SIGHTLINES EPISODE 2: THE ORBIS SPIRIT OF INNOVATION TRANSCRIPT

Hosted by Dr. Hunter Cherwek, with guests Dr. Andrea Molinari, Dr. Daniel Neely, and Dr. Eugene Helveston.


Dr. Hunter Cherwek: “Telemedicine” and “telehealth” are words we’ve heard a lot lately and that's because during the COVID-19 pandemic – when in-person interactions are limited – this kind of technology has taken on all new importance.

Fortunately, telehealth and e-learning in the field of global ophthalmology are something Orbis has been developing for decades. Because of this investment, when many of our in-person programs were forced to pause in 2020, we had an alternative, online solution ready and this has enabled us to continue providing critical training and care around the world.

Today on Sightlines, we’re going to take a closer look at Cybersight, Orbis’s telehealth and e-learning platform, and the role it’s playing during the pandemic. I’m your host, Dr. Hunter Cherwek, Vice President of Clinical Services at Orbis International.

The first thing to know about Cybersight is that, if you want to, you can see if for yourself right now. Just go to cybersight.org. What you’ll find is an online resource for eye health professionals in low to middle income countries all over the world. It offers structured courses, webinars, live lectures and surgical demonstrations – which are not for the squeamish, so please view at your own risk and not during lunch! There’s also a library full of video presentations, case studies, textbooks, papers, and so much more. All to help doctors, nurses, and others build their skills so that they can provide quality eye care in their own communities, and contribute to the fight against global blindness. There’s also a feature we call Cybersight Consult, where doctors seeking case consultations or ongoing mentorship can connect with experts.

It’s that notion of connection that sparked the idea for Cybersight back in the early days of the internet when a visionary ophthalmologist, who we’ll talk with later in this episode, set out to provide continuing support for doctors who had participated in projects with Orbis’s Flying Eye Hospital.

If you’re not familiar with it, the Flying Eye Hospital is Orbis’s flagship program, an ophthalmic hospital on board an airplane. It brings expert volunteers to provide hands-on training to local eye health teams. A typical Flying Eye Hospital program would last for a few weeks, so we developed Cybersight to provide a structured mechanism for mentors and mentees to stay in touch, and to continue the training, once the in-person program was over. And since then, the Cybersight platform has grown and evolved. And now with COVID, as I've said, it has taken on all new importance.

Cybersight is a bigger story than I can tell by myself, so I sat down – virtually – with Doctors Dan Neely and Andrea Molinari. Dr. Dan Neely is our Senior Medical Consultant for Cybersight. He’s also a Professor of Pediatric Ophthalmology at the Indiana University School of Medicine. Dr. Andrea Molinari is a pediatric ophthalmologist and an Orbis Volunteer Faculty member from Quito, Ecuador. They are both what I call rockstars of Cybersight. Here’s our conversation.

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Dr. Hunter Cherwek: Maybe you all can talk about what is Cybersight? Maybe, Dan, you start and then, Andrea, you talk about how you've used Cybersight as both a mentor and mentee? So, maybe Dan you'd start...

Dr. Daniel Neely: Of course. So, you know, Cybersight at its core was a consultation program. It was for people from low to middle income countries, who didn't have mentorship, who didn't have a lot of good training or experience to go on, that they could submit a case, for free, to an international expert and get mentorship and feedback as to what maybe they should do with that case.

Well, that was 1998, now that's actually become a relatively small percentage of what Cybersight does. Now, Cybersight is webinars, teaching platform to give a lecture. I think one of our records here recently was we had 1300 people from 105 countries simultaneously watching a webinar. So, that new teaching platform for us is really what the large majority of Cybersight has become. In addition to, like, the video library – we’re setting new records for video hits. And the thing that I like about Orbis videos in particular is not only are they done by international experts, but they're also all narrated and professionally edited. So you're seeing a definite teaching case; you're not just seeing a show-off case from someone that's been cobbled together. So, that's a tremendous resource that we have.

And now we also have growing library of flat out professional, educational material and our motive for this was a little bit selfish, at first, that we wanted to standardize our programs and what we taught. But we're building up this complete platform of, kind of like, what do you need to know, to do [or] to be a pediatric ophthalmologist, and what do you need to know to be a glaucoma specialist. You know, what is it you would learn during a year-long fellowship, if you had that opportunity. So we're seeing this tele-education component really outshine the telemedicine component that we offer. And I just think that's incredible.

