Democratizing vision exams with QuickSee

PlenOptika envisions a world where a clinical-quality vision exam (4.2B people need glasses, shockingly 1.1B people lack access) and eyeglasses (a $139B global marketplace), can be delivered to anyone, anywhere, anytime - preventing $411B annual losses in education, health, and productivity. 

Health disparity populations in India and Indonesia, in rural villages and urban slums, suffer inequitable access to vision exams because the eye doctors are segregated in high-resource urban centers and their clinical equipment is expensive and non-portable. 

QuickSee is a low-cost, handheld autorefractor that is operable by anyone that provides accurate vision exam in 30 seconds in any field condition. After being validated in 10+ clinical studies it commercially launched in 2019 and has been used on over 3M+ patients across 30 countries (including India and Indonesia). NGOs and 3 Indian states have armed 1,000s of community health workers/microentrepreneurs with QuickSee to provide 60M+ vision exams/eyeglasses by 2025.

Poor vision that is correctable with eyeglasses affects >1.1B people worldwide (>239M children), in low-resource settings (rural areas and urban slums). The scale of the problem remains extreme even though a simple scalable solution exists – affordable prescription eyeglasses ($5 each). The WHO and UN estimate that worldwide vision correction would increase global GDP by >$400 billion annually, and would only cost $5B (an 80x return-on-investment!), thereby and would improving childhood education, worker productivity, and improve quality of life.

In India, there are >550M people who lack eyeglasses but need them, concentrated in rural villages and urban slums, causing >$40B of economic loss to the economy. India needs >100,000 eyeglass stores and >100,000 eye doctors to provide equitable access to developed settings (1 doctor or store per 10,000 people). VisionSpring India demonstrated vision correction improved worker productivity by 34% and income by 20%. Studies in India and sub-Saharan Africa show a major barrier is loss of daily wages and travel costs when the distance to the eye doctor or eyeglass store is >3-5 km. 

In Indonesia, ~4.6% of the total population (12.5M out of 273M) wear glasses. However, ~10% (>15M) of the urban population lacks the glasses needed for vision correction including >7M children. Surprisingly, the affected population tends to reside in urban and suburban areas, but the problem and impacts of lack of access to vision correction are the same as India.

Poor vision affects people worldwide of all ages and ethnicities. 

IMPACTS:

1) Tragically, 239 million children are impaired by poor vision, profoundly impacting their education and future economic inclusion. Poor vision has been shown to cause a loss of >1 year of education during primary school, since ~80% of learning is visual, and has been demonstrated to be a significant contributor to delinquency and a downward educational/economic trajectory. 

2) In adults, poor vision has been shown to decrease economic earning potential for daily laborers by 30% and to reduce future economic trajectory.  

3) Elderly people suffering from poor vision become an economic and social burden on their families. Eyeglasses can restore an elderly person’s independence and therefore increase a family’s inclusion in the economy. Furthermore, poor has been shown to increase the likelihood of falls and acceleration of effects of dementia.

PLENOPTIKA’S APPROACH:

Since 2011, we have worked closely with eye care non-profits/NGOs, governments, eye doctors, and eyeglass retailers across US, EU, SE Asia, Africa, and LATAM to: 1) understand the access and cultural barriers, 2) societal impacts, 3) limitations of current approaches, 4) how QuickSee scales up vision exams and eyeglass adoption, 5) how QuickSee scales up the microentrepreneur workforce.

PLENOPTIKA’S IMPACT:

QuickSee enables non-clinicians to provide accurate vision exams anywhere, thereby increasing the pool of providers (vision microentrepreneurs and community health workers) to scalably and sustainably to provide more eye exams and sell more low-cost eyeglasses. Thus, we generate economic impact for both the provider and the patient.

The under-served populations in India and Indonesia suffer such drastic uncorrected refractive error (lack of vision correction with eyeglasses) because of the lack of eyecare professionals in low-resource settings  (100-1000x more eyecare professionals are needed, >200,000 in total).

