Concussion detection hardware, software company wants OD input

Brian Still

EyeGuide Focus is a proprietary hardware and software platform that tests for potential neurological impairment in a 10-second, easy-to-administer test.

Brian Still, PhD, chairman and CEO of EyeGuide, discussed with Primary Care Optometry News the concussion management platform and how optometrists can get involved in testing and shaping its future.

He believes in community-driven research and understands that through partnering with other specialties, like eye care, the product can be enhanced.

PCON: Where did the idea for concussion detection using eye tracking technology originate?

Still: We’ve had a company making eye tracking software since I was at Texas Tech University. We spun it off in 2011 and made primarily eye tracking hardware and software for the research space, to find low-cost alternatives for researchers.

In late 2014, I began to have conversations with optometrists, ophthalmologists and neurosurgeons, and in reading literature we reached consensus that there was an opportunity for putting this into practice for concussions. Even today, there are not many fast, quantitatively driven, objective concussion tests. Many tests rely on the injured patient answering questions, to recall symptoms. Many tests can’t be done right away and can be cost prohibitive. We wanted to address this need. We felt like we were ideally positioned to find that solution.

PCON: How does the hardware and software determine if neurological impairment is present?

Still: There’s quite a bit of literature to suggest – and the science isn’t ours; it has been there for quite some time – that one can determine neurological impairment by vision testing. You can also do it through balance testing, and there are products that can do that.

There’s enough research to suggest that if someone completes a pre-injury baseline and post-injury concussion test you can pick up things going wrong neurologically that speak to the patient’s ability to pay attention to a slowly moving target in front of them, to follow a consistent path. It suggests there is a possibility of impairment.

We are specifically measuring dynamic “visiosynchronization,” or smooth pursuit. We are interested in the ability for a person to follow a consistent path of a slow-moving object and measure how effective they are: how close they are to the object, how fast they are and whether they fall behind in speed or jump ahead. Then we compare the post-injury test to the baseline. We even do testing post-injury to see the athlete return to normal. There shouldn’t be any reason why someone who is healthy can’t follow a slow moving, 10-point dot, moving in a consistent “lazy 8” pattern. Most of the time when people are hurt, the result isn’t 2 standard deviations away from baseline, but 4 SD or more.

All we do is have them put their chin in a chin rest, remain still and look into the iPad screen. We have a fairly sensitive proprietary camera that illuminates the eye and identifies the pupil. After the test, 10 seconds later you’ll have the results. We use an iPad because we felt like most people had one and you can set it up quickly on the sidelines.

We store the data in HIPAA-certified Google Cloud servers. Every time someone does a baseline reading, the normative data set gets smarter.

PCON: Does the operator need any kind of special training to administer the test?

Still: Not much. We’ve mostly used Skype or video conferencing to train the operators. It’s relatively easy to set up. It’s essentially a product they are familiar with, an iPad, and most people that use it are athletic trainers or other health care professionals with experience with that technology. Eventually we’d like to have a web interface so there’s more training modules; it doesn’t take much to learn how to use it.

Getting the patient’s chin in the rest and remaining stable in a nondistracting environment is a large part of it.

PCON: You participated in the NFL’s Super Bowl startup competition geared toward player safety, 1st and Future. What was it like?

Still: The exposure was great. We met a lot of people. It would have been nice to have won and gone to the Super Bowl, but it’s the best exposure we’ve ever had. It came at a good time; a year or two ago we wouldn’t have been ready to maximize on that, as we were still early on and testing our hardware. Now, we feel really good about the dataset we’ve collected. I’m hopeful that we found some of those key adopters that want to use it in the next few months in the next stage as we are waiting to begin mass production. The NFL is smart to do the competition from a PR perspective, and we were honored to be part of it.

PCON: What stage of development are you currently working on? Do you have a projection for its availability?

Still: In 2016 and 2017, we released it to 30 beta customers; almost all our data is from that. There are about 30 sites now using the technology. We are pre-commercial. We are trying to get 30 or 40 more devices out there. Much of our dataset is from high school and college age students, 13 years to 21 years. We’d like to get data from a population that’s older. We want to expand our population. We would like to be selling it from our website as this year progresses.

We are trying to make it into a first-line tool. From an affordability and ease-of-use standpoint, it could be used by almost anyone, in any environment.

PCON: Is there anything else you’d like optometrists to know?

Still: We are looking for help, as far as optometrists interested in doing studies, serving on advisory boards – we want that sort of feedback. There’s next generation implementation that we want and applicability beyond concussion, and optometrists would know that better than us. We are looking for partners, for people to participate. I think that community-driven research is going to make the product better and will get all of us to solution faster for this issue. We aren’t interested in being the only tool. We realize that ultimately a complex problem needs a complex solution. Optometrists may have some ideas.

Disclosure: Still is co-founder, chairman and CEO of EyeGuide.