Courtesy of Geoff Oliver Bugbee and Orbis International -

better including doctors, nurses, biomedicalnurses, doctors, including cre was technicians, and engineers, Cybersight.through delivered and ated additionalan launched also Orbis forprogram Hospital Eye Flying virtual inprofessionals care eye 90 than more toforward look also We Cameroon. - -

Figure 1. Dr. Alward during his sixth Flying Eye Hospital program in Hue, , in 2019. Figure 1. Dr. Alward during his sixth Flying Eye Hospital program in Hue, Vietnam, in 2019. is not. In May, Orbis launched its virtu its launched Orbis May, In not. is programtraining Hospital Eye Flying al Zambiain professionals care eye for in-personreceive to due were who curricu remote A 2). (Figure training ofneeds training the to tailored lum providers, Zambian 100 than more - - - - ORBIS INTERNATIONAL’S FLYING EYE HOSPITAL FLYING EYE HOSPITAL ORBIS INTERNATIONAL’S GOES VIRTUAL BY HUNTER CHERWEK, MD, AND WALLACE L.M. ALWARD, MD has been affected by the COVID-19 pandemic and how those involved with international medical missions aremissions medical international with involved those how and pandemic COVID-19 the by affected been has

| SEPTEMBER/OCTOBER 2020

Although the Flying Eye Hospitalis Eye Flying the Although Orbis has more than 400 volunteer400 than more has Orbis At the onset of the COVID-19 pan COVID-19 the of onset the At Organizations adopt new ways of reaching underserved populations during the pandemic. underserved populations ways of reaching new Organizations adopt provide global ophthalmic care in this new reality. This article is part one of a series exploring the different ways that global that ways different the exploring series a of one part is article This reality. new this in care ophthalmic global provide time. unprecedented this during efforts their adapting the Flying Eye Hospital—theEye Flying the world’s ophthalmicaccredited fully only MD-10an board on hospital teaching 1).(Figure aircraft missionOrbis’ grounded, temporarily engineers, share their skills with localwith skills their share engineers, This world. the around teams care eye train providing by done primarily is Orbis’through hospitals partner to ing onCybersight, platform telemedicine on and hospitals, partner the at site faculty members from over 30 countries30 over from members faculty organization’sthe achieve to work who teamscare eye local help to mission pro can they care of level the improve volun These generations. future for vide ophthalmologists,include which teers, biomedicaland anesthesiologists, nurses, difficult decision to postpone its Flyingits postpone to decision difficult thethrough programs Hospital Eye plannedincluding year, this of end Mongolia,Cameroon, , to trips . and demic, Orbis International made themade International Orbis demic, With most international travel cancelled this year due to COVID-19, many medical missions have been unable to proceed as proceed to unable been have missions medical many COVID-19, to due year this cancelled travel international most With to order in practices their evolve and evaluate to opportunity the taking now are however, organizations, Some planned. IN THE ERA OF COVID-19 OF ERA THE IN GLOBAL OUTREACH GLOBAL GLAUCOMA TODAY

16 s GLOBAL PERSPECTIVES GLOBAL PERSPECTIVES s

offering these programs for eye care professionals in Mongolia and India this year and hopefully for other loca- tions in the future as well. The curriculum of every Orbis train- ing program is tailored to meet the needs of the participating local eye care professionals. Planning for a Flying Eye Hospital program is a process that Courtesy of Geoff Oliver Bugbee and Orbis International starts more than a year in advance, in coordination with partner hospitals with which Orbis has long-standing relationships. Because the virtual Flying Eye Hospital programs launched this year have served eye care profession- als who were originally going to train in person, the education they have been offered online has been informed by that meticulous preparation. In Figure 2. Dr. Alward during Orbis International’s inaugural virtual Flying Eye Hospital training program for eye care Zambia, for example, Orbis has been professionals in Zambia. working with partner institutions in the country for years and has a this often to our partner hospitals. that the courses improved their knowl- country office and permanent staff However, a chronic disease such as edge and that they would recommend on the ground; therefore, the Flying glaucoma does not stop progressing the courses to their colleagues. They Eye Hospital program—whether in because there is a pandemic. all showed interest in participating in person (Figure 3) or virtual—offers Fortunately, patients are slowly additional online courses and requested an opportunity to build on prior returning for in-person care, and more live educational sessions. training sessions. many of our partner hospitals around Of course, virtual training is not the world are looking to Orbis for without its challenges. One of the big- COVID-19’S EFFECT ON GLOBAL guidance on safety protocols as gest barriers to virtual training relates OPHTHALMIC CARE they reopen. In response, Orbis has to the lack of human interaction, Amid the lockdowns in the early launched a library of resources on which affects both relationships and stages of the pandemic, most oph- Cybersight that cover the topic of learning—for example, by eliminating thalmologists around the world were reopening—one more way in which the ability to shake someone’s hand or seeing only emergency cases, such the organization is virtually meeting provide hands-on support to demon- as patients with suspected cancer or the challenges presented by COVID-19. strate a technique. In addition, we miss traumatic eye injury. As a result, many out on working alongside other volun- patients missed their routine check- A VITAL RESOURCE teer faculty and Orbis staff members ups. Because glaucoma is a chronic Since the pandemic started, as well as the local nurses, technicians, disease, there is a danger that high Cybersight’s number of registered eye anesthesiologists, and bioengineers. IOP went undetected or uncontrolled care professionals has grown by more With virtual learning, we do not during the lockdown and caused irre- than 200%. Ophthalmology residents have the opportunity to get to know versible damage. It is possible that we who have been unable to return the people we are teaching in the still have not seen the full extent of to their institutions for traditional same way we would in person. Many those effects. in-person training have said that cultures are more formal than ours, Going forward, we do not want Cybersight has been a fantastic train- and training participants can be patients to forgo visits to their eye ing resource during this time. Users reluctant to ask questions of their care clinics or refrain from picking up have appreciated the ability to tailor teachers. On site, we can more easily their IOP-lowering medications from their learning by combining our syn- befriend the participants and help the pharmacy because they are con- chronous and asynchronous offerings. them to grow comfortable engaging cerned about COVID-19. We should Additionally, eye care profession- in dialogue, perhaps over lunch in the all take the necessary precautions and als from Zambia who completed the cargo hold of the Flying Eye Hospital. prioritize safety, and we emphasize virtual Flying Eye Hospital program said By working alongside our participants,

