Last Updated: November 27, 2023
Introduction
Cybersight is an online training and mentorship service for eye health professionals in developing countries. Our goal is to increase the capacity of eye health professionals and health systems to treat and prevent blindness and visual impairment. Cybersight is an initiative of Orbis International.
All Cybersight services are free of charge, and anyone can create a Cybersight account. Cybersight services are available in a variety of languages, including Chinese (Mandarin), English, French, Mongolian, Spanish, and Vietnamese.
Cybersight Consult
Cybersight Consult is a consultation and mentorship service for eye-health professionals in Low- and Middle-Income Countries (LMICs). Patient cases can be submitted for a second opinion on diagnosis and treatment options from a pool of approximately 100 international experts, and responses are expected within 24 hours. The system includes automated workflows to send cases to appropriate mentors, remind mentors of overdue cases, and reassign cases to new mentors as needed.
There are four case types supported by Cybersight Consult:
- Patient Case: a patient-specific case where a history and exam findings are mandatory. Attachments such as photos, videos and diagnostic reports can be optionally included. There are two methods of assigning a mentor to a case:
- “Next Available”: the mentor is automatically selected by the system based on the sub-specialty and other factors.
- Closed Loop: mentees can be directly paired with mentors and direct their cases to named individuals. These pairings may come about as a result of a past training relationship or a referral pathway.
- General Question: for academic or theory questions not specific to one patient. The template for these cases is simple, with a subject line and a text box for questions. Attachments can likewise be included. The mentor is automatically selected based on the category of the case, and this case type includes options for anesthesia, optometry and biomedical engineering questions in addition to ophthalmology sub-specialties.
- Program Case / Pre-Screening: a special type of patient case typically linked to Orbis-supported in-person training. In this model, the mentee-mentor pairing is pre-defined, as is the sub-specialty. Additional patient details such as name and location are collected to assist in-person screening of patients typically linked to these types of cases. Orbis uses this model to pre-screen patients prior to Hospital-Based Training, Flying Eye Hospital training programs and Remote Surgical Mentorship sessions. These types of cases are optionally integrated with the Shareable EMR (Electronic Medical Record), such that screening-day lists of patients can be automatically generated, and pre-screened patient demographics and preliminary diagnoses are available in the EMR.
- AI-only case: a case in which only retina images are attached for AI grading, and no mentor is involved. The primary purpose is to produce a PDF report from the AI system.
Cybersight AI
Cybersight AI is a clinical decision-support platform for ophthalmology. This artificial intelligence platform can analyze photos of the retina (fundus images) to detect and visualize glaucoma, macular disease and diabetic retinopathy – a process we call Machine Mentoring. Output from the AI is available within a few seconds, and up to 8 images can be analyzed at one time. Cybersight AI is the only open-access AI platform for ophthalmology and is available to eye health professionals in LMICs.
There are three methods of using Cybersight AI currently:
- Cybersight Consult integration: when you submit a Cybersight Consult case in the glaucoma, retina or pediatric retina categories, you can optionally designate images for AI grading. When you submit your case, the AI will analyze your images and return a PDF report attached to your case within about a minute. This report will be available to both the mentee and mentor.
- Web application: there is a standalone Cybersight AI web application that can be directly accessed to submit patients’ images for AI grading, for example within a DR screening program. This application is available to Orbis-supported projects and partners by special request.
- EMR integration: if an institution has an Electronic Medical Records (EMR) system, Cybersight AI can be integrated directly into this system, via an Application Programming Interface (API). Therefore, instead of using the separate Cybersight AI web application for image grading and results for DR screening of patients, Cybersight AI is accessed via the institution’s existing EMR system. This service is available to Orbis-supported projects and partners by special request.
Cybersight Courses
Cybersight Courses is a Learning Management System (LMS) that houses publicly-available online courses in ophthalmology and related fields, and is also used to create custom, private curricula for special cohorts of learners. Cybersight Courses can be accessed by anyone with a Cybersight account in any country.
There are two methods of using Cybersight Courses currently:
- Public courses: there is a publicly-available course catalogue containing self-paced courses. A learner can enroll in any public course and will receive a certificate of completion upon viewing all course content and passing a quiz with a certain minimum score.
- Private curricula: the LMS can be used to construct a private curriculum for a group of defined learners. These curricula do not appear in the course catalog, and individuals must be manually enrolled. Private curricula can be used to create a ‘blended-learning’ course that combines online and in-person training, or custom versions of course content for special groups.
There is a special, separate version of Cybersight Courses for learners in mainland China. This service is hosted physically in China to improve its performance and compliance with local regulations.
Cybersight Library
The Cybersight Library is an open-access repository of medical lectures, surgical demonstrations, textbooks, manuals and quizzes. Library content is continually updated, does not require a Cybersight account and is freely accessible to everyone. Library contents are searchable and filterable by type, topic, and language.
Cybersight Webinars
Cybersight Webinars are live, interactive teaching events that typically take the form of a lecture or surgical demonstration. Faculty from around the world lead typically 1-hour events with time reserved for audience Q&A. Anyone can attend a Cybersight webinar, and a simple registration (name/email/country) is required. Registrants will receive an email reminder 1 day and 1 hour before the event and will also receive a follow-up email with a link to the recording, which is posted in the Cybersight library. It is common to have attendees from 100 or more countries in a Cybersight webinar.
Participants who attend a Cybersight webinar for at least 80% of the scheduled time and have a Cybersight account will automatically be awarded a certificate of attendance in their Cybersight Courses transcript.
