Over 2 billion people worldwide live with impaired sight, and this number is rising sharply due to age-related and lifestyle conditions. Yet the eye care industry is not growing at the same rate as demand for treatment. Innovation is needed to overcome the bottleneck – which is exactly what PeriVision has set out to do. We spoke to co-founder and CEO Patrick Kessel about how the company is collaborating with both doctors and patients to identify pain points and deliver better eye care.
The eye care market is huge and only getting bigger: in fact, Patrick estimated that it is growing by 4 to 5% per year. Nevertheless, he stressed that ‘there is a fundamental mismatch between supply and demand, which is not unique to eye care, but is particularly pronounced in this field’. This is because a lot of eye conditions, including cataracts, age-related macular degeneration and glaucoma, are strongly connected to ageing – and the entire medical field is struggling to keep up with how rapidly the population is ageing across the globe. Add to this the growing prevalence of sedentary, screen-heavy lifestyles, as well as a stagnant number of eye doctors, and we have a ticking timebomb on our hands.
This is bad news for the patients experiencing these chronic, degenerative conditions, which can progress very quickly. Patrick pointed to horrifying cases in countries such as the UK, where patients have lost the majority of their sight while waiting for medical appointments. With this in mind, the current waiting times for testing and treatment are completely untenable.
What’s more, current testing modalities are outdated and unnecessarily resource-intensive. Eye doctors are rather thin on the ground, and yet most eye tests are lengthy and require supervision. Indeed, the key assessment for glaucoma – a group of diseases related to optic nerve damage and PeriVision’s initial area of focus – is a visual field test. It takes 20–30 minutes to complete and requires a dedicated technician: the test subject is presented with light stimuli in a variety of locations and has to respond while holding themselves in a fixed, uncomfortable position. As Patrick pithily put it: ‘Just from a productivity standpoint, it’s a nightmare – and it’s also not really suitable for a patient population that’s mostly elderly. Plus it doesn’t even generate consistently reliable results, so you go through a lot of pain and don’t necessarily know more about the patient’s vision at the end of it.’
Collaborating with doctors and patients to build a viable alternative
PeriVision was born out of the eye clinic in the University Hospital of Bern, so its founders have firsthand experience with the issues facing eye doctors. In Patrick’s words: ‘The biomedical engineering lab (ARTORG) led by my co-founder Raphael Sznitman works very closely with the eye clinic. So, we saw how acutely the clinic was struggling with glaucoma eye-testing workflows. The clinicians suggested that we start a joint project to use AI algorithms to improve the speed and efficiency of these tests – and that’s how the journey started.’
In light of the industry’s constraints, Patrick and his co-founders realised they needed to figure out how to do more with less – and technology soon presented itself as the way to bridge the gap.
‘We’ve leveraged AI and VR to create smarter systems, workflows and processes for glaucoma eye testing,’ Patrick explained. ‘The central piece of the puzzle is a VR headset that is ergonomic and portable – it can be moved in and out of the clinic – coupled with intuitive software that makes it easy to set up appointments and so forth. We’re really getting to the root of the issue: by making testing more efficient, automated and flexible, we’re addressing bottlenecks, which ultimately lead to a cascade of other problems, such as sub-optimal testing frequencies, progression tracking and treatment.’
Indeed, patients have always sat at the heart of the company’s mission and remain key stakeholders in the development of PeriVision’s technology. From the company’s first clinical trial, patient experience has been a major factor in the direction of travel. Patrick described sitting in on appointments with test subjects and feeling anxiety about the results, because these would decide whether or not the patient needed invasive surgery and/or lifelong treatment. As he put it: ‘We really try to keep a constant flow of interaction between us and patients alive, because that helps us understand the seriousness of what we’re doing. It’s only through appointments and interviews with patients and doctors that we’ve really grasped how psychologically taxing these conditions are. There’s often nothing to gain, you can only slow the decline, which is really terrible – it’s like the myth of Sisyphus, constantly pushing the stone up the hill.
Developing the company’s vision with a range of stakeholders
Nonetheless, as PeriVision has grown, so have its ambitions – and the scale of its collaborations.
Notably, PeriVision joined Biopôle’s Vanguard Accelerator in 2022, which, as Patrick affirmed, ‘was the moment our vision got grander’. He continued: ‘This phase was very encouraging, because we realised there could be strong interest in our product not only in Switzerland but also in places like the US. We made our first trip to the US during this time to present our work at conferences and meet with thought leaders – which in turn led to us finding additional partners, such as Roche.’
In addition, Patrick and his colleagues were subsequently approached by a start-up accelerator to work on specific use cases in clinical trials, enabling better and more frequent testing in a variety of settings. They were also invited to a competitive scouting process by the UK National Health Service (NHS), which wanted to assess new technologies to manage glaucoma patients. In Patrick’s words: ‘This was a dream collaboration because we were basically being paid to learn and develop with them.’
All of this has encouraged Patrick and his co-founders to continue widening their horizons and seek new avenues for collaboration. Indeed, having rolled out their technology to a wide network of clinics across North America and Europe, PeriVision is now looking to build new capabilities, such as prognostic algorithms to predict glaucoma progression, which will be unlocked by sharing data and expertise with other players in the industry. ‘We’re building a network of data-sharing agreements, which will give us much more information about patient symptoms and outcomes,’ Patrick said. ‘If all the signs point to a patient being a fast progressor, we’ll be able to say: “Hey, for this patient, we shouldn’t rely on eye drops, but rather move straight to surgery.” It could drastically improve patient triage and personalise treatment pathways.’
Opening up windows of opportunity together
Looking to the future, Patrick is hopeful that the various players involved in eye care will collaborate to make the industry more efficient and patient-centric.
In his words: ‘I think the future of eye testing will be much closer to the patient. The current model of patients attending appointments at central hospitals simply isn’t working – the systems are massively overburdened. So we need to create new access points for eye care. I imagine that in 10 years, you will do a bunch of eye tests using a PeriVision headset at an optician’s store and then the data will be relayed to an ophthalmologist, who can assess whether further action is needed.’
Patrick was clear-eyed about the fact that PeriVision’s technology represents just one part of the equation – innovation is also required from several other players in the field. ‘There are policy questions to be answered about how people can better access care, how different data systems can be made interoperable, how electronic patient records can be better integrated,’ he said. ‘Other companies and even governments need to do their part and build other pillars to get us where we need to get to. But we’re doing everything we can to tie into this wider landscape.’
Working with a range of organisations with different specialities is central to PeriVision’s strategy. Indeed, it is also active in the research space, collaborating with university hospitals to build a range of innovative new tests for retina diseases, among other things. It is also in the process of working with pharma companies in decentralised clinical trials, deploying its portable technology to reach a larger and more diverse patient population (by enabling at-home testing) and ultimately generate more frequent and robust endpoints.
Broadening the scope even further, Patrick affirmed that PeriVision’s technology could feasibly be applied to other medical fields, with exciting outcomes. As Patrick put it: ‘It’s not in our immediate roadmap, but we are interested in collaborating with companies to add a functional layer to their tests and systems. Notably, through the eye, you have a very direct view of blood vessels, so through imaging the eye, you can deduce information about cardiovascular and neurological diseases. Ophthalmology can actually act as a window to peek into the whole body – and we hope to forge partnerships that can realise the opportunities this generates for patients.’