SEPTEMBER/OCTOBER 2020 | GLAUCOMA TODAY 17 - - - - n For a long time, Orbis has run itsrun has Orbis time, long a For When in-person visits are once againonce are visits in-person When [email protected] Financial disclosure: None Vice President, Clinical Services, [email protected] Financial disclosure: None Volunteer Faculty, Orbis International Professor and Vice Chair, Department of of Iowa Carver College of Medicine, Iowa City, Iowa Orbis International Ophthalmology and Visual Sciences, University Ophthalmology and Visual Sciences, University      n n HUNTER CHERWEK, MD n n n depth educational experience. educational depth CONCLUSION understandingthat the with programs arelearning remote and telemedicine has COVID-19 future. the of tools the accep mainstream their accelerated hereare they and uptake, and tance socialof age current the In stay. to remoteand telemedicine distancing, Orbis’of place the taken have learning notare they but trainings, in-person usget to measure stopgap a simply inways The pandemic. the through learning and adapting are we which ofhistory long our on build today wehow enhance will and innovation in-personand virtual our both run future. the in programs WALLACE L.M. ALWARD, MD n n to bring free training and mentoringand training free bring to and low- professionalsin care eye to have we countries, middle-income thesee to surprised pleasantly been doc by offerings course our of uptake such countries high-income in tors theand Canada, States, United the as Kingdom. United makingto forward look we feasible, compo long-term a training virtual pro Hospital Eye Flying our of nent Forlearning. blended through grams educationvirtual use may we example, thebefore pre-learning provide to in-personon build to or arrives plane Wedeparts. plane the after training in- more a permit will this believe

Cybersight was launched in thein launched was Cybersight Orbis has a long history of usingof history long a has Orbis Flying Eye Hospital programs leverageprograms Hospital Eye Flying beenhas Orbis that training virtual the Cybersight. through leading hasit and internet, the of days early hubtraining virtual 24/7 a become canprofessionals care eye where lectures.live and books, courses, access designedwas platform the Although VIRTUAL TRAINING NOW VIRTUAL TRAINING NOW AND IN THE FUTURE eyethat ensure to solutions virtual middle- and low- in professionals care qualityaccess can countries income ourpivot to us enabled This training. atseamlessly and quickly approach virtualThe pandemic. the startof the - - - | SEPTEMBER/OCTOBER 2020

The price point of cutting-edge technologies such as AI have too often kept them out of reach for of reach for kept them out often have too such as AI point of cutting-edge technologies price The Orbis International has an open-access AI tool on Cybersight (www.cybersight.org) that can that can (www.cybersight.org) on Cybersight AI tool open-access has an Orbis International professionals how to better identify signs of glaucoma in their patients. Orbis also offers similar AI also offers similar AI Orbis in their patients. glaucoma identify signs of professionals how to better retinopathy. diabetic disease and macular the detection of for tools AI democratize Orbis is working to that reason, most. For need them care professionals who eye the these tools countries can access middle-income in low- and that eye care professionals ensure and Cybersight. free through for AI TOOLS ON CYBERSIGHT ON AI TOOLS seconds. Because glaucoma a few from fundus photographs in just detect and visualize glaucoma them through a mentor doctor talk to have choose can to diagnose, Cybersight users difficult be can Orbis is teaching eye care establish a diagnosis. In this way, and help them findings machine’s the In the case of the virtual Flying virtual the of case the In

Figure 3. Dr. Alward with eye care trainees on the Flying Eye Hospital in Hue, Vietnam, in 2019. Figure 3. Dr. Alward with eye care trainees on the Flying Eye Hospital in Hue, Vietnam, in 2019.

ties. Additionally, these programs these Additionally, ties. existing with seamlessly in fit have we models learning blended around partners with running been the before long since world the started. pandemic challenges due to our existing rela existing our to due challenges profes care eye local with tionships hospitals. partner and/or sionals educational their of aware are We equipment what know and needs facili local their in access can they Orbis volunteer faculty members also members faculty volunteer Orbis in gaps the gauge to chance the have addressed. be to need that knowledge has Orbis programs, Hospital Eye these of some mitigate to able been Courtesy of Geoff Oliver Bugbee and Orbis International Orbis and Bugbee Oliver Geoff of Courtesy GLAUCOMA TODAY

18 s GLOBAL PERSPECTIVES