Toku Eyes raises millions for AI tech that helps stop diabetes, preventable blindness

A retinal scan in progress. Toku Eyes' AI software, which sits in the cloud, is designed to be brand, neutral, working with any fundas camera that's connected to the internet. Photo / Supplied

Auckland startup Toku Eyes has raised $3.6 million to develop its AI software - which founder Dr Ehsan Vaghefi says can analyse eye images faster than a human clinician and pick up things they might miss, helping to spot conditions such as type 2 diabetes - the most common cause of blindness or vision impairment in New Zealanders aged 20 to 60.

The medtech company doubles as something of a personal crusade for Vaghefi.

"When I was going to school when I was little, other children would get help crossing the road and I would be helping my father across," he tells the Herald.

His dad was just 4 years old when he went blind as a result of congenital glaucoma - a preventable condition, even then.

"He's probably the most talented person I know," Vaghefi says. "He grew up to become a lawyer then a law professor. But he could have achieved even more with his sight."

That was decades ago, in Iran, but Vaghefi says that today, in 21st-century New Zealand and other developed countries, many cases of preventable blindness or vision impairment are still missed. Around 270,000 Kiwis have been diagnosed with type II diabetes, but experts estimate the true rate could be 30 to 40 per cent higher.

Toku Eyes founder Dr Ehsan Vaghefi says his company's AI software can analyse eye images faster than a human clinician and pick up things they might miss - helping to spot conditions such as type 2 diabetes - the most common cause of blindness or vision impairment in New Zealanders aged 20 to 60. Photo / Supplied

Vaghefi says his company's software will help to make analysis of fundus camera scans cheaper and easier to analyse, making ocular care more accessible to those on lower incomes.

A fundus camera is a combination of a digital camera and a microscope that takes an image of the back of your eye. Because your eye is transparent, its the easiest way to get a picture of your veins, which in turn can reveal early signs of cardiovascular problems or conditions like diabetes - which has implications for your the health of your whole body, and which can also cause macular degeneration that impacts on your vision.

Toku Eyes' AI software, called THEIA, can also catch the signs of hypertension (high blood pressure), cataracts or early signs of kidney disease, among other conditions.

"The AI sits in the cloud. If a fundus camera has an internet connection, it can upload an image that THEIA analyses in 10 seconds, down to the pixel level."

Challenge to the status quo

It's a challenge to the traditional business model of private practices in which highly trained optometrists manually view the scans of every patient. AI means these specialists can focus on the more complex cases and staff with less training can operate the scanner (a similar concept to other local medtech startups employing artificial intelligence - the Peter Beck-backed HeartLab in the cardiac field and Formus Labs in orthopedic implant).

Vaghefi hopes the tool will expand existing screening capacity by up to 50 per cent and reduce labour costs by a third, allowing more patients to access ocular, including Māori and Pasifika people in under-served areas, who disproportionately suffer type 2 diabetes.

"A lot of people still go blind for needless reasons, even in this country," he says.

"THEIA can clinicians more quickly work out who needs supervision or specialist care. At the moment, identifying the 10 per cent who might need help takes a lot of time."

Toku Eyes' THEIA software uses artificial intelligence to analyse a retinal image then return a result in around 10 seconds. Image / Supplied

Vaghefi first conceived of what became THEIA while working on imaging technology during his PhD in biomedical engineering at Auckland University (where he remain a senior research fellow and senior lecturer on top of his startup duties).

After graduating, he formed Toku Eyes (or "My Eyes") and set about developing his AI product with help from local ophthalmologist and options and capital from Uniservices (Auckland University's commercialisation arm), Icehouse Ventures and the rich-list Mafsen family.

On top of the $3.6m just raised, the company has also received around $4m in grants from organisations including the Health Research Council, MBIE (through its National Science Challenge) and Callaghan Innovation.

Today, he has 10 staff and THEIA is going through the US Federal Drug and Administration, which should serve as a springboard for approval in other territories.

Meanwhile, THEIA successfully completed its latest clinical trial in May 2021 at Middlemore Eye Hospital, Vaghefi and is being used in private practices across the country.

China crisis

Right now, it's being used to review analysis that's already been carried on image scans. Once it gains regulator approval, Vaghefi sees the AI being used for real-time analysis.

He hopes FDA approval for Toku Eyes first wave of software will arrive by the end of this year. If it does, he sees his company going to market in early 2022.

He sees the US and New Zealand as Toku Eyes primary markets initially, but will also use around a third of the $3.6m just raised on entering China - where that county's burst of wealth in recent decades has led to an explosion of bad eating and, according to some estimates, somewhere between 100m to 150m people suffering type 2 diabetes.

Development continues, and the founder is aiming to soon have an algorithm that can spot glaucoma.

Backing from US non-profit

The oversubscribed funding round just closed - Toku Eyes first external raise - was led by Icehouse Ventures and supported by a second local venture capital outfit, Artemis Capital and US non-profit Kera Link International, a social venture that invests in technology to address blindness in developing countries.

The funds were raised at a pre-money valuation of $8.5m, and at the end of the day, Vaghefi wants to make profits - the better to fund his socially conscious startups, and to expand to new initiatives such as cheaper, more accessible fundus cameras.