Kenya: Examination tool which has the potential to tackle blindness


A mobile app which is expected to be taken to market next year could transform the way in which eye care is provided in low-income countries around the world.

Developed by a team of ophthalmologists, developers and engineers, Peek is a mobile app, with accompanying clip-on hardware, which can transform a low-cost Android smartphone into an eye examination and diagnostic device which is able to complete a variety of ophthalmic tests, as well as taking pictures of the back of the eye.
Peek provides users with a variety of diagnostic tests including visual acuity, visual field, colour vision, contrast sensitivity, lens imaging for cataract, retinal imaging and image grading. The tests can help diagnose blindness, visual impairment, cataracts, glaucoma, macular degeneration and diabetic retinopathy, as well as other retinal and optic nerve diseases.
While Peek offers an easy to implement, cheap solution to providing eye care to those living in remote areas of low-income countries, it could also be used in practice, or as a diagnostic tool during domiciliary visits.
Kenya cohort
The brainchild of Dr Andrew Bastawrous, from the London School of Hygiene & Tropical Medicine, Peek was established to provide a solution to the logistical problems which the ophthalmologist found himself up against as he prepared to lead a follow-up study on the progression and incidence of eye disease in Africa.

The first-of-its-kind study, which is currently two-thirds complete, involves retracing and re-examining 5,000 people across Nakuru County in Kenya. To do so requires a team of 15 people and £100,000 worth of testing equipment which must be transported to 100 locations, many of which are in remote villages without road access.
“As I prepared for the study I began to realise that it would be extremely difficult to perform,” Dr Bastawrous explained to OT.
Despite the difficulties, the study is important, said Dr Bastawrous, as “it will generate important information about the incidence and progression of eye disease, and help inform the planning of eye care systems.
As a result, Dr Bastawrous sought an alternative, easier solution and, on learning that more people have access to a mobile phone than running water in low-income countries, he began thinking about how a smartphone ophthalmic tool might make such a study less resource hungry.
Dr Bastawrous initially developed a piece of hardware that made retinal imaging possible with a smartphone. However, when he moved to Kenya to embark on the study over a year ago, it proved too complicated for healthcare workers to execute. Going back to the drawing board, Dr Bastawrous met Dr Mario Giardini from the University of Strathclyde joined the Peek team soon after and was able to use 3D printing techniques to rapidly prototype the ophthalmoscope clip on and led to the creation of a much more user-friendly piece of hardware.
Prior to moving to Kenya, Dr Bastawrous met independent app developer Stewart Jordan, who agreed to work on the project and joined the ophthalmologist in Kenya. As a result, Peek has been developed ‘on the ground’ by the duo, in partnership with healthcare workers and support team in the UK.
Following a test, the information gathered can be sent to experts around the world for diagnosis.
Peek is dual purpose, working as an eye examination tool and a patient record, storing contact information and GPS data for each patient. Google-map integration provides users with a way to follow-up and treat patients.
While Peek could not provide Dr Bastawrous with an immediate solution to ease the process of the study, the device is now being tested for accuracy against the state-of-the-art hospital equipment on the 5,000 people who are currently being sought for retesting.
To date, results have been positive: “We have found that when healthcare workers test someone’s visual acuity in the community, they are able to accurately determine what their vision is and whether or not they have a vision problem,” Dr Bastawrous said. “They are also now getting to a level where they can determine the type of visual problems, like cataract for example.”
While certain modules of the app are expected to be released onto the market by early next year, “I don’t think the kit will ever be finished as it is really important that we continually evolve and improve it,” Dr Bastawrous told OT. True to his word, the team is currently working on a range of other apps for Peek, such an as an autorefractor and an entire suite of paediatric exam tools.
Paediatric possibilities
As one quarter of the core Peek team, Dr Iain Livingstone, an ophthalmologist from the Glasgow Centre of Ophthalmic Research at NHS Greater Glasgow and Clyde, is specifically interested in children’s vision and is leading the project’s paediatric acuity tests. He became involved with Peek after the ‘iSight’ app which he brought out in partnership with Kay Pictures was reviewed by Dr Bastawrous.
Passionate about advancing and improving children’s vision, Dr Livingstone explained: “There are lots of types of visual tests available for adults, but there is a massive gap in the market for the same types of tests specially devised for infants.”
“The current standards for infant preferential looking are really just pieces of card and they are really expensive,” he added, referencing one company’s cards with a £1,200 price tag as an example.
With an increasingly technology-aware population, the ophthalmologist believes that digital testing methods are “the way forward,” and that touch screen devices in particular lend themselves to vision testing for children. “By using a touch screen you can add lots of unique ways to test children, which turns it into a game.”
The tests which he is developing use animations and sound, together with touch targets on a screen. “So, provided that you get the distance right between the child’s eye and the tablet device correct, then they can play until the test reaches its end point and produces a visual acuity score,” Dr Livingstone explained.
While other applications for Peek are being validated in Kenya, the “main bulk” of the children’s testing will take place in the UK, Dr Livingstone confirmed.
Testing the app and collecting data for validation in an NHS setting, Dr Livingstone will begin trials on the test in the coming months.
“The wheels are in motion for the trials now,” he said, explaining that the study will be focused around three different models of acuity testing, with the results identifying the most accurate model to take to market.
The study will be performed in two stages, the first with around 20 adults, and the second with between 50 to 100 children.
Following the results, if all goes well, the app could be released for free within six to nine months.
Discussing the benefits that the app could bring to the sector, Dr Livingstone said: “In my own experience, I think it will be a much better tool than what is currently available, and it would free up orthoptists to do other things.
“I would also hope that, in time, it would help us look at the role of pre-school screening in the UK as well. We would perform a pragmatic trial to see how the test does in the hands of a layman or school nurse.”
A Peek into the future
The team behind Peek has received more than 2,000 enquiries from individuals and groups who are running various eye care programmes across the world, Dr Bastawrous revealed.
“We do not know specifically who will download it, but looking at the interest we have had, it will be predominantly people involved in eye care,” Dr Bastawrous reflected while sharing his UK-based ambitions for the device. “As well as being used in low-income settings, we also envisage it as having a lot of uses in general optometry practices, optometrists using it on domiciliary visits and in primary care” he added.
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