By Andrew Blaikie, NHS Ophthalmology Consultant and Senior Lecturer, University of St Andrews
Development and Evaluation of the BIO
The Arclight Holo Binocular Indirect Ophthalmoscope (BIO) is a device I’m deeply proud to see come to fruition, but its journey has been far from simple. It has taken over 10 years of effort, collaboration, and refinement to develop a tool that addresses critical gaps in global eye care.
The idea stemmed from the need to create a portable, affordable, and robust solution to diagnose serious eye conditions in resource-limited settings, but it has resulted in an invaluable tool for all settings. Traditional BIOs, while effective, are expensive, fragile, and often reliant on consumables like batteries or bulbs—luxuries that many clinics cannot afford to replace.
The Arclight BIO (Holo), designed by William J. Williams, embodies the principles of frugal engineering. Powered by solar energy, lightweight, and durable, it was created to be a practical alternative for health workers in the world’s most underserved regions.
Developing the Holo was no small feat. It required balancing functionality with simplicity, ensuring that the device could meet the rigorous demands of clinical use without unnecessary complexity. William’s ingenuity was pivotal in creating a device that maintains optical precision while reducing costs and material requirements. His work allowed the Holo to go from concept to a device that is now securing regulatory approval and scaling its impact globally.
Comparative studies have validated the device’s capabilities, showing it to be as effective as traditional BIOs. In some areas, the Holo even outperformed these devices, especially in terms of portability, ease of use, and comfort for healthcare workers.
Comparative Studies in the UK, Kenya, and Indonesia
To ensure the Arclight BIO could meet the demands of diverse clinical environments, it was put to the test in several contexts.
In the UK
The device has been rigorously evaluated within the University of St Andrews by a wide range of eye care practitioners. It performs on par with traditional BIOs for clarity of view, stereopsis and field of view. Clinicians additionally appreciated its lightweight design and simplicity, which reduced the strain of extended use.
In Kenya
Obaid Kousha, a lecturer in ophthalmology, led an inspiring programme in Kenya to train Ophthalmic Clinical Officers (OCOs) in using the BIO. The workshops demonstrated how quickly healthcare workers could learn to detect vision-threatening diabetic retinopathy (DR). Watching trainees gain confidence and realise the potential of the BIO to save sight in their communities was one of the most rewarding outcomes of the project.
In Indonesia
In Indonesia, Obaid also spearheaded a study comparing the BIO to traditional camera-based systems for DR screening. The results were striking: the BIO showed fewer ungradable images, a common issue with cameras in low-resource settings. This meant that fewer diagnoses were missed, showcasing the BIO’s practicality and accuracy in real-world conditions.
Applications in UK Clinics
The Holo is already making an impact in the UK. In my own clinical practice, I’ve used it to assess retinal detachments, screen for diabetic retinopathy, and detect Retinopathy of Prematurity (ROP) in neonates. Its lightweight, portable design makes it an invaluable tool, especially in busy general adult clinics where efficiency is crucial. The ability to achieve high-quality diagnostic outcomes without the need for bulky, expensive equipment has been a real game-changer for me.
Precision with the +3DS Magnification Lens
The +3DS magnification lens (or Maglens) adds significant versatility to the Holo, allowing detailed assessments of the optic disc and macula. This has proven particularly useful for the initial diagnosis of glaucoma, maculopathy, and full-thickness macular holes (FTMHs) without the need for other investigations. This has been especially useful for bed bound patients or in clinics without access to optical coherence tomography. The precision provided by the lens enables clinicians to make accurate initial decisions without the need for these additional diagnostic tools. This demonstrates its potential usefulness in low resource settings.
Anterior Segment Assessment
One of the Holo’s most innovative features is its utility for anterior segment assessment. By using the +2DS in the eyepieces and the +3DS magnification lens, it provides a clear view of the eye’s front structures. This capability is vital for diagnosing conditions like corneal opacities, cataracts, and anterior uveitis—making the Arclight BIO a truly comprehensive diagnostic tool. This function will see it as the go to tool for high volume cataract camps in resource poor settings where time yet accuracy are of the essence.
A Comprehensive Examination Tool
What sets the Holo apart is its ability to perform four key types of eye examinations:
- Widefield Retina Examination: Ideal for detecting posterior segment diseases, including DR and ROP
- Zoomed-In Disc/Macula Assessment: Using the +3DS lens for detailed views of the optic disc and macula
- Anterior Segment Assessment: For evaluating the eye’s front structures
- Fundal ‘red’ reflex: Additionally, its capability to perform the fundal ‘red’ reflex test makes it indispensable for neonatal screening
The device aligns perfectly with WHO recommendations for affordable technology that works as well as expensive tools to perform comprehensive examinations.
Commercial Release and UK Training
The Holo’s commercial release in the UK marks another milestone in its journey. I’m thrilled to announce that we are also planning dedicated workshops for ophthalmology trainees at the FORGE training unit in Queen Margaret Hospital. These sessions will provide hands-on experience, preparing the next generation of eye care professionals to use this groundbreaking tool.
Conclusion
The development of the Arclight BIO (Holo) has been a long and challenging process but seeing it in use around the world makes it all worthwhile. From William J. Williams’ initial design to Obaid Kousha’s fieldwork in Kenya and Indonesia, and our development manager, Helena Feasey’s careful stewardship, this has been a team effort in every sense.
The Holo represents more than just a diagnostic tool—it embodies the power of innovation to transform global health. Its journey from idea to implementation has required patience, hard work, and unwavering commitment, but the results speak for themselves.
As we look to the future, I’m excited about the opportunities to expand the Holo’s reach, train more healthcare workers, and continue making a difference in the fight against preventable blindness.