadkari.


Link to News Article in Times of India

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