Orbis' Flying Eye Hospital takes off for another flight in its mission to end blindness worldwide. (Photo by Geoff Oliver Bugbee)
For nearly five decades, the international nonprofit Orbis has sought to improve eye care in underserved communities in the developing world. And now, with today’s new technologies, it can offer the best training and access to first-rate ophthalmology to nearly any location on Earth.
Orbis’ latest aircraft, a Boeing MD-10 donated by FedEx in 2016, is a state-of-the-art medical facility featuring AI technology that is able to spot potentially blinding conditions faster than ever before. Its investments in cutting-edge technologies have revolutionized the nonprofit’s telemedicine capabilities by expediting two-way communication between ophthalmologists in the United States and Europe and their counterparts in Asia, Africa, and South America—even without the reliance on the Flying Eye Hospital.
Visual impairment remains a stubborn, yet treatable, problem. Approximately 36 million people worldwide are blind, 89 percent of whom live in low- and middle-income countries. There are simple medical procedures to address the underlying causes; if caught early, they even can be stopped or reversed. More than 200 million people globally suffer from moderate to severe visual impairment, and 80 percent of these cases can be prevented or treated.
Since its first flight in 1982, Orbis has supported nearly 1 million eye-related surgeries. Rather than trying to treat all the patients themselves, the organization seeks to build a global network of trained ophthalmologists. Because Orbis focuses on education, the airplane serves as a classroom. Surgeries take place in one part of the cabin and another section of the cabin contains a viewing area where clinicians can watch the surgery on a screen. Equipped with the latest medical technologies, the plane has become a model for how hospitals or clinics can be set up. “It’s great to take a head of state or health minister in and show them how a clinic can run, what procedures can be implemented,” says Orbis CEO Bob Ranck.
This focus on education distinguishes Orbis from other vision-related nonprofits. Everywhere Orbis goes, the organization invites local medical professionals into the plane to observe, learn, and replicate the medical practices onboard. “We’ve made a generational change,” Ranck adds, “from a first aid level to really changing people’s lives, by teaching more and more people how to treat cataracts, glaucoma, and trachoma.”
Onboarding Technology
Dr. David Paton, an ophthalmologist who taught at the Wilmer Eye Institute at Johns Hopkins University, started Project Orbis in 1973 to share his knowledge with medical practitioners in underserved communities. Those days did not have Skype, telemedicine, and the internet to transmit expertise, and doctors and nurses from lower-income countries often could not afford to travel to the United States to receive training.
The first Flying Eye Hospital took off a decade later. With a plane donated by United Airlines and a grant from the United States Agency for International Development (USAID), Orbis dispatched its new facility from Houston, Texas, to Panama City, Panama, in 1982. After this inaugural trip, volunteer pilots flew volunteer surgeons and ophthalmologists elsewhere, including Ethiopia, China, India, and Bangladesh, to train local medical professionals on eye care.
As Orbis’ scope expanded in the 1990s, it saw the need to improve its communication and data collection. In 1998, American ophthalmologist Eugene Helveston volunteered for Orbis to perform surgeries in Havana, Cuba, and then set up a rudimentary email system to keep in touch with the Cuban ophthalmologists who would provide follow-up care. This trip marked the beginning of the organization’s foray into telemedicine.
In 1998, a private doctor provided Helveston with a $150,000 donation to build a platform for tracking patient data. He used that donation to set up basic software that later became known as Cybersight, which enabled ophthalmologists to annotate three fundamental categories of data: history of the patient, exam finding, and diagnosis and treatment. Four years later, Orbis officially assumed ownership of Cybersight, with Helveston serving as its director. “Cybersight was used for 15 years with a few tweaks and upgrades,” says Dan Neely, senior medical advisor for Orbis and professor of ophthalmology at Indiana University.
In 2014, Orbis revamped Cybersight to make it easier to navigate and search for data. The program’s initial iteration made it nearly impossible for doctors to search for a particular case or specific region because all the information was cataloged in word processing software as notes. The revamp streamlined the process by introducing drop-down options, which were customizable and allowed for data analysis. Instead of typing in notes, a physician selects from an array of choices; these groupings can then be tagged and organized, effectively making the system more manageable, accessible, and easier to use.
Cybersight is the third leg of Orbis’ tripodic system, Neely says, along with the Flying Eye Hospital and on-the-ground eye care support. The system can be accessed on a mobile phone, tablet, or computer, and can run on lower bandwidths, making it ideal for telemedicine in under-resourced communities.