Dr. Hunter Cherwek: No, I agree and that record holder who had more than 100 countries watching her webinar is also Dr. Andrea Molinari. So, Andrea, maybe you could talk about how you've been on both sides of the tele-mentorship equation?

Dr. Andrea Molinari: Yeah, when I started, I started as a mentee to Dr. Helveston. As I told you, when I finished my residency program, there was no way I could do a fellowship program at that time. And I, also, I am originally from Argentina, where you have lots of academic activities going on. But when I came to Ecuador, first, I was the only ophthalmologist working exclusively as a pediatric ophthalmologist and strabismologist. So I had nobody to consult my cases. My learning was only through my own patients, but I learned from my mistakes.

Unfortunately, I had to learn from my mistakes till I met Dr. Helveston. And I actually met Dr. Helveston through a chat – a pediatric ophthalmology chat – where we were discussing about missions of doctors coming from the developed world to the not developed world. And the problem we had at that time is that they came with the residents, they perform surgeries and then they went away. But they didn't work with local doctors; that was the problem. And this is the big difference with Orbis. Orbis works with local doctors and, believe me, that makes a huge difference.

So we had the problem that doctors came here, did cataract surgery, glaucoma surgery. But they did not have any contact with local doctors, and went away and nobody did the follow-up of the children. And all the cases were destined to a failure, because there were no follow-up. So, we were discussing this in the chat. And then I sent a message one day and it said actually what we need here in the developing world is not doctors coming to us and making our surgeries. It’s doctors coming to us and teach us how to perform the procedures and be next to us to do those.

And that's when Dr. Helveston contacted me. Well, he said, you see that's what Orbis is about. And that's what Cybersight looks into contacting local doctors in the developing world and helping them to achieve that knowledge to perform their job better and easier. Imagine, I was thrilled when I got to know about that because, I said, well, that's my opportunity to keep training myself. At that time, I didn't have the means to travel too often go to meetings. And this opportunity was a fantastic opportunity to me.

I always say I did my fellowship training, I did an internet fellowship training with Dr. Helveston, because I consulted with him over 100 cases in that period of, maybe, 10 years. He gave me my first digital camera with which I could take the pictures of my patients and send them to him and it was fantastic. Then, I also started traveling. I did a very fast change from mentee to mentor, and also – you know, Dan – going to missions you go as a mentor, but you always learn something in each mission. So the training continues now. So I'm very happy and, definitely, Cybersight changed my professional life.

Dr. Hunter Cherwek: Orbis has always been about connecting, connecting the patients to providers who can help, to connecting doctors who want more training. Maybe you can talk about the personal connections and your experience with that at Orbis and through Cybersight. Maybe we'll start with you, Andrea?

Dr. Andrea Molinari: Well, personal connections are so important and I could sense this, or experience this, with my first connection with my mentor, Dr. Helveston. As I told you, I was the only pediatric ophthalmologist and strabismologist in Ecuador at that time. And I felt so lonely, because I didn't have anyone to consult my cases. Then, suddenly somebody of the stature of Dr. Helveston – which I knew from meetings or from books – suddenly being concerned about my patients and my well-being towards these patients. [It] was for me an incredible feeling, an incredible sensation. And this is-- remembering about that, this is what I tried to do when I was a mentor myself and making feel my mentees the way Dr. Helveston made me feel.

Dr. Hunter Cherwek: Yeah, I think you said something very important. You never feel alone when you know someone cares.

Dr. Andrea Molinari: That's right!

Dr. Hunter Cherwek: Even if they are 3000 miles away, at least someone cares that my patients do well, that I'm learning this, or someone remembered my birthday or something like that. It is funny now, how you can connect with someone that you've never met, and they can be your – that you've never met in person – you can quickly become friends now.

Dr. Andrea Molinari: Yeah, and Hunter, you can only imagine when you are in front of a very difficult case, the patient is desperate and you don't know how to start with this case and you feel so lonely and you know somebody somewhere is going to help you with that is such a relief.

Dr. Hunter Cherwek: Dan, maybe you can talk about the importance of connections with Orbis and through Cybersight in your career?

