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A Unique Business Model in Eye-Care

June, 2017

K. Chandrasekhar, Founder & CEO, Forus Health on innovations that enable quality eyecare solutions for everyone in need

India is home to approximately 15 million blind people (33% of the 45 million worldwide). Over 80% of the cases of blindness were preventable, if there was any prior action taken. Cataract, diabetic retinopathy, glaucoma, cornea issues and refractive errors are the cause of 90% of blindness cases. Some of these diseases do not show any early symptoms. But when they really do, it gets too late to take any action making blindness an inevitable consequence. This combined with scalability and unawareness, the impact on the rural sections becomes multi-fold. Around mere 20000 ophthalmologists practice in India and a small number of 800 ophthalmologists graduate every year, which makes the ophthalmologist to patient ratio roughly 1:70000. The same gets much, much worse as you descend into rural areas making it approximately 1:200000. Identification of problem is the biggest bottleneck even for bigger hospitals to direct appropriate treatment. Only around 7-8% of people at various stages of blindness are screened and treated as of today. Current system needs expensive screening and diagnostic devices (single device for every problem) coupled with the availability of highly skilled ophthalmologist or technologist. Most of such healthcare facilities are limited to people in urban areas, which leaves people in interior sections of the country grossly underserved. Ophthalmic solutions that are easy to handle and are portable have not been available to them for all these years.

The present system requires ophthalmic equipment with trained paramedic and presence of ophthalmologist during screening to classify the health of eyes. Whilst, this is not a hindrance to Tier 1 and Tier II cities, rural areas are deprived of screening facilities due to accessibility of such solutions and professionals like ophthalmologists. Like with most other professions, it is far more remunerative for ophthalmologists to practice in a city with a base of more health conscious people. Another reason is the difference in quality of life in the cities and in rural areas. In addition to this, people living in these areas do not visit cities owing to the direct and indirect costs of screening.

Therefore, three major issues faced by people in need of attention can be pointed out- Awareness, as potential patients are unaware of the diseases and their health in general. Affordability, as they are unable to afford, with present eye care facilities being expensive enough to pierce a hole through their pockets. Accessibility, as they are unable to access the solutions, since these facilities are majorly concentrated in urban cities.

The motto with what Forus Health was born was to exactly give what the eye healthcare ecosystem in India needs - Quality eye healthcare solutions to everyone in need. And by everyone, we mean everyone - to canopy as many patients as possible. This made us adopt the mantra of -




Forus doesn’t only aim at innovating and building solutions, but also deploying them just as effectively to masses, and have the desired social impact through it.

Forus as the name stands for means “For us” - me and my community. We are an innovation led technology enterprise managed by experienced professionals who want to give back to the society and to the nation’s economy in a way. We strongly believe that healthcare solutions for emerging countries have to be different both in terms of the development as well as disposition. Our products combined with our comprehensive software solutions enable not only screening at the patients doorstep but treatment as well.
We develop affordable technology solutions that can easily be used by a minimally trained technician thereby making health service accessible and scalable. We strongly believe that by "Democratising Wellness”, we can play an active role in the addressing India’s healthcare issues.

A dedicated R&D team has put in efforts to come up with the innovation called - 3nethra, which is a single, intelligent, portable, non-invasive, non-mydriatic (no dilation), low cost, ultra low power, all in one device that helps in automatic pre-screening of five eye major diseases - cataract, diabetic retinopathy, glaucoma, cornea issues & provides refractive error measurements. This product is also one-fifth the price of the similar currently available product. 3nethra Classic is Forus’ first and flagship product, along with its variations that specialise in different functions.

The 3nethra neo is used as a wide field retinal imaging digital camera to capture, store, and transmit images of an infant’s retina to aid in the diagnosis and monitoring of diseases and disorders.

It is a contact device that specialises in the capturing of digital colour images of the retina of pre mature babies while their eyes are dilated using mydriatic drops under clinical control. Ergonomic in design, the 3nethra neo comes with advanced features and intelligent solutions that benefit neonatologists worldwide. It is a lightweight, easily operable device which costs one-fourth of the price of nearest competitor in the market. The device is used to scan premature infants having chances of developing Retinopathy of Prematurity (RoP), which is the leading cause of blindness among babies.

Another factor which sets us apart is our continued effort to ensure that our products meet the behavioural and usability benchmarks very well. They are portable and can be used indoors in clinics and hospitals as well as in the rugged outdoors for medical camps conducted even in the most remote areas of the world.

3nethra also contains the integrated telemedicine module called ForusCare, which is a cloud based teleophthalmology platform. The objective of the program is to equip non-ophthalmologic health centres with an eye testing platform and remotely connect them to trained ophthalmologists who can perform grading of images uploaded on the cloud. Consequently, this makes diagnosis in remote areas a possibility. Hence we are not a company that is just making a product but one that is actually creating an infrastructure for end-to-end solution. Unlike most emerging startups that believe developing and manufacturing a finished product is all there is to it.

Deploying eye screening solutions to remote and rugged up areas is a challenge we faced, which pushed us to create products that can withstand rough circumstances and not be limited by geographical boundaries. 3nethra has reached out to people away and outside of a formal medical setup such as a hospital, in medical camps, diagnostic centres, mobile vans, etc. One of our customer is using the device installed on a motorcycle to enable movement in the narrow roads of the slums in urban Bangalore. The device is built so rugged that it can withstand the shock and vibration of the Indian roads. This is a step ahead in solving the problem of inaccessibility to quality eye healthcare to people.

We conceived Forus Health purely from an Indian context, but we discovered similar problems existed in other countries. This led us to start spreading awareness abroad as well both from a product and from an implementation perspective.

We believe in pacing through with velocity, and not just speed. Substance with just magnitude and no direction is just pointless. Similarly, innovating and creating a product is just not enough. If the true purpose of its existence is not achieved, it would nullify its existence. Moreover, what’s even more important is to create the desired impact among people. To come up with an effective solution, you need to first do a basic groundwork to get the true essence of the problem that needs to be addressed, and only then can you be able to make a social footprint. Forus Health also integrates with the “Make In India” movement initiated by the Government of India, as all our manufacturing happens within the nation’s boundaries. The initiative was launched by the Prime Minister in 2014 so as to encourage industries to produce in India. We believe this to be our contribution in constructing a stronger and self-sufficient economy. Going by the numbers, we have established presence in 25 countries, ranging from Asia, to Europe, North America, South America, and Africa, having over a thousand four hundred plus installations, where we have reached out to almost 2,000,000 souls. Out of which, a major chunk never had the required medical facilities to get hold of at the time of need. In future, we aim to see a bounce in these figures for good, as we are at that point in our journey where there is no looking back.

The opinions expressed in the article are the author’s own.