Undoubtedly, one of the obstacles in pediatric ophthalmology is being able to carry out examinations on little ones. After all, it can be difficult to keep a child still for examinations.
This difficulty is routine for ophthalmologist, Dr. Patrícia de Freitas Dotto, MD, PhD at the Dr. Jeser Amarante Faria Children’s Hospital, at the São José Municipal Hospital (HMSJ) and in her office, all in Joinville (SC), and at the Lavinsky clinic in Porto Alegre (RS).
“The main challenge is the non-mydriatic fundoscopic evaluation of children between ten months and three years old without sedation or restraint. That’s why it’s essential to create a playful and calm environment that brings peace of mind to the whole family. In this context, photographic documentation, or even fundoscopic imaging, in real time allows parents to be involved in the care, which improves the doctor-patient relationship and, consequently, has a positive impact on the child’s follow-up and/or treatment.”
Dotto says that she uses the Eyer portable fundus camera to speed up examinations on pediatric patients. The equipment, which is very suitable for examining infants and children due to its portability and high image quality, works in conjunction with a smartphone and performs retinal examinations in a few minutes. These photographs are then available on the EyerCloud online platform, making it easier to study and monitor the progression of cases.
“The field of vision is excellent. Under medicated mydriasis, it is also an excellent complementary propaedeutic tool for assessing the mid-periphery of the retina, particularly small hyperpigmented lesions of the choroid (nevus) and retina (melanocytomas), using it as an infrared scan,” she explains.
In her office, with help of the Eyer Slit Lamp Adapter, the ophthalmologist attaches the device to her slit lamp allowing exams to be performed more easily. “Although I really enjoy using it this way, it’s magical to use it in ‘mobile’ form in ICUs, operating rooms, home care and within the office itself, such as evaluations of children on their mother’s lap or in the waiting room,” she points out.
The doctor also uses the Eyer in the emergency room, in adult and child care, for documenting infectious diseases and Retinopathy of Prematurity (ROP) in neonatal ICUs severely debilitated adults in ICUs, as well as inter-consultations for neurology, neurosurgery, nephrology, cardiology, and in medical expertise for the National Civil Aviation Agency (ANAC) and the Santa Catarina Court of Justice (TJSC). “I literally carry Eyer in my bag. It makes my job a lot easier,” she says.
The ophthalmologist, Dr. Patrícia de Freitas Dotto, MD, PhDtreats infants and children at the Dr. Jeser Amarante Faria Children’s Hospital, the São José Municipal Hospital (HMSJ) and at her office, all in Joinville (SC).
Shaken Baby Syndrome
With daily use of the Eyer in various locations, Dotto has witnessed several remarkable cases, such as the care of a child suffering from Shaken Baby Syndrome. The syndrome occurs when the baby is shaken intensely, causing permanent brain damage or even death.
Here’s the doctors report on the case of shaken baby syndrome:
“The child had been followed up for a few months in hospital for convulsions and severe malnutrition. The suspicion of Shaken Baby was raised when neuroimaging alterations (hematoma) were observed during the complementary investigation of status epilepticus.
During the ophthalmological assessment, when I examined her visual acuity (grating), I found that the vision in one eye was outside the normal range for her age, despite the fact that she had no changes in ocular motility.
When I laid her on the gurney for the retinal mapping, she started crying desperately. It was a very difficult examination and I was struck by the fact that the child eventually let go, almost gave up, and then reacted again, without showing any change in her level of consciousness.
It was at one of these moments that I managed to photograph the fundus of the eye and identify retinal lesions, indicating serious damage to the central nervous system. In one particular case, the hemorrhage was very small, probably because it was being reabsorbed, and I could only be sure of the diagnosis because of the examination. It was a miracle for me and for her.
I was devastated that day, but very grateful to HaShem and Phelcom [the company that invented the Eyer]. The case was really investigated from a social point of view, the assaults were confirmed and the appropriate measures were taken.
We saved a life. And in my religion, Judaism, saving a life means saving the whole world.”
Next, see the images of this case taken by Dotto with Eyer:
More cases
Dotto performs retinography on all patients, as she considers it important the normal state of the retina. “We often look for illnesses and forget how important it is to make sure the fundus of the eye is normal, because problems happen throughout life and it’s important to make sure of the moment when the state of eye health is lost,” she says.