Dr. Daniel Neely: You know, when you go someplace and you see how busy these clinics are – whether it's in Siem Reap, Cambodia – and there are 100 patients being seen that day. And yet-- you’d think, well, they're just going to go into survival mode and get through everyone and go home and come back and do it again. But, you see people who are willing to do that kind of volume and then sit down at night and send in a consult or read a chapter or do a course on Cybersight. They're willing to do that on top of what they just did all day long. Like Andrea, being a self motivated learner, you know, she made herself. She had that drive and she sought out Cybersight's assistance, but she really did it on her own. And when we identify people like that, how can you not want to support them. How can you not support someone who wants to help themselves – and when you see people do that, that gives a great sense of joy.

Dr. Hunter Cherwek: One thing I definitely want our audience to know, because not everyone, you know, listening and watching today knows about the importance and how common blindness is in the low to middle income countries, especially amongst children. Maybe, Andrea, you could start just with some of what you've seen in your career, the successes we've had in pediatric ophthalmology, but also where the field is going? Maybe you can just talk about your perspective on global blindness and pediatric ophthalmology?

Dr. Andrea Molinari: Well, childhood blindness is a really big burden for society. I know, you know, that child blindness is the second cause of blindness after cataract if you think about blindness years. So a child that gets blind will be blind for the next 70, maybe 80 years, even in the developing world right now, because the life expectancy is growing. So, it's a big burden. And this is something sometimes difficult to make the governments understand how important it is to prevent a child from preventable childhood blindness. I was in charge with the child blindness prevention project here in Ecuador from 2003 until 2010, and we've seen a really significant improvement. Especially regarding blindness due to ROP – ROP is retinopathy of prematurity – which is the first cause of child blindness in most countries here in Latin America.

Dr. Hunter Cherwek: As you said, the disability-adjusted life here – giving someone who is 3 [years old] sight for 50, 60, 70 years – is an incredible amount of money saved and given back to society. Dan, maybe you can talk about your experiences, what you've seen in your career and what diseases are growing, like, Andrea said, with retinopathy of prematurity?

Dr. Daniel Neely: Oh hey, things are critical right now. I think the estimates are that blindness and severe visual impairment is set to triple between now and 2050. So 30 years. Blindness is going to triple. Well, why is that? In some, and in a lot of ways, the developing world is a victim of its own success. So, if you're in a low to middle income country, you can improve some screening for congenital cataracts and things like that and more nutrition. But, you also have the flip side of this as economies develop. You have now food is more available so diabetes and diabetic blindness goes through the roof. And you have people living longer so cataract disease becomes more prevalent. You have babies that are surviving at younger and younger ages because the neonatology system is improved, but now those younger babies are going blind from retinopathy of prematurity. So you're trading one set of problems for new problems that are the result of your advancement.

Plus, you add on all the just increased population that we have, an increased survival, and now you've got an ophthalmic emergency where blindness is tripling. Well, how are we going to deal with that? Again, this kind of comes back to how can Cybersight can help us – Orbis and our ophthalmic community – scale up to meet this challenge. And we can't have three Flying Eye Hospitals and we probably can't deploy three times as many teaching ophthalmologists, but from a digital standpoint we can scale that up infinitely and easily and at low cost. So, I think this is what's pointing out that what we're doing, the digital platform tele-health and tele-education, is so critical because we have to meet this burdening crisis. And if we can teach one person who can teach 10 people, who can teach another 10 people – that’s how we scale up to meet this crisis.

Dr. Hunter Cherwek: You know, certainly Cybersight is something that has had particular relevance during COVID, and maybe you all can talk about how telemedicine has been impacting your practices or what you've seen during the COVID crisis.

Dr. Andrea Molinari: Well, you know, I'm a Program Director of the fellowship program in pediatric ophthalmology and strabismus in Ecuador and I have been using it from the start. So, all my fellows have to complete the online courses of Cybersight in order to get their diploma. And, of course, we had to stop our program because, first, the place where we see our patients closed its doors and it will be closed till January. So there was no way we could continue. Also, my fellow was called to the hospital to see and she's now attending COVID patients, because there are so few doctors that they called also training physicians from other sub-specialties.

So we keep working academically for Cybersight for tele-consultations. One of my fellows is from another city, so she went back and she's consulting me – not exactly through Cybersight, but through telemedicine she's sending me pictures of the patients and we keep working. So, I think that this pandemia brought a stop for most academic activities that involve traveling to meetings, especially, and this is why webinars have become so popular. And you see webinars all over now. There are webinars every day and every hour, but the good thing about Cybersight is that it was doing that for many years ago. Cybersight didn't start this now. So the webinars from Cybersight, the Cybersight has lots of experience in organizing webinars. So that's why we have such a broad audience, because Orbis webinars are well known to be one of the best.

