An App That Can Catch Early Signs Of Eye Disease In A Flash

12 hours ago
Originally published on October 7, 2019 6:59 pm

It's hard for doctors to do a thorough eye exam on infants. They tend to wiggle around — the babies, that is, not the doctors.

But a new smart phone app takes advantage of parents' fondness for snapping pictures of their children to look for signs that a child might be developing a serious eye disease.

The app is the culmination of one father's the five-year quest to find a way to catch the earliest signs of eye disease, and prevent devastating loss of vision.

Five years ago, NPR reported the story of Bryan Shaw's son Noah, and how he lost an eye to cancer.

Doctors diagnosed Noah Shaw's retinoblastoma when he was 4 months old. To make the diagnosis, the doctors shined a light into Noah's eye, and got a pale reflection from the back of the eyeball, an indication that there were tumors there.

Noah's father Bryan is a scientist. He wondered if he could see that same pale reflection in flash pictures his wife was always taking of his baby son. Sure enough, he saw the reflection or glow, which doctors call "white eye," in a picture taken right after Noah was born.

"We had white eye showing up in pictures at 12 days old," Shaw said at the time, months before his ultimate diagnosis

Shaw is a chemist, not an eye doctor nor a computer scientist, but he decided to create software that could scan photos for signs of this reflection.

"If I would have had some software in telling me 'Hey, go get this checked out,' that would have sped up my son's diagnosis and the tumors would have been just a little bit smaller when we got to them. There might have been fewer," he says.

Now, that software exists.

Along with colleagues at Baylor University in Waco, Texas, Shaw created an app called CRADLE. It uses artificial intelligence to find white eye, which can be a sign of several serious eye diseases such as retinoblastoma, pediatric cataracts, and Coats' disease.

To test the app, they analyzed more than 50,000 pictures taken of 40 children. Half had no eye disease and half had been diagnosed with eye cancer or some other eye disease.

The app can scan picture on your phone and find the ones that might have signs of leukocoria. Inserts in upper right show magnified view of leukocoric pupil, which appears paler than a normal black pupil.
Munson et al., Sci. Adv. 2019; 5 eaax 6363

"On average the app detected white eye in pictures collected 1.3 years before diagnosis," says Shaw.

In other words, the app could give an early alert to parents that something might be amiss with their child. The results appear in the journal Science Advances.

The app isn't perfect. It sometimes misses white eye when it's there, and sometimes says it's there when it's not.

That latter condition is a problem. Even though those so-called false positive occur less than 1% of the time, ophthalmologist Sean Donahue of Vanderbilt University Medical Center says that's not good enough. Donahue explains that there are about 4 million children born in the U.S. each year. A 1% false positive rate would mean tens of thousands of children showing up at the doctor unnecessarily.

Still, Donahue is upbeat about the promise of the app.

"This is exciting new technology, and this is how I think we're going to go for screening for a number of diseases in the future," he says.

Alison Skalet, an eye cancer specialist at the Oregon Health and Sciences University agrees. "There's certainly promise here and it makes sense to me to be harnessing the technology that we have," she says. She expects the app will get more accurate as time goes on and its artificial intelligence gets smarter.

Bryan Shaw would like to see that, but to train the app to better recognize white eye, he needs people to send him pictures who've been diagnosed with leukocoria.

"We need more pictures. Especially from kids in Africa and Asia," he says. That will make the app more globally relevant, and Shaw hopes, save more children's vision.

Copyright 2019 NPR. To see more, visit https://www.npr.org.


A bipartisan delegation of Congresspeople is just back from Ukraine. It was a trip designed to strengthen the U.S.-Ukraine alliance, and it was planned before news broke of the whistleblower complaint against President Trump involving that same country. Congressman John Garamendi led the delegation as a senior member of the House Armed Services Committee. And the Democrat from California joins us now.

Welcome, Congressman.

JOHN GARAMENDI: Good to be with you.

SHAPIRO: One central question in the impeachment inquiry is whether President Trump demanded help investigating a political rival in exchange for U.S. aid to Ukraine. And I know that aid was a central topic on your trip, so what did you learn about Ukraine's reliance on American assistance?

GARAMENDI: Well, first of all, Ukraine is an extraordinary country. These citizens of that country are determined to be independent. They have been fighting a war against Russia for the last five years. They've lost 13- to 14,000 soldiers in the field. Crimea has been stolen from them. And they continue to fight in the Donbas eastern region. They are strong. They are resilient. They have a new government. And what I've learned is...

SHAPIRO: And to the question of U.S. aid?

GARAMENDI: It's absolutely essential - absolutely essential. When the government - when President Trump withheld that money, it put them at dire risk. The bullets, the ammunition, the equipment that they need to fight back against Russia was in that money. And the president withheld it - unconscionable.

SHAPIRO: And did officials tell you that their understanding was that it was withheld for a substantive reason or for political pressure? What was their understanding when you spoke to them?

GARAMENDI: We actually decided not to get into that issue. We wanted to know what their needs were, what they - what equipment they needed for the future, how they were going to protect their coastline; issues of that sort - the training that's necessary. We did not consider ourselves to be there to ferret out further information.


GARAMENDI: That's going to be done in the halls of Congress.

SHAPIRO: OK, so I understand you didn't discuss that with Ukrainian officials. I know you also met with Bill Taylor, who is the charge...


SHAPIRO: ...D'affaires at the U.S. Embassy in Ukraine. He is one of the people involved in the text messages that were turned over to Congress. Did you ask him about those texts, in particular, one saying that it was crazy to withhold security assistance for help with a political campaign?

GARAMENDI: Yes, we did discuss that with him. He said that it was true, that the text is accurate. He didn't go into further discussions beyond acknowledging that his view was that it was the wrong thing to do. And obviously, he said that in his emails and made it clear. He is - he knows Ukraine. He is a very, very good person for us to have there at this extremely awkward and very difficult time between the United States and Ukraine.

SHAPIRO: And as he was raising this red flag, I mean, did he explain to you anything about his reaching out to the White House or State Department about the aid being delayed? I mean, what was his narrative of what was going on at the time?

GARAMENDI: What he did share with us was that it was essential that we tell, in any way possible, the new Ukraine government that the Congress of the United States stands firmly with Ukraine, regardless of what the president may be doing, and that in the new legislation that we're writing - the National Defense Authorization Act - that we make it clear that there will be a continuation of the money that they need, the aid that they need, the soldiers that are training their troops - all of those things. And we did that.

SHAPIRO: And just in our last 30 seconds or so, what did the Ukrainians tell you about being at the center of this massive American political story?

GARAMENDI: They're very, very concerned. We met with the parliament. It was of concern to the parliamentarians when you speak to them privately. But what I found was a group of leaders that are strong, resilient. And they're going to soldier on. They're going to protect their country.

SHAPIRO: All right. Congressman John Garamendi, senior member of the House Armed Services Committee, thanks for joining us.

GARAMENDI: Thank you. Transcript provided by NPR, Copyright NPR.