British ophthalmologist Andrew Bastawrous started school, like many children, with poor eyesight. Once his vision was tested and he got his first pair of glasses, he started to do well academically. “The opportunities I had really opened up,” he says. “I was also acutely aware that had I been born somewhere else in the world, that wouldn’t have been true. It was always in the back of my mind that a huge imbalance exists between those who need eye care and those who have it available to them.”
That childhood experience has inspired his professional life. Now he is an entrepreneurial eye surgeon who is determined to make a sizeable dent in the number of people living with poor vision.
The vast majority of the world’s 285 million visually impaired people live in low-income countries, where they may have little or no access to diagnostic tests and treatment. Often they are in remote, hard-to-reach areas.
In 2011, Bastawrous left his job with the UK’s National Health Service and moved to Kenya, to lead a study of eye examinations among more than 5,000 people in remote areas. Trained eye specialists are especially scarce in sub-Saharan Africa.
With a team, Bastawrous travelled around rural Kenya in two vans carrying heavy, expensive machines for vision testing. Most villages had no electricity and often no roads. But most did have mobile phone coverage. He realized there had to be a more portable and economical solution.
“While I was carting around lots of high-tech equipment, I realized it may be possible to replace all of it using mobile devices. We could build a variety of apps and hardware that would enable non-healthcare workers to do high-quality vision testing without a huge amount of training.”
Peek, the Portable Eye Examination Kit, was the result. Bastawrous’s idea was to make an inexpensive, smartphone-based system for use in places where it is not practical to transport fragile, cumbersome electrical equipment and it is difficult for the few trained experts to reach.
Peek incorporates software applications, hardware adapters and systems. The apps replace standard ways of testing visual acuity and are based on the familiar ophthalmological eye chart that uses the letter E.
An adapter that changes the camera’s optics fits over the phone and enables the tester to see the patient’s retina. This test is critical to assess eye health in many types of chronic diseases.
Once the prototype system had been built, Bastawrous ran a clinical trial in which the team trained 25 schoolteachers to use Peek. They screened 21,000 students in nine days and found 900 with visual impairment. The training and the testing were met with enthusiasm by both teachers and the students who had their vision tested.
Bastawrous emphasizes that testing people without being able to treat them is useless, as is sending them into an overwhelmed healthcare system. His team carefully calculates the rate at which local services can absorb patients. Then the team provides training for screening, in a “train the trainers” model that can sustain itself.
In the trial, parents of children identified as having a vision problem received an SMS notification and the head teacher received a list of children needing care via SMS.
Screening programmes are now being organized for 300,000 more children in the same area of Kenya, with the possibility that Peek could become a national programme. Since beginning in Kenya, Peek is now also being used in Botswana, Tanzania and India, and there is interest from many other parts of the world, including the United States and Europe.
The price of success is how to implement the Peek system at scale, which the Rolex Award will help Bastawrous and his team do. The Award will allow for the establishment of a centre of excellence in Kitale, Kenya.
Bastawrous describes his vision for the centre: “We want this space we are creating in Kenya to become a place of leadership and high-quality training. But, more than that, we want to create an inspiring environment for local entrepreneurs, a co-working space, not only for Peek, but also for other entrepreneurial activities, right in the heart of where the problems are. I’ve worked with inspiring and humble leaders in Kenya and elsewhere who are striving to serve their communities. We want the centre to make a statement. For too long we’ve talked about helping Africa. Now, if you want help to deliver an eye-care programme you’ll be able to go to Kenya to get help.”