Dr. Daniel Neely: Yeah, I think that's right. I think that this pandemic and the effect on institutions – including Orbis because, obviously, Orbis couldn't send the airplane or send doctors to the local hospitals, brought that to a crashing halt – but because we already had Cybersight up and running, it was an easy transition to continue our work. So, just like the country song, "we were country before country was cool", and we've been doing this for years now. But, definitely, once the lockdown happens, then you see that everyone's at home, everyone wants educational material.

And I think, our registered users-- January 1 of this year, we had about 16,000 registered users on Cybersight. First of July, we had double that, basically. 28,000. And whereas before maybe our webinars would have 100 participants, then all of a sudden we're getting webinars like yours and others where it's well over 1,000 and the people are from all over the world. And, the other thing, and also, you know, just the number of video views, like I mentioned, and page views, all that stuff has just gone exponentially through the roof. But I think what's interesting: you mentioned the zoom webinars – and yeah we were doing that for a long time and some people were comfortable with that and some weren't – but now, because everyone's been forced to use that kind of platform, I think that that's just going to make telemedicine here to stay. You know, telemedicine was a fringe player and tele-education was a fringe player before all this happened. Now, it's ingrained in what we do on a daily basis. And I think that's going to continue being a boon, not just for Cybersight but for medical platforms everywhere.

Dr. Hunter Cherwek: Dan, where would you like to see the telemedicine go? Where would you like to see Cybersight in five years?

Dr. Daniel Neely: In five years, I would really like to see the remote surgical teaching be one of our mainstays. I would like to see that. The other thing that I -- that has been a goal for me in the last five years that we haven't got there that I want to see happen in the next -- is that we have a regional same-language approach. Like in China. There were so many ophthalmologists in China that need mentorship, and yet our usership from China is so low because of the language barrier, and maybe some other barriers, but if we could have regional Chinese mentors – or like in Andrea's case, regional Ecuadorian mentors – you know, I think that just brings a whole new level to what we do. If we can do that while maintaining the quality of teaching that we hold our standards to, then that's really how we're going to reach the rest of the world that we're not reaching.

Dr. Hunter Cherwek: And Andrea, obviously you're someone who's seen the entire evolution of Cybersight from first meeting with Dr. Helveston and submitting cases on floppy disks to now giving a live webinar with other people from India to 102 countries. Where would you like to see Cybersight and Orbis – so both Cybersight and Orbis – where would you like to see us focusing our efforts, especially in pediatric ophthalmology, over the next five years?

Dr. Andrea Molinari: I agree with him that language is such a big barrier. And if we can have mentors from all over the world-- because if I could become a mentor coming from a developing country, we can get many other mentors from developing countries that might not have a formal training, but that are really interested in, that are good, and are interested in becoming mentors. So we can get mentors from all over the world who speak different languages. I think this is, what he pointed out, is very important.

Dr. Hunter Cherwek: Well, again, I just want to thank you both. I know you all are extremely busy. You have so many pressures and demands on you academically, professionally and, especially now, with COVID. So just want to thank you so much for taking the time to talk about your careers, your perspectives on global ophthalmology, and your history with Orbis. So from me to you: Thank you very, very much!

Dr. Andrea Molinari: Thank you, Hunter! It was a pleasure being with both of you here. Thank you also!

Dr. Daniel Neely: Thank you both. Always a pleasure!

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Dr. Hunter Cherwek: That was Dr. Dan Neely, joining us from Indiana, and Dr. Andrea Molinari, Zooming in from Ecuador. A name that came up a few times during our conversation was Dr. Gene Helveston and that’s because it would be impossible to talk about what Cybersight is and how we’re using it right now without talking about the visionary who created it. I had the pleasure of talking with Dr. Helveston over the summer. Here’s just part of our fascinating conversation.

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Dr. Hunter Cherwek: Well, Gene. Thank you so much for joining us here at Sightlines! Obviously, you've been a huge legend at Orbis, you're a pioneer in pediatric ophthalmology as well as telemedicine as the founder of Cybersight. I just really wanted to start this by thanking you. They say you should never meet your heroes, but always thank your mentors. So, I definitely want to start this segment by first saying thank you – not just for what you've done for me, but what you've done for Orbis and global ophthalmology.