Eyecare and eyeglass stakeholders (NGOs, governments, eye doctors, and eyeglass retailers) are creating networks of vision clinics run by community health workers and mobile vision microentrepreneurs to reach the unreached 1.1B people needing low-cost prescription eyeglasses. However, they face a challenge of training new refractionists capable of accurately and reliably administering a clinical-quality vision exam – to become a proficient refractionist takes 2+ years of training!

As a result, these stakeholders are innovating the training and up-skilling of non-clinical personnel through the use of automated digital health technologies such as PlenOptika’s QuickSee. Similarly to how basic health vitals are measured by nurses/technicians instead of doctors, QuickSee addresses the tradeoff constraints of enabling the rapid scale-up of the vision exam workforce (a few hours to a few days of training) while maintaining clinical accuracy of a highly trained eye doctor (without the 2+ years and high-costs of training).

Community health workers and vision microentrepreneurs tend to be women and unemployed young adults recruited from rural villages and urban slums, because of their rapport within the local communities. Importantly, technologies like QuickSee increase the economic opportunity for these workforces and pull them into the digital health future.

Shivang R. Dave, PhD, is co-founder and CEO of PlenOptika. Trained at UC Berkeley and MIT, he has 15+ years of entrepreneurial, global health, and biomedical engineering device design experience - successfully translated 3 technologies from the university into industry including low-cost drug-eluting intraocular lenses, ultrasensitive cancer diagnostics, and QuickSee.

For over a decade, PlenOptika’s 4 founders have been studying and working on the overall problem of uncorrected refractive errors for the 1.1B unreached. Early on, we realized that the scale of the problem mandated our solution be massively scalable and separate-but-complimentary to the traditional approach of training eyecare doctors (which is increasing only slowly and with great expense) and physical vision clinics/eyeglass stores. This is the only way to bring more people into the eyecare workforce and to reach those patients in need.

Towards scalability of health impact, our focused was the technology must be robust enough to work in any setting, low-cost enough to be deployed in low-resource settings, clinically accurate enough to be adopted in high-resource settings, and and easy enough to use to be deployed on children, eldery, non-literate, and special needs patients. 

These product attributes of QuickSee have unlocked a scalable healthcare delivery solution (QuickSee-powered community health workers and vision microentrepreneurs) that has accelerated QuickSee’s adoption across the US/EU, India / SE Asia, and Africa. By de-skilling the vision exam, each QuickSee reduces the training time and costs (while maintaining clinical accuracy) required to add a  new vision care worker into the workforce.

Each 30-second QuickSee vision exam is >20x faster than the traditional 10-minute vision exam. In India, Aravind Eye Hospital nurses test ~60 kids/hour for ~8 hours/day, resulting >100,000 kids/year (>10-30x than a US optometrist). 

QuickSee scalably catalyzes both vision exam workforce creation and eyeglasses deployed in the field.

PlenOptika leverages two types of technology to have global healthcare and workforce impact – low-cost eyeglasses (old tech) and QuickSee-based eye exams (new tech). This marriage of technological approaches will enable > 1.1B people at the middle-and-bottom of the pyramid to improve their economic productivity and inclusion. Without good eyesight, it’s impossible to be fully integrated into the rapidly evolving digital economy as a worker or consumer!

QuickSee utilizes wavefront aberrometry, an advanced optical imaging technique that powers expensive LASIK surgery, and ML/AI-powered algorithms to process images and arrive at the clinical vision correction prescription for eyeglasses. Our ergonomics were designed to work on all children, adults and the elderly. The hardware was designed to be made and sold 10x and 3x lower in price than traditional clinical desktop wavefront aberrometers (that cost >$40k and weigh > 50lbs) and handheld autorefractors (that cost $14k), respectively. Unlike these traditional technologies, QuickSee is portable and works in any light condition (setting) and it’s accuracy in the hands of a non-clinical technician matches the gold standard prescription from a high-end optometrist for >90% of the population. 

QuickSee’s core patents were developed at MIT by PlenOptika’s co-founders, who have developed additional IP within PlenOptika. Our research team has worked to reduce the manufacturing cost through innovative design, while our algorithms are improving to enhance the accuracy for eyes with more complicated eye health (typically for elderly patients).

