Most people have the ability to identify a problem and then complain about it. Far fewer identify a problem and take it upon themselves to find a solution. Robin Kuriakose, MD, is in the latter group.
In response to the pressing problems of digital eye strain among patients and physicians accurately diagnosing uveitis, Dr. Kuriakose developed SightKick, an eyecare computer application, and uveitisOnCall, a phone app which creates more accessible treatment practices.
Dr. Kuriakose is a New York native and currently a Cornea and Refractive Surgery fellow at Northwestern University in Chicago. He completed his surgical ophthalmology residency at Loma Linda University Health in Southern California. Prior to this, he attended a combined BS/MD program at Virginia Commonwealth University in Richmond, Virginia.
In addition to technology, he is passionate about mentorship, which led him to create several educational websites and write The Complete Guide to Direct BS/MD Programs: Understanding and Preparing for Combined Medical Programs to provide academic guidance to high school students interested in medicine.
In this interview, Dr. Kuriakose offers insights into his inspiration and approaches to addressing ocular conditions using accessible resources.
What originally drew you to the field of ophthalmology?
Kuriakose: I went to medical school with the intent of becoming a cardiologist. In fact, I had no idea that ophthalmology was even a field within medicine. Then, during my second year of medical school, I attended an ophthalmology interest group meeting and I instantly knew that this was what I wanted to pursue.
The field checked off all the things I hoped for in a career. It offered the chance to:
- Work both in an operating room and outpatient clinic (not the hospital).
- Perform fine, delicate surgeries, while seated, with excellent life-changing outcomes for patients.
- Have a career with an excellent quality of life.
- Be surrounded by incredible, avant-garde technology—and, now, be able to contribute to it!
- Be the “expert” in a specific field within medicine.
- Have the ability to make meaningful contributions abroad.
The latter was one of the biggest pushes for me to pursue ophthalmology. Cataracts are the number one cause of blindness worldwide. I learned that ophthalmologists could remove cataracts in a quick surgery, not only restoring a patient’s sight, but in turn granting them their life back. I knew that if I could help those in underserved areas across the world suffering from reversible blindness in this way, I had done my part.
Having just returned from a surgical mission trip in India, I can assure anyone who has yet to participate that it is a truly unforgettable and life-changing experience.
How did you become interested and involved with app development?
Kuriakose: I have been involved with entrepreneurial efforts since starting college in 2010, when I created a website and subsequently published a book, designed to help students gain admission into direct medical programs from high school. After that incipient event, I created over a dozen other websites all designed to address eclectic needs.
I learned quickly that not only do I love solving problems, but I enjoy creating because of the impact it can have on others. One of the earliest and most challenging parts of the journey is determining how you will create your product or service with limited resources.
While I was able to learn to create websites from my undergraduate years all the way through residency training, I knew application development, particularly robust ones, would be another ballgame. In the two latest applications, SightKick and uveitisOnCall, I was fortunate to be able to partner with talented coders who were able to turn these ideas into reality.
Your SightKick app addresses digital eye strain; why do you feel this is an important issue?
Kuriakose: SightKick was born out of a ubiquitous problem in our current day and age: excess digital screen time. This has only been exacerbated by the COVID-19 pandemic, where people are spending unprecedented hours in front of a screen.
We know that with screen time, one’s blink rate on average drops by over 60%.1-3 This disrupts the tear film, and by doing so, contributes to dry eyes, blurry vision, eye fatigue, strain, burning, redness, and even headaches. It may also contribute to decreased workplace productivity.4-6
Very often, eyecare professionals see patients with these symptoms that are directly linked to excessive computer or phone use. Though we tell our patients to take frequent breaks, we now have a product that can concretely show the impact it is having and—most importantly—intervene.
How exactly does the app work and how can individuals best utilize it?
Kuriakose: SightKick works quietly in the background to detect when one’s blink rate is less than optimal and nudges users to take breaks when they need it the most. Specifically, it encourages users to look 20 feet away from their screen for 20 seconds, giving their eyes and tear film a chance to stabilize. In doing so, SightKick uses artificial intelligence to halt digital eye strain or “computer vision syndrome” at its root.
It uses the camera to perform this function, but exclusively and instantaneously extrapolates blink rates only, so no video is ever saved locally or elsewhere. Privacy is paramount. For those that do not want this advanced “smartBlinks” feature, there is also a basic feature whereby the nudge comes in at selected intervals (i.e., every 20 minutes). By offering these two modes, SightKick becomes a product for everyone.
The app is FREE and currently available for Mac OS users only (coming to PC soon).
