The Aussie Innovation Redefining Global Eye Care Access

Glaucoma is a leading cause of irreversible blindness worldwide, with cases expected to rise dramatically in the coming decades. By 2040, an estimated 111.8 million people globally will be affected by this disease.¹ In many developing countries, lack of access to eye care often leaves glaucoma undiagnosed or inadequately treated. This represents a tragic missed opportunity, as early detection and proper management can prevent blindness in many cases.²

Visual field testing is critical for diagnosing glaucoma and monitoring disease progression. However, conventional visual field machines are expensive, bulky, and often unavailable outside of major hospitals in the developing world. This lack of accessible testing equipment contributes significantly to high rates of undetected glaucoma globally, despite numerous efforts from governments, local, and international organisations. Additionally, rapidly growing populations exacerbate the demand for alternative glaucoma testing strategies, with online perimetry being a leading solution. In the developed world, interest in artificial intelligence (AI) and telemedicine, combined with growing healthcare costs for managing chronic disease, are opening opportunities for tele-ophthalmology care.

Online perimetry has recently been developed to enhance both accessibility and affordability, bringing these tests close to patients and in developing settings. One such innovation is circular contrast perimetry (Eyeonic). This online visual field test (oVFT) allows patients to conduct online visual field assessment using an internet-based application on any computer or tablet with similar results to SAP.³ 24-2, 30-2, and 10-2 protocols are available, as are driving (binocular) and pilot (monocular) suprathreshold screening licence tests. By making visual field testing more accessible, affordable, and user friendly, the Australian developed oVFT has the potential to revolutionise eye care globally.

Figure 1. Use of online circular contrast perimetry globally.

How the Online Visual Field Test Works

Eyeonic’s oVFT assesses 52 points over 24° of visual field eccentricity (10° and 30° strategies are also available). Users are presented with a series of flickering targets consisting of alternating light and dark rings. They fixate on a spinning golden star and click when they see the flickering target in the peripheral vision. The test maps the user’s blind spots to ensure proper fixation and uses webcam monitoring with facial detection AI to track head position. Verbal cues and audio feedback guide the user throughout the test, which takes between two and five minutes. Multiple languages are made available to remove language barriers for non-English-speaking patients.

Importantly, Eyeonic’s oVFT does not require any additional hardware or equipment support beyond a standard computer or tablet. The AI-powered software analyses the results and produces detailed visual field maps and metrics comparable to conventional perimetry output.

Several large clinical studies across multiple sites globally have confirmed the clinical equivalence of Eyeonic’s oVFT to SAP, but also demonstrate the significant advantages of online perimetry to machine-based perimetry. In validation studies,^3,4,5 the oVFT has demonstrated strong diagnostic accuracy similar to SAP, with high levels of agreement, reliability, and repeatability. Figure 4 compares Eyeonic’s oVFT and SAP for patients with normal, early, and moderate glaucoma. The oVFT is able to detect visual field defects comparable to that from conventional perimetry.

Patient Experience and Acceptance

Beyond the clinical benefits, studies have shown that patients generally find the online test more comfortable, less stressful, and more user-friendly than traditional visual field testing.³

Patients readily adapt to using Eyeonic’s oVFT despite varying levels of computer literacy. By offering instructions and interfaces in various languages, the system aims to improve accessibility for patients and healthcare workers across different linguistic backgrounds.

Addressing the Need in Africa

I first became aware of the potential for the oVFT to address gaps in glaucoma care in Africa when I connected with Dr Deus Bigirimana, an ophthalmologist from Burundi who had relocated to Melbourne. Dr Bigirimana was passionate about improving glaucoma services in Africa and painfully aware of how sparse testing resources were in African hospitals.

In many African regions, visual field testing is non-existent in routine clinical care, available only in some large urban eye hospitals or private practices. He saw immense potential for the Eyeonic technology to revolutionise glaucoma detection and monitoring across Africa by eliminating the need for expensive, stationary perimetry machines.

