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Sriram Kannan

                 Technologist, i2i Telesolutions
                Founder & CEO, Nivaata Systems




Tele-ophthalmology solution using the iPhone,
      in a quest to cure infant blindness




                            1
MIT                                       The Problem Review
                                              •     ROP (Retinopathy Of Prematurity) is a disease that
                                                    affects premature children, typically infants weighing
                                                    less than 2Kg at birth. If not diagnosed early, these
                                                    infants could potentially become blind.
                                              •     Diagnosis involves viewing of retinal images by ROP
                                                    experts, and instructing trained technical assistants to
                                                    take next steps (such as to start medication and/or
                                                    preparation for laser treatment).
                                              •     In most cases, possible to cure the disease but only if
“Retinopathy of prematurity is the leading          detected early enough.
cause of preventable infant blindness
worldwide. In India, over 8% of 27 million    •     Only a handful of specialists in India (~300) and world-
births each year are at risk of this                wide, who can diagnose for ROP.
potentially blinding condition. Roughly if
100 „at-risk‟ infants are screened, 15-20%
may require treatment that can prevent
blindness. This requires a fast and
efficient system of screening infants
                                                                   BOTTOMLINE
especially in the peripheral rural areas
where expertise is lacking”
                                                  2.5 lakh infants need to be diagnosed every
                                                  month, by about 300 doctors from throughout
Dr Anand Vinekar,
Project Co-Ordinator & Pediatric Retinal          India…
Surgeon,
Narayana Nethralaya, Bangalore.


                                                       2
The Solution – TeleOphthalmology using eyePhone!

                                       Instant image
                                       retrieval using cell
                                       network




                                       ANALYZE AND REPORT ANYWHERE,
                                             ANYTIME, REAL-TIME
                  Images sent to
                  server for
                  secure storage


           Images acquired
           from retinal camera




                                   3
eyePhone Solution Key Features
 A complete telemedicine solution                                 Optimized for handhelds

   Worklist processing module                                  Imaging modules neatly fit into handheld display size
                                                                 and resolution
   Image viewer module
                                                                Images are always streamed from server and never
   Reporting module                                             stored on the handheld itself (unless explicitly
                                                                 required by specialist, such as during offline reporting)
   Instant alert sent to a specialist as soon as a
                                                                Imaging module makes maximal use of capabilities of
    new study for a patient is uploaded and                      handheld, such as the pinch and drag, zoom and pan
    assigned to him/ her.                                        for the iPhone.



             Tele-consultation                                Disease specific reporting templates


   Facility to refer to other specialists and request        for each specialty and sub-specialty, built using
    for opinion.                                               inputs from specialists in the field.
   Facility to view and compare images and                   Facility for specialists or institutions to further
    reports across different studies of the same               customize reporting templates
    patient.




                                                         4
EyePhone Screenshots – login and worklist query




                          5
eyePhone Screenshots – worklist and studies browser




    worklist          Studies list     Main menu

                            6
eyePhone Screenshots – Medical Image Viewers




         Image viewer        Image comparison

                         7
FICCI-MEF Recommended Focus Areas


•   Rural Telehealth / Home care                            •   Mother and Infant Care
         89% of rural patients have to travel about 8               2.1 million children (<5 yrs) die annually
        km to access basic medical treatment ~620
        million rural Indians                               •   Diabetes Care
•   Early detection of Cancer                                       Treatment cost ~ 0.2% of GDP
        ~1 million new cancer cases are expected to                 Productivity loss ~ 1.9% of GDP
        be diagnosed in India by the year-end               •   Implantables
•   Cardiac care                                                    Advanced Bionics device, eg cochlear
        By 2010, 60 % of world's heart patients will                implants: 4/1000 children are born deaf. Deaf
        be in India                                                 population ~ 14 million.
        1/5th of heart attack victims in India get to
        hospital well after 12 hours.                               Implantable Retinal prosthesis : India has 15
                                                                    million blind out of 37 million global the world's
                                                                    largest number of blind people in a country.
                                                                    Globally 37 million blind people.




