1) What is the motivation of Dr.

Chandra Kumar, Director (TNSBC) to employ AI-solution in

cataract screening?

Dr. Chandra Kumar believed that by effectively using the technology, he can work ensuring his objective
of eliminating all cases of preventable blindness is achieved.

The motivation to employ AI-Solution to the problem of Cataract screening stemmed from the following:

 Resource constraint that limited the reach: One of the primary reasons that acted as a driving
force was the unavailability of human resources to reach all the rural and urban households for
screening and identifying the cataract-affected eyes.
 Raising concern of cataract cases: The case mentions the report by National Blindness and
Visual Impairment Survey of India and tells us how cataract is one of the prominent reasons of
blindness among elderly individuals. Despite being a preventable problem if identified in an
earlier stage i.e Immature Stage, cataract continues to be the major cause of blindness as
individuals often do not identify them in the early stage and often realize that disease only in the
later stage when it is difficult to restore the sight.
 Inefficient Government measures: Even though Government hospitals arrange in rural areas,
camp organizers face many challenges including logistics, organizing resources and
disseminating information about eye screening camps.
 Shortage of Ophthalmologists: There are only 12000 ophthalmologists in India, this acts as a
major constrain.
 Shortage of Paramedical ophthalmic Assistants: Even though the government conducts camps
to screen for cataracts there are no sufficient trained paramedical ophthalmic assistants (PMOA)
who screen for cataract. It is mentioned in the case that there are only 500 PMOAs in Tamil
Nadu’s public health system. These create challenges to organize camps at a larger scale and
higher frequency.
 Availability of the AI technology to scan eyes in the market: The cataract screener was using
the AI technology was already developed so, Dr. Chadra wanted to meet with the TNeGA team to
develop a low-cost solution.

2) Do you see challenges in the e-Paarvai at large scale? Provide suggestion for better adoption and
exploitation of e-Paarvai.

Challenges:

 Datasets represent a particular region or an environment so the AI model might be biased. If the
findings are scaled up across the state, this will have an impact on their accuracy.
 There is a shortage of ophthalmologists, which creates a bottleneck. So even when the cataract is
identified, the patient’s proper treatment and diagnosis are delayed.
 Discrepancies may arise between volunteers and ophthalmologists, and it will be difficult to gain
acceptance for treatment post screening.
  Usage of smart phones in rural areas is limited and people are technically not well versed. This
may pose a challenge to e-Paarvai while expanding on a large scale.
 When we increase to a large-scale availability of volunteers and providing proper training for
them will be an issue.
 It is challenging to deliver a faster diagnostic while executing it on a wide scale. This will be
challenging since it is tough to prevent blindness when a cataract is discovered at an advanced
stage.

Suggestions:

 Data collected from users can be added to the existing database to produce more accurate results.
 Make the app more user friendly and incorporate tutorials explaining how to screen with a
smartphone within the app.
 Doctors should monitor the databases periodically and confirm the cases.
 For the non-technical volunteers, a standard training procedure can be provided to ensure proper
usage of the app.
 At the moment, the app can only be accessed by volunteers and users. If e-Paarvai is planning to
implement it on a larger scale, then they should look into making the app accessible to all citizens
with proper guidelines.

3) Discuss steps to make e-Paarvai solution more accurate/smarter?

 Train the model to give suggestions for Cataract negative case.

 Keep the database of patients who have already used the device and keep track of the timeline
when they have come for the test. Once the person returns again for the test to take a retest, we
can compare results and make suggestions for the same.
 Multiple Languages and Text to Audio Assistance- Extending the application that can be
directly used by the individuals instead of depending on volunteers. Small Self-help Booths can
be established in the rural zones and the application usage can be displayed through the local
language in that area and also Audio Assistance. Given the target individuals of this application
are from rural areas where literacy is low. Additionally, their proficiency with technology is also
minimal. Hence the app can come with text to Audio feature that can guide them through the
process.
 Periodic Reminders: The tested reports must be updated on a periodic basis to ensure the
database is up to date.
 Finger print tracking system: When a patient initially goes for testing, he/she needs to give
finger print and later after the surgery or initially treatment, patients can use e-paarvai for the
follow up. e-paarvai will compare the current status with the past status, and gives feedback.