The Smallerst Health Tracker Ring So Far: Dr. Antonino Caizzone, Velia Smart Ring

Dr. Antonino Caizzone, Velia Ring  0:00  
You will need more and more vital sign monitoring, you'll need to gather more data.

Alex Jani, X-Health.show  0:09  
Hi, I'm Alex and welcome to the X-Health.show, where I talk to visionaries behind the latest innovations in healthcare. For the eXtra health of the future. We're in Neuchatel, Switzerland, in the Microcity space where startups focusing on micro technology and micro manufacturing grow. Dr. Antonino Caizzone is an engineer specializing in micro engineering and nanotechnologies, especially sensors, with experience working on wearables. He co-founded Symbiosis, a Swiss startup that developed Velia Smart Ring, the smallest at the time of this recording, ring to track your health and wellness. Thanks to the crowdfunding campaign that raised so far over $1.7 million, on the way to launch the ring at the beginning of 2024. You'll hear about the differences between various wearables – smartwatches, rings, bands. What is PPG technology and how small the sensors can be. And also how to stay ahead of big players if you're a startup? [INTRO ENDS] How was your night?

Dr. Antonino Caizzone, Velia Ring  1:14  
My night was good, despite my son can be very noisy.

Alex Jani, X-Health.show  1:19  
What can you see in your metrics? You've got your ring on your finger, right?

Dr. Antonino Caizzone, Velia Ring  1:25  
Yes.

Alex Jani, X-Health.show  1:26  
I know you guys tested it. So tell me tell me what you can see in your metrics?

Dr. Antonino Caizzone, Velia Ring  1:32  
I can see that, if you have a nice routine, which means you go to bed the same time and you try to wake up the same time, if you reduce the quantity of blue light before actually going to bed – these things help a lot. And in the long term, you can see clearly that you have a very, very balanced night. And what does it mean? It means that you have cycles of 90 minutes in which you alternate: REM-light-deep, REM-light-deep continuously, that's a sign that the night was regenerative, helpful.

You can't see it because of your son, can you?

Sometimes. It's interesting, because when you check the app, what the app basically says, there is usually a match between how you feel and what the app says. Because we have a kind of feedback. We understand if the night was good or not. Sometimes you wake up in the morning and say, That was really bad. And it's interesting that you look in the app, and the app says Pay attention, that the night was not so good. Which means, sometimes we need really to trust our internal gut feeling or internal sensor. If you have a device, which is more or less matching, of course it cannot be a one to one match but if it's a close match, then you perhaps picked a good device. That's the problem with wearable devices, sometimes, I mean, particularly the bracelets, you don't really feel that there is a match. Sometimes you see a bunch of random data, you have lots of deep sleep, but don't have the feeling that actually had so much deep sleep. That's the problem sometimes.

Alex Jani, X-Health.show  3:24  
Okay, what do you measure then?

Dr. Antonino Caizzone, Velia Ring  3:26  
What we measure is several vital signs. The basic one is the heart rate, the heart rate variability, you can measure the body temperature as well and you can measure the respiration rate. Then you combine all these things and the algorithm basically looks at all these vitals and interpret them, and gives what it's called the Hypnogram. It means that when you fall asleep, what is the quantity of REM sleep, light sleep, deep sleep. When you wake up, what is the sleep efficiency. This is the ratio because we can actually spend 10 hours in the bed but if you slept five hours, you have 50% sleep efficiency, which is not good. Usually you should have 90+% efficiency. All these things are basically the outcome of these vitals. So imagine all these vitals, they are the input, they are given to the algorithm and the algorithm gives all of this as an outcome. 

Awesome. So it's a ring, what's it made of? So how do you measure stuff,  with what?

All these vitals, they are basically measured thanks to a technology which is called PPG which stands for...

Alex Jani, X-Health.show  4:41  
Photoplethysmography, I already was trained on that.

Dr. Antonino Caizzone, Velia Ring  4:45  
Exactly. Which is I will say the main ingredient today of any wearable devices. If you buy all the wearable devices on the market, they have a PPG device. But what is interesting is that for all the mainstream devices, I don't think we should give names but let's say all the big names for the watches or for the rings, for the wearables, there is a common denominator, which is the way all these big companies integrate this PPG  – it is always the same. In electronics it is called discrete components. You take off-the-shelf components, you put them together, and then you get a PPG system. Which is exactly the way the first finger clip measuring oxygen saturation was built in the 70s. It didn't change that much. What we have, maybe I'm anticipating a bit some of the questions... 

