Dr. Ross teaching on the slit lamp in Liberia during her stay with the Fulbright program.
Dr. Ross teaching on the slit lamp in Liberia during her stay with the Fulbright program. Foto: Ross.

»My future pipe dream is to develop a simulation center to train doctors from countries with limited resources.«

Dr. Ross, you initiated the development of the global health cases for the Eyesi diagnostic simulators. How did the idea for the project and the cooperation with VRmagic evolve?

The number of patients worldwide with preventable blindness has been growing throughout my career. What started as a huge number of 280 million blind or visually impaired has now exploded to one billion, as published by the WHO last year. Vision 2020 was the WHO initiative to eliminate global blindness by the year 2020. My idea in 2015 was to start working on a way to use simulation technology to bridge the training and knowledge gap for surgeons working in limited resource countries. At that time, I first contacted a US representative for VRmagic to test drive the simulators first hand. I was heading to Liberia that year to work on the PREVAIL project by the National Institute of Health, examining Ebola survivors. US ophthalmologists had the opportunity to collaborate with Liberian Ophthalmologists in both examining research participants during the longitudinal study and teaching. This was a rare opportunity to build eye care capacity and contribute to global health research. I had the idea for a capstone project to train primary care in direct ophthalmoscopy and to retrain ophthalmologists using indirect ophthalmoscopy.

What are typical problems that the new case package helps to solve?

When I arrived in Liberia, there had been 14 years of civil war that destroyed the infrastructure, so most trained ophthalmologists had been without ophthalmic equipment for years and retraining was critical to building eye care capacity. Available to us was a Gullstrand model to practice in the clinic, but this was not very dynamic and just featured macular degeneration, diabetic retinopathy, normal eyes, and glaucoma. We had a teaching scope on the slit lamp and cameras on the slit lamp, but teaching slit lamp and indirect ophthalmoscopy proved very challenging. My Liberian colleagues agreed that obtaining culturally appropriate cases and bringing simulation someday to them as we do to our US residents was a great goal.

Screenshot of an Eyesi Indirect simulator showing the examination of a virtual Zika patient.
Screenshot of an Eyesi Indirect simulator showing the examination of a virtual Zika patient.

“Vision is more than eyesight and begins with the training of our next generation of physicians.”

Who are the involved parties and how did you collaborate for the project?

Many of the US ophthalmologists who rotated over the 5 years of the PREVAIL 3 clinical trial and the first cataract surgical trial, PREVAIL 7, in Liberia, collaborated on the project. Along this journey, I met on the US side with Marshall Dial, the US representative at VRmagic and we continued brainstorming about a global case series. We wanted to get those colleagues passionate about global health to contribute cases. In 2019, Marshall Dial connected me with Dr. Camila Ventura from Brazil, who is an expert on the Zika virus. Over the next two years, our group worked on developing the models and fine-tuning the initial cases. VRmagic digitally modeled these cases and complemented the pathologies and medical background information.

Digitally modelled retina of a Malaria patient
Digitally modeled retina of a Malaria patient.

How will the simulator be used in NGO projects?

The idea of testing the VRmagic simulators in a low-income country and ultimately training doctors in Sub-Saharan Africa using a cataract and vitreoretinal surgical simulator is a future pipe dream. My capstone ultimately was a proposal to utilize VRmagic simulators to train Liberian ophthalmologists using relevant cases and modules. The VRmagic team really championed completing this project during the Covid-19 outbreak. The goal of the global health series was to deliver on Vision 2020 to continue working on eliminating preventable blindness. Vision is more than eyesight and begins with the training of our next generation of physicians. For me personally, my pipe dream of developing a private ophthalmology simulation center to train doctors from countries with limited resources is my career end goal.

Dr. Robin Ross is teaching Global Health at the University of Arizona College of Medicine Phoenix and ophthalmology at the Global Retina Institute in Scottsdale, Arizona. She founded the non-profit Red Rover Ventures, whose mission is to break barriers to eye care access in low-income countries by engaging in clinical research, health care provider education, and development work.

Dr. Ross teaching medical students at the Global Retina Institute
Dr. Ross teaching medical students at the Global Retina Institute.

Contribution of didactically adapted cases and consultation on the Global Health Package:

Robin D. Ross, MD, MPH, Global Retina Institute, Clinical Director; Director of Global Health Outreach, University of Arizona College of Medicine Phoenix, USA

Bryn Burkholder, MD, Assistant Professor of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins Hospital, USA

Allen O. Eghrari, MD, MPH, Assistant Professor of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins Hospital, USA

Veena Raiji, MD, MPH, Clinical Assistant Professor, Director of Uveitis,Loyola Stritch School of Medicine, USA

Steven Yeh, MD, Louise Simpson Professorship in Ophthalmology, Section of Vitreoretinal Surgery and Diseases, Director Section of Uveitis and Vasculitis, Emory University, USA

Jessica Shantha, MD, Assistant Professor, Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Emory University, USA

JP Gorham, MD, Clinical Lecturer Ophthalmology, University of Michigan Kellogg Eye Center, USA

Brent Hayak, MD, Oculoplastic and Reconstructive Surgery, North Georgia Eye Clinic, USA

Grace Prakalapakorn, MD, MPH, Associate Professor in Ophthalmology, Associate Professor in Pediatrics, Duke Eye Center, USA

Mandi Conway, MD, Chair, Department of Ophthalmology, University of Arizona College of Medicine Phoenix, USA

Madeline Heiland, MD, University of Arizona College of Medicine Phoenix, USA

Camila Ventura, MD, PhD, Department of Ophthalmology, Retina Specialist, Department of Research, Director Altino Ventura Foundation (FAV) and Hope Eye Hospital, Recife, Brazil

Rachel Bishop, MD, MPH, National Eye Institute (Contractor), National Institute of Health, USA