MSF teams in Mali are testing new mobile phone technology to help diagnose children with cerebral malaria, a severe condition that can lead to death if not treated. MSF tropical medicines advisor Estrella Lasry explains how this simple technology is helping to transform MSF’s treatment of this disease.
What is PEEK?
PEEK stands for a ‘portable eye examination kit’ – which allows doctors to diagnose eye disease using an ordinary smartphone. It was developed by scientists at the London School of Hygiene and Tropical Medicine and the University of Strathclyde.
What’s so good about it?
The usual tools for looking at a patient’s retina are an ophthalmoscope – which can be difficult and time consuming – and binocular indirect ophthalmoscopy – a fancy and expensive device that only ophthalmologists know how to use and is rarely, if ever, available in the field.
The best things about PEEK are that it’s simple, cheap and accessible. And with a few days’ training, it can be used just as effectively by a non-specialist doctor as by an ophthalmologist.
"We knew we needed better diagnostics at the bedside. When one of our paediatricians heard about the portable eye examination kit, we realised that this could be just what we were looking for."
Why did MSF decide to test it in Mali?
Our paediatric department in Koutiala hospital, Mali, sees huge numbers of children under five with severe forms of malaria – many of these children have cerebral malaria, which causes coma.
The problem is that cerebral malaria can easily be confused with other diseases, such as meningitis. We were seeing an increase in the number of children with suspected cerebral malaria, but with the limited diagnostics available, we couldn’t be sure which disease they had, and therefore which treatment to give them.
We knew we needed better diagnostics at the bedside – a simple tool that would help us identify malarial retinopathy. When one of our paediatricians heard about the portable eye examination kit, we realised that this could be just what we were looking for.
how does it work?
You fit the sleeve onto your phone and shine the phone’s inbuilt light at the patient’s dilated pupil.
The phone sleeve channels the light and focuses automatically on the retina, the tissue at the back of the eye.
On the phone’s screen, you see a close-up image of the retina.
The images are recorded and stored on the phone.
You can examine the image along with colleagues, replay the image to have a closer look, or email it to others for a second opinion.
An app that comes with it stores the patient’s notes on your phone, so all the information you need is in one place.
In the types of places where MSF works, brain biopsies are not plausible. But there’s another way of seeing inside the brain – by looking at the back of the eye. The retina is a mirror of what is happening in the brain. With cerebral malaria, the retina can undergo certain changes, known as malarial retinopathy. These are:
1 Haemorrhages – caused by the red blood cells sticking together and not allowing microcirculation. 2 White patches and 3 abnormal vessels – caused by malaria parasites sticking to the lining of the small blood vessels in the brain and eyes where they disrupt the supply of oxygen and nutrients.[[Article-CTA]]
The presence of these changes confirms that a patient has cerebral malaria – though of course they may have other diseases too. It also gives us an idea of the prognosis: the more changes there are, the more likely the disease is to be fatal.
Knowing this can help us prepare the patient’s family for the likely outcome. The prototype is still being approved, but everyone’s asking for it now.
We hope to use it wherever we see high numbers of children with cerebral malaria – which is mainly in countries in east and west Africa. Some other diseases – such as diabetes and HIV – are also associated with changes to the retina, so we really hope to be able to use PEEK for these patients too.
