Retina Technologies: Revitalizing the Vision Screening Market to Protect the Right to Sight
The ability to see is one of the grandest gifts bestowed upon humanity. At least that is what a majority of Americans across every age group think. And while we as a species value this form of sensation so much, billions around the world lack access to adequate visual screening necessary to either confirm healthy vision or identify the need for immediate treatment to prevent vision loss due to disease. What is even more alarming is that the United States, with some of the most advanced medical practitioners and technologies in the world, has vast shortage of both optometrists and ophthalmologists, leaving millions without access to visual examination (see Figure 1). Indeed, as medical students at the Icahn School of Medicine at Mount Sinai, we experience this screening disparity frequently while working in clinics that serve resource-poor communities.
Figure 1. Availability of vision specialists by county in the United States. Source: Gibson, DM.
Last December, Aashay Patel, a Retina Technologies team member, was seeing a patient as part of the East Harlem Health Outreach Partnership, Mount Sinai’s student-run free clinic for uninsured East Harlem residents. A 65 year old woman, who we will refer to as Maria, arrived that day taking painful steps due to foot ulcerations and joint pain. Aashay performed a physical exam, and aside from noting a host of illnesses including hypertension and recurrent chest pain, he discovered that Maria had peripheral vision loss in her right eye. She could only see what was directly in front of her. Had a car zoomed by her side on a busy crosswalk or had her grandchild fallen out of a crib, that which she would have seen from the “corner of her eye” would have be lost to her peripheral visual field defect
As soon as Maria’s visual deficits came to light, the focus of the conversation drastically changed. Her face became overwhelmed with worry. “No puedo pedir mi visión. Es la única cosa que tengo. Preferiría morir...”, which translates to “I can’t lose my sight. It’s all I have left, I’d rather die”. Hypertension, diabetes, ulcers were all secondary to her when her sight was in jeopardy. Yes, losing sight doesn’t end one’s life, but it can make life challenging. And too many like Maria don’t have access to the visual diagnostics and therapies they need to ensure that quality of life. Patients like Maria need options and physicians need tools to provide the eye-care that these patients require.
Figure 2. Retina Technologies VR-capable vision screening versus Humphrey (current gold standard), demonstrating portability and increased patient.
A potent early indicator of potentially global vision loss from various diseases is loss of peripheral vision. That is why testing for this deficit is commonly, yet very crudely, done in any comprehensive physical exam. The gold standard for perimetry testing is the Humphrey Visual Field Analyser, a space-consuming machine that costs ~$30,000. Additionally, facilities that utilize these machines generally require a technician for operation, and ophthalmologist feedback suggests that patients are also not physically comfortable while taking the test, particularly those who are older (see Figure 2). These factors make it improbable for healthcare facilities in ophthalmology deserts, such as primary care practices, to adopt this machinery.
Enter portable technologies. With the advent of devices such as virtual reality headsets and hand-held retinal imaging devices, it is now possible to bring more sophisticated and automated examinations into clinics that handle underserved populations. In certain situations, these products are capable of providing actionable test results on the spot, but with the recent expansion of tele-medicine reimbursements, forwarding results to remote specialists (including ophthalmologists) has now reached feasibility as well.
At Retina Technologies, we are striving to enter the portable vision screening market in a holistic manner by integrating several vision examinations into a virtual reality headset, with results and urgent referral recommendations provided immediately. These examinations are straightforward, requiring minimal training of physicians or their staff, and are reimbursable as well. Most importantly, we have developed this technology around financially-feasible adoptability, with an expected hardware sales price that is less than 10% that of a Humphrey. Looking forward, our product design allows for the possibility of expansion to global, underserved populations with the help of medical non-profit organizations.
80% of global blindness and moderate-severe vision impairment cases are preventable, and we are making it our responsibility to decrease this percentage via accessible, portable, and affordable vision screening technologies.
Retina Technologies is utilizing virtual reality to develop ophthalmology diagnostics that catch blindness before it strikes, enabling early intervention and vision preservation.
Universities: Icahn School of Medicine at Mount Sinai; and NYU College of Global Public Health.
Team Members: Aashay Patel, Andrew Warburton, Randal Serafini, Aly Valliani, Pinkey Patel.
Kopf D. “The sense Americans say they would miss most if they lost it, by age.” Atlas, 2018. Web. <https://www.theatlas.com/charts/S1xU0khVQ>.
Gibson DM. The geographic distribution of eye care providers in the United States:Implications for a national strategy to improve vision health. Preventative Medicine, 2015. 73:30-36.
Sherer J, Joseph A, Vernon D. “CMS Proposes to Expand Telehealth Reimbursement under Medicare.” American Bar Association, 2018. Web. <https://www.americanbar.org/groups/health_law/publications/aba_health_esource/2018-2019/september2018/telehealth/>
Khanna RC, Marmamula S, Rao GN. International Vision Care: Issues and Approaches. Annual Reviews Vision Science, 2017. 3:53-68.