Clinical software to support eye care professionals reduce preventable blindness.

We aim to reduce needless vision loss worldwide by using innovative technology to increase early detection of progressive eye diseases such as Glaucoma, the third leading cause of blindness and the fourth leading cause of all vision loss worldwide. Vision impairment in glaucoma cannot be cured but can be prevented if detected early and effective treatment instituted. By 2040, it is expected that 111.8 million people will suffer from glaucoma, with figures to continue rising unless improved screening and effective treatment strategies are implemented. In Africa, glaucoma accounts for 15% of blindness and it is the region with the highest prevalence of blindness relative to other regions worldwide. Most forms of glaucoma do not show symptoms in the early stages and patients often present for treatment only after vision loss has occurred, and in many cases when they have become completely blind.    

Eye to the Future (EttF) offers a clinical decision support software aimed at assisting eye healthcare professionals to deliver timely and consistent care. Our software supports engagement with patients ensuring they are well informed about their eye health and treatment options. By providing rapid automated analysis of retinal images, we liberate eye healthcare professionals’ time allowing them to focus on delivering more value-added patient care services. Eye to the Future is committed to providing innovative tools to empower, not replace, eye healthcare professionals, helping to shape a brighter future for eye healthcare and minimize preventable vision loss.  

To do this, EttF uses a suite of sophisticated analytics tools, identifying areas of change that are vital for tracking progressive eye conditions like Glaucoma - enabling diagnosis before it becomes debilitating.  Critically, pictures can be taken by lower-level health-workers and analysed by optometrists or ophthalmologists in another part of the country, meaning detection can occur sooner; without the need for patients to travel to urban centres, which is a barrier for the poorest. The technology is being tested in the UK with data from UK, France and USA and is ready to be tested/used in different populations where, if integrated into health systems to support standard screening and diagnostic programmes, can have an even greater impact.   

EttF’s system takes in retinal images, that have been taken on any fundus camera - the most ubiquitous piece of image capture equipment worldwide. It helps make the process more efficient allowing more people to be seen and to be treated sooner. Currently an eye care professional (optometrist) compares images manually for detection of progressive diseases like Glaucoma. This can lead to disease being missed or increased backlogs with longer appointments. EttF’s product addresses these issues and fits into existing clinical workflows and identifies change between images from 2 time points. This is unique. The system therefore helps disease to be spotted earlier and allows more people to be seen especially where resources and access to healthcare are limited. 

Glaucoma presents earlier and is more aggressive in Africans, therefore leading to blindness earlier than in Caucasian counterparts. In Africa, 50% of patients presenting are already unilaterally blind. Low awareness of disease, late presentation and poor adherence to treatment are major challenges to glaucoma management. These inequities are compounded as individuals and communities with lower incomes, lower levels of education, and rural areas are more likely to experience poor health outcomes and have limited access to healthcare services. Additionally, women are 12% more likely to have vision loss and 8% more likely to be blind than men and yet are often deprioritised for access to finances to pay for health care, this situation is even more dire for African women.  

EttF, the leading partner, is a dedicated vision software start-up based in Edinburgh, Scotland.  It is led by founder, David Bowie, who has over 30 years of international sales, marketing, business development, and management experience in the global healthcare sector. He has worked for multi-nationals and at C- level for several successful exited local start-ups and growth businesses in medical technology, digital health, life sciences and animal health driving commercialisation of new technologies and products internationally. The rest of the EttF team has the right blend of technical, scientific, project management and regulatory skills to be able to deliver this project with our partner Vision Action.  

The implementing partner for this project is Vision Action, an international NGO with over 3 decades of experience working directly with partners and communities in Africa breaking down access barriers for the most underserved populations. Vision Action works with governments, communities, CSOs and the private sector with the ambition to increase equitable access to eye care services and glasses, and in doing so, accelerate achievement of the UN Sustainable Development Goals. Their systems strengthening approach targets key barriers of the barriers of availability, accessibility, affordability, and acceptability, to deliver greater impact.   Vision Action currently works in 4 countries in sub-Saharan Africa (Ethiopia, Ghana, Sierra Leone, and Zambia), and they have a small team of staff in each country to coordinate the programmes alongside our country partners. 

They work closely with the Ministry of Health (MOH) in each country, and with professional associations such as the national Optometry Associations, and Universities.

Eye to the Future’s technology product is at the stage where the technology has been proven and there is a clear need (product-market fit) but now it is needed to be implemented and validated in diverse real-world settings. To validate it fully, greater amounts of longitudinal data are needed to clinically validate the product in those real-world environments. These datasets will also help with the development of further products to help other diseases and conditions and ultimately help more people who have avoidable sight loss. We are aiming to build the number of users, grow the technical implementation and support regulatory approval in international markets with a vision to launch the product to multiple countries beyond UK and USA with a specific target on Ghana and Ethiopia. Gathering data from around the world with diverse population backgrounds, is very important to EttF and a key part of proving the value of the product and trust in it.  