This encounter has led to connections with key collaborators in Uganda – Dr Honorine Nizeyimana, an ophthalmology trainee, and her supervisor Dr Simon Arunga, a lecturer at Mbarara University of Science and Technology and Assistant Professor at London School of Hygiene and Tropical Medicine. Together, they initiated a research project to demonstrate equivalence of the Eyeonic technology to SAP in the African context.

The data showed a strong agreement between Eyeonic’s oVFT and SAP with similar perimetric accuracy, similar to studies in Australia, and confirmed the role of oVFT as an accessible and user-friendly alternative to SAP, particularly applicable to the African context

Validation Study in Uganda

In 2022, the team in Uganda began the study with an aim to collect data on 180 consecutive patients attending the Mbarara University of Science and Technology Hospital eye clinic. The goal was to compare results from the oVFT to conventional visual field testing. Despite challenges and pivots, the team persevered and by June 2024, data from 184 patients had been collected. The data showed a strong agreement between Eyeonic’s oVFT and SAP with similar perimetric accuracy, similar to studies in Australia, and confirmed the role of oVFT as an accessible and user-friendly alternative to SAP, particularly applicable to the African context.

Real World Implementation: OCCP in Africa

In 2023, I spoke at the South African Glaucoma Congress to introduce the technology and discuss its applicability in Africa. Having received official endorsement by the South African Glaucoma Society (SAGS) committee, the test is now used routinely in many optometry and ophthalmology practices in South Africa. Similarly in Ghana, where I presented to the inaugural Pan African Glaucoma Association Congress, dozens of clinicians have signed up to the system and are using it in their routine clinical practices, as is the highly respected Military Hospital in Ghana.

Our team has also partnered with the Oromia Health Bureau in Ethiopia to work on delivery of scalable perimetry to the wider community. Oromia is the largest and the most populous region in Ethiopia. After successfully passing a pilot study in Oromia across multiple clinical institutions, and once clearance is received from the Ethiopian Food and Drug Administration, the oVFT is planned for rollout across Ethiopia, as part of an Ethiopian Department of Health government initiative to use digital health to improve access to healthcare for its 126 million citizens.

A similar pilot study has been completed in Nigeria, involving 11 academic institutions that trialled Eyeonic’s oVFT, prior to a wider nationwide roll out. This resulted in 860 eyes from 430 patients performing oVFT with good agreement with conventional visual field testing.

Francophone Africa

Online visual field testing is also being used in the francophone Africa world, translated into French. Road safety is a critical issue globally and ensuring motor vehicle drivers have adequate vision for road driving is a key part of achieving this. Academics at Senegal’s prestigious Thiès University are undertaking a nationwide survey of vision standards in truck drivers as a United Nations-guided initiative, and are using Eyeonic’s online widefield binocular suprathreshold test to ensure Senegalese truck drivers have sufficient field of vision for driving. Eyeonic’s oVFT was chosen as the major assessment tool for this landmark nationwide road safety study because of its online binocular suprathreshold test, with sufficient width of field for licencing requirements, which can be performed on any computer. In addition, a targeted population-based glaucoma screening programme is under development in Côte d’Ivoire, using Eyeonic’s 24-2 oVFT in combination with other modalities of glaucoma testing.

Combined with its success in Uganda, Ethiopia, Ghana, and South Africa, the oVFT’s expansion into countries like Côte d’Ivoire and Senegal demonstrates its growing presence and potential impact across Africa. The technology’s ability to provide accessible, cost-effective visual field testing is proving valuable in addressing the continent’s significant eye care challenges, particularly in regions with limited resources and high glaucoma prevalence.

Online Visual Field Testing in Asia

Many parts of Asia face similar challenges to Africa, with limited resources for healthcare, and a high prevalence of glaucoma.

