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HomemiequipmentAnywhere, Any Time the Eyeonic Online Visual Field Test

Anywhere, Any Time the Eyeonic Online Visual Field Test

Eyeonic wins SmartCompany’s ‘The Pitch’.

Online visual field technology is an exciting development in the field of glaucoma, with the potential to redefine the future of disease diagnostics and care. Forging the way is Melbournebased company, Eyeonic, with its novel product that offers visual field testing via any computer, tablet, or laptop.

The Eyeonic visual field test is an artificial intelligence (AI)-powered, cloud-based, online application that can accurately and reliably detect glaucoma with similar diagnostic accuracy and repeatability to conventional clinic perimetry machines. Developed by Associate Professor Simon Skalicky, a glaucoma sub-specialist, ophthalmologist and tech developer, it offers patients an accessible, cost-effective, and user-friendly alternative, with the hope to significantly expand the provision of care through home-based and community testing.

GLAUCOMA: A GROWING BURDEN

The number of individuals affected by glaucoma is expected to increase dramatically. Already, more than 80 million individuals globally have glaucoma, and this number will increase to 111 million by 2040, making it one of the leading causes of irreversible blindness.1 Patients diagnosed with glaucoma require lifelong, regular surveillance reviews to monitor disease progression and guide treatment. Already, the growing demand for chronic eye care is placing increasing pressure on health systems globally. High patient caseloads, long appointment wait times, gaps in care, and delays in treatment are becoming the reality across health systems worldwide. Because of limited access to care in low-resource settings, many individuals with glaucoma remain undiagnosed and inadequately treated. In the developed world, 50% of glaucoma is undetected; in the developing world, this proportion reaches 90%. These figures represent a tragic missed opportunity for early diagnosis to save sight.2

VISUAL FIELD TESTING

Visual field testing remains critical for diagnosing glaucoma and monitoring for disease progression. Large, in-clinic perimetry machines have remained the clinical standard, however, they have several challenges including high capital and maintenance costs, technical issues, floor space requirements, reliance on trained staff, patient discomfort, limited portability, and lack of availability in resource-limited settings.

An online application that could support visual field testing on portable devices may offer a viable solution to overcoming the barriers of clinic machines. In recent years, visual field testing has been trialled on several devices including computers, tablets, virtual reality headsets, and mobile phones, with variable testing accuracy and high hardware costs being common limitations. An ideal computer-based or device-based visual field test should be accurate, reliable, user-friendly, and economical, particularly outside of a controlled, supervised environment. It should work consistently on clinicians’ and patients’ existing devices (computers, tablets) without requiring the purchase of specific hardware.

THE EYEONIC STORY

In 2019, Assoc Prof Skalicky was becoming increasingly aware of the limitations of clinic perimetry machines. He observed they were causing patients unnecessary anxiety and distress, were time-consuming, and disrupted clinic flow, contributing to increasingly crowded waiting rooms and patient dissatisfaction. There needed to be a way to make visual field testing more accessible, efficient, and enjoyable for patients, but it also needed to be cost-effective. Portable medical technologies were already well-integrated into modern healthcare, and the widespread successes of telemedicine and remote healthcare delivery signalled the potential benefits and viability of online visual field testing.

Assoc Prof Skalicky considered the possibility of an online visual field application – one that could provide testing on any computer, tablet or laptop with an internet connection. This would offer several advantages to both patients and clinicians over conventional machines, with versatility to be used either supervised inclinic, or for home monitoring. Firstly, it would improve patient convenience, by mitigating the number of required clinic appointments, which would reduce the costs and commute times for patients. Home-based visual field testing would also allow for clinic visits to be streamlined, thereby reducing waiting room numbers and resource expenditure.

Improved access to care might also facilitate earlier detection of disease by expanding screening to broader areas, and facilitating more frequent monitoring in patients at higher risk of disease progression. An improved user experience would hopefully reduce patient anxiety around perimetry testing and promote compliance.

In rural or low-resource communities, community medical clinics could potentially offer visual field testing without the need for clinic machines. In essence, an online visual field application appeared to offer several benefits as a cost-effective, accessible, viable alternative, with the potential to significantly expand the provision of glaucoma care.

Inspired, Assoc Prof Skalicky began programming an online visual field software. After extensive development and optimisations, and with support from the Microsoft for Startups program, the prototype of Eyeonic was produced – a cloud-based, AIpowered visual field test, operated via an easily available browser-based web application.

To begin testing, patients were offered the opportunity to try the computer-based online test during their routine clinic appointments. Initially, data from patients with normal eyes were collected to establish a normative database, then data from patients with glaucoma.3 To assess the application’s diagnostic efficacy, the data were compared to that of standard automated perimetry (SAP) in multiple validation studies.4 The test was also compared in terms of its user experience, with patients showing a stronger preference for it over SAP.5 Patients found it more comfortable, user-friendly, less stressful, and they valued its potential for home testing.

