Adapting glaucoma training and treatment: Insights from the Orbis Flying Eye Hospital

In a conversation with Ophthalmology Times, Omar Salamanca, MD, staff ophthalmologist, Orbis Flying Eye Hospital, discusses Orbis's tailored glaucoma training programs, which focus on hands-on surgical skills, early detection, telemedicine, and personalized follow-up care, helping underserved regions improve glaucoma management and blindness prevention.

Video Transcript:

This transcript has been lightly edited for clarity.

David Hutton: I'm David Hutton of Ophthalmology Times. I'm joined by Dr. Omar Salamanca, staff ophthalmologist, Orbis Flying Eye Hospital, to discuss how Orbis treats and trains in glaucoma. Thanks for joining me. First, how does Orbis tailor its glaucoma treatment protocols to meet the specific needs of the regions where you provide care?

Omar Salamanca, MD: Hi, David. Thank you for this interview, for providing this information to the people. My team, we normally visit the country 6 months or 1 year before. So, we try to understand what is happening in the ophthalmology field in the country. We have to understand what the level of training is, and we can tailor the program according to that. We can scale up or down according to the needs. Because we, as Orbis Flying Eye Hospital, can provide different levels of training, starting from basic, intermediate, or advanced. So, after these interviews, we decide what kind of surgeries we’re going to teach during the Flying Eye Hospital program.

David Hutton: What role do you see telemedicine and virtual reality playing in the future of glaucoma training through Orbis, particularly with the Flying Eye Hospital?

Omar Salamanca, MD: Well, technology definitely is something very important now to train all the personnel in eye care—not only in eye care, but in medicine. So, it’s a very important tool. And with Orbis, we have different platforms. We have Cybersight, and with Cybersight, we have a lot of courses, nearly 20 different courses, again at different levels: intermediate, basic, and advanced. We also have this system to telementor for the doctors. So, that means that we can ask the doctor to upload the information of a specific patient, and they will be connected with a glaucoma expert anywhere in the world. Within 24 hours, they will have recommendations, and they can start this conversation about the patient. It’s a very interesting platform that helps. That platform allows you to include images, which are very important in ophthalmology, and you can also upload videos. You can do it from your laptop or even from your cell phone. And another important thing is about the artificial intelligence in Cybersight. We have a system where you can upload the single images of the fundus. So, it works very well for diabetic retinopathy because it can tell you if it’s positive or negative for that disease. But we can also check for the optic disc. The system, within 10 or 20 seconds, will tell you if the optic disc is normal or abnormal. After that, you can make a decision as a doctor. I have to say that glaucoma diagnosis is a little bit more complex, so we need to consider age, intraocular pressure, and visual fields, but it’s a very important tool that we have available in Cybersight.

David Hutton: What are the key challenges you face when diagnosing and treating glaucoma in underserved regions, and how does Orbis help overcome these barriers?

Omar Salamanca, MD: Yes. There are many different barriers, according to the countries that we visit, of course. But first is sometimes the doctor doesn’t have the surgical skills to deal with this disease. But sometimes, they don’t even have the clinical skills to properly diagnose the disease. So, this is where Orbis is focused, mainly doing the MTH programs. But again, it’s mentioned in the access to the health services. Sometimes, the patients don’t live close to the centers. So, with this technology that we mentioned before, we try to close that gap. Sometimes, there’s a lack of instruments, lack of special equipment, and Orbis not only provides the training through the FEH programs, but we also work with Orbis offices in the country, so we try to do some long-term programs to address these needs.

David Hutton: How does Orbis ensure that training participants acquire hands-on experience in glaucoma surgery and postoperative care, especially in complex cases?