She highlights the case of a 22-year-old woman who was admitted to the ER with compromised visual acuity, severe hypertensive retinopathy and serous detachment of the macula. The team suspected Autoimmune Nephropathy (IgA). “Unbelievably, four or five days after pressure control (in the ICU), she progressed to 20/20 visual acuity and total resolution of the serous detachment.”
Another situation involved a patient in the ER with anterior uveitis and an apparent normal USG. After remission, when mapping the retina, the doctor noticed a peripheral blackened lesion. “Using the Eyer, I was able to document it. We redid the USG thinking it was a melanoma. And it was indeed a melanoma at the level of the ciliary body,” she says.
In children, the ophthalmologist recalls the care of two patients with slight vitreous hemorrhage: “After improving the transparency of the media, it was possible to record the presence of a slight vascular malformation at the level of the optic nerve,” she recalls.
Among the most commonly diagnosed diseases in babies are ROP, congenital infections, optic nerve hypoplasia and retinal and optic nerve colobomas. “I also use the Eyer a lot to quantify the size of the optic nerve and the excavation. This helps with the differential diagnosis of suspicious glaucomas, particularly in short-sighted children,” she concludes.
Below are some images taken by the ophthalmologist with the Eyer:
Patient with retinal displacement.
Patient with microembolization in the choroid due to covid.
Patient with arterial occlusion.
The Eyer
The Eyer is a portable fundus camera that works in conjunction with a smartphone and performs high-quality retinal examinations in a few minutes without the need for pupil dilation.
The technology supports the diagnosis of more than 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, ROP, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile, Colombia and Japan.
It was recently approved in the United Arab Emirates and is in the regulatory process of being marketed in Mexico, Egypt and Saudi Arabia.
Portability, connectivity and integration with intelligent functions such as EyerMaps, together with the technology’s affordability, contribute to increasing access to retinal examinations.
Three out of ten patients that ophthalmologist Juliana Barbi consults in her clinic in Belo Horizonte (MG) come from Instagram. Some of them live in other Brazilian states or even abroad.
“These patients form bonds with me even before the first consultation, because of the content I produce in my profile. They come to the office only to get to know me in person, because they already decided to begin treatment with me. So, the power of identification of Instagram is very strong”, states Barbi.
Doctor Barbi has been investing in producing social media content since 2018. She makes all the content, (script, recording, editing and posting) by herself.
And no, you do not need to dance performances to lure the right public (but you can, if you want). Barbi talks about medical procedures, shows patients’ “before and after” and shares about her professional – and sometimes personal – routine with her more than 10 thousand followers.
Ophthalmologist Juliana Barbi’s Instagram. The doctor has been investing in the social network for 5 years.
Doctor Barbi produces content on a daily basis. Usually, “Stories” videos that, many times, have space in her feed as Reels. “I look for dividing one single subject in various short videos to draw the follower’s attention and not to get boring. For example, I can divide a subject as “eyelid surgery” into post-surgery care, stitches, scar, etc.”, she explains..
When this article was written (October 5, 2023), she posted a Reel in her feed, showing a patient and demonstrating how a superior and inferior blepharoplasty ends. She shared her part in an interview on her story, a personal reel about wrinkles while smiling, and the recording of the next episode of her videocast “ENTRE(vistas)”, that goes live every other week on her Instagram.
In the videocast, the ophthalmologist invites professionals of healthcare and even other areas related to her work. For example, a tennis teacher highlighted the importance of knowing the dominant eye to make contact with the ball during a game. And a makeup artist taught tricks to improve the appearance of the eyes. “The idea is to diversify the subjects commonly addressed on my social profile with different topics related to vision in some way”, she explains.
TikTok and website
Recently, Barbi also signed in to TikTok, a social network to share short videos. A very successful platform, mainly among young people. “They may be my future patients”, she reflects.
In addition to social media, the doctor has a website where she presents her specialties, services and courses (including tips on content creation).
Barbi considers it fundamental to invest in communication technologies to reach good results with medical marketing. A professional profile on Instagram may be the first step. The second one is a website and a TikTok account. “Using websites to target an older audience, instagram to target middle aged patients and even tiktok to reach the youngest audience”, she says. However, she also emphasizes: “People who do not do it, end up falling behind”.
You do not need to be so extroverted as the ophthalmologist to go “viral” in social networks, as some fellow professionals believe, you only need to be yourself. “For the profile to be good, it is essential to be authentic. I do not show anything that I am not. I talk before the camera exactly as I work with my patient in the consultation office”, she states.
