At least 80% of eye ailments in India, such as cataract that can lead to blindness, is believed to be preventable or curable with timely check-up and treatment. Now, a Bangalore-based start-up aims to bridge the gap between India?s small number of ophthalmologists and its vast population with an all-in-one portable device that can help screen people in rural areas at a fraction of the cost of bigger machines.

Forus Health, a two-year-old company, has sold 18 units of the device named 3nethra, besides testing it at more than 35 locations, including a remote area in Mizoram. It expects to have a few hundred of the device, each costing R5?6 lakh, in operation over the next year.

Blindness is prevalent in 1% of the Indian population, or roughly 12 million people, according to a 2006 survey by the World Health Organisation (WHO) and the National Programme for Control of Blindness (NPCB), but the number of ophthalmologists in the country is estimated to be between 20,000 and 25,000.

?We want ophthalmologists to only do surgery and treatment, free them up so that they can solve the problem,? says K Chandrasekhar, Forus Health founder and CEO. He claims that 3nethra is among the first such devices to offer anterior imaging and posterior imaging of the eye and a refraction test in a single equipment. ?We want diabetic centres, diagnostic centres or general physicians to start screening the eye and refer cases to an ophthalmologist whenever they find there is a problem,? adds Chandrasekhar.

The device essentially works on algorithms that can point to indications of ailments such as cataract, diabetic retinopathy, glaucoma or cornea problems. It does not require dilation of pupils, which, Chandrasekhar says, can also help save a rural labourer his working day.

Chandrasekhar spent two decades in the semiconductor industry before teaming up with Shyam Vasudev, a former director of technology at the Philips Innovation Centre in Bangalore, to address the problem of avoidable blindness. Forus, which is in talks with potential investors, is now looking at other medical screening devices too.

?There are a lot of new areas where people are trying, but traditionally, since India has been (strong in) software, a lot of things are happening in the telemedicine space. But if you take physical hardware, not much has happened,? says Chandrasekhar. Still, he says, his firm is not in competition with global optical equipment makers whose machines are typically more sophisticated and used in hospitals. ?They are in a different space. In fact, we will be actually aiding them to sell more because we will be identifying more,? he adds.

The challenge of making medical care more affordable and taking it to the rural population has already seen several initiatives to devise new machines. For instance, GE Healthcare has launched about 14 solutions devised in India to address cardiac ailments and maternal deaths as part of its approach aimed at bringing down healthcare costs by 15%. These include a battery-operated portable ECG system that can interpret the report in English and a digital X-ray system that costs a third of imported systems.

?We have found tremendous acceptance to these solutions in smaller towns, super-speciality hospitals as well as healthcare providers and systems in other developing and developed markets,? says Munesh Makhija, chief technology officer, GE Healthcare (India), adding that the company is working on a cost-effective PET/CT scanner to detect cancer at the earliest stage.

Makhija says GE?s systems are designed for Indian conditions like limited availability of electricity and semi-trained manpower.

The company is also looking at the possibility of advanced training on cardiac conditions, ECG taking and interpretation.

While several ophthalmological devices are currently available, having two or three functions together in a single device would be a welcome initiative for India?s primary eye-care programmes, says Ashok Grover, president of the All India Ophthalmological Society, a body that has about 14,000 members. ?Cost is a major consideration when we talk about giving primary eye care in under-served areas,? he says. Devising specific schemes for primary eye-care, such as mobile centres, is a key focus area of the 12th Five Year Plan, he adds.

The NPCB, a nodal agency, aims to reduce the prevalence of blindness by initiatives such as developing eye-care facilities in every district, increasing manpower and enlisting voluntary organisations. For 2011-12, it has a target for conducting 7 million cataract surgeries compared with 6 million in the previous year.

While a structure for ophthalmological services exists at primary health centres, only a third of these centres may have a technician, says Grover. ?Its not difficult to get these devices, but organising the service is the more difficult part.?

India adds about 1,000 ophthalmologists each year but the ratio of doctors to technicians is roughly 1:1, while the desired ratio would be 1:6, says Grover, adding that it is a similar situation across other branches of medicine. ?We need possibly to develop a paramedic council that can take care of planned development of paramedic manpower,? he says.