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Novel telemedicine technology platform allows for real-time mentoring in clinical setting
Using Cybersight telemedicine technology, Orbis International can teach procedures in real-time and mentor doctors-in-training abroad.
Orbis International, which operates the Flying Eye Hospital and is the world’s only ophthalmic teaching hospital on board an MD-10 aircraft, is best known for its charitable missions, where ophthalmologists travel to underserved countries and deliver sight-saving procedures aboard the (landed) aircraft.
However, it isn’t without great cost and effort. Teams of nurses, anesthesiologists, and biomedical engineers must be assembled, and travel doesn’t come cheap-especially when medical equipment needs to be transported.
But what if service could be delivered instantly, without the expenses or logistics of traveling? Thanks to Cybersight, a technology platform that digitally bridges the gap between volunteer ophthalmologists and trainee ophthalmologists, it can be.
Education at the click of a button
Cybersight uses real-time video, online courses, and an Artificial Intelligence (AI)-equipped consultation service to help train and mentor other ophthalmologists in low and middle-income countries.
Daniel E. Neely, MD, professor of ophthalmology, Midwest Eye Institute, Indiana School of Medicine, University of Indiana, IN, and medical advisor for Orbis, says, ultimately, the program’s goal is help rural and impoverished communities create sustainable methods of ophthalmic care which were previously unavailable.
The program fosters a mentor-mentee relationship between an accredited ophthalmologist and a trainee ophthalmologist who lives in an underserved part of the world.
“You can only send people and equipment to so many places, but you can go everywhere, an unlimited number of times, with technology,” Dr. Neely says. “That is the power and force-multiplier that technology provides us.”
Orbis says it was able to train more than 5,000 professionals in 165 countries with Cybersight, and also facilitated more than 2,100 patient consultations in 2018.1
It’s also useful, as mentees can create individual profiles and have access to Cybersight’s digital library, which houses surgical demonstration videos, medical lectures and quizzes. Mentees are also able to have their course and lab homework graded by a volunteer ophthalmologist for accuracy with Cybersight, an extension of the platform which Dr. Neely praises.
“Not only is Cybersight not impersonal, it is a multi-part, in-depth conversation. I don’t simply tell a mentee what to do on a patient case they have submitted; I ask them questions, they provide follow-up information and updates, and we work together towards getting the best possible outcome for the patient,” he says.
Dr. Neely has completed almost 1,200 online consults during his span of 17 years with Orbis International.
“Technology is the facilitator, but the interpersonal communication is the most powerful tool we have,” he says.
However, the human element is still crucial when it comes to learning development, which can be challenging given that each person is thousands of miles away from each other.
“You get the best teaching when a relationship develops beyond watching a webinar,” Dr. Neely says. “You need trust and confidence in your teacher when being mentored, whether that is via technology or face-to-face.”
As with most technologies, there are still strides to be made-particularly when it comes to retina imaging and treatment, according to Dr. Neely.
Due to the inconsistencies of the local hospitals Orbis partners with, some have access to the equipment, but most do not.
“We still struggle to provide the highest quality retina consultations because the subspecialty is very imaging technology-intensive: fundus photos, OCT, FA, etc.,” he says.
The path ahead
However, a collaboration with Visulytix, an AI company, that integrates their technology, Pegasus, with Cybersight’s platform, could address the issue.
Pegasus analyzes retina images, which can be taken with a standard retina camera or even a mobile phone. The images are then uploaded to Visulytix’s cloud service, and in a matter of eight seconds the AI system generates a report to Cybersight with an analysis.
“Its [Pegasus’] addition to Cybersight enables doctors in low-resource countries to be some of the first to access to this latest advancement in medical AI to help them detect, diagnose and treat patients with blinding eye diseases,” says Dr. Neely.
In terms of educational outreach, Cybersight speaks volumes about what’s ahead for the future of charitable missions.
“I would like to see a day when we can easily do live, remote ‘hands-on’ teaching. By that, I mean the ability to have a mentor and a mentee in two different countries who can examine a patient together or perform a surgery remotely with the mentor as a virtual assistant,” says Dr. Neely.
While Orbis is piloting these things now, there are still kinks to work out, such as having enough bandwidth and limited latency.
“It’s coming-we can do it in a few places now, but I want to see us be able to do it everywhere we work,” says Dr. Neely.
Daniel E. Neely, MD
Dr. Neely is professor of Ophthalmology at the Indiana University School of Medicine Glick Eye Institute and specializes in all aspects of pediatric ophthalmology.
1. Orbis International. What we do: Cybersight. Orbis International web site. https://www.orbis.org/en/what-we-do/cybersight?gclid=Cj0KCQiAg_HhBRDNARIsAGHLV50hMuchIzP2tOGipYLv1L2OcEbDv9eJEmNqNU341aPX7jfaAIqTK0caAvqSEALw_wcB. Accessed December 6, 2018.