Alex Jani, X-Health.show  4:46  
Oh go ahead, it's interesting.

Dr. Antonino Caizzone, Velia Ring  4:59  
What we have in the ring is still a PPG but it's a PPG, what we say PPG 2.0. It's a different paradigm. Instead of using of these off-the-shelf components, we have a very miniaturized chip.

And you're showing, like, a centimeter?

Oh, no, it's a millimeter chip. It's super small. It's barely visible with the naked eye, which basically combines all these things together. In electronics, when you bring all these things together, that is called integration. It comes with a lot of advantages: cost because you can actually ramp it up and it will cost less. And also performance. I don't know if you heard about all these processors, like TSMC, we're talking about nanometer or these nanotransistors. In there, this is called the Moore's law, it always gets smaller and smaller, because the smaller the better, basically. And our ring is integrating a constellation of this PPG 2.0, which basically allows a couple of things. It allows, first of all, reducing the size of the ring because these PPG sensors consume very little power. So it means that you don't need big batteries, you can imagine that in a ring device, the battery occupies quite the big area. So the smaller the ring, the smaller the battery, the smaller the ring gets.

Alex Jani, X-Health.show  7:07  
It's awesome. I mean, even now, imagine a battery fitting into a ring, like, any ring. It's awesome. And you claim that your batteries are even smaller than other batteries?

Dr. Antonino Caizzone, Velia Ring  7:18  
Yes. If you compare our ring versus other rings, exactly, our battery is 10 times smaller. Because it's all about being efficient. If the system gets efficient, then you don't need a lot of energy. So you can reduce the battery, which means that the device gets ultimately smaller. And then of course, our technology is based on what you find on the cameras of the phones. It's a very sensitive technology, which is called CMOS image sensor, which means that you don't need a lot of light to measure all these vitals.

Alex Jani, X-Health.show  7:18  
You just stepped into the how does this PPG work? So it sends light, right?

Dr. Antonino Caizzone, Velia Ring  8:09  
You have an LED that is shining light in the tissue. Not necessarily the finger. You can do it on the wrist, you can do it on the forehead, you can do it on the chest but the way it works is the same. You have this light that gets into the tissue in the skin. It goes deeper in the skin, through all the layers. It interacts with whatever we have in the skin, you have a lot of things: blood but you also have muscles, fat and a very big part of this light gets lost in the in the skin. What does it mean lost? It transforms into something else, basically. And there is a very tiny part that gets reflected. and is sensed by a photodetector. A photodetector is an optical component that is capturing these photons. It may seem like they're taking a walk through the skin, okay, they can walk through the skin, some of them decided to take a beer, some of they say no, I have to go back. So they're good students, they go back. And they're basically sensed by this photodetector, which is converting these photons into electrons. Electrons is a signal that is then processed by integrated circuits, amplifiers ADC and then you get this signal, which is the PPG. If you can imagine, it's a sinusoidal signal and the sinusoidal behavior comes from the modulation which is brought by the heart. The heart is pumping and the frequency at which the signal modulates, is exactly the frequency of the heart.

Alex Jani, X-Health.show  9:44  
Okay, so there is light. I mean, it's not only the sensor, this PPG sensor that you mentioned, that is so tiny but also the light needs to be tiny.

Dr. Antonino Caizzone, Velia Ring  9:49  
Yes, the LEDs should be small.

Alex Jani, X-Health.show  9:51  
So there's the light and then there's the sensor What else is there?

Dr. Antonino Caizzone, Velia Ring  9:58  
The basic components are what is called the PPG optical module. It is the LEDs, then what is called the AFP – the analog front ends, and the photodetector. So the LED will be shining the light, the photodetector will be receiving this light and converting into electrons – so photon to electron conversion – and then the AFP will be processing these electrons, which is a voltage signal. And then you're gonna get a wave that will be processed by your DSP, by your microcontroller, by your CPU. That's the idea.

Alex Jani, X-Health.show  10:35  
How is it that you can measure so many things from just sending this light and losing some of it?