By de-skilling the vision exam, governments, NGOs, and eyeglass retailers can scale-up their capacity and workforce cost-effectively.

The global need for vision correction and direct impact on 7 of the 17 UN SDGs has been reported:

1) 2016 World Economic Forum-EYElliance (https://www3.weforum.org/docs/WEF_2016_EYElliance.pdf)

2) 2019 EssilorLuxottica (https://www.essilorseechange.com/elimination-in-a-generation/)

3) 2019 WHO Report

 (https://www.who.int/publications-detail-redirect/9789241516570)

4) 2020 UN Report

(https://www.un.org/development/desa/disabilities/news/dspd/accelerating-vision-for-everyone.html)

5) 2021 Lancet Global Health Commission on Global Eye Health (https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30488-5/fulltext). 

#1 No poverty: vision impacts education/employment

#2 Zero hunger: vision impacts earning a living wage

#3 Good health and well-being: vision affects quality of life/mental health

#4 Quality education: vision affects education

#5 Gender equality: vision is crucial for women to be educated, employed

#7 Decent work and economic growth: vision impacts wages

#10 Reduced inequalities: vision improves educational and wages, decreasing inequality

2 examples of QuickSee’s theory of change:

1. TwoBillionEyes (NGO, Kenya), used QuickSee to train 8 unemployed teenagers to become microentrepreneurs in 2 weeks. They provided vision exams to 550 trunk drivers (66% never had a vision exam before) in 1 week to improve roadside safety. 40% of drivers needed glasses! This model was expanded to The Gambia where18 female microentrepreneurs were trained.

2. EssilorLuxottica (for-profit eyeglass retailer), trained 5,000 EyeMitra microentrepreneurs from underserved areas (India). Quicksee helped improve training and vision exam quality. 400 EyeMitras (without QuickSee) provided 70,000 eyeglasses causing $4.4M/year in impact (Dalberg study, https://www.essilorseechange.com/what-we-do/2-5-new-vision-generation/eye-mitra/).

This QuickSee-enhanced microentrepreneur model has scaled-up eyecare workforce, vision exams and eyeglass adoption in the field eyeglass in 10+ countries across SE Asia, Africa, LATAM. Revenue from low-cost eyeglasses sustains microentrepreneurs and NGOs.

Scaling our global impact requires engaging with eyecare stakeholders (eye hospitals, governments, NGOs, eyeglass retailers) whose outreach is amplified by QuickSee. This requires global sales channels and commercial partnerships.

Since 2019, we focused on: 

1) publishing high-impact clinical studies establishing QuickSee clinical accuracy and scalability in global health conditions

2) conducting case studies of the QuickSee-powered community health worker / microentrepreneur model in India, Kenya, and France

3) gaining medical device registrations for 50+ countries (FDA, CE Mark, and local approvals)

4) establishing an international distributor network (30 distributors covering 50+ countries in the US, EU, Africa, LATAM, Middle East, India, SE Asia)

5) accelerating brand awareness amongst stakeholders by being highlighted in global reports by Essilor, ATscale2030, and International Agency for the Prevention of Blindness

6) driving QuickSee adoption via 5 state/nationwide vision screening and eyeglass programs (India, Mongolia, Micronesia)

7) driving revenue amongst high-resource optometrists in USA, EU, India to cross-subsidize our lower margins in global health settings 

2022 goals:

1) Support current partnerships to drive vision exams for 20M+ patients in India/Indonesia

2) Work with partners to deploy QuickSee with health workers in Zimbabwe, Botswana, Kenya, Cambodia, India, Malaysia, Vietnam, and Indonesia to screen 60M+ patients by 2025

3) Double 2021 revenue 

4) fund-raise $5M from social impact investors

5 year goals:

1) establish QuickSee as the global standard for vision exams, perform >250M vision exams across 100+ countries

2) launch lower-cost QuickSee models that detect additional eye diseases

3) sell low-cost glasses to grow our sustainability

Our Key Performance Indicators (KPIs, or metrics of success) are:

1) Overall revenue and units sold. 

This is an indicator of QuickSee adoption (product-market-fit) and organizational sustainability (to support existing and expand new programs)

2) Revenue and units sold by region. 