Your second app, uveitisOnCall, aids in uveitis diagnosis; what are the particular challenges of this disease?
Kuriakose: uveitisOnCall was co-founded by myself, Moises Enghelberg, MD, and Dhruv Sethi, MD, MBA, MPH (with his team at mHealthWellness LLC). Uveitis is a frequent diagnosis that is encountered anywhere from the outpatient clinic to the emergency room.
Depending on one’s experience, it can be a really difficult disease to diagnose based on a patient’s history, their clinical findings, and lab or imaging findings. While these factors are paramount, there is an ever-increasing “shotgun” approach to ordering labs and imaging. By avoiding this approach, we can decrease waste in healthcare dollars and help get patients the care they need faster.
Can you explain how uveitisOnCall works and how MD/ODs can best use it?
Kuriakose: uveitisOnCall is an app designed to guide ophthalmology residents, ophthalmologists, optometrists, and select ER doctors in their workup of patients with suspected uveitis. It does so by guiding users through a guided and intuitive workflow.
The app first asks for the predominant site of inflammation (anterior uveitis, posterior uveitis, panuveitis, etc). After that, it brings up specific signs and symptoms the user should ask the patient or look for upon exam. Based on this input, it provides possible diagnoses and suggested workup. You can then print/save/send the results. The app is also equipped with a ‘mini-EMR’ documentation tool, so you could include the findings of your exam and print/save/send the findings to a colleague.
In a study presented at the annual meeting of the American Society of Retina Specialists (ASRS) in 2022, the mobile application showed an agreement with an attending retinal specialist on the top three diagnostic considerations and the final confirmed diagnosis by laboratory testing in 84% of cases.
uveitisOnCall is a FREE app that can be found on the Apple App Store (not yet available for Android).
How do you see the intersection of this type of technology and ophthalmology enhancing the field?
Kuriakose: Ophthalmology is ripe for innovation. It’s what continues to excite me. The technologies presented here today tackle two facets: the physician experience and the patient experience. Of note, uveitisOnCall has already been used and studied to demonstrate usefulness when used among on-call residents.
By addressing this initial group, we hope that patient’s presenting with uveitic conditions obtain appropriate testing so that they can reach a diagnosis and treatment faster while reducing costs in workup. SightKick acts as a “sidekick” for the patient. We now have a tool for our patients to use at home to help reduce the symptoms associated with “computer vision syndrome.” By providing this tool, we are enhancing the care our patients receive beyond the office.
Do you have any favorite apps you use as an ophthalmology resident?
Kuriakose: Yes! Eye HandBook is definitely my favorite mobile application because it lets you access various tests you may need in a pinch (color vision, OKN drum, and contrast sensitivity). It also includes Peds Fixation targets with and without sounds, which can help significantly during difficult pediatric exams.
I also use the Ullman Indirect app, which helps me take pictures or videos during a fundoscopic exam. Though it takes a little bit of "getting used to," it can be super helpful as a resident when you are trying to save pictures or videos of your findings on call.
Finally, thankfully uveitisOnCall was available as a beta test during my final year of residency, so it definitely helped guide the diagnosis and workup of my uveitis patients!
Closing thoughts
Finding new solutions to old problems is the definition of innovation. Visionaries, like Dr. Kuriakose, who are also practicing clinicians, are an integral part of the field’s advancement.
As more and more technology becomes available and accessible, ophthalmologists can increase their arsenal of tools to combat both common eye issues and sight-threatening diseases to reach the goals of a healthier patient population and ending preventable blindness.
References:
- Gowrisankaran, Sowjanya, et al. "Asthenopia and blink rate under visual and cognitive loads." Optometry and Vision Science 89.1 (2012): 97-104.
- Tsubota, Kazuo, and Katsu Nakamori. "Dry eyes and video display terminals." New England Journal of Medicine 328.8 (1993): 584-584.
- Patel, Sudi, et al. "Effect of visual display unit use on blink rate and tear stability." Optom Vis Sci 68.11 (1991): 888-892.
- Uchino, Miki, et al. "Dry eye disease and work productivity loss in visual display users: the Osaka study." American journal of ophthalmology 157.2 (2014): 294-300.
- Uchino, Miki, and Debra A. Schaumberg. "Dry eye disease: impact on quality of life and vision." Current ophthalmology reports 1.2 (2013): 51-57.
- Patel, V. D., et al. "Work productivity loss in patients with dry eye disease: an online survey." Current medical research and opinion 27.5 (2011): 1041-1048.