Dr. Antonino Caizzone, Velia Ring  10:43  
That's a good point. That's why you need to be sensitive, because actually, the quantity of light that you get back is, just to give you an idea, is five to six order of magnitude. This basically means that you shine 1 million photons and you get one back. So you must be very sensitive. And the more sensitive you are, the higher the likelihood that you are going to get anything out of this signal. When you think of this PPG signal, this sinusoidal signal, there are things that are more or less evident. Simply, you look at the frequency of the signal, that's the heart rate. Then you look how this beats to beats variation changes over a timespan and that is called heart rate variability. Then you can look at other things. You can look, for instance, at the AC over the DC of the signal – you can get the oxygen saturation. You can look at how the baseline of the signal gets modulated and you can get the breathing rate. We're always going deeper and deeper on the signal. Or you can look at very tiny features in these signals that are almost invisible to the naked eye but if you have a good algorithm, you can see these things. These features are hiding information about the arterial elasticity. From this you can deduce for instance, what is your blood pressure, knowing whether you're hypertensive or not hypertensive. That's the whole idea behind that, all these vitals. You can imagine that the cleaner the signal gets at input, the more things you can extract out of it.

Alex Jani, X-Health.show  12:28  
And the temperature? 

Dr. Antonino Caizzone, Velia Ring  12:29  
The temperature doesn't come from the PPG. In the ring, there are three main sensors. So you have the PPG, from which you capture all the vitals, then you have the body temperature – you can have different sensors. You can have surface temperature, you can have infrared sensors, but they all measure the body temperature. And then you have the accelerometer, which is measuring your inertial activity, so how much you move in the three axis.

Alex Jani, X-Health.show  12:56  
Like steps, for example.

Dr. Antonino Caizzone, Velia Ring  12:57  
Steps exactly is measured, thanks to the accelerometer.

Alex Jani, X-Health.show  13:02  
Okay, so now some practical questions. Why would people want it? What they can use it for? Who can consider that or I don't know, maybe even should consider wearing the ring?

Dr. Antonino Caizzone, Velia Ring  13:17  
Let's say that this smart ring is a device that should be used, in my judgment, for a very specific purpose. And I explain you why by comparing to something else. We compare this smart ring to one of the most famous wrist device, I will not say a name. A wrist device is a very nice device when it comes to performance and athleticism. So if you want to run, if you want to do cycling, then that device makes a lot of sense. But imagine a device that should rather focus on yourself. Suppose that you want to know better yourself. You want to know, for instance, if you sleep well, if you have an issue, or if you get stressed. Sometimes, it's a bit inversion in logic flow, but sometimes less is more. You don't need actually to have the full picture, just have to focus on what really counts. Why am I saying this? Because the ring is a very nice device in this regard. You don't have a screen, you don't have a GPS, you focus on what really matters in your objective. If your objective is knowing yourself better, understanding whether you may have lead yourself towards not super healthy life and so you need to do correction, the smart ring is the best device.

Alex Jani, X-Health.show  14:49  
We're speaking, basically, healthspan, longevity.

Dr. Antonino Caizzone, Velia Ring  14:53  
It's all about that. It's basically what is called improving self-awareness knowing ourself better because in the end, it's all about ourselves. I mean, if we want to live longer and living longer in good shape, the crucial part is that it's a healthspan, not lifespan. We need to take actions upfront. But to take actions, we need to know whether there is a problem or not.

Alex Jani, X-Health.show  15:16  
And you can see the results in the app or online somewhere in the cloud, right?

Dr. Antonino Caizzone, Velia Ring  15:23  
It's in the app.

Alex Jani, X-Health.show  15:24  
One question here. How do you deal with data privacy? Or what happens with the data?

Dr. Antonino Caizzone, Velia Ring  15:31  
The data stream happens this way. Imagine that the ring transfers the data to the app and then the app communicates to a server. It's not science fiction, it's something that is business as usual. But where we're very attentive is being sure that, first of all, there are no third usage of this data – this is against the law. And also that the user has access to the data. Something which is a bit controversial is that sometimes with devices, you get a lot of data but you really don't know what's happening with this data. You don't even have access to the data. That's the reason why in our app, we will always give the possibility to the users to download the data in CSV format. Which means you know, what's going on. You know the type of IBI, the type of HRV, the heart rate – all these things, you can get them. Then, of course, the data will be stored into servers. These are servers in Europe and US, they are geographically distributed. These are servers by very big companies like Google, Amazon. Of course, the way that they are handled, it's according to the law. It's according to what is called the GDPR. So there, in my judgment, yes, you can bring innovation, but you should rather do based on the law, you should not invent anything, just do it the way it is clean, it doesn't create issues. Rather bring innovation on what is actually the experience of the user, which means the use cases that you can unlock and things like that.