New rules for medical marketing
Recently, the Federal Council of Medicine (CFM) updated the rules for medical marketing. The new text, more aligned to the current needs of communication, including the medical class, affirms that the doctor may share their work on social networks, advertise equipment available in their workplace and, for educational purposes, to use images of patients or photo databases.
The proposal, according to the CFM is to assure the doctor has a right to show people the range of his/her services, respecting the market rules, but preserving medicine as a support activity. The new resolution authorizes advertising consultation prices and making of marketing campaigns.
“Before, I showed only a small part of the procedure and treatment results. Now I can share the ‘before and after’, of course, respecting the patients who authorized sharing their images. It is important for the patient to know better each step of a blepharoplasty, for example”, she explains.
Patient Journey
Medical marketing is one of the steps of the patient journey. In order to consolidate all investments being made to bring a patient to the office, it is fundamental to offer a great experience.
For example, Barbi searched to improve patient care by acquiring an Eyer handheld fundus camera. The equipment works coupled with a smartphone and carries out high-quality retina exams in a few minutes. Seconds after capturing the image, the device-embedded artificial intelligence, EyerMaps, identifies possible retinal alterations.
Barbi has used the Eyer handheld fundus camera since 2019.
“I explain what the optical nerve and macula are and, if it is the case, any alteration that may suggest pathologies, such as glaucoma, diabetic retinopathy, among other diagnoses primarily reachable through fundoscopy. They think it is great, get impressed with this technology and feel welcome”, she tells.
Eyer is non-mydriatic, offers the patient more comfort and speeds up the clinic service flow. “Nowadays, Eyer is my fundus examination. I do not even use a slit lamp anymore. I carry out the retinography and promptly store the patient’s image in EyerCloud for future follow-up”, she says. EyerCloud is a cloud system synchronized with the Eyer camera to manage patients’ data and exams.
Barbi examines all her patients using Eyer, except for the ones who already have a report. Using Eyer, there have been over one thousand exams since 2019.. “I already identified choroidal nevus from a routine exam in a preoperative of a preventive consultation. I sent it to a retinal specialist for evaluation. He found an extreme-peripheral retinal tear that was properly treated by laser before the surgery. Eyer was able to detect it and I felt safe to send the result to the retinal specialist before proceeding the surgery”, she recalls.
In terms of technology cost-effectiveness, Barbi believes it is worthwhile. “For doctors who serve patients with medical insurance, retinography costs may be sent to the insurance”, she ends.
About Eyer
Barbi holding Eyer handheld fundus camera.
Portability, connectivity and integration with intelligent functions, as EyerMaps, along with a more accessible value, allow Eyer to contribute to increase the access to retina exams.
The equipment supports the diagnosis of more than 50 diseases, such as glaucoma, cataract, diabetic retinopathy, DMRI, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million exams have been already carried out in Brazil, The United States, Chile, Colombia and Japan.
Eyer has recently been approved in the Arab Emirates and is going through the regulatory process for marketing in Mexico, Egypt and Saudi Arabia.
About Phelcom
Phelcom Technologies is a Brazilian medtech company headquartered in São Carlos, inland São Paulo. The company’s history began in 2016, when three young researchers – a physicist, an electric engineer and a computing engineer (PHysics, ELectronics, COMputing) – created a handheld fundus camera integrated with an integrated smartphone.
The project of the first prototype was born from the interest of company partner Diego Lencione on visual health, since his brother has a condition that severely compromises his retina and vision and has since childhood.
In 2019, Phelcom launched its first product in the Brazilian market: Eyer handheld fundus camera. Now, the technology has already reached more than two million people all over Brazil and the countries where it’s available.
In four years, the company has already taken part in more than 100 social actions and has recently been elected one of the 10 most innovative companies in Brazil by Forbes.
By 2030, over half a billion people are expected to be diagnosed with diabetes. Currently, Brazil ranks as the sixth country worldwide with the highest population of diabetics.
Currently, there is no national diabetic retinopathy screening strategy by the Unified Health System (SUS). Thus, social initiatives for diagnosing the disease in communities with inadequate healthcare infrastructure are crucial.
For instance, we have the “Mutirão do Diabetes” in Itabuna, Bahia, and “Iluminar” in the countryside of Sergipe, supported by the NGO Retina Global. This American institution focuses on developing sustainable solutions for managing retinal diseases in underserved areas around the world.
