The Courier & Advertiser (Fife Edition)
Let there be sight
Dundee-raised eye surgeon and St Andrews University clinical academic Dr Andrew Blaikie tells Michael Alexander how a pioneering device could save the sight of millions in the developing world
It is ideal for students or any qualified healthcare worker
Here, their diagnosis and treatment is a routine procedure but cataracts remain the leading cause of visual impairment outside developed countries, according to figures from the World Health Organisation (WHO).
In the least-developed nations, and in particular Sub-Saharan Africa, the condition is blamed for half of all cases of avoidable blindness, followed by glaucoma (15%), corneal opacities (10%), trachoma (6.8%), childhood blindness (5.3%) and onchocerciasis (4%).
But now pioneering Scottish researchers – including a Fife-based surgeon and scientist – have launched a pocket-sized device which could prevent millions in poor countries from losing their sight or hearing.
Progress
The breakthrough tool, Arclight, is being trialled in parts of Africa and Asia to screen patients for the onset of blindness-causing eye disorders such as diabetes, cataracts and glaucoma, as well as retinoblastoma – a rare but potentially fatal type of eye cancer which mostly affects children under five but which can be cured in 95% of cases if identified early.
The device is also being used in Malawi to detect and treat ear conditions which can lead to deafness, and is already being sold to medical schools and GPs in the UK to help diagnose eye and ear diseases after preliminary studies showed it was more effective than existing machines, which cost hundreds of pounds more.
Dr Andrew Blaikie, 47, a clinical academic at St Andrews University who also works as an eye surgeon with NHS Fife at Queen Margaret Hospital in Dunfermline, said Arclight’s strength was the fact it was pocket-sized, lowcost and solar-powered.
Working with colleagues at Leicester University and University College London, he has been a central member of the team steering the development and testing of Arclight, which has been designed specifically as an easy-to-use tool for outreach or screening programmes in low-income countries.
Performance
It enables users to make instant on-the-spot diagnostic decisions – and a study from the International Centre for Eye Health in London already shows it performs as well as traditional devices costing up to 100 times as much.
“Around 285 million people in the world are estimated to be visually impaired, and 360 million hearing impaired, with the majority of cases considered preventable or treatable if diagnosed promptly,” said Dr Blaikie, a former pupil of Eastern Primary, Broughty Ferry, and Dundee High School.
“Ophthalmoscopes and otoscopes are typically designed for wealthy countries and are complex, heavy and expensive; their basic designs have remained relatively unchanged for over 100 years.
“Very few practitioners in low and middle income countries have these essential tools.
“If they do, they are typically hand-me-downs that don’t work because they need parts that are hard to find or expensive, such as bulbs and batteries.
“The vast majority of cases of vision and hearing impairment, however, are found in these countries with least access to equipment.
“Using the Arclight an examiner can see the front and back of the eye, helping reveal all major blinding conditions such as trachoma, cataract, glaucoma and diabetes.
“It is ideal for students or any qualified healthcare worker in low or high resource healthcare settings.”
A medicine graduate of Edinburgh University, Dr Blaikie gained knowledge of eye problems in the developing world while travelling as a student.
Later, at Leicester, he was inspired by working with doctors from areas like Sub-Saharan Africa who were being trained to treat patients back home.
Distributed
Dr Blaikie said that through collaboration with the Fred Hollows Foundation and the International Agency for Prevention of Blindness, thousands of units had already been distributed to countries around the world, including Malawi, Ethiopia, Kenya, Tanzania, Rwanda, Ghana, Fiji, Indonesia and the Solomon Islands.
This has enabled healthcare workers to perform comprehensive eye and ear examinations for the first time.
“The work of the Global Health Team at St Andrews has helped focus attention on the exact needs and challenges of healthcare workers in low-income countries,” he added.
“We now aim to add internal memory loaded with teaching material and a clip to allow image capture with mobile phone cameras to the next version of the device.
“At the same time we are developing several other potentially disruptive lowcost diagnostic tools aimed at serving the needs of healthcare workers in poorer countries.
“Our studies have also shown the device is an ideal tool for medical students and doctors in the UK too, and through sales here and in other wealthy nations we aim to cross-subsidise distribution to poorer countries such as Malawi, where Scotland has strong historical links.”
St Andrews University has now established a spin-off company to promote sales of the device and coordinate the subsidised distribution to low-income countries.