Module bridges remote gap in learning, mentorships

The Cybersight platform of Orbis International links health personnel in low- and middle-income countries to healthcare experts worldwide for consultations and training. 

This article was reviewed  by Hunter Cherwerk, MD

Orbis International has one of the largest and most diversified ophthalmology resource offerings in the world, and what it offers is completely free, with the goal of using technology to scale up its efforts to eliminate avoidable blindness in developing countries.

Cybersight, founded by Gene Helveston, MD, in the late 1990s, is the free eye health learning and mentorship telemedicine platform used by Orbis International to teach and disseminate information as part of its mission to prevent and treat avoidable blindness.

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Since the time when Dr. Helveston sought to teach strabismus procedures to Cuban physicians, Cybersight has evolved substantially to incorporate the Cybersight Consult, Cybersight Learn, and Cybersight Live Teaching components into its program.

“All of these areas are about building capacity in human resources in the low- to middle-income countries in which we work,” said Hunter Cherwek, MD, who is vice president, clinical services, Orbis International.

According to Dr. Cherwek, in the area of consultation, more than 150 top international ophthalmology experts are serving as mentors, and there have been more than 20,000 patient consultations undertaken for complex cases to date.

“We have been involved in 950 cases of retinoblastoma and linked doctors worldwide to St. Jude’s Hospital in Memphis and Toronto Sick Children’s Hospital in Canada,” he said. 

Dr. Cherwek noted Cybersight Learn offers online courses and an open-access library in topics related to ophthalmology, nursing, and associated fields. 

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“Doctors can go online free of charge and take multi-hour courses in, for example, phacoemulsification, small incision cataract surgery, pediatrics, and glaucoma,” he said. 

Cybersight Live Teaching offers live lectures and surgical demonstrations through real-time video conferencing, Dr. Cherwek explained, adding that it has been an explosive field for the company’s platform. 

“We are using artificial intelligence to enable our consults not only to teach our doctors what the diagnosis is but also how the diagnosis was derived, what algorithmic thinking was used, and how the ocular structures and associated factors are viewed,” he said.

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Growth spurt
The data collected from 2018 boast about the increasing numbers of surgeons taking advantage of the resources offered by Cybersight:

> 5,052 new users bring the total number of users to more than 12,000 globally; 

> 2,160 patient consults; and 

> 89 live webinars in 2,868 locations in 127 countries. The webinars and online courses trained 5,872 people in 165 countries.

The courses offered are not just for ophthalmologists but also include nurses, optometrists, schoolteachers, and community village workers. The online courses that are proving to be of special interest are those providing instruction in phacoemulsification and small incision cataract surgery, the latter of which is the most highly accessed course. 

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Mobile access
For Dr. Cherwek, the most exciting technologic advances are smartphone apps being used, for example, to enable tribes to move their cattle from place to place in anticipation of changing weather patterns. The mobile utilization of Cybersight has increased markedly from 2017 to 2019, compared with desktop access, he reported.

“It is exciting to see how much we have been able to democratize education and open up access via cell phone technology,” he emphasized.

Remote wet labs
Dr. Cherwek described the creation of academic bridges through the Cybersight platform with wet labs that have been established worldwide.

“We have normalized remote surgical mentorship in Peru and have the equipment ready to expand to Ghana, Cameroon, South Africa, Indonesia, and Bolivia,” he said. 

In this teaching model, international ophthalmology experts observe and mentor local surgeons in real time during live surgery, from thousands of miles away.

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The digital wet lab model, he explained, is now in Peru and at Emory University, and new equipment is on-site at Shroff’s Charity Eye Hospital in India. The wet lab courses now have standardized curricula, and individuals must be able to demonstrate knowledge and basic science competency before entering the wet lab in Peru.

Based on this experience, the residents receive grades based on the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) score and comments about their surgical performance and then review their surgical videos. 

Dr. Cherwek reported the results of a study in which 12 final-year residents who submitted 120 surgical videos were followed. The trainees’ average competency scores increased from 15.9 before training to 25.1 afterward.

Among 60 resident surgeries performed after training, the patients’ vision exceeded 20/60 in 91.7% of cases, compared with 76% at baseline.

Related: 10 effective habits of a cataract surgeon 

Cybersight insight
Cybersight is, first of all, a product that is free to people in low- to middle-income countries. However, it is ultimately a platform, according to Dr. Cherwek.

With the Cybersight Consult function, the primary purpose is to link clinic personnel in these countries to ophthalmology experts worldwide. 

“We can now do this using digital photography and the Internet to link any two eye health professionals,” he said.

In Cybersight Learn, all of the content is free and is being translated almost instantaneously into more than 35 languages. 

“This has become a learning management system not just of basic science but for evaluating residents’ wet lab training, OSCAR scores, and videos,” he noted.

The Cybersight Live Teaching component provides live global webinars on clinical and surgical topics. Dr. Cherwek acknowledged the work of Dan Neely, MD, a pediatric ophthalmologist who devotes 20% of his time to Cybersight, and is linked with all of the pediatric ophthalmologists he has trained in Mongolia, Peru, and elsewhere. From Indiana University, he has participated in surgeries in real time and provided surgical coaching. 

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Robert J. Weinstock, MD
E: rjweinstock@yahoo.com 
This article is based on a paper presented by Dr. Weinstock at the American Academy of Ophthalmology 2019 annual meeting. Dr. Weinstock is a consultant for Alcon.