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MIT TECHNOLOGY REVIEW
MIT TECHNOLOGY REVIEW
If a Phone Does
a Doctor’s Job
A simple, cheap way to measure
eyesight could face resistance.
Vitor Pamplona isn’t a doctor. He’s not
even an optician. He can’t write you a
prescription for glasses, or sell you a pair.
Still, he’s pretty sure he’s going to “disrupt”
the $75 billion global eye-care market.
At EyeNetra, the startup he cofounded,
goofy curiosities like plastic eyeballs line
the shelves, and a 3-D -printing machine
whirs in the background. It’s printing out
plastic binoculars that, when paired with
a smartphone screen, can measure the
refractive error of the eye. The prototype
device, called Netra-G, costs a few dollars
to make and in less than two minutes can
tell you what kind of eyeglass prescrip-
tion you need. It does the job of a $5,000
instrument called an autorefractor.
More important, just about anyone
could use it. That’s where the disruption
comes in—and the trouble. Right now,
only doctors or optometrists can prescribe
glasses or contact lenses. Pamplona, a
brash Brazilian programmer who arrived
in the U.S. a few years ago, thinks that
won’t always be the case. “We’re changing
medicine by providing the user the right
to measure themselves,” he says. “We see
doctors as more of a coach.”
Mobile phones are giving rise to a
new class of clip-on diagnostic devices
that could challenge doctors’ monopoly
on diagnosing disease, not just errors in
vision. Since doctors’ fees account for over
20 percent of U.S. health-care spending—
and fully 3 percent of the country’s GDP
on their own—such devices could poten-
tially slash costs as well.
But getting them on the market and
into consumers’ hands won’t be easy.
“ The patients only trust fancy doctors,
which only trust fancy equipment,” says
Pamplona. The U.S. Food and Drug
Administration is so strict that cheap
inventions like his can be expensive by
the time they’re approved.
EyeNetra has received more than $2
million from the outspoken Silicon Val-
ley investor Vinod Khosla, who last year
antagonized doctors by calling what they
do “witchcraft” and predicting that 80
percent of their work diagnosing and pre-
scribing could be done by machines.
Khosla is backing several other similar
ventures, including AliveCor, which sells a
heart monitor that attaches to an iPhone,
and Cellscope, a company developing a
phone camera that could let parents diag-
nose a child’s ear infection.
Pamplona invented the Netra while at
an MIT lab specializing in computational
photography, which uses computers to
bend the limits of traditional photogra-
phy. The device consists of a pair of plas-
tic binoculars that a user places against a
smartphone screen. Spinning a dial your-
self, you align a green and red line. From
the difference between what you see and
the actual location of the lines, an app cal-
culates the focusing error of your eyes. It’s
like a thermometer for vision.
Using the device, a person might fig-
ure out his or her prescription and then,
from the very same app, order glasses
from an online store like Warby Parker.
After running into Pamplona at a con-
ference last year, Dominick Maino, an
optometrist in Chicago, wrote a column in
his industry’s newsletter telling colleagues
it was time to “panic ... just a little.” The
price of an eye exam in the U.S. is $50
to $150. Optometrists also make money
Maino thinks Netra can “give a good
prescription, most of the time.” But an
optometrist—there are 40,000 in the
U.S.—looks at your eye health overall and
can deal with complex cases. “He wants to
put much more power into the hands of
the individual, which isn’t a bad thing,”
Maino says of Pamplona. “But you can’t
write the doctor out of the equation.”
Euan Thomson, an investor with
Khosla’s fund, says of all the challenges
mobile-health companies must overcome,
the most difficult “is going to be that act of
diagnosis by the doc.” In the U.S., doctors
don’t get paid unless they see a patient.
“ Yet much of mobile health is around
avoiding the need for patients to go in to
For now, EyeNetra, based outside Bos-
ton, has been testing its device in India,
where it may prove easier to find a mar-
ket. In India, about 133 million people are
blind or can’t see well because they don’t
have access to eye exams or glasses, and
optometry is not heavily regulated there.
Yet Thomson says mobile diagnostics
companies eventually need to reach con-
sumers directly because that would give
them access to millions or billions of elec-
trocardiograms or glasses prescriptions.
That could open new avenues for both
medicine and marketing.
“What’s at the center of all this is
the information, not the device,” says
Thomson. —Antonio Regalado
BUSINESS REPORT — A CURE FOR HEALTH-CARE COSTS
Heart rate, blood
heart rate, blood
Photo of inner
Startups are developing portable diagnostics that consumers might use.
10/3/13 11:38 AM
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