Cybersight Mobile App
The Cybersight mobile app is available for iOS and Android devices. It focuses primarily on the Cybersight Consult service, making it faster and easier to create and respond to cases. It also supports the ability to submit AI-only cases, and the ability to work offline and automatically sync data when connectivity resumes. The app also provides easy access to Cybersight Courses through a seamless, single sign-on capability.
Remote Surgical Mentorship®️
Remote Surgical Mentorship (RSM) is a private, 1:1 video conference between a surgeon in an Orbis-supported project location and an international volunteer faculty who observes and mentors the surgeon during live surgery on a local patient. The remote faculty sees through the operating microscope, and the two doctors are able to discuss the case in real-time. Cases are pre-screened through Cybersight Consult to ensure the two doctors agree on the diagnosis and treatment plan, and to ensure the case is appropriate for this type of training. Day 1 post-op updates are also provided through Cybersight Consult. RSM is only available at Orbis partner hospitals where special audio-visual equipment has been installed.
Remote Wet Lab
Remote Wet Lab is a model of simulation (wet lab) training for residents facilitated through Cybersight. A remote wet lab curriculum is created in Cybersight Courses (typically 5 or 6 weeks long), with a video-conference lecture each week followed by a ‘homework’ assignment(s) to be completed independently in the wet lab. Those assignments are recorded on video by the residents and uploaded through Cybersight for grading and feedback by the faculty. An 80% score is typically needed to ‘pass’, and assignments can be re-done and re-uploaded as needed. Optionally, remote wet lab training can include full simulation surgeries done before and after the training and graded independently to measure skills/competency improvement. Remote wet lab is only available at Orbis partner training institutions where special audio-visual equipment has been installed.
Appendix: Implementation Considerations in Orbis Projects
All Cybersight tools and services are available for implementation and integration within Orbis projects and are designed to enhance project cost-effectiveness, efficiency and sustainability.
Listed below are examples.
Cybersight Consult
The implementation of Cybersight closed-loop consultation is designed to strengthen eye care delivery within a specific geographical region that Orbis is supporting. This would entail pairing doctors/eye health professionals at secondary or district level facilities with a senior ophthalmologist at tertiary level, to enable these doctors to seek advice on diagnosis or treatment of patient cases. This arrangement allows for remote mentorship but also to strengthen referral systems within that geographical area.
Orbis project example
In one province in Zambia, primary health care workers (PHCs) were paired with ophthalmic clinical officers (OCOs) and ophthalmologists at the province’s district and tertiary level hospitals. Using Cybersight Consult, the PHCs and OCOs submitted patient cases either to seek a diagnostic/treatment advice or to facilitate a referral for further examination. This set-up proved particularly beneficial for the PHCs, improving their diagnostic skills for basic eye health problems and improving the quality of referrals they sent to their colleagues in the province.
Cybersight Courses & Webinars
The integration of Cybersight courses and webinars may prove to be a valuable addition in meeting Orbis project objectives. In terms of publicly-available online courses, enrolling project learners into a fundamentals online course could be logical prerequisite to a hospital-based training program. Or, in instances where such a course doesn’t meet specific needs, online curricula may be created or tailored to meet the learning objectives of project participants or make it easier to track the progress of a specific cohort of learners
To complement this blended learning approach, regional and/or language specific webinars may also be valuable addition.
Orbis project example
As part of Orbis’s ‘innovative model of ophthalmic education in Mongolia’ project, Mongolia-language webinars conducted by local experts were a core part of residency training as well as the completion of three existing 16-hour online ‘fundamentals’ courses: paediatric ophthalmology, glaucoma and MSICS. These digital education initiatives were an integral part of the project for continued professional development where hands-on practice and didactic training during residency are limited. The program manager was able to track learners’ progress in the custom curriculum by monitoring the % complete and ‘nudge’ people where needed.
Remote Surgical Mentorship
Remote surgical mentorship (RSM) is an appropriate training/mentorship approach for senior registrars and early career surgeons and may prove to be a valuable addition to an Orbis capacity-strengthening project with a tertiary level institution. It is best leveraged in conjunction with parallel training interventions, and as part of a broader blended learning program. For example, depending on the project’s training objectives, RSM may be implemented as a follow-up to a series of in-person hospital-based training programs where the mentee is looking to improve and build confidence in certain surgical techniques.
Orbis project example
As part of an Orbis-supported paediatric eye care project in Indonesia, two ophthalmologists undertook a paediatric ophthalmology and strabismus sandwich fellowship program, with a 3-month hands-on training rotation in India. This was followed up with further surgical skills and confidence-building through remote surgical mentorship back at their home institution in Indonesia with the same mentor from their India rotation program.
Remote Wet Lab
The integration of remote wet labs into Orbis-supported residency programs and where local faculty/mentors are in short supply is proving a popular implementation methodology in Orbis-supported projects in the LAC region, especially Peru and Bolivia.
Orbis project example
In Bolivia, Orbis has been supporting the National Institute of Ophthalmology (INO) to broaden the scope of their residency program. In addition to establishing a fully-fledged wet lab, the wet lab was also digitalised. This has meant that both first- and second-year residents could benefit from structured 5-week virtual MSICS wet labs with Orbis Volunteer Faculty (based in Mexico), through video conferences and graded video assignments. Remote wet labs have also been of particular benefit during COVID-19: with eye care surgeries coming to a complete standstill in many locations, residents have been able to continue to practice surgical techniques in their digitalised wet labs and benefit from virtual mentorship and support.