Scientists at Nanyang Technological University, Singapore (NTU Singapore), with clinicians from the Singapore Eye Research Institute (SERI), have invented a new 'pen camera' that makes it easier for doctors to diagnose patients with glaucoma.
The 'pen camera', called the GonioPEN, could help tackle the eye disease with its ability to detect the type of glaucoma in a faster and cheaper manner. It causes negligible discomfort, unlike the current gonioscopes, which are glass scopes that must be pressed against the eyeball of the patient for doctors to look at the eye's drainage canal to diagnose the cause.
Glaucoma is a leading cause of blindness in the world. It has no early symptoms, but a build-up of pressure inside the eye can be an indicator. In Singapore, about three per cent of people over the age of 40 years - or over 65,000 people - have glaucoma. This percentage rises with age.
Built by a team led by NTU Associate Professor Murukeshan Vadakke Matham, Director of NTU's Centre for Optical and Laser Engineering, in collaboration with Professor Aung Tin, the Executive Director of SERI, the GonioPEN allows doctors or trained technicians to capture more detailed images of the eye drainage canal with minimal contact at the side of the cornea. A software is then used to analyse the images, helping doctors and eye specialists with their diagnosis.
In a recent pilot study by Assistant Professor Baskaran Mani from SERI, all 20 patients found the GonioPEN more comfortable than the conventional hand-held lens used with a microscope - a gold standard used in clinics now.
As the current gonioscopy method takes up to 15 minutes to perform and requires a skilled specialist's expertise to diagnose the problem on the spot, it is not done in clinics as a routine, said Asst Prof Mani. As a result, half the patients here do not go through the test in clinics, leaving glaucoma largely undiagnosed here, he added.
The GonioPEN circumvents these problems with its ability to quickly capture in just three minutes high-resolution digital images of the eye from the side of the cornea. The images, which could be taken by a technician, are reviewed separately by the eye specialist, shortening the time the patient's eye needs to be under the microscope as the specialist makes his diagnosis as in the existing method.
Innovative devices such as the GonioPEN, developed on campus, are aligned with NTU's Smart Campus vision of harnessing the power of digital technology and tech-enabled solutions to support better learning and living experiences, the discovery of new knowledge, and the sustainability of resources.
Assoc Prof Murukeshan, who is from NTU's School of Mechanical and Aerospace Engineering, said: "With the GonioPEN, a digital camera image of a higher resolution can now be stored for future reference and retrieved easily. A technician could perform the gonioscopy before a specialist reviews the images to give an in-depth diagnosis or a second opinion. Doctors can also better track the changes in their patients' condition over time.
"The GonioPEN's ease of use means it can be used by primary, secondary or private eye care physicians, while its compact size makes it portable for all healthcare set-ups. The cost is also kept low because a microscope is no longer required."
Prof Aung Tin, who is also Deputy Medical Director (Research) at the Singapore National Eye Centre, said that in the digital era of healthcare and future teleophthalmic care possibilities, such a device will enable advancement in the standard of medical care. "The GonioPEN, with its compactness and integration to our electronic medical records, will achieve such goals for the future eye care model in Singapore," he added.
How it works
In glaucoma, high pressure within the eye is caused by an imbalance between fluid production and its drainage out of the eye, typically caused by clogged drainage channels.
An eye specialist determines the type of glaucoma through a gonioscope, a hand-held lens put in direct contact with the eye. The specialist then peers through a microscope paired with the lens to make a visual diagnosis. Each type of glaucoma will require a different form of treatment.
The drawback of this manual method of peering through a lens is that the doctor cannot review the image of the eye at a later date. While there are other machines on the market that can capture images of the angle with or without any direct contact with the eye, they are expensive, ranging from US$25,000 to US$120,000 (S$33,000 to S$158,000).
In contrast, the GonioPEN combines a high-resolution camera and LEDs for illumination to take a high quality image of the human eye. The prototype pen camera, estimated to cost $5,000, is connected to a computer via a USB cable. The camera captures images of the eye from four different perspectives and saves it to the computer, which can then be magnified several times for a better diagnosis by an eye doctor.