THE EYEONIC ONLINE TEST

The Eyeonic visual field test assesses 52 loci over 24 degrees of eccentricity. Ten-degree and 30-degree strategies are also available, as are licence screening tests for driving and pilots.

It is operated via a Python-based web application, hosted on Azure (Microsoft), with tailored high-security architecture and database integrity. Users are presented with a series of flickering targets consisting of alternating light and dark rings. Users fixate on a spinning golden star and click when they see the targets. The test maps the user’s blind spots and uses webcam monitoring to detect changes in head position via the app’s built-in facial detection software. Verbal cues and feedback sounds guide the user throughout the test. Eyeonic does not require additional hardware or any equipment supports. Test duration is similar to standard perimetry tests at around three to five minutes per eye. In recent validation studies, Eyeonic demonstrated strong diagnostic accuracy that was similar to SAP, with high levels of agreement and reliability. It also showed very good repeatability in an 18-week cohort study that is currently in review, and promising early results from a home-monitoring study.

FOUR YEARS OF ACHIEVEMENT

Eyeonic has grown tremendously since its initial conception and is now operated by a dedicated technology, research and development, and commercial team, which is actively working to transform the future of glaucoma care.

The team has worked collaboratively to develop, validate, and optimise the application for patients, continuously pushing the boundaries of technology through ingenuity and innovation.

After four challenging years, commercialisation is underway across several continents and the rewards are beginning to flow as Eyeonic emerges as a leading developer of visual field technology. Already the company’s research has led to multiple international publications and prizes, and has been presented at many conferences across the globe.

Recently, Eyeonic won SmartCompany’s ‘The Pitch’, a highly competitive, early-stage Australian startup competition. Multinational collaborations are also underway in the United Kingdom, Vietnam, Israel, Brazil, Uganda, South Africa, and New Zealand, with strong expressions of interest from researchers and potential global partners. The Australian Therapeutics Goods Administration and the United States Food and Drug Administration are currently reviewing the application for approval; it has already achieved approval in the United Kingdom and several countries in Africa. Further trials are being conducted in both Africa and Asia, which are the two continents with disproportionately higher rates of glaucoma and therefore, offer significant opportunity for large-scale impact. The application was formally endorsed by the South African Glaucoma Society in 2023 and has been successfully trialled by Sydney Eye Hospital.

THE FUTURE FOR EYEONIC

Eyeonic has the potential to make visual field testing more accessible, enjoyable, and economical, with seamless integration into modern healthcare. Consistent encouragement from patients in support of the application and the team’s dedication have been strong motivating forces behind the company’s achievements, as it works toward redefining glaucoma care and driving a global change.

It is anticipated that portable technologies will increasingly become mainstream in the field of eye care diagnostics, assisting providers to expand the provision of care and improve outcomes for patients. It is hoped that Eyeonic will play a large part in building this future and help to improve vision for patients worldwide.

eyeonic.com.au

Joshua Meyerov MD is a Junior Doctor at Alfred Health and is completing his Master of Medicine (Ophthalmic Science) in 2024. He is a Clinical Research Associate at Eyeonic.

Associate Professor Simon Skalicky is a specialist ophthalmologist with subspecialty skills in glaucoma and cataract surgery. He is an Associate Professor at the University of Melbourne, Centre for Eye Research Australia, and a consultant at the Royal Victorian Eye and Ear Hospital, where he teaches medical students, ophthalmology trainees and glaucoma fellows.

Assoc Prof Skalicky serves on the Australian and New Zealand Glaucoma Society executive and the editorial board of the Journal of Glaucoma. He is the immediate Past President of Glaucoma Australia and is actively involved in the World Glaucoma Association. In 2020 he founded Eyeonic, supported by Microsoft, to provide online visual field testing on any computer or tablet. Rod Minett is the Chief Commercial Officer of Eyeonic. He has a successful track record rebuilding underperforming businesses through strategic focus and employee engagement.

References

  1. Tham, Y.C., Aung, T., Cheng, C.Y., et al., Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and metaanalysis. Ophthalmology. 2014;121(11):2081–2090.
  2. Soh, Z., Yu, M., Betzler, B.K., et al., The global extent of undetected glaucoma in adults: a systematic review and meta-analysis. Ophthalmology. 2021;128(10):1393-1404.
  3. Skalicky, S.E., Bigirimana, D., Busija, L., Circular frequency-doubling perimetry via a web-application: optimizing parameters and establishing a normative database. Eye (Lond) 2022 May 16:1–7.
  4. Meyerov, J., Bigirimana, D., Skalicky, S.E., et al., Online circular contrast perimetry: comparison to standard automated perimetry. Asia Pac J Ophthalmol (Phila). 2023;12:4–15.
  5. Meyerov, J., Deng, Y., Busija, L., Skalicky, S.E., Circular contrast perimetry via web application: a patient appraisal and comparison to standard automated perimetry. Ophthalmol Sci. 2022;2(3):100172.