From September 2021 to March 2022, “Iluminar” used the portable retinal camera, Eyer for diabetic retinopathy screening in Itabi, Graccho Cardoso, Canindé de São Francisco, and Poço Redondo.
The device is connected to a smartphone and performs retinal exams within minutes, producing high-quality images, and uploads the images to the EyerCloud online platform, facilitating remote assessments.
The results of the pilot project were presented at ARVO 2023, one of the most renowned international ophthalmology conferences held in the United States in April.
The Study
One of the leaders of the “Iluminar” project, ophthalmologist Fernando Malerbi, explains that the aim of the retrospective observational clinical study was to evaluate the grading capacity of retina images obtained using a low-cost, non-mydriatic portable retinal camera — in this case, the Eyer — along with the use of artificial intelligence and telemedicine for diabetic retinopathy screening.
In total, 968 individuals with diabetes were evaluated:
65.9% were female;
Average age of 60.3 ± 14.2 years;
Duration of diabetes: 8.0 ± 7.2 years;
64.2% had systemic hypertension;
17.7% were using insulin;
28.5% had previously undergone fundus exams;
20.6% were illiterate;
50.6% had only completed primary education;
3.4% had health insurance.
A trained technician captured images without pupil dilation and then assessed image quality. Diabetic retinopathy requiring referral, defined as severe non-proliferative or proliferative retinopathy or the presence of diabetic maculopathy, was automatically detected by an embedded artificial intelligence system (EyerMaps). The AI was provided for clinical validation.
In a matter of seconds, EyerMaps indicated the possibility of retinopathy with a high sensitivity rate. Subsequently, all exams were evaluated by ophthalmologists.
Patients with inadequate images underwent pupil dilation and then a new assessment. Those with non-gradable images even after mydriasis, along with cases of referable diabetic retinopathy, were referred for ophthalmological evaluation.
Corneal opacities that hindered retinopathy classification were the exclusion criteria. The primary outcome measure was image gradability.
The Results
Grading was possible for 858 individuals (88.6%), with 85 of these (9.9%) showing referable diabetic retinopathy. Non-grading was associated with older age and longer diabetes duration.
Among patients with gradable images, 81% did not require pupil dilation. The need for mydriasis was associated with older age, longer diabetes duration, higher hypertension rates, and more severe retinopathy.
The strategy of utilizing a low-cost portable camera with embedded AI system and mydriasis when necessary achieved suitable images in 90% of cases within a resource-limited real-world environment. Malerbi emphasizes, “Avoiding unnecessary pupil dilation contributes to higher adherence to diabetic retinopathy screening programs.”
Enhanced Portability Facilitated Screening
This novel screening was conducted in primary care clinics located near patients’ homes to encourage participation.
Malerbi highlights that the portability of Eyer was a facilitator, along with connectivity. “We had remote experts evaluating images, sometimes in real time,” he explains. All of the exams taken were uploaded to EyerCloud.
Lastly, Malerbi emphasizes the availability of EyerMaps for use in social initiatives. “Partner ophthalmologists were instantly notified whenever EyerMaps identified a high likelihood of retinopathy. Thus, we could prioritize patients for confirmatory exams and, if necessary, treatment,” he shares.
The AI accurately detects any suspicions of retinal abnormalities. Within seconds of capturing the fundus image, if an abnormality is detected, the system generates a new image with an attention map (heatmap) highlighting potential retinal anomalies.
Synchronized with EyerCloud, it categorizes images and exams captured based on the likelihood of abnormalities using color markers:
Green: Image or exam with low likelihood of an abnormality (up to 30%);
Yellow: Image or exam with moderate likelihood of an abnormality (31 to 70%);
Red: Image or exam with high likelihood of an abnormality (71 to 100%).
All patients diagnosed with diabetic retinopathy were referred for free laser treatment.
As the popular saying goes, the eyes are said to be the windows to the soul. When we apply this to the realm of healthcare, we might adapt it to say, “the eyes are the windows to the body.” This is because various diseases that affect our body manifest in the eyes.
Ophthalmologic exams can identify signs of abnormalities within our body, aiding in patient diagnosis. For instance, retinography and fundoscopy can detect infectious, chronic, vascular, hematologic, rheumatic, neurological disorders in addition to eye-related conditions.
