Manoj Verma of Rampur Maniharan, a small town in Uttar Pradesh’s Saharanpur district, found his vision blurring. A gradual deterioration in his ability to see left him frightened and sleepless with worry. In all his anxiety, the 42-year-old never imagined that his problem would be solved by a specialised doctor in Delhi. The beleaguered Verma was suffering from diabetic retinopathy, one of the leading causes of partial or total loss of vision, but postponed going to even the local eye clinics because the dilation of pupils before an ophthalmic examination would force him to miss a day’s work. Then Verma heard about the new eye hospital in Rampur — they could detect the cause of his problem within minutes, and prescribe medicine the very next day, so he wouldn’t have to compromise on his daily wage.
Could he really hope? Indeed, he could. Dr Shroff’s Charity Eye Hospital in Daryaganj, Delhi, which set up its satellite clinic in Rampur Maniharan in 2010, is using 3nethra, a device developed by Bengaluru-based Forus Health. 3nethra is a pre-screening ophthalmic device that diagnoses all eye-related problems, including refractive errors, by scanning both the anterior and posterior segments of the eye in five minutes, without dilation. Verma was grateful. His digital report was forwarded to the doctors at Shroff in December 2011, and he escaped almost certain blindness narrowly and providentially.
Down south, in Karnataka’s Tumkur district, where the high content of fluoride and minerals in the soil cause cataracts in the eyes of 5-6 year-old children, 3nethra is a boon. The Sree Sharada Devi Eye Hospital has installed the device in a mobile van, which travels through the district and screens up to 200 people every day. Patients requiring surgery are referred to the hospital in Pavgada, where they get more help in the form of free operations.
Behind these critical and resolvable scenarios is the simple, cost-effective and transportable 3nethra. A device which costs just₹6 lakh, can be lugged around in a suitcase, can be operated by a trained person (who need not be even a paramedic) and consumes just 10 watts of power (one-fourth of what a tubelight uses). This makes the device a landmark in the fight against preventable blindness and the conditions that cause it, which could range from glaucoma to cataract, and diabetic retinopathy to cornea problems.
Of course, there are several machines that assist in the diagnosis of eye problems, including those made by multinational medical equipment firms such as GE Healthcare and Siemens Healthcare, but they are much costlier. The basic device for medical imaging of the retina, called the retinal camera, costs around₹15 lakh while more advanced devices are tagged at around₹25 lakh and above. Moreover, they are sensitive machines that cannot be taken out of clinics after installation, and can only be operated by experts, which keeps them out of reach of most of rural India. The All India Ophthalmic Society estimates there are only 15,000 ophthalmologists in India. Clearly, in a country of 1.2 billion people, Forus’ 3nethra is now almost a necessity.
Seeing is believing
It’s not that 3nethra can be run without any tech support — it is cloud-enabled, and requires data to be sent to an online cloud-based platform so that doctors in city hospitals can diagnose the problem and advise treatment. Internet dongles are used for connectivity and a UPS for power supply when the 3nethra travels around rural India. If a connection is not available, patients are advised over their mobile phone on the following day. Since other operations happen through a laptop, it can get charged through battery of the van. Even the use of solar panels is being piloted.
Set up by 51-year-old Dr Shyam Vasudev Rao, president and CTO, and 45-year-old K Chandrasekhar, CEO, in January 2010, Forus Health has already installed 40 of its devices in Karnataka, Tamil Nadu, Uttar Pradesh, Madhya Pradesh and Delhi since July 2011, and one machine has been installed in Mauritius. In fact, Forus is looking at installing 3nethras in 15 countries across Africa, South East Asia and Europe this fiscal. The company expects to put up 160 more machines through FY13, taking the total number sold to 200. “Our aim is to enable screening and treatment of patients who cannot go to hospitals,” says Chandrasekhar, more popularly known as ‘KC’.
Prevention is better than cure and it applies to eye care as well,” says Chandrasekhar. “About 80% cases of blindness can be avoided if people are diagnosed early and treated on time,” he says. The detailed concept for 3nethra was first offered to Philips. “The concept was exciting but the business team was not impressed,” recalls Rao. However, they decided to go ahead and the duo started up with angel funding of₹3.5 crore from friends. Both of them pumped in an almost equal amount in various stages and, thereafter, by July 2011, Forus was selling 3nethra by outsourcing production to contract manufacturers.
Going all out
“Capacity is not an issue as these are large contract manufacturers,” says Chandrasekhar, who adds that Forus itself has only 30 employees. The scalability of the model got a thumbs up from venture capital companies when Forus raised a funding of $5 million from Accel Partners and IDG Ventures India in April 2012.
Those who have used the device are all praise for it. Kiran Anandam Pillai, who is trying to deliver eye care in under-served areas, is installing the device in the premises of some general practitioners in Chikballapur district in north Bengaluru. These vision centres, operating under the ‘Drishti’ brand name, will cover a population of one lakh, including small towns and villages. Cases requiring surgical intervention will be referred to a hospital at the district level. While Drishti is charging₹100 per patient, the screening is free for those who cannot afford the services. “We are expanding to four machines this year and we will have 10 centres functional in the next one-and-a-half years,” says Pillai.
The first machine was presented to Aravind Eye Centre. From there on, sales picked up through word of mouth. While the company is currently focused on rural areas, the idea is to install the machine eventually in places like railway stations, airports or malls, where entry barriers are low and people can undertake preventive screening. The company’s role will be limited to making machines rugged enough for use at these places — clients, who are interested in targeting those users, can install the devices.
Meanwhile, Forus is focusing on setting up a network to provide quick and effective after-sales services. With 3nethra already being touted as a breakthrough, Chandrasekhar and Rao have also started research on devices for screening ailments related to ENT, heart and nephrology. The focus areas may have widened but the driving force for Forus remains the same – reaching out to the masses in rural India and small towns, and providing affordable preventive healthcare. Forus comes from ‘for us’ — a device for all of us, not just a privileged few.