The project is focussed on testing and validating with real world data in real world environments. Our objective is to prove the technology, clinical and patient value so that it can be deployed in stages around the world so that our technology has the greatest impact for the largest number of people – reducing unnecessary blindness, improving quality of life and supporting sustainable economies. 

The future of health care is shifting with the advancement of innovative technology and the digital sphere, and yet there remain substantial challenges within the eye care sector. We believe that through the Solve network we will be able to provide equitable solutions to communities most in need of our intervention. Our work and commitment in providing innovative tools to those most in need aligns with Solve’s objective of ensuring access to quality health services as and when needed. Our solution will increase the capacity and effectiveness of health care systems, including providing cutting edge software with optimised efficiency and ensuring that through a continuum of care, marginalised communities will receive access to the quality health care provisions and services they desperately need. Our work and our solution are rooted in and driven by the need and local context of the communities we serve. Our role is to leverage our knowledge and technology to increase access to necessary services that will; as a domino effect, enhance and empower local communities. Specific challenges that we hope a collaborative partnership with Solve could facilitate include; Market Expansion, with the potential of providing this software to more marginalised communities in need. Networking Opportunities, that allows EttF and Vision Action to broaden their network with innovators and entrepreneurs. Financial Constraints, that provides scope to alleviate some of the financial challenges that comes with scaling up software and services to reach a wider target audience.

Initially targeted at general eye heath and glaucoma, EttF’s software platform offers a comprehensive set of benefits:  

1. Cutting-edge eye care: we provide software that can seamlessly integrate into our customers’ service offerings to benefit their patients.  

2. Referral decision support: our software improves confidence to refer at the right time, reducing unnecessary referrals and costs on healthcare systems.  

3. Optimized efficiency: we streamline and fit with current workflows, liberating valuable resources and elevating patient throughput, which boosts the financial health of our customers’ businesses, ensuring a clear return on investment.  

4. Continuous improvement: we offer a dynamic platform for ongoing enhancement and refinement, ensuring that our customers remain at the forefront of evolving and advancing retinal image analysis technologies. 

The key things that make the technology within Eye to the Future’s product innovative are:

• that it comes from a background of over 20-years of clinically-motivated research from 2 respected Scottish Universities – Edinburgh and Dundee
• the technology is the only one that focusses on change over time – looking at 2 time points to spot changes associated with eye conditions. This is vitally important for clinical diagnosis of progressive diseases such as Glaucoma
• the software is hardware agnostic and can use images taken already at eye appointments on fundus cameras, therefore no new hardware is required, so costs are kept low.  

The Eye to the Future platform product is aimed to enhance what an eye care professional does in their work not replace them. It takes away a key area of manual work that can be labour intensive and time-consuming and automates the identification of areas of change relevant to disease.

Demonstrating an effective method for glaucoma detection that may help to address the maldistribution of eye health professionals in Sub Saharan Africa, ie to enable hospitals/clinics in more rural settings to identify glaucoma through taking the images and sharing with Optometrists in the cities to do the analysis/diagnosis. 

Increasing knowledge of glaucoma prevalence and treatment in East and West Africa, specifically Ghana and Ethiopia.  We could even broaden out to Sierra Leone and Zambia if we felt appropriate/possible to do so.  This could be through 1) analysis of existing data sets, and 2) through the tracking of new patients. 

Increase understanding of issues relating to eye drop compliance amongst glaucoma patients.  Using the reports to show the effects of using/not using medication and how it impacts the progression of the disease over time. 

For health services, earlier diagnosis enables quicker and less costly treatment, reduced need for surgery and avoids long-term chronic conditions, thereby delivering both short-term and long-term cost savings. Improved quality of diagnosis within community settings, reduces the burden of diagnosis on hospital-based eye services. 

Eye to the Future’s product is a clinical analytics software platform, that analyses retinal changes in digital fundus camera images over multiple routine eye examinations by comparing images taken at different times. Fundus photography involves photographing the rear of an eye, also known as the fundus. Specialized fundus cameras consisting of an intricate microscope attached to a flash enabled 2D digital camera are used in fundus photography. Fundus cameras are the most ubiquitous equipment worldwide. The images needed by the EttF system are routinely captured at eye test appointments – by optometrist and ophthalmologists. The EttF product makes it easier for eye care professionals to look at areas of significant change. The system saves time by automating this part of the workflow which is currently done by manual comparison which has inherent risks with it as the human eye cannot pick up very small changes in images. Saving time allows for better time management thus increasing efficiency. 

Images are retrieved by the EttF system and then registered and compared to highlight regions of change relevant to general eye care and then used to support the physician to make quicker, more consistent, and more informed decisions. Initially, the product is specifically aimed at evaluating retinal changes indicative of glaucoma (the second most common cause of irreversible blindness globally [Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040; Tham, Yih-Chung et al. Ophthalmology, Volume 121, Issue 11, 2081 – 2090]. The technology is image capture hardware device agnostic in that it works with images from fundus cameras of any manufacturer, meaning that no further hardware investment is needed. The system provides additional valuable clinical information to the eye care professional, which will lead to more confident and efficient assessments for either onward referral to the hospital eye services or routine follow-up in their own community setting.  