Vietnam

Dr Tung Hoang, having completed his Australian glaucoma fellowship at Sydney Eye Hospital in 2021, undertook his prize-winning PhD at Hanoi Medical University evaluating Eyeonic’s oVFT application, translated into Vietnamese, in clinic and at home. Similar to results in Africa and Australia, his research demonstrated the oVFT had equivalence to machine-based perimeters in Vietnam, with significant advantages with regards to improving clinic efficiencies, at-home detection, and scalability of healthcare services in an emerging Asian economy.

India

In November last year, I met with senior United Kingdom-based healthcare business leaders in India to workshop the introduction of Eyeonic’s oVFT system in India. Supported by the Australian High Commission in India, this work has led to three important pilot programmes from highly prestigious Indian institutions – the All-India Institute of Medical Science in Delhi, Shroff Eye Centre in Delhi and the LV Prasad Institute in Hyderabad. Using online visual field testing, leading Indian ophthalmologists and health bureaucrats are using innovative technology including Eyeonic’s oVFT to design outreach clinics for glaucoma monitoring outside of major hospital centres. Innovations like these are necessary to meet the huge and rising population need for community glaucoma services.

Eyeonic has achieved early global success as an AI-based future-looking Australian med-tech startup.

Eyeonic: A Rising Australian Med-Tech Startup

Eyeonic has achieved early global success as an AI-based future-looking Australian med-tech startup. In a highly competitive environment where funding is challenging, Eyeonic won the 2023 Australia-wide SmartCompany ThePitch, and secured AU$2.7 million in funding for 2024. Eyeonic is now a global company with eight staff and operations in nearly every continent. It has eight papers published in the international literature with many more underway. Eyeonic’s oVFT has been successfully registered by the regulatory bodies of Australia, New Zealand, the United Kingdom, United States, India, and several African countries. In Australia and New Zealand, it is available commercially, distributed by Ophthalmopro, and registered as a class II device for in-clinic or out-of-clinic visual field testing. It is being piloted by Vision Australia, predominantly for outreach and community-based assessment.

Protocols are being developed in the United Kingdom, Australia, India, and Africa to use Eyeonic’s oVFT for out of clinic assessment. Eyeonic is forming strategic partnerships with other forward-looking med-tech organisations, such as those that scale AI-based fundal assessment, to improve the quality and scope of out-of-clinic monitoring. Such steps are necessary to meet the dual goals of easing the burden on stretched healthcare providers in the developed world and to meet the growing demand for services in developing economies.

With a commitment to excellence and technological progress, Eyeonic believes it can help provide solutions for a world that badly needs more glaucoma awareness and more glaucoma services to prevent glaucoma blindness.

Associate Professor Simon E Skalicky BSc (Med) MPhil, MMed MBBS (Hons 1) FRANZCO PhD is a Melbourne-based ophthalmologist, specialising in the management of glaucoma and cataract. He is an Associate Professor at the University of Melbourne. Assoc Prof Skalicky is the Founder and Director of Eyeonic. Visit: eyeonic.com.au.

References

1. Tham YC, Aung T, Cheng CY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and metaanalysis. Ophthalmology. 2014;121(11):2081-2090. doi: 10.1016/j.ophtha.2014.05.013.
2. Soh Z, Yu M, Betzler BK, et al., The global extent of undetected glaucoma in adults: a systematic review and meta-analysis. Ophthalmology. 2021;128(10):1393-1404. doi: 10.1016/j.ophtha.2021.04.009.
3. Meyerov J, Deng Y, Skalicky SE, et al. Online circular contrast perimetry: a comparison to standard automated perimetry. Asia Pac J Ophthal. 2023;12(1):4-15. doi: 10.1097/APO.0000000000000589.
4. Skalicky SE, Bigirimana D, Busija L, Online circular contrast perimetry via a web-application: Optimising parameters and establishing a normative database. Eye. 2023;37:1184–1190. doi: 10.1038/s41433-022-02085-4.
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