Asst Prof Mani said the prototype device is portable and digital, allowing a trained technician to capture images of the eye quickly with minimal training. He added: "With GonioPEN, the diagnosis can be generated with an automated software, instead of only relying on a doctor's expertise. This saves time for both doctors and patients involved in eye care, allowing more patients to be examined in clinics. Clinically, patients found the GonioPEN more comfortable than a gonioscope."
Patents have been filed for the GonioPEN by NTU's innovation and enterprise arm, NTUitive, and the research is supported by grants from the National Medical Research Council and the National Research Foundation Singapore.
It was developed over the last two years by a joint research team, which includes NTU researchers Dr Sandeep Menon P, Dr Shinoj VK and Mr Hong Xun Jie, Jesmond.
Foo Jie Ying
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About Nanyang Technological University, Singapore
A research-intensive public university, Nanyang Technological University, Singapore (NTU Singapore) has 33,500 undergraduate and postgraduate students in the colleges of Engineering, Business, Science, Humanities, Arts, & Social Sciences, and its Interdisciplinary Graduate School. It also has a medical school, the Lee Kong Chian School of Medicine, set up jointly with Imperial College London.
NTU is also home to world-class autonomous institutes - the National Institute of Education, S Rajaratnam School of International Studies, Earth Observatory of Singapore, and Singapore Centre for Environmental Life Sciences Engineering - and various leading research centres such as the Nanyang Environment & Water Research Institute (NEWRI) and Energy Research Institute @ NTU (ERI@N).
Ranked 11th in the world, NTU has also been placed the world's top young university for the last four years running. The University's main campus is frequently listed among the Top 15 most beautiful university campuses in the world and has 57 Green Mark awards (equivalent to LEED-certified), of which 54 are Green Mark Platinum. NTU also has a campus in Novena, Singapore's medical district.
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About Singapore Eye Research Institute (SERI)
Established in 1997, SERI is Singapore's national research institute for ophthalmic and vision research. SERI's mission is to conduct high impact eye research with the aim to prevent blindness, low vision and major eye diseases common to Singaporeans and Asians. SERI has grown from a founding team of five in 1997 to a faculty of 220, encompassing clinician scientists, scientists, research fellows, PhD students and support staff. This makes SERI one of the largest research institutes in Singapore and the largest eye research institute in Asia-Pacific. In addition, SERI has over 250 adjunct faculties from various eye departments, biomedical institutes and tertiary centres in Singapore.
SERI has amassed an impressive array of more than 3,118 scientific papers as of December 2017, and has secured more than $276 million in external peer-reviewed competitive grants. To date, SERI's faculty has been awarded more than 454 national and international prizes and filed more than 127 patents. Serving as the research institute of the Singapore National Eye Centre and affiliated to the Duke-NUS Medical School, National University of Singapore, SERI undertakes vision research in collaboration with local clinical ophthalmic centres and biomedical research institutions, as well as major eye centres and research institutes throughout the world. Today, SERI is recognized as a pioneering center for high quality eye research in Asia, with breakthrough discoveries that has translated to significant paradigm shift in eye care delivery.
About Singapore National Eye Centre
Singapore National Eye Centre (SNEC) was incorporated in 1989 and commenced operations in 1990. It is the designated national centre within the public sector healthcare network, and spearheads and coordinates the provision of specialised ophthalmological services with emphasis on quality education and research. Since its opening in 1990, SNEC has achieved rapid growth and currently manages an annual workload of 330,000 outpatient visits, 34,000 major eye surgeries and laser procedures.
Ten subspecialties in Cataract, Cataract and Comprehensive Ophthalmology, Corneal and External Eye Disease, Glaucoma, Neuro-Ophthalmology, Oculoplastic and Aesthetic Eyeplastic, Paediatric Ophthalmology and Strabismus, Refractive Surgery, Ocular Inflammation and Immunology and Retina (Medical & Surgical) have been established to provide a full range of eye treatment from comprehensive to tertiary levels for the entire spectrum of eye conditions.
SNEC was accorded the Excellence for Singapore Award in 2003 for achieving excellence in the area of Ophthalmology, thrusting Singapore into international prominence. In 2006, SNEC received the first Minister for Health Award for public health. Three clinician scientists from Singapore National Eye Centre and Singapore Eye Research Institute were awarded the prestigious President's Science and Technology Award in 2009, 2010 and 2014 for their outstanding contributions in translational, clinical and epidemiological research in cornea, retina and glaucoma.