Do you remember when we first met? Do you remember the first time we picked up the phone or when I flew out to Indiana to meet you?

Dr. Eugene Helveston: I remember that very well. You were a young whippersnapper and you came highly recommended and highly touted and, when I met you, you met and exceeded all of those expectations. And it was a lot of fun to get to know you, and it was even better to have you come aboard and do all the good things that you've done for Orbis and continue to do. So yeah, it was pretty good.

Dr. Hunter Cherwek: It was pretty funny. I was still in my residency training and I flew to meet Dr Helveston and joined my co-ophthalmologist or colleague, James Lehman – and to this day we remain friends and his son is my godson – and you sat us down and said, tell me what you know about telemedicine and tell me what you know about simulation. And we did not cover either of those topics in med school or residency. And within the first 30 minutes you had James on the laptop working on Cybersight – our telemedicine platform, which we're going to talk about more and more today – and you sat me down on the simulator. And we were doing more technology with you than we had been doing in our respective programs. So, obviously, you've introduced me to two very important fields that have carried on and grown within Orbis today, both simulation and the Cybersight telemedicine distance learning.

Dr. Eugene Helveston: I would have to say that you were both apt pupils and did a great job. And I can tell you at that stage for my own self with simulation and Cybersight, I was still learning too. So we were all learning together, I wasn't anybody very far ahead.

Dr. Hunter Cherwek: Well it’s kind of one of my favorite quotes: "the Wright brothers didn't have pilots licenses.” Nobody had a lot of experience with something new and it takes a bold innovator, like you, to not only see the vision but then drive it into the field. And what was most exciting was taking that technology to places where they had never even seen some of the internet or digital photography that you were, kind of, bringing out to the field on Orbis programs. And, certainly, I remember you joined us in Libya. When the plane first touched down in Libya, you came and did an entire week of teaching within the OR – but then also, with telemedicine in the clinic, teaching people how to upload and take digital pictures. Maybe you can talk a little bit about how you got started with Cybersight and, kind of, how that evolved into becoming the cornerstone of your career in technology.

Dr. Eugene Helveston: Well, I began to dabble with telemedicine in the ‘80s. I don't know why, it just interested me and I used it in some clinical applications – not for anything other than to learn how to do it. Then I picked up a book written about the history of telemedicine and I found out that it basically had its start in about 1967 at Logan Airport, connecting the airport with the Massachusetts General Hospital. And it wasn't used very much, at that time, but it was at the ready. And in Georgia they had some statewide telemedicine system, mostly connecting institutions, and I thought this sounded pretty cool. And I tried it, mostly with real time practicing and with some store-and-forward, but that stayed in the back of my mind until an Orbis program in 1998 in Havana, Cuba – one of the early hospital-based programs, where you go by yourself, the airplane had been there, had gotten the people all excited and interested in the learning that Orbis could offer. But in five days there I couldn't even scratch the surface. So the idea of telemedicine came back to the forefront and then that was basically the start of Cybersight over the next approximately six months.

Dr. Hunter Cherwek: Yeah, and it's really exciting when you go back and, obviously, to look at how your career has evolved where you're both a pioneer in pediatric ophthalmology and with global ophthalmology. Maybe for those who are not as familiar with global ophthalmology or visual impairment, maybe you can talk about your experience and why vision is so important to all patients, but especially pediatrics.

Dr. Eugene Helveston: People are born with the equipment for sight, but they have to learn how to see. The brain has to be able to receive the light rays, the in focus light rays, identical from each eye, except for the location located on either side of the face and brought together in a single unified image. And that starts with the child, the infant.

Dr. Hunter Cherwek: And you, obviously, have been dealing with children and the importance of pediatric vision, where a child who cannot see, cannot learn, has difficulty getting jobs. There's all kinds of psychosocial issues associated with blindness or strabismus and children and how it affects their development. So, you know, certainly your impact not just here in the United States with the fellowships and the research and the books you've written, but how you used Orbis and Cybersight to connect the world and connect you and your experiences as a pioneer in pediatric ophthalmology to experts in all over the world who have gone on to become thought leaders and trainers and professors in their countries.

