Exam Lane: The Rx Vision Testing, On the Go By Andrew Karp Monday, June 16, 2014 12:08 AM RELATED CONTENT Refraction Reboot DigitalVision Systems Goes Beyond the Phoropter Opternative Explores the Online Option A new class of low cost, portable refraction devices that run on specialized apps and software is adding a new dimension to the field of vision testing. These products, some of which are available now and others that are soon to be released, are attracting interest from non-profit organizations, educators and pediatric vision professionals. Here’s a look at some of the latest products in this emerging category. EyeNetra EyeNetra’s first product, Netra-G consists of a smartphone that snaps into the back of a special binocular viewing device. Used together with EyeNetra’s proprietary app, the low cost system can generate accurate sphere, cylinder, axis and PD measurements, according to EyeNetra. The Somerville, Mass.-based company, which spun off from MIT Media Lab, has completed clinical testing of Netra-G with New England College of Optometry, LV Prasad Eye Institute and Lotus Eye Hospital in India. Ramesh Raskar, PhD, associated professor at MIT MediaLab, discussed EyeNetra’s technology at VM’s 2012 Global Leadership Summit. It is currently ramping up more clinical trials and pilot tests in preparation for a U.S. launch soon. Among its business advisors are health care entrepreneur and former MIT Media Lab chief Frank Moss and Warby Parker co-founder Neil Blumenthal. “We’ve shown that our device performs like any top tier autorefractor,” said EyeNetra co-founder and COO David Schafran. He said Netra-G uses hybrid technology that combines elements of objective and subjective refraction. “It’s objective because we’re shooing wide at discrete angles,” he explained. “We have the customer do an alignment test at each meridian. An algorithm calculates refractive error. It’s subjective because the customer is the one aligning the line. They see unique images. The test is only based on their perception of when they think the line is aligned correctly, not how we think it’s aligned.” Schafran believes there is a global opportunity for EyeNetra, which has also developed a device that tests for cataracts. “Our goal is to empower customers with better eye tests,” he said. Although EyeNetra plans to market the Netra-G to consumers, the company advises that the device must be used under guidance from an eyecare professional. Smart Vision Labs EyeNetra’s Netra-G uses hybrid technology that combines elements of objective and subjective refraction. Smart Vision Lab’s Smart Autorefractor is an aberrometer with a wavefront sensor. Peek consists of a mobile app and hardware that clips onto a smartphone. Smart Vision Labs, a New York-based start-up, has developed a pocket-sized autorefraction device called the Smart Autorefractor. “The Smart Autorefractor is an aberrometer with a wavefront sensor that can convert wavefront measurements into a prescription,” said Marc Albanese, who co-founded the company with Yaopeng Zhou, PhD. “Our test is completely objective,” he explained. “We create an image of the wavefront by creating local measurements. We divide the eye into quadrants, which we can then reconstruct into a full picture of the eye. From that we can derive a prescription.” Although it is not yet on the market, the Smart Autorefractor has already attracted notice for its innovative features. In a contest sponsored by Verizon, Smart Vision Labs won the first prize of $1 million in the health care category. Albanese, who has a background in biomedical engineering, electronics as well as an MBA, said he and Zhou are working on a number of different prototypes and will be conducting clinical trials in the U.S. soon, including one with a local university. The company is also looking to test the Smart Autorefractor in various developing countries. “There is a massive international need for vision measurement,” Albanese noted. Peek Peek (Portable Eye Examination Kit) is a smartphone-based system that can be used to conduct comprehensive eye examinations, even in remote settings. Easy to use, affordable and portable, Peek allows general health workers and eyecare practitioners to diagnose eye diseases and provide a means for managing and monitoring the treatment of patients, anywhere in the world. “When people work to improve health care, they often look at the latest developments in health care to improve from within,” said Dr. Andrew Bastawrous, an ophthalmologist and research fellow in international eye health at the London School of Hygiene & Tropical Medicine who is a member of the Peek team. “We are taking an alternative approach by looking at different industries to utilize what already exists elsewhere. If Peek lives up to its potential we hope people around the world can benefit. And with the fast-paced advances in mobile technology, this innovation will continue to get better and better automatically as mobile phones improve.” The Peek system consists of a mobile app and hardware that clips onto a smart phone. The system currently has the following applications: Patient record with geo-tagging Visual acuity Visual field testing Color vision testing Contrast sensitivity testing Lens imaging for cataract Retinal imaging Image grading The Peek researchers are working on several other applications including an autorefractor, visual field testing, front of the eye imaging and a suite of pediatric-centered examination tools. They are planning on performing a range of studies and are open to suggestions and collaborations. PediaVision PediaVision’s Spot is a handheld binocular autorefractor. The compact, lightweight 2Win Refractometer is fully automated, runs on batteries and offers printer and PC connectivity. Spot is a handheld binocular autorefractor from PediaVision that is being used by a growing number of ophthalmology and optometry practices. A portable, lightweight, Wi-Fi-enabled device, Spot measures monocular or binocular refractions, eye alignment, pupillary distance and pupil size. The device’s combination of patent-pending optics and processing algorithms makes these procedures as simple as using a camera, providing a comprehensive, reliable analysis in seconds, according to PediaVision. Among the device’s fans is Donna Norwood, the ophthalmologic technician at the Hunkeler Eye Institute in Overland Park, Kan. She particularly appreciates the device’s quick and non-invasive nature, which requires minimal cooperation from patients. “We use it on our most difficult patients,” said Norwood, referring to patients with medical conditions that cause them to respond badly to the close proximity required by normal autorefractors, e.g., senior citizens with Parkinson’s disease. “When the other autorefractors are introduced to patients with Parkinson’s, their shaking gets worse,” Norwood explained. “With Spot, I can get out of the patient’s space and do the test from about three feet across the room.” 2Win The 2Win Refractometer is a point-and-shoot instrument that produces more complete reports of a patient’s visual system than traditional vision measurement equipment, according to Adaptica, the Italian company that developed the device. The 2Win Refractometer is effective for use with infants, children, the elderly and patients who cannot cooperate because it is less invasive and requires a shorter use time than conventional equipment. In addition to checking all parameters of every visual function, the 2Win enables early detection of refractive errors. Adaptica recently released its version 3.0 software for 2Win. “Version 3.0 of the 2Win software makes it even easier to measure the vision of a moving or distracted patient—and the accuracy has improved as well. We also have made it easier for the software to deal with ambient lighting in a dimly lit room,” said Gianluigi Meneghini, CEO of Adaptica. Key benefits of the 2Win include its light weight, full automation, battery operation, printer and PC connectivity. The report produced after the 7-second test covers automatic refraction measurement, pupil diameter and distance, and the direction of the patient’s gaze—all without the need for dilation drops. The 2Win is in use throughout the world. More usability and connectivity features are under development, according to Adaptica. The product is available in the U.S. through M31USA, Adaptica’s San Jose, Calif.-based accelerator, and worldwide through Adaptica’s international distribution network.