Omar Salamanca, MD: It’s a very dedicated process, because we plan in advance, like 1 year. One of my jobs at Orbis is to visit the country 1 year before to understand how the situation in ophthalmology is, and especially glaucoma, because that’s my specialty. So, I have a lot of interviews with the doctors who have an interest in glaucoma, trying to understand what the level of training is, because there are different surgeries that we need to perform to treat glaucoma. And those are very basic, like trabeculectomies, and sometimes include tube insertions or the MIGS. So, regarding that assessment, we decide what kind of surgery we will teach during the program, and we identify the expert in that surgery. Before we start the program, we do a simulation training week in the Flying Eye Hospital. So, that’s part of my role. I teach them with the plastic eyes, with models, and in the very safe environment without patients. I try to teach very, very specifically—how to hold the instruments, how to grab the eye. This is very important. And the following week, we have the surgeries with patients. The expert should have a lot of experience teaching residents and doctors in their home countries, so they teach them and also follow up on the outcome of the surgery. And when we finish the program, in 6 weeks or 8 weeks, it depends, one of the staff visits the country to see the outcomes and to provide feedback. It’s a very, very connected program. We try to connect.

David Hutton: What kind of follow-up care is typically provided for glaucoma patients after Orbis has completed a project, and how are they monitored for disease progression?

Omar Salamanca, MD: Yes, through our platform, Cybersight, we are able to upload the information before surgery, during surgery, and after surgery. We encourage local doctors to communicate with the volunteer faculty, our expert, but also the Orbis staff is visiting the country to be sure that the outcome is according to the clinical standards. If we identify something that is not going well, we have to provide the advice regarding how to treat the patient, and we also provide, not only advice, but sometimes some medications to treat the patient after surgery. As mentioned before, sometimes we support them with technology. So, it’s very important, not only to do the surgery, because most of the time it goes well, but with time, especially with glaucoma, you can identify some specific conditions that you need to treat to prevent the progression of the disease.

David Hutton: How do the Orbis glaucoma training programs address the differences between open-angle and angle-closure glaucoma, particularly in those diverse populations with varying genetic predispositions?

Omar Salamanca, MD: That’s a very, very interesting question. Glaucoma, in the end, is a problem in the optic nerve, which is in the back part of the eye. What you mentioned is something in the anterior segment. So, we try to focus the training, because the diagnosis may be different and treatment also may be a little bit different, but that’s part of the program that we decide. If we are going to Asia, for instance, we will find more narrow-angle glaucoma. But if we go to Africa, there’s going to be more prevalent open-angle glaucoma. So, we try to understand that context for the countries. We also identify and provide the structure or the content of the training lectures—how to make a distinction between narrow-angle and open-angle. We have to focus on gonioscopy, which is something very specific to identify if the angle is narrow or not. When you’re a glaucoma specialist, you see glaucoma as a whole, but you have to check for the details. And we’re very good at trying to identify those details because it’s very important regarding the prognosis and also the treatment.

David Hutton: How do you balance teaching new glaucoma surgical techniques with the importance of improving early detection and preventive care while you’re on a training mission?

Omar Salamanca, MD: That’s definitely a must. We cannot focus only on training in the latest surgical techniques. We have to go to prevention, and that’s not including only ophthalmologists. We also have to include local doctors—I mean, general practitioners, nurses, optometrists—because what we know about glaucoma is if we detect it earlier, we will have more chances to provide proper treatment. So, during the program, specifically, we have lectures in our classroom, and we broadcast the surgeries. But between surgeries, we are speaking about how to understand the risk factors for glaucoma, which is very important, how to properly assess the optic nerve, intraocular pressure. So, we have to do a balance. The other thing is that we raise awareness about blindness prevention. We invite people from the government, sometimes prime ministers or the Ministry of Health, and other important people, so we can bring attention to blindness prevention, and this is where glaucoma screening in the early stage has a very, very important role.

David Hutton: What kind of feedback do you get from the trainees afterwards?

Omar Salamanca, MD: Well, we have the professional feedback, which is regarding the cases. But it’s also a very good thing because we establish a good relationship with them. So, they start speaking not only about the cases that we did there in the program, but we also start having new conversations about new cases, new opportunities for them to be trained. Sometimes, we interact with them in medical conferences or at the Congress. So, it’s a very interesting part, not only in the professional field but also in the personal field. We start growing this community that’s been trained with the Orbis program. We try to establish this fair communication. And sometimes we become friends with them.