Orbis has always been at the confluence of technology and training, where we can take the best technology, the best trainers and really transform a physician, a child or a family member’s life, or a health care system. And, you know, I think one of the things, I think you'd agree with me, ophthalmology has always seemed to concentrate the latest in innovation, whether it's lasers or imaging… I mean, just in the last five years, the FDA has approved the first gene therapy in all of medicine for ophthalmology and the first artificial intelligence in all of medicine and ophthalmology. So, it just seems by its nature, ophthalmology is always pushing the envelope of what is possible. And Orbis and that Flying Eye Hospital is right at that edge, trying to make sure that those trainings and those technologies get to the places that need it most.

You know, Gene, obviously I want to start talking about Cybersight. Maybe you can talk about how you not only continued your career in clinical medicine, but used technology to be a force multiplier so that you could have even a larger training legacy online through the Internet and digital photography.

Dr. Eugene Helveston: Well, Hunter, it started in 1998 in Havana, Cuba. I was asked to go on a hospital-based program for a week in Havana to the Ramon Pando Ferrer Eye Hospital, which was the premier hospital of its kind in Cuba. And I went and I met some very eager and enthusiastic young ophthalmologists. And we embarked on a, what I hoped would be a very fruitful week. It turned out that from some equipment shortages and some safety factors, that fulfilling the operative schedule was not going to be, in my opinion, in the patient's best interest. So I said I would come back in 10 days. I would bring some instruments with me and we would complete the operative schedule and sort of touch bases on a few other things. I did and I was feeling pretty good about myself and that would things had worked out, but I said there's a lot more that that we can do.

Even with this two sessions. And I said, let's figure out a way to keep in communication with the Internet and email and with digital photography. So, I came back for a third visit and brought cameras and a computer and a printer and so forth, and some medicines, and we learned together how we would take the appropriate pictures to capture the physical findings of the patient and then set up a data collection sheet. And we practice this and send a few emails back and forth. And I said, well okay, I'm going back to Indianapolis and I want to have you send me patients. They did several a week and I sent back my advice and recommendations, and then there was send back the results. So, we had that back and forth going between Havana and Indianapolis was quite successful. But I said, be careful and don't actually do things to the patients; just observe what's going on and I'll come back again and re-examine the patients personally.

So I said, let's go ahead and function as though this were a legitimate consultation, and you can do what I recommend and tell me how things turned out. And this continued for 10 years. In the meantime, I was contacted by doctors in Bucharest, Romania, and I visited there and set up a similar program. Then Orbis said, let's try this – the telemedicine, as we called it at the time – in a program in Dominican Republic. And so I went there in the fall of 2002 and we had a very successful time there, and I worked with two doctors there for most of the last 10 years that I was with Orbis. By the fall of 2002, Cybersight was an Orbis program and it was being incorporated into our teaching.

Dr. Hunter Cherwek: You saw the opportunity with internet, cell phones and digital photography to connect patients and connect their doctors to a global network. And I'm sure when you first went to Cuba on that hospital-based training by yourself on an Orbis program, you never thought that you'd have over 30,000 consults today. 25,000 learners are actively using Cybersight for the books, the courses, the lectures, the videos, the questions – all the things you started. The snowball effect has just been incredible. And so, you're right, I go to countries now and pediatric, especially the pediatric professors, they say, yes, my first teacher was Dr. Helveston. “I haven't met him or I only met him once, but we've managed hundreds of patients together.” Like Margarita Barnoya. I was just speaking to her the other day; she's in Guatemala. She is now the preeminent pediatric ophthalmologist in her country and she used Cybersight to manage retinoblastoma, a disease that is a pediatric cancer that affects the eye, and you created a link that put those children and those doctors to St. Jude's Hospital and to Hospital for Sick Children in Toronto.

I mean this is just an incredible thing that you've created. What makes you most excited about what you've done and the people that you've trained? What really sticks out for you about Cybersight?

Dr. Eugene Helveston: It's what you just said. And first of all, Cybersight, talking about it as an entity, I feel like I'm just a sideshow to it. Because it's the patients, the people who we are treating, the doctors, the Orbis volunteers who are in the multiple dozens, all of that-- It's like an orchestra, that has the violins on the left, the cellos on the right, and all of the trumpets and all of the parts and the wind instruments. It's a whole family of accomplished people and the only way it works is to have them all working together on the same page. And I sort of had a little bit of a role of, maybe, as a conductor's helper or helping get the music sheets together and so forth, to kind of help put these people together and put them all on the same page to work so.

