Work has begun on a new low-cost eye scanning device that it is hoped will detect brain swelling in critically ill patients with cerebral malaria to produce better outcomes.

Dr Nick Beare and Professor Yalin Zheng from St Paul’s Eye Unit, and the Department of Eye and Vision Science, University of Liverpool (UofL), are combining expertise in clinical research with image analysis, artificial intelligence (AI), optical and electrical engineering to develop the eye scanner.

More than 400,000 people die from malaria each year, mostly children under five years of age, with 90 per cent of malaria cases occurring in sub-Saharan Africa.

The malaria parasite infects red blood cells which stick inside the blood vessels in the brain as well as the eye. Severe brain swelling sadly causes death in many, but at present an MRI brain scan is required to identify it. However, most hospitals in Africa do not have a MRI brain scanner due to their prohibitive cost of up to £1 million.

Dr Beare, a consultant ophthalmologist who has been researching cerebral malaria and its effects in the eye for more than 20 years, has previously shown that the eye changes can improve diagnosis and ensure that treatment can be given with greater confidence. The eye changes, known as malarial retinopathy, have provided many insights into cerebral malaria because it is possible to see small infected blood vessels at the back of the eye but not the brain.

Professor Zheng has developed techniques to automatically analyse images from the back of the eye in diabetic eye disease and glaucoma, and working with the Dept of Electrical Engineering a similar eye scanning device has been developed for China to tackle diabetic retinopathy. Prof Zheng and Electrical Engineering are now using those skills to help develop this scanner into a hand-held, low-cost device for use in Africa.

The cerebral malaria OCT scanner will be built for £5,000 to £10,000 and can identify swelling of the optic nerve, which is connected to the brain. Dr Beare will also investigate whether retina scans can identify children at risk from long-term brain damage whose families will benefit from early support and guidance.

Previous studies have shown that long-term neurological damage from cerebral malaria can affect around 30 per cent of survivors, whilst adding epilepsy and ADHD-like behaviours can bring the proportion with long-term effects to 50 per cent.

Dr Beare said: “Thanks to a grant from the Wellcome Trust, we are able to begin developing the OCT scanner for use across Africa, to identify children who need additional treatment for severe brain swelling.

“There is a tremendous amount of collaborative work from many different fields here in Liverpool and our partners in Malawi and the US, to demonstrate the insights into malaria that we can get from looking into the eye.

“Thanks to Prof Zheng and his team we are able to deliver the innovations in AI and imaging technologies to Africa where the healthcare resources are scarce, which in turn will benefit millions of African children suffering from malaria.”

A Clinical Research Fellow has been appointed to conduct this study and will start in Malawi this September to begin enrolling children with malaria and other comas into this study; whilst researchers in Liverpool continue to develop the scanner. The UofL scanner will be brought out to Malawi in two years’ time after passing all the required safety testing.