India faces a significant challenge with visual impairment, accounting for one-fifth of the global disease burden. Recent surveys suggest that nearly 62 million Indians encounter visual impairment, with conditions like diabetic retinopathy and age-related macular degeneration increasing in prevalence due to the ageing population as well as the high occurrence of NCDs like diabetes and hypertension that cause ophthalmological complications. At the same time, uncorrected refractive error significantly burdens public health, as approximately 60% of visually impaired individuals require corrective measures. These errors can diminish productivity and hamper learning, particularly in school children. Furthermore, they may pose safety risks to the public when professionals such as drivers suffer from these conditions.

While technological innovations in ophthalmic screening have been around for decades, most of the routine screening devices are expensive, bulky, and not suitable for resource-limited settings. For example, a table top fundus camera used routinely in ophthalmic clinics can range from Rs. 15 to 20 lakhs. This has made widespread screening difficult outside of well-equipped urban centres, leaving many without access to essential eye care services.

There is an urgent need to develop and deploy innovations that are not only affordable but also portable and digitally enabled for tele-medicine applications, which could operate under resource constrained settings. Forus Health, a holistic digital ophthalmology platform that unifies devices, specialists, and AI to deliver comprehensive eye screening services globally, is addressing this gap in a big way – their proprietary hand-held autorefractors and non-mydriatic fundus cameras are designed to screen for refractive errors and retinopathy respectively in resource constrained settings without the need to dilate pupils.They have undergone rigorous clinical and field testing in multiple reputed institutions and have been certified by CE and USFDA. 

Our grant support to Forus, in collaboration with the Karnataka Department of Health and C-Camp, has enabled the deployment of Forus’ fundus cameras (3nethra series camera) at Primary Health Centers (PHCs) and Community Health Centers (CHCs) across Karnataka to operationalise tele-ophthalmology in a hub and spoke model. In these centres, optometrists would capture and upload retinal images on a cloud-based digital platform, allowing ophthalmologists at district hospitals to review the images at their convenience and recommend follow-up actions for patients. This model allows for easy access and timely referral for retinal conditions at the periphery and given the high patient volumes at these centres, the auto refractometer assists optometrists in quickly optimising prescriptions, thereby reducing the turnaround time.

Scaling in public health demands evidence from real-world settings, optimization of workflows and resources, and clear demonstrations of improvements and benefits over existing eye screening methods, along with the ability to build capacity within the system at scale. It must show volume and agility with improved quality of healthcare delivery. This deployment in KA’s public health settings aims to generate such evidence. It will help scale this initiative to the entire KA state and integrate technology-driven solutions into wider public health settings. 

As ACT For Health, we look forward to catalysing Forus to drive an improvement in the accessibility and quality of eye care, especially among underserved populations like school children and rural populations. At a larger level, we also expect that the use of AI and telemedicine platforms will also  boost the capacity to manage and treat eye conditions effectively at the primary care level​. Our ongoing commitment to this initiative is aimed at creating a sustainable and scalable model of eye care that aligns with our mission to enhance the quality of life through appropriate healthcare innovation!