• Orbis: Transforming an Epic Crisis into an Opportunity

    In 2020, those of us in global grassroots and governmental organizations eagerly awaited new prevention of avoidable blindness initiatives worldwide.

    But preparations abruptly halted as COVID-19 brewed. In the many months since, however, a commitment to innovate and adapt has paved the way for new opportunities, and Orbis, a global eye care organization, has been at the center of it. 

    “Never let a good crisis go to waste,” British Prime Minister Winston Churchill once said, and Orbis has approached the pandemic by creating novel opportunities in global eye care that have helped reshape global ophthalmology.

    Background

    Even before the pandemic, Orbis had been changing the landscape of global ophthalmology by transforming lives through the prevention and treatment of avoidable blindness for nearly four decades. Orbis used these resources during the pandemic:

    • The Flying Eye Hospital, a fully accredited ophthalmic teaching hospital on board an MD-10 aircraft
    • Cybersight, Orbis’s award-winning telemedicine platform. Through this telemedicine platform, in 2020 alone, Orbis reached 192 countries and regions, trained 26,041 eye health professionals, completed 746 consultations for remote patient cases, enrolled 1,485 new eye care professionals and conducted 107 live webinars and surgical demonstrations with 15,589 unique participants from 175 countries and regions. 
    • Over 400 volunteer faculty (medical experts), who share their skills and expertise with local eye care teams
    • Long-term eye care programs in 14 countries

    I had the humbling opportunity to work with Orbis in the field in South Africa and Argentina and was truly amazed by its ability to be a catalyst for increasing access to eye care in areas with the greatest need and as an advocate for stronger eye health systems that can prevent and treat avoidable blindness.

    COVID-19 Pandemic Challenges

    When COVID-19 happened worldwide, “we stayed calm, level-headed, and ensured that the health and safety of all our patients, staff, and partners were prioritized first,” Orbis Vice President of Clinical Services and Technologies Dr. Hunter Cherwek said. 

    Orbis prioritized leveraging its existing technology of Cybersight to scale distance learning, remote surgical mentorship, artificial intelligence (AI) and simulation training virtually. In fact, the Cybersight AI tool (see the slide show) can detect common eye diseases – like glaucoma, diabetic retinopathy and macular disease

    In addition, the organization created virtual COVID-19 trainings and resources for partner institutions, helping them keep their staff and patients safe. More than 200 institutions adopted COVID-19 prevention protocols Orbis provided in 2020. 

    That systematic response and reputation for prioritizing safety led to Orbis’ selection as one of the first groups to continue mass drug distribution of antibiotics to fight trachoma in Ethiopia; people trusted its COVID-adaptation methods. Here are specific COVID measures that Orbis implemented:

    • Ensured COVID-19-safe access to care continued through door-to-door outreach. Orbis continued trachoma-elimination efforts in Ethiopia by going door-to-door for mass drug administrations, rather than conducting them at communal gathering places. In Nepal, Orbis’s Refractive Error Among Children (REACH) program typically provided vision screenings for children at school. But when schools closed due to the pandemic, it changed to a door-to-door screening model and even home delivery of glasses.
    • Ensured rural communities were not left behind. Orbis continued to support vision centers that ensure rural communities in countries like Bangladesh and India can access care close to home, which is especially critical when travel is not possible or is risky due to COVID-19. Some centers were also equipped with the technology to use telemedicine to connect patients who need more specialized care to experts at hospitals – virtually.
    • Ensured eye care teams everywhere could access training. Orbis leveraged Cybersight to keep eye care professionals in areas with the greatest need from falling behind in their education amid the pandemic and to launch online adaptations of the trainings traditionally taught on board the iconic Flying Eye Hospital. As a result, Orbis is now training more people in more places than ever before.

    Dealing With Stress

    The other difficulty that Orbis responded to was one faced by every member of its global team. The human suffering and internal struggles that families faced — from the Orbis headquarters in New York to country offices and affiliates around the world — was palpable. 

    “Taking continual inventory of our mental health and support and caring for one another were key for the organization to sustain its scaled-up pandemic response. Getting this right has not always been a perfect science,” Dr. Cherwek said. 

    “Because of our training, the tendency for those of us in the medical field is to prioritize the people we care for. But COVID-19 was a reminder that we have to take care of ourselves and our teams as well,” he said. “We all became patients in the COVID experience.”

    What Young Ophthalmologists Can Learn 

    With a changing landscape bringing artificial intelligence and other technology to the forefront, there has never been a more exciting time to be a young ophthalmologist and to pursue global ophthalmology. 

    Gone are the days that catching a flight and traveling are synonymous with outreach and global eye care. The Cybersight telemedicine program shows us how Orbis has been able to leverage grassroots technology to reach eye care teams no matter where they are. 

    This shift is also critical to decolonizing global ophthalmology and democratizing access to eye care more effectively and efficiently. Technology is the force multiplier in learning agility in the future of global ophthalmology with uniquely blended learning platforms. 

    Young ophthalmologists must continue to look beneath the surface of a crisis to uncover the opportunities in the global health arena. 

    “In this new COVID era, the largest impact we can make in global ophthalmology is by leveraging new technology versus just our passports,” Dr. Cherwek said.

    About the author: Luxme Hariharan, MD, MPH, is a pediatric ophthalmologist and global health expert in the division of ophthalmology at Nicklaus Children’s Hospital. A global researcher and child health advocate, Dr. Hariharan is passionate about international health policy. She has worked at the World Health Organization in Geneva, Switzerland, to prevent controllable blindness and on blindness prevention programs in Argentina, India, Mexico, Niger and South Africa.  She is also a member of the Academy’s YO International Subcommittee.