In neurology, headaches, cerebral aneurysms, multiple sclerosis, and intracranial hypertension — the latter of which can be related to brain tumors can all impact the structure of the orbit and eyeball.
Since last year, neurologist Marcos Christiano Lange has been using Eyer, the portable retinal camera, to map a patient’s retina from the initial consultation. The device uses a built-in smartphone to conduct high-quality retinal exams within minutes, without the need for pupil dilation.
“Eyer is a significant help in screening. Besides being more convenient, when the attention map indicates potential abnormalities outside my field, I advise the patient to consult their ophthalmologist or refer the exam to a partnering ophthalmologist,” he explains.
Neurologist Marcos Christiano Lange
This was how one of Lange’s patients was diagnosed with Age-Related Macular Degeneration (AMD). “She reported worsening vision, attributing it to possible cataracts. Upon examination, I observed protein accumulation in the macula and referred her to an ophthalmologist, who diagnosed AMD and initiated treatment. If I had performed a traditional eye fundus examination as a neurologist, focusing solely on the optic nerve, I wouldn’t have detected these findings,” he recalls.
Heatmap
Recently, Phelcom introduced a new feature: EyerMaps, an innovative Artificial Intelligence (AI) system that accurately detects any suspected retinal abnormalities.
Within seconds of capturing a photo of the eye’s fundus, if a suspicion of an abnormality is detected, the AI generates a new image with an attention map (heatmap) highlighting potential retinal abnormalities.
Synchronized with EyerCloud, Phelcom’s cloud-based system for patient data and exam management, the tool visually categorizes images and exams based on the probability of alteration, using color markers in the images and exams:
Green: Image or exam with low probability of abnormality (up to 30%);
Yellow: Image or exam with moderate probability of abnormality (31 to 70%);
Red: Image or exam with high probability of abnormality (71 to 100%).
The AI aids in diagnosing over 50 diseases, including diabetic retinopathy, hypertensive retinopathy, papilledema, and headaches. “I like to keep up with new technologies and am already familiar with Eyer. During a headache course I conducted, Phelcom provided the equipment for us to perform fundus assessments. After using it in practice, I decided to invest in acquiring the device,” he recalls.
Since then, the neurologist has conducted over 400 exams with Eyer, all stored in EyerCloud for reports and tracking. “As soon as I capture the image, I upload it to the platform and open it on the computer to show the patient and explain the details in case of suspected pathology,” he says.
Eyer for Neurologists
For Lange, investing in a portable retinal camera like Eyer is important for neurologists to have an expanded view of the retina. “Even though retinal diseases aren’t our specialty, we can still assist the patient. And that’s priceless,” he emphasizes.
Another advantage is following up with patients who exhibit papilledema and degenerative diseases, such as diabetic retinopathy and hypertensive retinopathy.
Eyer
Eyer is a portable retinal camera that performs high-quality retinal exams in a few minutes, without the need for pupil dilation.
The technology is currently available in Brazil, the United States, Japan, Chile, Colombia, and will become available soon in other countries.
Portability, connectivity, and integration of intelligent functions like EyerMaps, along with the more accessible price, contribute to increased access to retinal exams.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, São Paulo. The company’s story begins in 2016, when three young researchers – a physicist, an electronic engineer, and a computer engineer (PHysics, ELectronics, COMputing) – created a portable retinal camera integrated with a smartphone.
The idea for the first prototype arose from co-founder Diego Lencione’s interest in visual health, as his brother had a condition that severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the portable retinal camera, Eyer. More than 2 million people in Brazil and around the world have been examined by it so far.
In four years, the company has participated in over 100 social initiatives and was recently ranked among Brazil’s top 10 most innovative companies by Forbes Brazil.
Premature Retinopathy (ROP) is an ocular condition that affects premature infants. According to retina disease and premature retinopathy specialist Samuel Montenegro, ROP is one of the primary causes of preventable childhood blindness. In Brazil, an estimated 13,500 cases occur annually, and among these cases, 1,000 infants may need treatment.
Therefore, identifying newborns in need of treatment early is crucial to reduce ROP-related blindness. Premature babies weighing up to 1.5 kilograms and/or born before 32 weeks’ gestation are a high risk group for ROP.
This period might extend to 35 weeks if the child experiences sepsis, intraventricular hemorrhage, respiratory distress syndrome, requires blood transfusions, or if the mother had a multiple pregnancy, even if the baby’s weight is above 1.5 kilograms.
