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Double vision: Medical innovations aim to improve access to eye care in rural and remote areas


The Joule Innovation grant program offered funding, professional support and mentorship to physicians and medical learners making a difference in health care. This is part of a series of stories about the 2020 recipients and their innovations.

For Canadians living in rural and remote communities, accessing eye care is an uphill battle.

“There are often many logistical barriers when these patients need to see ophthalmologists located in urban centres,” explains Dr. Jovi Wong, a University of Toronto ophthalmology resident physician. “Traveling hundreds of kilometres for a medical appointment is hard on anyone. This is especially true for patients with vision loss who need to bring a sighted companion who can take time off work.” 

Currently, only 27% of patients living in rural and remote areas who need regular eye follow-up actually receive it. With one in six Canadians at risk of developing vision loss, timely access to high-quality eye care and specialist referrals is essential.

Stuti Tanya is a fourth-year medical student at Memorial University of Newfoundland. She lives and studies in a province that has Canada’s fastest aging population and high rates of chronic diseases that affect ocular health, such as diabetes and hypertension.

“Accessing an ophthalmologist in Newfoundland and Labrador can take hours by road and has lots of associated costs, including time off work,” she says. “Exposure to ophthalmology in medical school is limited, which can also make the assessment and management in primary care settings challenging.”

Both Dr. Wong and Ms. Tanya are turning to technology to help fill this eye care gap. Their projects — which each received a $10,000 Joule Innovation grant — will make it easier for primary care providers in rural areas to identify eye conditions and streamline the referral process.

Dr. Jovi Wong and medical student Stuti Tanya are using technology to fill a gap in eye care.

Retinographer: A smartphone-based fundoscope with artificial intelligence

Given that 75% of all vision loss and blindness is preventable with early screening and treatment, Dr. Wong’s innovation aims to empower front-line community health workers in rural communities to monitor and screen patients’ eyes within their own communities.

Retinal examination through fundoscopy is the main method for screening, diagnosing and monitoring three leading causes of blindness: age-related macular degeneration, diabetic retinopathy and glaucoma. Dr. Wong’s inexpensive smartphone-based fundoscope — dubbed Retinographer — takes an image of the retina, which is responsible for vision, and uses an algorithm to detect major diseases. She is already in the process of testing her prototype.

“Artificial intelligence has the potential to transform delivery of eye care in Canada. Algorithms for medical image analysis, including our own, which powers Retinographer, have been shown to be at least as accurate as human experts.” — Dr. Jovi Wong

While traditional methods of retinal examination require prolonged face-to-face interaction with patients, Retinographer offers a safer alternative during the COVID-19 pandemic. Eventually, Dr. Wong would like to see health care workers across Ontario use Retinographer on their smartphones. They would download a phone or web application and attach a 3D-printed frame with a mounted lens sent to them by mail.

“Our goal is to help reduce preventable vision loss. I hope my innovation will have long-term benefits for patients’ quality of life, their mental health and their ability to continue employment,” she says.

Rhythm: An intuitive triage and referral software for primary care providers

When primary care physicians, optometrists or nurse practitioners screen patients for eye disease, it’s not always clear whether to refer them to an ophthalmologist.

“Take a red eye, for example,” explains Ms. Tanya. “Is it viral conjunctivitis or a different diagnosis that requires urgent ophthalmologic assessment?”

Rhythm aims to help primary care providers arrive at a more accurate diagnosis for referral purposes and estimate whether an eye concern is urgent. The software uses artificial intelligence to guide primary care providers through a step-by-step examination process using clinical observations.  

“We decided to leverage technology to improve the flow of referrals from primary care to ophthalmology, which is where most of the inefficiencies in the care delivery pipeline arise.” — Ms. Stuti Tanya

Rhythm will improve that flow by replacing the traditional paper-based system. It will also ensure that patients — wherever they live — are diagnosed and seen within an appropriate time frame.

Currently, Ms. Tanya is working to finesse the software before testing it further.

“We hope to turn Rhythm into a revolutionary tool in Canadian health care,” she says.

The 2020 Joule Innovation grant program provided $500,000 to support physician-led innovations in the areas of sustainable health care, physician health and wellness, health care solutions and access to care.

Read about the other innovations funded through the program:


About the author(s)

CMA Joule supports physicians and medical learners in the pursuit of clinical excellence. As a subsidiary of the Canadian Medical Association (CMA), we support the profession with continuing education and other learning opportunities as well as leading evidence-based clinical products and research.