This allows us to monitor and modify product pricing and marketing with knowledge of local requirements.

3) Time-to-train a non-clinical QuickSee operator. 

This information is used to continuously improve our online training system, which allows organizations to train (and quiz) large numbers of QuickSee users without requiring PlenOptika personnel to travel. 

4) Manufacturing costs and product failures.

This information continuously optimize our manufacturing process and design to reduce the overall product price and improve product stability.

5) Repeat product orders and widescale adoption by larger eyecare / eyeglass stakeholders.

This indicates how QuickSee is helping these stakeholders achieve their mission to reach more patients and deploy (or sell) more eyeglasses via community health workers and vision microentrepreneuers.

6) Estimates of the number and demographics (age, income level, etc.) of patients examined with QuickSee by partners and eyeglasses sold.

This information directly indicates how QuickSee is impacting 7 of the 17 UN SDGs.

Our team has been able to successfully surmount the initial R&D and downstream regulatory and legal barriers to commercialize QuickSee. By working with local partners, we have navigated cultural, language, and training barriers.

The main barriers to 2022 and 5-year goals are financial. Additional financial support is needed to: 

-expand our team (10 hires) to provide sufficient support (training, sales, and regulatory) for our growing partnerships across the globe

-support manufacturing / inventory costs for current QuickSee model

-support initial manufacturing costs ($500,000) for newer lower-cost QuickSee models

-support R&D ($250,000) to enhance QuickSee measurement capabilities to detect other eye health diseases

-support additional product marketing ($250,000) to raise regional brand awareness

-incorporate low-cost eyeglasses into our product portfolio ($500,000)

Another set of barriers, which we cannot control, are the rolling pandemic-related lockdowns in SE Asia (Vietnam, Thailand, Indonesia, Malaysia, Philippines) during 2021. These will likely continue through the first half of 2022. These lockdowns shut down non-essential eye care clinics and reduce vision outreach programs.

We have 3 direct routes to address our financial constraints, and thus unlock the above-mentioned barriers:

1) Increase revenue as the pandemic begins to decrease in countries that were locked down because of COVID-19 surges. This involves continued engagement with our existing distributors and helping them jump-start QuickSee sales via customized marketing campaigns and product promotions.

2) Increase revenue in countries where adoption is already strong with individual optometrists and opticians, by engaging larger customers (NGOs, governments, eyeglass retailers) for larger bulk orders (volume-based discounts) and largescale deployments.

3) Raise sufficient capital ($5M) via social impact and strategic investors (family offices, foundations, industry partners) to accelerate our current traction and achieve our 5-year goals.

PlenOptika has 4 co-founders and our total headcount is 16 team members located in our Boston and Madrid offices, and includes 1 team member in Singapore and another in India (working onsite at our manufacturing partner’s factory).

PlenOptika’s 4 founders (PhDs) developed QuickSee at MIT during advanced translational fellowships in the Madrid-MIT M+Vision Consortium for Biomedical Imaging & Entrepreneurship. This training focused on deeply understanding clinical unmet needs and impacts. Our collective experience includes biomedical imaging, medical device design (MRIs, advanced microscopy), global health, and entrepreneurship (spinning out 6+ technologies). Shivang is a technology advisor to the International Agency for the Prevention of Blindness’s Technology Taskforce and the Refractive Error Working Groups.

Our research team are experts in ML/AI and clinical optometry. Our commercial team has 25+ years of medical device sales and market creation. Our advisory members have successfully deployed digital health technologies, are clinical optometrists, global health ophthalmologists, and Directors of global eyecare NGOs. Our Board Members are successful digital health investors, having scaled up numerous startups.

Our manufacturer, Aurolab (India), a non-profit that is globally renowned for its high-quality, low-cost manufacturing of ophthalmic goods (produces 5% of world’s intraocular lenses). Our clinical partners include Aravind Eye Hospital (India), New England College of Optometry (Boston), Johns Hopkins Wilmer Eye Institute (Baltimore), PEEK (UK), Orbis (New York), Fred Hollows (Australia). These are the organizations that guide global thinking on scaling up eyecare and setting global policy. 

