Introduction

Visual impairment is estimated to affect 1.3 billion people worldwide,1 2 over 80% for preventable or treatable reasons.3 Although many are curable, there are significant challenges in providing treatment to those in remote areas. Due to this, low-income countries disproportionately shoulder visual impairment. It is therefore essential to develop low-cost and simple methods for diagnosis and treatment. Advances in technology are now providing possible solutions to achieve this, with smartphones already being used to identify those with visual impairment.4

In Africa, more than three times as many people have access to a mobile phone than a flushing toilet.5 This well-established technology base provides the grounding for developing diagnostic tools using the imaging and connectivity mobile phones can provide. Telemedicine has shown promise in a number of different fields, and ophthalmology lends itself particularly well to this technique as it is a highly image-based specialty. Significant benefits have been reported using these methods for screening ophthalmic diseases such as diabetic retinopathy,6 and mobile phone adaptors have been validated as a tool for imaging optic disc pathology in rural areas of Kenya.7

Likoma Island, on Lake Malawi, is a stark example of a rural area isolated from mainland healthcare services. There is no government-funded hospital on the island, so the burden of healthcare for Likoma’s 10 000 residents falls on St Peter’s Hospital, which is sustained entirely by charitable donations. The hospital is severely understaffed with 12 nurses, 2 clinical officers, 1 dental clinician and 1 ambulance. There are …