By adopting the use of portable vision screeners throughout India, the vision of approximately 10 lakhs (1m) children can be treated and saved before the onset of permanent damage from amblyopia
Amblyopia: Affecting 10 lakhs (1m) Children Every Year
Amblyopia is a medical condition in which a person’s vision in at least one of the eyes is reduced because the eye and the brain are not working together properly, according to the National Eye Institute. “The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye.” According to Contemporary Pediatrics, amblyopia is caused by an abnormal development of the visual areas of the brain and likely occurs in about 10 lakhs, or 1 million, children under the age of six in India per year (presuming the same incident as in the United States where it occurs in about 3% of children). Children and adults that have amblyopia lack clear visual inputs to one or, sometimes, both eyes. The US Preventative Services Task Force believes that amblyopia is a children’s disease that is more difficult to treat the older the child, and that the effects of the disease are irreversible if not treated before the age of six.
Important Eye Testing is Widely Performed Even in the USA
Unfortunately, amblyopia is not a routine test performed by most pediatric physicians today. Less than 40% of three year olds in the US have been tested, and only 80% of five year olds have been screened at least once. It reasonable to assume that these numbers are at least an order of magnitude above the screening rates in India. Even among those children who were tested and subsequently failed their vision screens, only about 20% followed up with vision specialists. To address this unfortunate, but entirely treatable condition, vision screens must become a routine test for children from a young age when it’s possible to fully reverse the effects of amblyopia.
The Big 3 Vision Screeners: Plusoptix, PediaVision, and iScreen
To perform a vision test today, physicians typically turn to one of three portable vision screeners to diagnose children. These three screeners are the S12C by Plusoptix (shown in use to the left), the Spot by PediaVision (shown in use below to the left), and the Vision Screener 3000 by iScreen (shown in use below to the right). What these devices do is test for “pupil position, equality, size, steadiness, reaction to bright light, extraocular muscle function, ocular deviation, and the presence of unequal red reflexes.” Each of these devices are different in their specifications, however all three are much faster and more effective methods of diagnosing amblyopia than visual acuity testing using eye charts. While an eye chart test could take more than 10 minutes, these three devices will be able to diagnose a patient in seconds with a higher degree of sensitivity and specificity. Today, many healthcare payers cover vision screens because they understand that these devices are better at detecting a variety of eye diseases, like amblyopia, from early stages whereas many times eye chart tests cannot.
The Big 3 Are Effective and Better than the Conventional Eye Chart Tests
According to a study completed by the Alaska Blind Child Discovery organization in 2013, the Plusoptix, PediaVision, and iScreen devices had varying levels of sensitivity, specificity, and inconclusive results at times, but all three were considered effective. The Plusoptix screener received a sensitivity score of 83, a specificity score of 88, and an inconclusive score of 22. The PediaVision screener received scores of 80, 84, and 3, in sensitivity, specificity, and inconclusiveness, respectively. Lastly, the iScreen screener received scores of 76, 88, and 12, respectively. To avoid confusion, the higher the score, the more favorable the device is in that function. Therefore, the PediaVision device has the highest occurrence of inconclusive results because it has the lowest score, followed by the iScreen and Plusoptix. The PediaVision also has the lowest score in specificity, followed by a tie between the iScreen and Plusoptix. Lastly, the iScreen has the lowest sensitivity score, followed by the PediaVision and Plusoptix.
Typically, inconclusive results are considered “referral” images that cannot lead to a definite diagnosis by the vision screen and instead needs to be further reviewed by a specialist for diagnosis. From this study, it is clear that of the three devices, the Plusoptix screener is the best screener followed by the iScreen and PediaVision screeners. However, the Plusoptix is priced at about $7400 per unit, the iScreen is priced at about $4200, and the PediaVision is priced at about $7500. Therefore, it is up to the physician and her preferences for which device is best-suited for her and her patients.
Unitus Ventures and the Indian Vision Screening Market
Welcare Health Systems is one of Unitus Ventures’s newest and most exciting portfolio companies. Welcare is an affordable eye screening services company which operates quality eye screening services for the masses in India. Welcare sets up eye screening services within existing health centers making them accessible to patients at high-risk for eye diseases (such as those caused by diabetes) which could lead to blindness. Welcare leverages new technology for the screenings and keeps costs low by having certified ophthalmologists working remotely.
We believe that eye screening is a pressing issue worldwide, including especially countries with young populations such as India. As a result, we are looking to partner with leading medical technology companies, like Plusoptix, PediaVision, iScreen, and others that can help us fight against eye diseases in India. By adopting faster and more effective eye care practices, such as vision screens using cutting-edge technology for early detection, and offering these services to the masses, Unitus Ventures believes that the lives of many of India’s citizens, especially those in the BoP can be drastically improved.
If you are on a mission to aid India’s BoP through a healthcare initiative or medical product or service, we would love to hear from you.