New Delhi: Indians have smaller pupils, about 2.5-3 mm in size, compared to those in the West (4-4.5 mm). Maybe that’s evolution’s response to the harsh sunlight tropical countries are exposed to. This is why ophthalmologists in India need to dilate pupils to get good images of the retina to understand eye conditions. But dilation, and the waiting time it involves, is a big challenge if there are lots of patients. Imported eye testing equipment is mostly built for Western eyes, which are naturally dilated. How can you create a device that can test Indians’ eyes without dilating them?
This was the question K Chandrasekhar (KC) and Venkatakrishnan S (Venkat) had to answer when they realised, about 15 years ago, that there’s widespread eye problems among poorer Indians, and most are not diagnosed. They were then working for Philips in its semiconductor division (which later became NXP). A guest at Philips once was a leading doctor from Aravind Eye Hospitals in Madurai. That discussion gave KC and Venkat the first insights into eye problems in India. KC recollects an Aravind video that says: “In India, a blind man is seen as a mouth without hands.” A liability to his own kith and kin. “A daily wage worker who has worked for 60-70 years often goes blind and then his own children consider him a liability as they have to go for their day-to-day job,” KC says.
The two started visiting Aravind Hospitals regularly. They found many serious eye problems – like diabetic retinopathy, glaucoma and macular degeneration that lead to vision loss without even the patient realising it – were growing rapidly, mainly because of rising incidence of diabetes, but were treatable. They understood why the common man did not go to an ophthalmologist. They understood how scarce ophthalmologists were. And they decided to address the problem.
They formed a company called Forus to create a device that could be taken to remote areas for mass eye testing. Putting dilation drops on hundreds of people and asking them to wait for their tests was impractical. That’s when they confronted the small aperture of Indian eyes. “All eye equipment are basically illumination and imaging systems,” says Venkat. While refraction issues (where you need prescription glasses) and cataract are mostly about the front of the eye, the more serious issues are about the retina at the back of the eye. And that needed to be illuminated and the image extracted.
KC and Venkat put together a team with expertise in optics, mechanical and industrial design, electronics and firmware. It took them three years, but by the end of it, they had created what they call one of the best lenses in the world – lenses that could throw enough light, which is also medically safe, and get back a diagnosable picture of the retina.
Today, they have 7 granted patents, another 12 are pending. They have 8 products. They have 3,800 installations across 73 countries. “We have touched 16 million lives, and we probably ensured about 3 million didn’t go blind,” KC says. Accel, TPG and IDG are investors. Revenue, KC says, grew by about 30% in each of the last three years, and the company has been profitable in these years. They even do the assembly of the product in the basement of their office in Bengaluru in a high-quality clean room.
Future with AI
AI today is enabling fascinating innovations on top of their original products. The nerves and blood vessels in the eye are biomarkers for cardiovascular, neurological and nephrological risks, and autoimmune disease. The millions of images captured by Forus systems over the years are enabling them to analyse multiple parameters in nerves, arteries and veins in the eye, to predict these other diseases. “We’re actively working on Alzheimer’s and dementia, and also trying to see if we can do stroke prediction,” KC says. It’s work in progress, but the results so far, he says, are very promising. Making predictions non-invasively, with eye images, could be transformational.