This is because premature birth can disrupt the development of the baby’s retinal blood vessels. In these cases, vascularization might expand, twist, or even rupture. In advanced stages, this can lead to the formation of retinal scars or even retinal detachment, resulting in permanent vision loss.
The International Classification of ROP (ICROP) defines the disease by severity (stages 1-5), location (zones I-III), and extension in analog hours (1-12 h), with or without additional disease (arteriolar dilation and venous tortuosity), and the presence of which would indicate disease activity (4-5).
Check the table below:
Premature Retinopathy Classification
Stage 1
White line separating vascular from avascular retina
Stage 2
Elevated ridge
Stage 3
Fibrovascular proliferation from ridge
Stage 4
Proliferation leading to subtotal retinal detachment (4a, extrafoveal; 4b, total detachment, including fovea)
Stage 5
Total retinal detachment (open or closed funnel)
Threshold disease (defined by CRYO-ROP) (untreated cases show poor anatomical outcomes in 50% of cases)
Stage 3 retinopathy, zone I or II, with at least five contiguous hours or eight cumulative hours of extension, with an additional disease disease (arteriolar dilation and venodilation).
Type 1 pre-threshold disease (defined by ET-ROP)
Any ROP in zone I with an additional disease (aggressive posterior disease) Stage 3, zone I, without plus disease Stage 2 or 3 in zone II, with additional disease(s).
Type 2 pre-threshold disease (defined by ET-ROP)
Stage 1 or 2, zone I, without additional disease(s) Stage 3, zone 2, without additional disease(s).
Image caption: Samuel Montenegro examining a newborn with the Eyer. Photo: personal archive.
ROP bears two dangerous characteristics: it’s silent, showing no visible symptoms, and it progresses rapidly. Therefore, adhering to international and national protocols for early diagnosis and treatment is crucial.
Montenegro explains that routine eye examinations for premature babies should be conducted four weeks after birth. “The child isn’t born with the disease, so it’s essential to assess during this period.”
The examination should be performed by an ophthalmologist experienced in evaluating preemies and knowledgeable about the disease to identify location and sequential retinal changes.
Image caption: Image taken with the Eyer. Photo: Samuel Montenegro.
Subsequent examination scheduling will be determined by findings from the initial examination.
After identifying ROP, Montenegro tracks and documents patients using a portable retinal camera, Eyer. This equipment, highly recommended for infant and child examinations due to its portability and high image quality, attaches to a smartphone and conducts retinal exams within minutes. It also makes images available on the online platform, EyerCloud, facilitating study and case progression monitoring for physicians.
Image caption: Image taken with the Eyer. Photo: Samuel Montenegro.
“The device has been a game-changer as it greatly assists me in capturing the patient’s retina at that exact moment, in a practical, quick, and high-quality manner,” he states. Previously, the specialist used a retina mapping lens with smartphone assistance for videos. “Then I’d freeze the image, take a screenshot, and store it on the computer. It was quite labor-intensive,” he recalls.
Premature Retinopathy Treatment
Montenegro explains that treatment is most effective when ROP is identified early. “The secret to managing this disease lies in early diagnosis and immediate treatment when necessary.”
Currently, retinal ablation with a laser is the gold-standard treatment. Depending on the stage, there are alternatives, such as anti-VEGF injections and cryotherapy. “In this disease, we’re fighting blindness. Therefore, we apply laser therapy to prevent blindness in cases where it’s the best indication. However, this may permanently restrict the field of vision,” he points out.
Children with ROP receive follow-up care from a multidisciplinary team: pediatric ophthalmologist, retina specialist, occupational therapist, and physiotherapist. This follow-up extends beyond retinal ablation, aiming to achieve early visual stimulation.
“Newborns diagnosed with ROP are at a higher risk of developing ophthalmological issues in the future, such as strabismus, amblyopia, and refractive errors. Therefore, ophthalmological follow-up after discharge is recommended,” he emphasizes.
Image caption: Samuel Montenegro examining a newborn with the Eyer. Photo: personal archive.
ROP Brazil
Montenegro is part of a project called ROP Brazil, which aims to share knowledge and further study premature retinopathy.
