HOLLI W. HAYNIE

Dr. Barrett G. Haik examines a patient in Panama.

A child in Central America with retinoblastoma used to have little hope for a positive outcome. Fortunately through the mission of the Hamilton Eye Institute (HEI) telehealth program at the University of Tennessee Health Science Center (UTHSC), physicians and surgeons in developing nations have the ability to provide specialized treatment for these complex cases. Ophthalmologists at HEI have long been dedicated to contributing to global research in eye diseases and injuries. In partnering with organizations like St. Jude Children’s Research Center, and the Cyber-Sight program through Orbis Telemedicine, physicians are able to provide training, offer consultations and study cases with ophthalmologists throughout the world.

“Ophthalmology is probably the best suited field of medicine for telemedicine and telesurgery because we deal with a transparent organ,” explained Dr. Barrett G. Haik, director of HEI and chair of UTHSC’s department of ophthalmology. “It’s the only place in the human body where you can literally see through the entire depth of the eye.”

Haik said the interest in participating in telemedicine came from the work already being done through UTHSC and St. Jude’s international outreach program, which serves developing countries where childhood diseases like retinoblastoma and retinopathy of prematurity (ROP) are more prevalent and severe.
Ophthalmologists from developing nations have the opportunity to become fellows in Memphis training with physicians at HEI and St. Jude. Here they develop skills and knowledge to carry out medical care in their country. While that is a necessary and worthwhile system, the partner organizations realized the need for regular conferencing to keep physicians up-to-par with perpetual innovations in technology and procedural techniques.

“Medicine is always advancing and changing so even with six months of training in this field, it takes many years to become a true master,” said Haik.
Building a telesurgical link became essential, which is why St. Jude and HEI partnered with Orbis Telemedicine’s Cyber-Sight program, an Internet networking system designed to promote the provision of high quality eye care, with the ultimate goal of eliminating avoidable blindness in the world. This telemedicine system allows physicians from anywhere in the world to consult on cases and even watch surgeries being performed in Memphis, and vice versa. In addition, Cyber-Sight provides the world’s only flying eye hospital which aids countries in developing their own hospital based programs. FedEx Corporation is also integral in the Cyber-Sight program by transporting x-rays, slides and biopsies from parts of the world that are not yet digitized.

HEI is networked through a series of countries, the strongest of which are in Central America. The first center of excellence established from this effort was in Guatemala, which is the most advanced of the international sites. Other locations include Panama, Honduras, El Salvador and Costa Rica.

“We get to know the patients over time and since we can’t be there every month, we can see their eyes through the telemedicine program to see how a child has progressed and changed every month, and determine if their treatments are at the right level,” explained Haik.

Dr. Haik and his team also travel to these cites twice annually via the Orbis program to provide on-site visits.

Teleconferencing is another use of the telehealth program which allows HEI physicians to review and discuss cases locally and internationally.

The latest international collaboration with HEI was with Vietnam, a country where patients typically present with advanced disease. Pediatric oncologists, pathologists and ophthalmologists presented retinoblastoma cases which were reviewed, via live video feed, by Haik and his team.

Teleconferencing has a tremendous benefit back home as well, allowing physicians to review and discuss cases among their peers. It’s also become useful for physicians in the state for general grand rounds and pathology conferences.

“Every time we have one of these conferences, I realize how many different approaches there are to different procedures,” said ophthalmologist Dr. James Hart. Every location, he added, has unique aspects in the way patients present and the provision of medical services. “We are sometimes able to participate in brainstorming to come up with better approaches.”

Ultimately the HEI staff would like to expand their teleconferencing abilities into a sort of world-wide grand rounds.

“Teleconferencing and telemedicine in ophthalmology is a great way to open communication,” maintained Haik. “We’d love to partner with other major institutions in the U.S., Europe and Asia to help carry some of the load of ensuring we elevate this level of care across the world.”



July 2008