Zobia Chunara

Our first week in the ophthalmology clinic allowed for observation of many examples of good and bad design.

One example of good design in the clinic was the standard chin and forehead stabilizing bar attached to each slit lamp as the bar allowed patients to intuitively position themselves properly for examination with little guidance. Another example of good design was the Schirmer paper strip which the physician places in the patient’s eye to stimulate tear production to test for dry eye disease. This test is simple, yet effective, and requires little effort on behalf of the physician or the patient.

An example of bad design was the tear collection process. The physician administers artificial tears to the patient’s eye, allows the tears to incubate in the eye, and then collects the tears by holding tiny glass capillary tubes next to the ocular surface. As the risk of scratching the surface exists, this process is unsafe. A second example of bad design was the subjective eye grading process. After assessing the patient’s eye using a slit lamp, the ophthalmologist writes numbers on an outline of the eye to grade the severity of dry eye disease. Because this process is not automated and there are no controls/standards used to compare with each examined eye, this seems to be quite a subjective process.

Tear collection is quite a precarious process. There exists no effective standard for tear sampling. Thus, Dr. Jain invented his own method to collect tears, which requires an ophthalmologist trained in using a slit lamp, 2 assistants, a slit lamp, 8 capillary tubes, a fluid dispenser, Eppendorf tubes, and a box of ice. Here, I explain the current work flow to collect tears:

The first assistant passes a micropipette filled with saline to the ophthalmologist who looks into the slit lamp while holding the pipette to eject the fluid into the right lower eye lid. The ophthalmologist asks the patient to look left, right, up, and down while he moves the lower lid of the eye around to allow the drops to mix with the ocular surface for about 30 seconds. The second assistant holds up 4 small glass capillary tubes. The ophthalmologist takes a small glass capillary tube from the second assistant, pulls the patient’s bottom eyelid down, and holds the tube at the base of the eye to collect the pooling tear fluid. He hands the tube back to the second assistant, who passes it to the first assistant, who dispenses the tear volume in the tube into Eppendorf tubes sitting on ice. The physician repeats this process again with 3 more capillary tubes.

The above tear collection process is then repeated for the left eye.

Our time shadowing Dr. Jain led us to create a needs statement focused on creating a user-friendly tear collection process that allows any healthcare professional with minimal training to collect patients’ tears safely. We came upon this needs statement through interviewing patients and research assistants involved in the tear collection process. We also thought about the populations we would want to serve. In order to bring the tear collection process to low-resource settings where slit-lamps are unavailable, we would need to create a process/device that would allow for tear collection without the use of a slit-lamp.

After much brainstorming on the process of tear collection, my team came up with a few salient criteria such as safety, comfort, efficiency, and accessibility. We will look towards creating a solution that prevents the direct use of glass capillary tubes, requires only 1 person to collect tears, is intuitive in terms of use, and does not alarm patients.

We created concept cards this past week. On my concept card, I drew two ideas that my group had been discussing. The first idea was a mechanical apparatus that would allow the user to collect tears. The second idea is a motorized version of the same idea. Drawing out our ideas on concept cards allowed us to verbalize/demonstrate what we each were envisioning to our teammates. We showed our concept cards to our mentor who gave us feedback on what features he preferred, additional ideas, and future plans.