Levelling up in ophthalmic diagnostics

How a grant from Sight Research UK helped Dr Mario Ettore Giardini, Senior Lecturer in Biomedical Engineering at the University of Strathclyde, to develop a next-generation screening tool for eye disease in children, using the latest technology from the games industry.

What problem did the project seek to address?

Amblyopia, or “lazy eye”, is one of the most common causes of sight loss in children, affecting around 1 child in 50. It occurs when there is a breakdown in the way in which the brain and eyes work together. Normally, the brain processes visual information from both eyes to enable us to see. However, if an eye condition such as a squint, long or short-sightedness, or cataract, causes visual impairment in one eye, the brain may start to rely solely on signals from the “stronger” eye, causing the vision in the “weaker” eye to deteriorate further.

Children with amblyopia may struggle to see clearly and have difficulty with depth perception. If left untreated, vision may never reach normal levels, leading to lifelong problems. Early diagnosis is crucial because the younger the child can be treated, ideally in early infancy, the greater the chance of a successful outcome.

But screening very young children for amblyopia is problematic. For example, children who have not yet learned to speak cannot follow instructions, and so the standard tests involve presenting the child with a printed card or paddle, and relying on the child’s “looking response” to determine whether or not they have seen the target pattern.

These tests need to be administered in a hospital or specialist healthcare setting, by highly skilled personnel, who are trained to evaluate the child’s attention response. The level of skill required from the operators does not lend itself to large-scale screening and so, in those countries where screening programmes are available, they are normally directed at older children, of age 4-5, who are able to follow instructions and engage with testing. By this age, however, the most sensitive phase of visual development is already over, and treatment for amblyopia will be less effective.

What solution did the project propose?

Dr Mario Giardini, a biomedical engineer from the University of Strathclyde, whose research explores the frontiers between optics, electronics, and medicine, approached Sight Research UK together with Dr Iain Livingstone, Consultant Ophthalmologist of NHS Forth Valley, with an inspired idea as to how the process of screening very young children for amblyopia could be completely transformed.

Dr Giardini and Dr Livingstone had worked on a project in collaboration with the London School of Hygiene and Tropical Medicine to develop portable equipment for imaging the back of the eye, designed for use in large-scale population testing programmes in sub-Saharan Africa. Building on this project, and combining their respective expertise in engineering and ophthalmology, they began to explore how paediatric screening protocols could be developed, using digital technologies from the gaming industry, to develop a vision testing platform that could be used with very young children.

What did the project achieve?

In 2017, Sight Research UK awarded Dr Giardini a grant which, together with funding from Rosetrees Trust, enabled him and Dr Livingstone to develop and pilot test two digital vision screening prototypes. The first platform consists of a computer screen, webcam, and a bespoke analysis software library, developed as an integral part of the product. Test patterns are presented on the computer monitor while the webcam focuses on the subject. The computer then analyses the video stream from the webcam, and detects whether or not the target image has been seen. The second prototype functions in the same way, but uses a virtual reality headset instead of a webcam.

As a first step, both platforms were tested on healthy child and adult volunteers, who wore blurring lenses to simulate visual defects. The results exceeded expectations. Not only were both platforms successful in detecting whether visual targets had been seen, but the test results indicate that the technology can be used to analyse a wide range of other eye conditions, in addition to amblyopia.

Importantly, the equipment is designed to be operated by non-specialist personnel, including non-medical staff. Its portability offers the potential for it to be used in schools or other community settings instead of hospitals, meaning that greater numbers of children could be checked for amblyopia, and other conditions, than is currently the case.

What further impact has the grant made?

We were delighted to learn that the grant we awarded for Dr Giardini’s pilot project has helped to leverage over £200,000 from other funders including Rosetrees Trust, The R S Macdonald Charitable Trust, and the University of Strathclyde’s Centre for Doctoral Training in Medical Devices (funded by the Engineering and Physical Sciences Research Council). This major investment will enable Dr Giardini to explore his screening tool’s broader diagnostic potential and to develop his prototype into a clinical product, possibly within the next two years.

Sometimes, discoveries made through a particular research project have a wonderful way of delivering wider benefits than imagined. For instance, we were thrilled to hear that Dr Giardini and Dr Livingstone have been exploiting techniques developed through the amblyopia project, and through earlier collaborations, to help people with eye emergencies during the COVID-19 pandemic. They had already started supporting NHS Scotland, using digital technology to provide remote consultations. When they started using cameras and computer screens to observe how patients respond to vision testing, they quickly realised that the technology could be used to perform remote diagnosis, as well as consultation. Over the past year, they have been supporting a network of emergency eye treatment centres, using digital technology to triage patients, enabling those people for whom it was possible, to be treated in the community instead of being admitted to hospital at a time of crisis for the health service.

We know that it can take many years of painstaking work for research to actually make a difference to patients, which is why it has been truly exciting to learn that knowledge gained through the amblyopia project has already contributed to help people in urgent need of care. As Dr Giardini says, “the goal of research is to support society”. What better goal could there be?

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