                                                        8
Future…
• Focus on other ophthalmic diseases such as Diabetic Retinopathy,
  Retinoblastoma (eye cancer)

• Focus on telecardiology, teledentistry

• Activities started already, a sneak peak… 




                                   9

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Tr35

  • 1. Sriram Kannan Technologist, i2i Telesolutions Founder & CEO, Nivaata Systems Tele-ophthalmology solution using the iPhone, in a quest to cure infant blindness 1
  • 2. MIT The Problem Review • ROP (Retinopathy Of Prematurity) is a disease that affects premature children, typically infants weighing less than 2Kg at birth. If not diagnosed early, these infants could potentially become blind. • Diagnosis involves viewing of retinal images by ROP experts, and instructing trained technical assistants to take next steps (such as to start medication and/or preparation for laser treatment). • In most cases, possible to cure the disease but only if “Retinopathy of prematurity is the leading detected early enough. cause of preventable infant blindness worldwide. In India, over 8% of 27 million • Only a handful of specialists in India (~300) and world- births each year are at risk of this wide, who can diagnose for ROP. potentially blinding condition. Roughly if 100 „at-risk‟ infants are screened, 15-20% may require treatment that can prevent blindness. This requires a fast and efficient system of screening infants BOTTOMLINE especially in the peripheral rural areas where expertise is lacking” 2.5 lakh infants need to be diagnosed every month, by about 300 doctors from throughout Dr Anand Vinekar, Project Co-Ordinator & Pediatric Retinal India… Surgeon, Narayana Nethralaya, Bangalore. 2
  • 3. The Solution – TeleOphthalmology using eyePhone! Instant image retrieval using cell network ANALYZE AND REPORT ANYWHERE, ANYTIME, REAL-TIME Images sent to server for secure storage Images acquired from retinal camera 3
  • 4. eyePhone Solution Key Features A complete telemedicine solution Optimized for handhelds  Worklist processing module  Imaging modules neatly fit into handheld display size and resolution  Image viewer module  Images are always streamed from server and never  Reporting module stored on the handheld itself (unless explicitly required by specialist, such as during offline reporting)  Instant alert sent to a specialist as soon as a  Imaging module makes maximal use of capabilities of new study for a patient is uploaded and handheld, such as the pinch and drag, zoom and pan assigned to him/ her. for the iPhone. Tele-consultation Disease specific reporting templates  Facility to refer to other specialists and request  for each specialty and sub-specialty, built using for opinion. inputs from specialists in the field.  Facility to view and compare images and  Facility for specialists or institutions to further reports across different studies of the same customize reporting templates patient. 4
  • 5. EyePhone Screenshots – login and worklist query 5
  • 6. eyePhone Screenshots – worklist and studies browser worklist Studies list Main menu 6
  • 7. eyePhone Screenshots – Medical Image Viewers Image viewer Image comparison 7
  • 8. FICCI-MEF Recommended Focus Areas • Rural Telehealth / Home care • Mother and Infant Care 89% of rural patients have to travel about 8 2.1 million children (<5 yrs) die annually km to access basic medical treatment ~620 million rural Indians • Diabetes Care • Early detection of Cancer Treatment cost ~ 0.2% of GDP ~1 million new cancer cases are expected to Productivity loss ~ 1.9% of GDP be diagnosed in India by the year-end • Implantables • Cardiac care Advanced Bionics device, eg cochlear By 2010, 60 % of world's heart patients will implants: 4/1000 children are born deaf. Deaf be in India population ~ 14 million. 1/5th of heart attack victims in India get to hospital well after 12 hours. Implantable Retinal prosthesis : India has 15 million blind out of 37 million global the world's largest number of blind people in a country. Globally 37 million blind people. 8
  • 9. Future… • Focus on other ophthalmic diseases such as Diabetic Retinopathy, Retinoblastoma (eye cancer) • Focus on telecardiology, teledentistry • Activities started already, a sneak peak…  9