PROJECT SUMMARY / ABSTRACT
Worldwide, 671 million people have uncorrected refractive error out of which 161 million people have distance
vision impairments due to uncorrected refractive error (URE). Distance vision impairment due to URE
especially affects children and young adults, limiting their educational activities and social life. Although the
prevalence of refractive error is lower, the prevalence of blindness due to URE in Africa is 6 times as that in
high-income regions of the world. This indicates widespread disparities in access to eye care in Africa, which
leads to long term negative effects. As a matter of fact, there are only 2.5 ophthalmologists per million
population in Sub-Saharan Africa, against a global mean of about 32 ophthalmologists per million. Innovative
community-based approaches are needed to tackle the increasing burden of providing the needed healthcare.
In response to the grant opportunity to improve healthcare access to low and middle-income countries using
mobile health, we propose to develop an AI-powered mobile application for measurement of refractive error
and validate it by performing field tests in Ethiopia. With its relatively simple protocol, the app can allow lay
people measure myopic refractive error using only a smartphone, without needing any phone attachments.
Thus, it overcomes the main barriers of cost and accessibility. A recent study on this refraction app showed
good consistency with clinical measurements of refraction in a multi-center study in the US and China. Given
the bias and inaccuracies of AI algorithms in people of underrepresented African ethnicities, in the R21 phase,
we will train a custom neural network on face datasets of African origin to make the current version of the app
more suitable for dark-skinned Africans. We will validate the app measurements of refraction in Ethiopia by
comparing it with standard clinical measurement, and also by determining the improvements in the visual
acuity resulting from the app-based refractive correction. After the validation of the mobile technology for
prescribing affordable eyeglasses in hospital settings, we will further evaluate community vision care programs
in the R33 phase, including vision testing and dispensing of eyeglasses. Community volunteers will be trained
to perform vision screening with the app and a field test will be performed in rural Ethiopia to determine the
sensitivity and specificity of community-based myopia screening approach in real-world settings. With the
mHealth solution, we are poised to make significant impact on the eye care in under-served Africa.