The doctor Gustavo Rosa Gameiro, a PhD student in ophthalmology at Unifesp, was selected by the Brazilian Academy of Sciences (ABC) and the Ministry of Science, Technology and Innovation (MCTI) to participate in the 8th BRICS Young Scientists Forum. The event occurred from July 31th to August 8th in Gqeberha, South Africa.
BRICS is a group of five developing countries focused on mutual economic cooperation: Brazil, Russia, India, China and South Africa.
Gameiro was one of the six Brazilian scientists nominated to take part in the panel “The future of education, skills and skill sets”. The PhD student points out that education entered the BRICS agenda with great force this year. “In my presentation, we discussed applications of basic models and the use of the Eyer portable fundus camera with artificial intelligence for teaching ophthalmology based on the results of our workshops,” says the doctor, the youngest member of the Brazilian delegation at the event at 27 years old.
Gustavo Gameiro used the Eyer portable fundus camera in his project presented at the 8th BRICS Young Scientists Forum. Photo: personal archive.
Gameiro explains that the first approach to diseases such as glaucoma, Age-Related Macular Degeneration (AMD) and diabetic retinopathy in primary care is often carried out by the newly qualified clinical doctor.
“However, studies reveal that they have a huge deficit in the teaching of ophthalmology during their degree, compromising the correct approach and prognosis of these cases. This can lead to insecurity in referring or treating patients with ophthalmic complaints,” he explains.
Workshops
The workshops took place with undergraduate students from Unifesp and the Albert Einstein Israelite Institute for Education and Research and were supported by the ophthalmologists Thiago Gonçalves Martins and Paulo Schor, Gameiro’s PhD advisor. The Eyer portable fundus camera and the EyerMaps AI system were provided free of charge by Phelcom Technologies for the project.
“With the EyerMaps AI resource, which uses a heat map to highlight areas of the retina with possible alterations caused by different pathologies, we were able to teach and correct the student’s interpretation findings at the same time as captured by the fundus of the eye,” says the doctor.
“The clarity of the images is absurdly incredible. We did exams on our colleagues and we were able to see every detail of the retina, optic nerve and vessels. Transforming large, heavy devices like a fundus camera into portable ones makes the doctor’s life much easier, because we can go to the patients and achieve better results,” says Unifesp medical student Suellyn Alves, who took part in the workshop.
Gameiro goes further: “Perhaps we need to change the paradigm of only teaching students how to acquire images using ophthalmic equipment. We need to focus on how to interpret them and manage these exams, organizing them in the cloud, for example. and with the Eyer, you can easily teach interpretation and management” he says.
With the satisfactory results of the workshops, the doctor reveals his desire to expand the project and turn it into support material for teaching ophthalmology throughout Brazil.
Brazilian delegation during the 8th BRICS Young Scientists Forum. Photo: personal archive.
“Eyes to the Future” contest
Gameiro is also working on a new project at the same time: evaluating the impact and follow-up of the projects presented in the “Eyes to the Future” contest, held by the Brazilian Association of Academic Ophthalmology Leagues (ABLAO), in partnership with Phelcom and with the support of the Brazilian Ophthalmology Council (CBO).
The competition seeks to teach students and encourage leagues to develop extension activities aimed at creating educational and/or assistance projects with the objective of reducing blindness due to posterior segment pathologies. To accomplish this.Phelcom provided 20 Eyer units with access to the EyerMaps feature and the EyerCloud cloud system.
The competition selected 10 projects and the top three will receive an Eyer. “It would be very interesting if we could permanently leave a portable fundus camera with each of the 10 leagues. We’re going to work on getting sponsorship to buy the seven remaining devices,” says the doctor.
“After the Academic Leagues were selected, we spoke to ABLAO’s president Luís Sabage and realized the need to evaluate and follow up on the projects submitted. Our future goal is to increase the number of ophthalmologic leagues, medical students and patients reached by the outreach projects developed,” he explains.
Furthermore, based on the results obtained in the “Eyes to the Future” contest and the points for improvement found, Gameiro intends to structure an online ophthalmology course for medical students and general practitioners, covering basic eye examination techniques, the use of artificial intelligence platforms and the interpretation of retinography images.
The doctor points out that traditional equipment for evaluating the fundus of the eye, such as fundoscopy performed with an indirect ophthalmoscope and condenser lens, is relatively difficult to handle, requires lengthy training, has a learning curve and depends on the examiner for evaluation. Besides, most of the time it doesn’t allow photographic recording of the retina for later discussion and review.
Alternatively, there is the conventional fundus camera. However, it is expensive to purchase. “Capturing images of the retina is extremely important for more accurate assessment and for monitoring the disease and treatment. It also plays a fundamental role in the training of new professionals through the presentation and discussion of findings in a group, allowing students and doctors to compare their exams and review the results,” he says.
