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Alex Kietzman’s research aims to detect vision impairment through photos

CPN member Alex Kietzman joined Dr. Bryan Shaw’s bioanalytical lab in 2018 as a sophomore at Baylor University in Waco, Texas. It matched his interest in the digital future of health care and allowed him to explore options for specializations in medical school. As an undergraduate researcher in the lab, Kietzman worked on the development of one of Shaw’s biggest projects as an associate professor, the ComputeR Assisted Detector of LEukocoria – or CRADLE – algorithm used for the “white eye detector” smartphone application available in both Android and Apple app stores.

Kietzman rubs the John Harvard statue’s toes for good luck at the National Collegiate Research Conference.

A descendant of the Higbee and Lorraine families, Kietzman double majors in biochemistry and philosophy with a minor in biology. His aspirations include medical school. As part of the team continuing to develop and improve CRADLE, he worked on scientific research that turned into his first published study. Autonomous early detection of eye disease in childhood photographs appeared in the October 2019 edition of the publication Science Advances, and at that time, more than 10,000 devices had downloaded the app.

“The vast majority of people who are conducting research and writing papers are graduate students, postdoctoral fellows, or people who are currently just working with their Ph.D.,” Kietzman said. “It’s really exciting to be introduced to this sort of published community at a younger age.”
Kietzman also discussed the application and its updates in front of peers and professionals at the National Collegiate Research Conference at Harvard University in January 2019 — his first presentation of its kind. Despite his nervousness, he appreciated and learned from the eye-opening experience.

“People always consider Boston or Ivy League areas as a step up, intellectually. It’s sort of humbling to recognize how similar a Texas education is in many ways,” he said. “So, I get to Boston; I fly to Boston. I step off the plane, and I see more snow than I’ve ever seen in my life. I see a frozen river. Just things that I’ve never seen before. On top of a distinct geography, I repeatedly came across some of the most intelligent minds in the country. For a weekend it was normal to have conversations with famous professors like Steven Pinker, Nobel Laureate Oliver Hart, Surgeon General Vivek Murthy, or (former) Editor-in-Chief of Cell, a top biology journal, Emily Marcus.”

CRADLE

As medical software, CRADLE helps detect leukocoria, or “white eye,” which sometimes can be seen in photographs. Leukocoria is often a symptom of more pressing ocular issues, including cataracts, Coats’ disease, and retinoblastoma, a type of eye cancer usually found in young children. The refraction of light off certain ocular surfaces created by these diseases results in the white pupil. Alleviating these issues depends on early detection and treatment.

“The goal of the app is to use casual photography that parents take of their kids on a daily basis and sort of sum it all together in some aggregate way as a single test to view the pupil and see if there are any abnormalities like leukocoria,” Kietzman explained.

After downloading CRADLE White Eye Detector, the user grants it access to their device’s photos. Then, it uses both facial recognition and a hue saturation value scale aligned with instances of leukocoria in photography to detect possible instances that may warrant further testing.

As part of Dr. Shaw’s lab, Kietzman assisted with “the first large-scale, longitudinal testing of its accuracy, sensitivity and specificity” of the software. While the project previously focused on the iPhone, Kietzman’s addition encouraged an expansion into Androids as the owner of a Google Pixel.

“I was over at (Dr. Shaw’s) house with a friend of mine, who was also in the lab, working on the project, and I pull out my phone. He saw my phone, and he goes, ‘What type of phone is that?’ and then I start telling him about my phone and how at the time, it was sort of at the top of the line of the Android market,” Kietzman said.

In an attempt to make CRADLE universal, availability on every device seemed logical and necessary. Android functionality also increases its potential presence in developing nations as those makes and models become most popular in those markets.

“The goal is just to have as many people as possible download it and be using it whenever they need. … It’s the most important (there) because the density of doctors and pediatricians is far lower than that of the United States,” Kietzman said. “And an awful disease like retinoblastoma, the cancer of the retina, is curable, if caught early enough.”

Due in part to his contributions, the lab’s team is currently assessing approximately 100,000 images to build its training set and improve its accuracy.

Virtual health care and the future

Kietzman finds CRADLE exciting as a part of telemedicine. He hopes to be on the fringe of technology as medical appointments via video call and self-assessment with the help of digital applications become more common.

“I think telemedicine is a really, really important thing, and that’s where I imagine very much of or maybe even the majority of medicine in the future going,” he said. “And CRADLE is, I think, just another way, another example of how telemedicine is expanding in nature. … It’s just great to be a part of some movement to expand health care or medicine beyond the clinician’s office.”

Kietzman, a junior in his undergraduate program, keeps his career options open. His declared majors and minors incorporate varied schools of thought and subjects that overlap one another, particularly in this branch of health care.

“It’s definitely something that even if it wasn’t a trend, I think that I would still be drawn to approaching medicine that way, and it’s clearly a beneficial thing to have those sort of cogs already moving in my mind,” he said.

“It’s humbling to be a part of something that’s so much greater than myself.”

The opportunities to shadow and gain perspective on different medical fields ranging from cardiology to primary care excite Kietzman as well. He calls those future decisions “up in the air, but in a good way.”

Read the Science Advances’ publication of Autonomous early detection of eye disease in childhood photographs at cpn.news/cradle. CRADLE is available free on the Apple’s app store and Google Play. It is also on Facebook @white.eye.detector and on Instagram @cradle_white_eye_detector.

Dr. Shaw’s bioanalytical lab is currently requesting childhood photographs for analyzation to increase their work’s accuracy. Email Shaw Research Labs at bryan_shaw@baylor.edu for further information on contributing. Visit the lab online at shawlaboratory.com.