Cybersight enticed Gil Kliman, managing director of InterWest Partners, an early-stage health care and IT fund, to support Orbis and join its board: “With a mission that is obsessively focused on fighting avoidable blindness, I’m impressed by Orbis’ commitment to using technology and innovation to scale up their cutting-edge work, training and mentoring more eye doctors in more places than ever before,” he says. “I can’t think of a better way of using technology as a force for good.”
Flying Into a New Tech Era
While Cybersight previously provided only communication between ophthalmologists, it now live streams surgeries to a global audience and allows for two-way communication between surgeons and audience. Neely once watched a surgeon perform cataract surgery in Trujillo, Peru: “I could see what she was seeing and we could converse while she was conducting the surgery.”
The process also works in reverse: A retina surgeon in Cleveland, Ohio, for example, can broadcast the process, answer questions from clinicians around the world, and then make the video available on the database.
Orbis trained 5,872 eye health professionals in 2018 via Cybersight and conducted 89 live webinars consisting of lectures or surgical demonstrations that were broadcast globally. “Of the 196 countries in the world today, we were reaching 165 of them, and we did it for less than the fuel cost for the plane for the year,” Neely says. “This lets us go where we can’t take the plane or physicians.”
For example, Orbis can go to Syria and Afghanistan, where conflict is a constant threat. “I recall doing an online session with a physician in Syria and he had better connectivity than me in Indianapolis,” Neely adds. “The connectivity and broadband access are less of a problem now than they were 10 years ago. When Orbis started, you had to take the plane. Now, it’s hard to take the plane [because] there are security concerns. Internet, though, is almost everywhere.”
The pervasiveness of technology has enabled Orbis to expand its offerings. In December 2018, the organization added one more dimension to Cybersight: AI. With the simple addition of a digital photograph the software can help diagnose eye conditions such as diabetic retinopathy, age-related macular degeneration, and glaucoma.
Working with Visulytix, a London-based AI company, Orbis developed a new system called Pegasus that analyzes images of the back of the eye and then immediately transfers them through Cybersight to Visulytix’s cloud service. In eight seconds, a report is generated offering a diagnosis of the condition.
Jay Lakhani, CEO of Visulytix, says Pegasus can detect a range of conditions, but it is not exhaustive. “We are working on increasing the number of pathologies that can be detected,” he explains.
Neely agrees that Pegasus is not perfect yet. “Where it still falls short is in providing a treatment solution,” he says. “A lot of ophthalmology is very visual and requires pattern recognition. When it can start reading patterns, it’ll become a more powerful tool.”
The challenge, Lakhani explains, is in building algorithms that work reliably in real-world practice. “Image quality varies substantially in low- and middle-income countries where Orbis operates,” he says.
But Lakhani is optimistic. “I believe AI will completely change eye care. At the moment, there are far too many patients who see a clinician after they notice vision change or blindness,” he observes. “Sadly, this is far too late. … AI will detect these patients earlier when sight can be saved.”
Pegasus is just one tool in Orbis’ growing tech toolkit. In addition to developing software that lets surgeons access each other’s work, Orbis has also been investing in simulator eyes to train surgeons.
Ranck, who spent 31 years in the US Air Force before becoming the CEO of Orbis, thinks simulation can provide an ideal learning environment. Much like how pilots step into a simulator room and learn to fly planes, Orbis is putting surgeons to the test: Using synthetic eyes from London-based Phillips Studio, a company that specializes in creating simulator eyes, surgeons can practice multiple times before working on patients. Each eye can be used about a half a dozen times, Ranck estimates, and a dozen of them cost only $180, making it an affordable option.
The international development industries, particularly those addressing poverty and health care, are rapidly adopting AI, says Nick Martin, founder and CEO of TechChange, an organization based in Washington, DC, that runs online courses for professionals in development. “With the increase of AI technologies, Orbis and other similar providers are part of the next wave, using images that are captured at the point of care and running them against an extensive library of photos and algorithms in a matter of seconds to diagnose and treat with greater accuracy,” he says.
These new technologies, now a central part of Orbis’ work, only improve upon the original mission that Orbis set out to accomplish more than 40 years ago—not replace it. “Teaching people is a wonderfully sustainable model,” Ranck reiterates. “We’re looking at different technologies that make it easier to do that in the most remote parts of the world.”
This article appeared in the Fall 2019 issue of the magazine with the headline: "Seeing a New Horizon"
Read more stories by Esha Chhabra.