And I had, there was a lot of people who worked in the background. Faruk Orge, who started off as a research fellow, was extremely helpful to me in the beginning putting things together – just the mechanical part, just having a young guy at your shoulder, who was more computer literate in those days. Linda Smallwood, who was just right at the right hand at the right time for everything. She kept me on course in all aspects of it. And there are many other people. People from Clarity in Canada, who put the website together. And the Canadian International Development Association. And the Von Bryson family, who provided the cash infusion in the beginning when it was really necessary to have somebody to say, well, you know, we think this is worthwhile and we're going to support it. We don't want anything from it, except hopefully that it's successful and it works. All of this, all this stuff went together and it was basically a thing that the world was ready for it to happen. And I was very lucky to be there right at the time when it was going to happen anyway and I had the opportunity to pick up some pieces and put them together and it worked. So, it was a team effort and the story doesn't end here. I think this is ongoing. I think it's going to become more a part of healthcare delivery and doctor training as time goes on. Because like you mentioned, on the other technical aspects we keep learning new things. And this is not the end; it's the more the beginning or the continuation than anything.

Dr. Hunter Cherwek: Yes, I definitely think some of the best chapters for Cybersight have yet to be written. And, right now, we're obviously in a very difficult time with COVID. Right now, the Orbis plane is not flying for obvious reasons of the COVID pandemic. But, what's been incredible: since the pandemic started, Cybersight has grown 300% and has become the resource where many doctors now can't go to conferences, they can't go to their hospitals, the residents can't go and operate. I think that COVID has really highlighted the value that Cybersight and telemedicine bring. What are your thoughts on the utility of Cybersight, especially now during the COVID crisis? Not just for patient care, but for teaching and keeping the world and the ophthalmic community connected and driving innovation during COVID?

Dr. Eugene Helveston: It's the key, it's the link that's going to keep us connected, and it's going to keep us involved. It's going to make sure that things don't get out of hand that we don't get isolated in silos. And I think in teaching and communication and so forth, the COVID just introduced us to possibilities and we're going to use these possibilities in a positive way. After we learned about it, with a very negative thing that we'd like to wish away if we can. So no, this has been a crucial time and people's ingenuity, initiative, and necessity has just upped the stakes and made it clear that the telemedicine and communication like this is really key to our lives and it's going to be around. Around and enhanced.

Dr. Hunter Cherwek: Absolutely! And I think that's what's most exciting is obviously how Orbis is still continuing its mission through Cybersight today. For example, the plane was supposed to be in Africa right now with Zambia and Cameroon partners. Well, we've been doing-- just this week we've been doing training in Zambia and we've been doing several weeks of training in Bolivia with nurses, engineers and ophthalmologists. All of this is through the Cybersight platform. So, I can tell you that Cybersight has grown, not just within the ophthalmic community of the world, but even within Orbis now, Cybersight has become the solution for many of the challenges that COVID has presented to us. I think what's incredible is how much innovation we've taken and brought under the roof of Cybersight. For example: artificial intelligence. I believe we're the only healthcare organization in the world that has democratized AI where any eye doctor in the world can use our AI platform to validate and see patients. But we're not doing it to diagnose the patients as much as machine mentor them, or use artificial intelligence to show the learning doctor how the computer made the diagnosis and then our human mentor gets on and goes through the consult and discusses it with a doctor. When you first were in Cuba with your digital camera and your printers, did you ever think we'd be talking about Cybersight bringing AI to the world?

Dr. Eugene Helveston: No! But on the other hand, I didn't think that David Paton could talk people into helping him make a Flying Eye Hospital. But, having said that, I do have a boundless enthusiasm and confidence that we're just going to get bigger and better and smarter and that applies to Orbis is going to get bigger, better, smarter and more effective. And it has done that, steadily over the years, and it's just going in the right direction and it's got a long way to go and it's going to make it. I'm sure.

Dr. Hunter Cherwek: You started all of this many years ago and that was your vision, that we still continue to take forward today. So thank you for all that you've done for Orbis and our mission.

Dr. Eugene Helveston: Thank you.

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Dr. Hunter Cherwek: That was Dr. Eugene Helveston, Emeritus Professor of Ophthalmology at the Indiana University School of Medicine, and the founder of Cybersight.

Thank you for joining me for Sightlines today. I hope you’ll join us for the next episode and for the entire series. If you would like to learn more about Orbis and the Flying Eye Hospital, please visit us at orbis.org.

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Until next time!

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