The product has been based on credible and internationally recognised collaborative research from the VAMPIRE (Vascular Assessment and Measurement Platform for Images of the Retina) involving Universities of Edinburgh and Dundee, and then developed into a commercially ready product within EttF over past 4 years.  

The system ingests retinal images from existing fundus cameras, thus preserving our customers’ investment in equipment and fundus cameras are the most ubiquitous equipment worldwide. The images are routinely captures at eye test appointments. We are hardware and image format agnostics so we can work with any system  

The system architecture is cloud-based using AWS. EttF has from the beginning ensured that the technology can be scaled internationally. 

The background technology has been developed from the scientific credibility of nearly 20 years of research of the VAMPIRE initiative, created and led by EttF co-founders and Scientific Advisors MacGillivray and Trucco.

VAMPIRE was created with the aim to support clinical research on retinal biomarkers and retinal conditions by providing clinically-motivated, advanced software tools. 

They have collaborated internationally with other eminent clinicians and partners and published a number of papers on the science. Since late 2019 Eye to the Future has developed its own IP on top of this background technology and has always spent resource and time on validating the idea, the hypothesis of benefits to nlniclans and patients. We continue to do this using real-world data sets at each step of the way. We also have to document all steps of the development process indluinc user testing for our regulatory clearances and our quality management system. We currently do not have any company data that can be shared or published as this is proprietary information.

Following are 2 of the many papers published by our scientific founders:

Gibbon, Samuel; Muniz-Terrera, Graciela; Yii, Fabian SL; Hamid, Charlene; Cox, Simon; Maccormick, Ian JC; Tatham, Andrew J; Ritchie, Craig; Trucco, Emanuele; Dhillon, Baljean; 

A method for quantifying sectoral optic disc pallor in fundus photographs and its association with peripapillary RNFL thickness

Chiquet, Christophe; Gavard, Olivier; Arnould, Louis; Mautuit, Thibaud; Macgillivray, Tom J; Bron, Alain M; Semecas, Rachel; Trucco, Emmanuele; Florent, Aptel; 

Retinal vessel phenotype in patients with primary open‐angle glaucoma

The EttF team has 6 full time team members with a further 6 who work as part time advisors on science, regulatory, business, finance, and algorithm development.  

Vision Action has a team of 7 in the UK (3 of whom are part-time), and 12 global staff, one of whom is part-time. 

The background technology from the 2 Universities (Edinburgh and Dundee) has been worked on for over 20 years. The actual Eye to the Future product development has been in progress for over 4 years to date.  

Vision Action and Eye to the Future have been in consultation since 2022 on how to collaborate and increase impact within the sector. This global challenge provides the right framework for our team to put into action our proposed solution.  

Vision Action and EttF prioritise diversity and inclusivity across gender, identity, race, ethnicity, nationality, religion, and orientation. As such we are working to update our internal Diversity, Equity, and Inclusion policies and leadership, striving to be better and do better. Within our international programming we work with local communities, aiming to empower and promote local ownership, prioritising equitable employment opportunities.   

The Eye to the Future product will be commercially available as a Software as a Service product on a per user per month basis. This allows clear budgeting of the system for customers and users, and is aimed at a level that can be afforded and provide valuable return on investment for purchasers and users and to enable more patients to be seen and disease to be detected and diagnosed and treated earlier.  

Working with health systems and our partner Vision Action we can also consider alternative pricing models if this will provide a better uptake of the system for use on to help more people with potential vision loss. 

EttF has a credible track record over the past 4 years of using any funding efficiently. To date we have been funded by Scottish Enterprise, InnovateUK (Biomedical Catalyst) and other providers of grants and loans. We have received a mix of funding to date to build our product and test it robustly and will continue to do so. We continue to seek sources of appropriate funding (funding that matches with our vision and values) whether that be grants, loans, prizes, philanthropic funding as well as we are currently raising an equity investment round from angels and VCs. We have a clear and detailed financial plan for the coming 5 years and are very well positioned to deliver on that plan. The key for us to keep the cashflow in balance so that we can retain our brilliant team, deliver on projects and work with excellent partners like Vision Action.  

For the long term we will fund our business form a combination of revenue, starting in early 2025 and if necessary further equity investment. Our product is sold as a Software as a Service product which by its nature is recurring in nature and will build over time.  

Vision Action prioritises financial sustainability to continue to achieve impact in the sector and regions we work in, with three decades of experience to lean on. Our funding comes from a diversity of sources, including trusts, foundations and institutions, corporate partners and sponsors, local governments, authorities, and ministries in the regions we serve, as well as through our strong network. Some of our larger partners include USAID, Optometry Giving Sight, the Fund for Innovation in Development, Else Kroner Fresenius Stiftung among others.