Various surveys indicate that the proportion of blindness caused by ROP is greatly influenced by the level of neonatal care (availability of human resources, equipment, access, and quality of care), as well as the presence of effective screening and treatment programs. Consequently, there’s significant variability in disease occurrence between developed and developing countries.
“That’s why, understanding more about the disease is essential to decrease cases of preventable childhood blindness in the country,” he states.
Phelcom Technologies has just launched EyerMaps*, an innovative Artificial Intelligence (AI) system that runs embedded in the portable retinal camera, Eyer, and detects any suspicion of retinal abnormalities with high accuracy.
Within seconds of capturing the photo of the eye’s fundus, if an abnormality is detected, the AI generates a new image with an attention map (heatmap) highlighting potential retinal abnormalities. Synchronized with EyerCloud, Phelcom’s cloud-based system for patient data and exam management, the tool visually classifies captured images and exams based on the probability of abnormality, using colored markers on the images and exams:
Green: Image or exam with low probability of abnormality (up to 30%);
Yellow: Image or exam with moderate probability of abnormality (31 to 70%);
Red: Image or exam with high probability of abnormality (71 to 100%).
Phelcom’s Co-Founder and CTO, Diego Lencione, explains how EyerMaps assists in ophthalmic clinical practice, “It’s important to emphasize that EyerMaps is not intended for diagnosing or referring patients. The system was developed to be a tool that aids the physician in the analysis and investigation of retinal changes, making ophthalmic care more agile and precise. Recognizing that we can all make mistakes, EyerMaps aims to be a tool that assists in detecting any retinal abnormality”.
The AI can assist in detecting diseases such as glaucoma, Age-Related Macular Degeneration (AMD), diabetic retinopathy, hypertensive retinopathy, vascular tortuosity, occlusions, papilledema, retinitis pigmentosa, and nevi, among others.
“Minor changes can go unnoticed. And an assisting system like EyerMaps is precisely designed to assist the doctor in early diagnosis,” Lencione points out.
High Sensitivity and Specificity
Lencione shares that EyerMaps is the result of five years of work by Phelcom in the field of artificial intelligence. “Since the foundation of Phelcom, we have maintained high investments in Research and Development. It’s in our DNA. Since 2018, we have been working on the development of EyerMaps, and I believe that one of the main merits of our team was to, after much effort, arrive at a highly accurate AI model that practically runs in real time on the Eyer, utilizing the high processing capacity of smartphones,” he explains.
The results were analyzed and published in various articles, including the Journal of Diabetes Science and Technology. “In some studies focused on the detection of diabetic retinopathy, we have already achieved sensitivity and specificity with EyerMaps above 90%,” Lencione affirms.
Phelcom’s Co-Founder and CTO emphasizes the importance of imaging and investigating the retina, not only for visual health but also for its power to reveal systemic, neurological, cardiac diseases, and more. “We created Eyer so that the retina can be more analyzed and studied by doctors, as we believe in the benefits this can bring to our society. When I see that nearly two million people have already been examined with Eyer, and some of them also with EyerMaps, I see that we are on the right path, fulfilling our mission as a company and as individuals by directly and indirectly helping to bring fundus exams to places and people that may not have been possible before.”
Phelcom Eyer
The Phelcom Eyer is a portable retinal camera that attaches to a smartphone and performs high-quality retinal exams in minutes without the need for pupil dilation.
The technology supports the diagnosis of over 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, retinoblastoma, hypertensive retinopathy, and ocular toxoplasmosis. It is available in Brazil, the United States, Japan, Chile, Colombia, and will soon become available in other countries.
Portability, connectivity, and integration of intelligent functions like EyerMaps, along with a more accessible price, contribute to increased access to retinal exams.
About Phelcom
Phelcom Technologies is a Brazilian medtech company headquartered in São Carlos, São Paulo. The company’s history began in 2016 when three young researchers – a physicist, an electronic engineer, and a computer engineer (PHysics, ELectronics, COMputing) – created a portable retinal camera integrated with a smartphone.
The idea for the first prototype arose from the interest of partner Diego Lencione in visual health, as his brother has a condition that severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product in the Brazilian market: the portable retinal camera Eyer. More than 2 million people in Brazil and around the world have been examined using Eyer so far..
In four years, the company has participated in over 100 social initiatives and was recently listed among the top 10 most innovative companies in Brazil by Forbes.
*EyerMaps are designed for adult examination, do not substitute professional validation and can not be used alone for diagnostic purposes.
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