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  • Writer's pictureJyoti Pande

A keen eye on healthcare

Innovations by start-ups in eye diagnostics may help detect ailments much before the first symptoms appear Jyoti Pande Lavakare / April 30, 2011, 0:08 IST For someone who plays so little sport, I’ve sat across from a surprisingly large number of sports physicians, especially while living in California — it’s the standing joke in my family. However, the tables were turned recently, when a skiing accident finally caught up with the real sportsperson in our house, and I found myself sitting outside the operation theatre in an Indian hospital, waiting for news about a finger surgery under general anaesthesia.

What struck me was the extreme makeover private hospitals have had in the less than half decade that I’ve been away from India. Between the gleaming granite interiors, cool cafés and smartly turned out staff, I fully expected a welcome drink – antibiotic-laced, no doubt – and a cold towel, while registering my patient. It’s truly amazing how far behind these hotel-like hospitals have left their state-run counterparts. My last visit to a government hospital left me feeling sick to the stomach at the stench and filth in the corridors — though I was still impressed with the quality of its overworked doctors. It’s the sheer numbers that makes it all unmanageable. Or is it? If populous countries like India focused aggressively on preventive healthcare, most of which can easily be done off-site, state hospitals wouldn’t get so overloaded. Most patients waiting at state-run hospitals come from satellite towns and rural areas, usually in advanced stages of a disease, by which time intense treatment becomes inevitable, and both costs and mortality are higher. What if these millions could be caught at beginning stages before the first symptoms manifest and much before the disease has proliferated — without overworking existing doctors? This is exactly what a start-up called Forus Health Pvt Ltd is trying to do. Forus, founded last year, focuses on the preventive healthcare space. Its first product – a pre-screening optical device called 3nethra – can detect up to five common eye problems non-invasively even before first symptoms appear. Without a doctor behind the controls. “India has 25 per cent of the entire world’s blind population,” Dr Shyam Vasudeva Rao, president and CTO of Forus Health, told me in Bangalore earlier this month. “Over 80 per cent of that is easily preventable.” If that isn’t shocking, Rao’s statistics are relentless. “Diabetic retinopathy, cataract, glaucoma, cornea and refraction problems constitute 90 per cent of all blindness. Our ophthalmologist to patient ratio is approximately 1: 60,000. This is much worse in our villages — because of which only 10 per cent of people at various stages of blindness are screened and treated today.” India’s entrepreneurial eco-system is coming alive with start-ups like Forus in the healthcare space – curative, preventive, palliative or as part of the new “wellness” industry – and technology is mutating existing models. These start-ups are devising innovative products and ideas aimed at democratising healthcare and making it more affordable. Hospitals are testing telescreening and remote diagnosis as viable options, and if successful, these could end up transforming the existing medical terrain. Such improvisations help funnel patients to the required specialists, making treatment more effective, detecting diseases before they get critical thus taking some pressure off hospitals. These and hundreds of new ideas are stirring up some serious action in the medical field — eye diagnostics is one. The World Health Organisation has launched a global initiative to eliminate avoidable blindness, called Vision 2020 — The Right to Sight. According to WHO estimates, 284 million people globally are visually impaired, 90 per cent of these are from developing countries — imagine the economic burden. The Indian government is participating in Vision 2020 — which means devices like 3nethra, NetraScan and others can become important tools in detecting early-stage impairment. NetraScan, a hand-held optical prototype is currently being incubated by Remidio, another Bangalore product design and development company, which plans clinical trials in its next stage of development. “3Nethra does retina and cornea imaging, refraction index measurement and intelligent image processing to classify whether the patient needs to visit an eye doctor or just a optics shop. If an eye doctor — a diabetic retina specialist, glaucoma specialist or cataract surgeon?” It can also catch premature birth infant blindness, another large statistic, Dr Rao said. “All this can be done without pupil dilation or local anaesthesia, making it easy and safe to use. Plus its tele-medicine-enabled, making it best-suited for remote diagnostics.” Forus is focusing on the low-cost, high-volume zone to ultimately move patients out of hospitals to health kiosks and camps, which also increases rural outreach. “These sorts of devices can be very useful for community work — as long as they stand the test of time,” Dr Hem K Tewari, former chief of the Dr R P Centre for Opthalmic Sciences, said after seeing the product at an opthalmological conference a couple of weeks ago. And it’s not just the poor who benefit from eye examinations. A routine eye check-up can detect serious health conditions like diabetes, hypertension, even cancer, in addition to glaucoma and cataract. “Opportunistic screening in a diabetologist’s office – just like a blood test – can easily prevent diabetic retinopathy,” and 3nethra has a strong price advantage, Dr R Kim, chief medical officer of Aravind Eye Hospital, Madurai, said. Aravind, the world’s largest eye-care provider, has bought two machines from Forus last month and is currently test-using them to analyse the clarity and quality of its digital images compared to existing pre-screeners. Its USP is that anyone can be trained to operate it — Forus suggests undergraduates from the local population since local skilling also provides rural jobs while freeing up doctors for more specialised functions. This is just one area in the medical space where innovation is making inroads — there are several others. Whether or not these ideas take off, one thing is clear — entrepreneurship has seeped into India’s medical healthcare space and is here to stay.

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