Alex Jani, X-Health.show  17:19  
Sounds legit. So you have the app when you can check how are you doing, apart from how you feel. But also, I've read that the ring can send some signals, blink red light when something happens. Could you tell more about that?

Dr. Antonino Caizzone, Velia Ring  17:39  
Yes. The ring doesn't have a screen, which means that if you want to communicate, you need to use the phone. That's, in my opinion, not an issue per se but I also recognize, for instance, that suppose you are in your office and you spent last five hours on the chair, maybe at a given point, you need to have someone that is suggesting to take a walk. So what we thought is, why don't we equip the ring with a tiny LED outside, which is this spot here, which is doing what is called optical feedbacking. This means you can decide to have it or not to have it.

Alex Jani, X-Health.show  18:28  
Okay, so I basically can set what is important for me.

Dr. Antonino Caizzone, Velia Ring  18:31  
Exactly. You can say, for instance, why don't you start blinking in red if I'm not moving every three hours. And this allows the user to free himself or herself from the usage of the phone because the ring is capable of capturing data for many days. Of course, you have to have access to the phone because at the given point you need to see the data, you need to see the vitals, you have to see the indexes but you may stay one day without necessarily using it. The ring still is giving some high level feedback that can still be be useful. Another use case could be, suppose your heartrate gets elevated because you are stressed, because of whatever reason, then you can program this to shine in blue or whatever. It's an RGB LED, so basically, you can program it, you can get basically all the colors. That's the whole idea about optical feedback.

Alex Jani, X-Health.show  19:33  
Okay, and how about integrations? With Apple, Google or some apps. I already spoken with people who develop apps, you know, focused also healthspan and the wearables actually could be integrated in their apps. How do you see it?

Dr. Antonino Caizzone, Velia Ring  19:53  
In our roadmap, what we'll be offering since the beginning is integration with the main, the two flagship health platforms, which is Apple Health and the equivalent in Google. Which means that we're working on the application on the beta, exactly to be compatible with both the iOS environment and the Android environment. Because, yes, it's important that the user has the choice of deciding also that. You can have access to Velia application but then you can also decide maybe to collect data on Apple Health, because maybe you want to also collect other data from other devices. So this will be possible.

Alex Jani, X-Health.show  20:40  
And now, a super practical question. How do you charge the battery?

Dr. Antonino Caizzone, Velia Ring  20:45  
The ring via a docking station. It's like a jewerly box. So it's something that is closed. Once it's closed, then via what is called Qi, inductive charging, during discharge. But the nice story is that the box is also a docking station, so it has a battery. Like for the Airpods. Basically this means that it is capable of charging several times, the ring, before actually getting charged.

Alex Jani, X-Health.show  20:57  
And how long does the battery last? 

Dr. Antonino Caizzone, Velia Ring  21:18  
The battery lasts from three to four days, depending on the size of the ring. You can imagine that smaller rings... 

Alex Jani, X-Health.show  21:31  
Three to four days?

Dr. Antonino Caizzone, Velia Ring  21:09  
Yes, that's three to four days, but but three, four days is based actually on our first estimates that we're going to see. We've been very conservative, because you can imagine that if, for instance, if you track your heart rate less often during the day, then you can expand it even further. But to think three days for the smallest size, which is your six, and let's say something like four days for the biggest size, I think it's going to be possible.

Alex Jani, X-Health.show  21:35  
OK, and how long does the charging last?

Dr. Antonino Caizzone, Velia Ring  21:45  
It depends on the state of charge, but it can be as quick as 20 minutes.

Alex Jani, X-Health.show  21:52  
All right. Yes, that's cool. So we spoke about like, what's inside? But maybe you could tell me now, how did you come up with the idea of the ring at all?

