A small team based out of the School of Medicine at St Andrews University has helped develop an innovative pocket ophthalmoscope and otoscope called the Arclight, which is designed to be used in almost any clinical setting.
The main aim was to make direct ophthalmoscopy much easier and far more affordable, especially in low and middle income countries. As designer William J Williams says, 'Babbage's ophthalmoscope has been reborn for the 21st century.'
He explains, 'Moving from prototype to product came from listening to ophthalmologists such as John Sandford-Smith (author of 'Eye Diseases in Hot Climates') and Richard Le Mesurier (medical director of the Fred Hollows Foundation), as well as the International Agency for the Prevention of Blindness (IAPB), who were all convinced that there was a huge need for this device, especially in Africa.'
Ophthalmoscopy for all
The Arclight's simple design includes an LED, a solar panel and a USB socket, and the pocket-sized device weighs less than an AA battery. An examiner can see the front of the eye and eyelids, media, fundus, and the external and middle ear, helping to reveal cataract, glaucoma, diabetic changes, hypertension, and macular degeneration, as well as otitis externa and media.
It is suitable for mid-level eye workers, but also neurologists, physicians, optometrists and ophthalmologists everywhere as a handy back-up device. The magnifying loupe can be fitted with speculae to create an otoscope, also letting health workers identify hearing problems.
While the Arclight's design makes it extremely useful in low-income countries, William points out that it is also ideal for students everywhere. 'Direct ophthalmoscopy is an easily learnt and surprisingly powerful technique,' he says. 'Spotting swollen optic discs is the stand out case for the widespread use of ophthalmoscopes in hospital and general practice settings.'
William believes that being able to wield tools such as ophthalmoscopes, and confidently making speedy decisions on-the-spot, ought to be central to all doctors' and nurses' training. 'Over the decades these skills have eroded,' he says, citing, 'varying course structures, increasing specialism, glamour of the high tech, risk aversion and defensive medicine, elimination of medical mavericks, plus the relative cost, bulk, and poor ease-of-use of traditional instruments.'
Given the positive feedback the team have already received and with further development plans in place for future versions, the Arclight gives healthcare workers a simple and clever tool for use both at home and abroad.
Free to new training grade doctors
The MDU is proud to be helping promote the Arclight by offering them free to members moving from their final foundation year to ST1/CT1/GPST1 (when joining or renewing membership and paying by Direct Debit). It will also be available to buy online from the University of St Andrews' online store when back in stock later in the year.
Photo credit: Arclight Medical
A member's experience
The simplicity and versatility of the Arclight means that it can be used by clinicians at all levels and a wide range of situations. One such clinician is Dr David Nicholl, MDU member and clinical lead for neurology at Sandwell and West Birmingham NHS Trust, and honorary assistant secretary to the Association of British Neurologists.
'I think the Arclight product is a great little ophthalmoscope, which I use every day,' he says. In his case, 'every day' use includes when teaching neurology both in the UK and overseas, most recently in Tanzania, as well as when assessing ward referrals or on ITU.
Dr Nicholl goes on to mention a case from 2004, where the damages of £275,000 were paid in a case of a missed diagnosis of papilloedema. 'And in 2016,' he continues, 'a missed diagnosis saw the optometrist Honey Rose convicted of gross negligence manslaughter, let alone the harm to all the individuals concerned.
'The reality is you must assess the optic nerve for papilloedema in any patient with a new diagnosis of headache as part of the neurological examination', he explains. 'My published work has shown how these important clinical skills are being lost. It is superb to see the MDU support this and ensure that patients are being assessed properly.'
RCP bedside vision check tool
The need for clinicians to effectively assess patients' vision also motivated the production of another initiative, this time from the Royal College of Physicians (RCP). Shelagh O'Riordan is the RCP's clinical lead for the National Audit of Inpatient Falls, and led the development of 'Look out! Bedside vision check for falls prevention'.
'There is an established link between patient vision and the risk of an older person tripping or falling while in hospital,' she explains. 'All older patients should receive a vision assessment on admission to hospital as part of their care plan, however the latest National Audit of Inpatient Falls revealed that only 48% of patients are receiving this.'
The RCP therefore went on to develop the new vision check tool, which like the Arclight is designed help clinicians assess quickly and effectively whether a patient has an undetected vision problem. 'The tool looks simple,' says Shelagh. 'In fact it took many hours of collaboration between the RCP and experts from British and Irish Orthoptic Society, the College of Optometrists, the Royal College of Ophthalmologists, the Royal College of Nursing and NHS Improvement to produce.'
Initial trials of the tool have garnered positive feedback, with more evaluation planned for later on in 2017. 'A patient's whole care plan will change once a problem with eyesight is identified,' concludes Shelagh, 'and part of this plan will include taking measures to compensate for the poor vision to minimise the risk of a fall.'
Both the RCP's tool and the Arclight will prove invaluable in helping clinicians make informed decisions about patients' care. To find out more, follow the links below.
Renew your membership or join the MDU for your ST1/CT1/GPST1 year
Download the RCP's 'Look out! Bedside vision check for falls prevention' tool