Out of approximately 2.2 billion people with a visual impairment or blindness, at least 1 billion cases could have been avoided or still need to be treated. Currently, 537 million adults live with diabetes worldwide. Around 320,000 of them live in Norway. Diabetes is a leading cause of visual impairment and blindness as it causes retinopathy – severe damage to the retina. But regular eye screenings can help prevent this. However, these represent a challenge for most people living in over 60 sparsely populated countries or in remote areas far from large cities where most ophthalmologists are based. Zeiss has several decades of innovating and facilitating remote care, with two recent projects reaching almost 10 million patients in Asia. But eye diagnostics always required a specialist to be present. We needed to rethink remote care and bridge the distances that disempower patients and cost them their eyesight.

With over five years in the making, our system established a new level of eye diagnostics. For the first time ever, patients can get an eyesight-saving diagnosis without travelling a long distance to see a specialist. We took a retinal camera – formerly exclusive to ophthalmology clinics – and reimagined its operation so it can literally be installed anywhere. Even in the most remote places. Together with Dr Skau, we optimised different software and hardware to give birth to a unique remote care approach that can potentially transform disease management at a global scale – safely transporting data instead of patients.

Knowing that only 50% to 70% of diabetic patients actually attend their eye screening programme appointments and that in many countries, the number of specialists can't keep up with the growing demand, we aimed to make ophthalmology more accessible. We needed a simple system that could be replicated anywhere to create a successful and rapidly scalable approach. Cost-efficient and also easy to set up. An ideal solution to support doctors in managing their workload and simultaneously empower proactive self-care for patients. Furthermore, we needed to design a system that provides maximum precision and reliability to comply with all diagnostic and healthcare regulatory guidelines. Plus, it also needed to provide safe data transfer, storage and management capabilities to handle confidential patient information.

The setup includes an ultra-widefield camera to take high-resolution images of a patient's retina. The camera can be placed anywhere with an internet connection; the first we simply installed at optician stores.The ZEISS FORUM Cloud Viewer software encrypts the data and sends the retinal images in real-time to a clinic where an ophthalmologist can evaluate them via the ZEISS Ophthalmology software. Following medical guidelines, patients are notified of their follow-up appointment via email, video call or SMS.

The images taken replicate what is seen during clinical examination, so doctors can use this true colour and exceptional clarity to ensure confident evaluation and diagnostics.

It took several years of testing and developing the system's feasibility, replicability and safety to arrive at a scalable product that could be rolled out. One of the biggest challenges was the secure transmission and storage of sensitive patient data along with regulatory and bureaucratic challenges.

The system allows 97% of all retina examinations to be done remotely, and it can be easily adapted to monitor other prevalent diseases. We have already reached patients who had never had their eyes checked – many requiring immediate treatment.

Lowering the barrier for regular eye checkups can save the eyesight of millions. This new approach offers relief for public health systems and the environment by reducing CO2 emissions.

In Norway, where over 5% of the population has diabetes and there is only one eye clinic in the entire north, over 2,000 patients already use the system in five locations. Iceland also launched the system, and rollout in Wales and China is next.

Most importantly, ZEISS encourages and empowers diabetic patients to get their eyes checked quickly, easily and at any time to minimise their risk of blindness. With this solution, ZEISS protects diabetic patients against worsening disease progression.