Dr. Antonino Caizzone, Velia Ring  22:16  
Well, it came up because as I was mentioning some minutes ago, in the company, we are strong believers that the smart ring is the best device for exactly this longevity business, for boosting people's healthspan. When you really want to focus about yourself, you want to know whether there are actions to be taken, actually to go towards a healthier life. And let's say one of the reasons is to sleep. Because the sleep is maybe the only way that we can really recover from, you know, whatever, daily aggressor to our lives. It can be stress, it can be whatever. Even pollution, things like this. It's during the sleep that we regenerate, we rebuild ourselves. And it's mandatory that there should be, if you want to talk about lifespan, there should be a very good sleep detection. Myself, for instance, I've been testing plenty of devices on the ear, on the wrist, on the finger, and there is nothing more comfortable than sleeping with a ring device. And so you can imagine that if the user finds it comfortable, then the likelihood that he or she will basically sleep with it increases massively. And which means you're assured that you will be recording data, you will be knowing what's going on. And that's the only way I show you can really create something that can be useful for the user. So sleep is one of the main reasons why the ring is so important, and why there are so many ring devices that are actually popping up today in the market.

Alex Jani, X-Health.show  24:05  
Your PhD. wasn't about constructing the ring was it?

Dr. Antonino Caizzone, Velia Ring  24:09  
My PhD was about building this PPG 2.0.

Alex Jani, X-Health.show  24:14  
So the small miniaturized PPG.

Dr. Antonino Caizzone, Velia Ring  24:16  
All of this. I could have stayed in academia and trying to push it farther, maybe thinking about PPG 3.05, whatever. I was more interested in... I mean, I'm still a strong believer that this PPG technology can be a breakthrough for these new devices to come. My objective was taking this technology from the lab and bringing to the market. That's the reason why I co-founded the company Symbiosis which is the company behind Velia smart ring, and for four years I've been doing just that, working hard taking this technology from the lab to the market. In these four years journey, the team that we built, we built vertical know-how not only on the chip, but also in on how to build devices, wearable devices, which basically means combining mechanics with electronics, integrating batteries, and then building algorithms that have done clinical trials, for instance, on the blood pressure, but even other things. And then we said, together with this increasing awareness that smart rings are very useful devices, it has been a cocktail that eventually convinced us that this was making rings was the right decisions to take. And this basically goes into late 2022, when eventually the company took the decision to go into the ring market.

Alex Jani, X-Health.show  25:58  
And you mentioned "us" and you mentioned "co-founded", so who is your co-founder?

Dr. Antonino Caizzone, Velia Ring  26:03  
My co founder is Assim Boukhayma. He used to be my colleague during the time of PhD, actually he is slightly older than me, so he was finishing his PhD a bit earlier than me. Then he stayed as a postdoc at EPFL. For a couple of years we worked together and then we founded the company together. Since  January 2018, when the company was founded. I mean, we've always worked together, and we're still working together. And today we are co-leading the company.

Alex Jani, X-Health.show  26:21  
And when you were working on this, because you are working on this miniaturization, weren't you? What were the challenges to make it smaller?

Dr. Antonino Caizzone, Velia Ring  26:47  
You mentioned, making smaller the chip or the full system?

Alex Jani, X-Health.show  26:53  
No, no, the chip.

Dr. Antonino Caizzone, Velia Ring  26:58  
If we go back to what I said, that you have, let's say 1 million photons and you get one photon back. Imagine that you take basically a bucket and it's raining. And you want to fill the bucket with the drops of rain. I mean, if there are not a lot, if there are few drops, then in the end, you're gonna get nothing in your bucket. Imagine a bit like this, you know, so you need to think that, yes, I'm gonna have few drops of water from the sky, but I still have to take all of them on something which is very small. This is the main challenge. And we overtook it, thanks to the usage of this technology, which is called CMOS Image Sensor, that is a magic technology because it allows on very tiny pixels, it's what you have, like, in a camera or a phone, it allows on something which is very tiny to collect quite a lot of light. And that is actually the breakthrough about this.

Alex Jani, X-Health.show  27:59  
How do you remember the moment when you actually achieved that?

Dr. Antonino Caizzone, Velia Ring  28:04  
Very well. It was exactly in 2018...

THE CONVERSATION CONTINUES ON THE PODCAST