Our founding team and Board of Directors are from different 5 countries (US, Spain, Italy, Singapore, Estonia), from different socioeconomic backgrounds, and include both men and women. 

By having offices in Boston and Madrid, and having team members in Singapore and India, we are able to include different cultural viewpoints into our research and commercial efforts. 

Our previous head of R&D and current head of Algorithm Design were/are women, which is rare in technology companies. 

Overall, we have brought together a team that balances academic, clinical, and commercially oriented experiences and perspectives.

Our manufacturer, Aurolab (India), a non-profit that is globally renowned for its high-quality, low-cost manufacturing of ophthalmic goods (produces 5% of world’s intraocular lenses, sold in 100+ countries). 

Our clinical partners include Aravind Eye Hospital (India), New England College of Optometry (Boston), Johns Hopkins Wilmer Eye Institute (Baltimore), PEEK (UK), Orbis (New York), Fred Hollows (Australia). These are the organizations that guide global thinking on scaling up eyecare and setting global policy. 

Together we perform clinical studies, nationwide vision screening programs, and develop and test scalable approaches to increasing the eyecare workforce and reaching patients in low-resource settings.

We sell a higher-margin QuickSee model (with additional features) in high-resource settings and high volumes of lower-margin QuickSee models (with fewer features but same clinical accuracy) in low-resource settings. Both product models utilize the same manufacturing process and components. The high volumes in low-income countries helps improve our manufacturing economies of scale, benefiting our margin in high-income countries, which further subsidizes low-margin QuickSees to be sold in low-income settings. This help PlenOptika achieve profitability and impact.

By working with large-scale NGOs, eyeglass retailers, and governments - stakeholders who already perform vision exams and sell eyeglasses - we leverage their brand, networks, and access to patients in need to achieve rapid scale across multiple geographies.

QuickSee helps them train new workforce more cost-effectively, perform more eye exams more efficiently for untapped populations (patients and customers) in underserved settings, and thus, catalyzes more eyeglass adoption/sales to improve their sustainability and impact.

By being part of the MIT SOLVE Future of Work in India and Indonesia Challenge community:

(1) we hope to gain exposure to and learn from like-minded innovators and advisors with experience in scaling up innovations aimed at impacting the base-of-the-pyramid. As part of this, we will be open to re-evaluating our business models, and exploring new delivery models and methods to analyze and improve our theory of change.

(2) we will share our experience and insights with others participants. By interacting with the SOLVE community we may be able to attract talent or to foster new partners to advance our international commercialization efforts.

(3) we believe that the SOLVE community can help us amplify the social impact work we have achieved to date, thereby raising awareness amongst vision care and global health stakeholders. We anticipate this amplification to happen by organic word-of-mouth (which has been highly successful for us) through SOLVE network of impact innovators, key opinion leaders, and global health / international development stakeholders. This is a critical barrier for us and we believe there is a lot to learn from other SOLVE colleagues about the best way to approach marketing and branding in different regions of the world. SOLVE is a platform for us to further connect with appropriate social impact channels.

(4) we would like to connect with social impact focused investors, knowledgeable of the challenges of deploying healthcare solutions in high- and low-income settings, who are patient and focused on long term value creation.

The partnerships we aim to make by participating in SOLVE Future of Work in India and Indonesia include building relationships with social impact innovators where there may be synergies to advance our mutual missions. 

For instance, we may meet global health innovators developing other last mile healthcare solutions with which QuickSee may pair, and may enhance the microentrepreneur health worker model. 

Or, we may meet academics (e.g., MIT Sloan faculty, TATA Center for Reverse Innovation, Legatum Center, and J-PAL) with interest in quantifying and analyzing our theory of change, which may help us refine our impact model. These groups have experience bringing technologies and new delivery models to the base-of-the-pyramid. They have broad networks with global health stakeholders that may leverage QuickSee to increase vision care workforce and eyeglass delivery.

Other potential partnerships include leveraging the communications/PR channels of the SOLVE cohort and MIT to expand our brand awareness and broaden our stakeholder base. 

The partnerships may be simple collaborators or interactions, or, may become more involved long-term mutually beneficial relationships.