The Eyer portable fundus camera is an extremely advantageous option in several aspects:
It makes it easy to capture high-quality images of the retina without much prior training;
Lightweight and small (it fits in the palm of your hand);
It does not require specialized labor;
Relatively more affordable than a traditional fundus camera;
It is non-mydriatic, shortening the examination time and avoiding possible adverse effects (visual discomfort, photophobia, keratitis and increased intraocular pressure);
Through telemedicine, it sends the images to the cloud, enabling remote diagnosis.
For Gameiro, the Eyer can have a significant impact on medical education. “The device can be used by medical students as a practical learning opportunity, demonstrating clinical cases and monitoring the progression of eye diseases over time, as well as stimulating interactive discussions between students and teachers, encouraging research projects and cases and facilitating access to and recording of a wide variety of cases,” he points out.
The equipment also has on-board artificial intelligence, which can be a reliable and cost-effective option for screening retinal and optic nerve pathologies using algorithms built on extensive databases.
“These algorithm models are able to predict the risk of alteration and thus notify the examiner of the need for follow-up with a more qualified specialist. In this way, the use of AI, together with deep learning and telemedicine, can represent an effective long-term solution for screening and monitoring patients in primary health care,” he concludes.
About the Eyer
Eyer Portable Fundus Camera
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, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile and Colombia.
The technology’s portability and affordability democratize access to retinal examinations. It costs approximately six times less than a conventional tabletop fundus camera, which still needs to be integrated with a computer.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The idea for the first prototype was realized by Diego Lencione’s interest in visual health, as his brother has had a condition that has severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people across Brazil and worldwide.
In four years, the company has participated in more than 100 social actions and was recently named one of the 10 most innovative companies in Brazil by Forbes.
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.
Ophthalmologist Balamurali Krishna Ambati, known as “Bala” Ambati, is the youngest doctor in the world, according to the Guiness Book of Records. At the age of 17, he graduated in medicine in Mount Sinai School of Medicine, in New York (USA), in 1995.
After that, he did residency in ophthalmology at Harvard University, where he developed strategies to reverse corneal angiogenesis. Since then, he has helped various non-profit organizations all over the world, such as ORBIS – Cooperation and Development and Sight for the Sightless, which acts to combat blindness in the Indian countryside.
He received various important awards for his work, such as the Gold Humanism Award and the Troutman-Veronneau Prize. Nowadays, he leads the clinic Pacific Clear Vision Institute, in Eugene, in the state of Oregon (USA).
For six months, the ophthalmologist has been using the Eyer Portable Fundus Camera in the clinic, on a daily basis. The technology works coupled to a smartphone, to carry out high-quality retinal exams in a few minutes, without need of pupil dilation.
“We acquired the Phelcom Eyer camera about 6 months ago and have been incredibly pleased with it. Its image quality, easy to use and easy to learn form factor, panoramic image stitching, and heat maps make photo acquisition and image transfer to the EMR seamless”, highlights Ambati.
The doctor remarks that using the equipment does not break the clinic workflow and points out the capacity to acquire images through a 2,5mm-wide pupil as “impressive”.
Furthermore, the ease of taking photos and making the documentation simplifies the doctors’ work. The exams are automatically sent to EyerCloud, a platform for remote diagnosis.
Another pro from Eyer is its portability: one can handle it manually or stabilize it on a slit lamp.
The patient becomes more engaged in the treatment, according to Ambati
As it makes device imaging available in real time, Ambati says the patients appreciate the chance to learn about their condition and what goes on with their retinas.
The ophthalmologist tells that both them and the medical team were impressed by the way the heat maps of retinal elevation reveal the pathology. “It is a factor that motivates patients to be involved with the treatment and take diabetes or DMRI seriously”, he says.
Phelcom Eyer
Phelcom Eyer is a portable fundus camera that works coupled to a smartphone and carries out high-quality retina exams, in a few minutes and without the need of pupil dilation.
The technology can identify more than 50 diseases, such as glaucoma, cataract, diabetic retinopathy, DMRI, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million exams have already been carried out.
The device integrates to an online platform, Eyer Cloud, to which data is sent automatically. A specialist can analyze them remotely from anywhere in the world.
More than that, the embedded artificial intelligence provides intelligent functions to help the medical diagnosis and the capture of retinal exams. On the other hand, portability and the technology lower prices democratize the access to retina exams.
Phelcom Technologies
Eyer is developed by Phelcom Technologies, a startup that invests in innovation and technology to democratize visual health. The company is headquartered in São Carlos-SP, Brazil and has an operation in Boston, USA.
Launched in April 2019, the technology has already reached more than 1,2 million people all over Brazil and in countries such as the United States, Chile, Japan and Colombia.
The startup creates portable devices with embedded artificial intelligence, for immediate diagnoses. It aims to revert the fact that 75% of the 250 million cases of blindness or severe visual deficiency happen due to lack of prevention or wrong treatment.
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