Seva Foundation Technology Blog

Category: Outreach

World Sight Day Webinar 2025
We’d like to thank those who joined us for our webinar on October 16, 2025, and invite everyone to watch it on demand!

Timestamps for Reference

1:40 – Welcome, Kate Moynihan

4:10 – Technology Introduction, Katie McMillan

6:23 – Vision Center Management Software, Dr. Shalinder & Team at Dr. Shroff’s Charity Eye Hospital

15:18 – Pre-School Vision Screening with SPOT, Dr. Manisha Shrestha & Team at Bharatpur Eye Hospital

23:29 – Retinal Imaging in Outreach, Dra. Gabriella Pena at INVIS

29:25 – Pristine 5.0 in Africa, Dr. Tamara Chirambo Nyaka, Malawi

36:30 – Panel Discussion & Questions

Additional Questions

We had some questions we didn’t have time to answer live. If you have comments or additional questions, we’d love to hear from you on this post!
1. Does anyone have insight into digital ocular pathology?
Katie: I admit I’ve not researched this topic deeply. Do you mean taking digital images/photographcs of the pathology so that it can be interpreted elsewhere? I’d love to talk more about your use case and questions – please feel free to send an email to kmcmillan@seva.org!

It is quite a futuristic question, and an exciting one. It reminds me of the Zeiss Artevo 800 retina operating microscope which I am looking forward to experiencing. It combines 3D viewing (like the Alcon NGENUITY VS) for improved ergonomics; and has a fully integrated intraoperative OCT (iOCT) for real-time microscopic tissue viewing for both the surgeon and assistant (and others in the room via a screen). It is for both anterior and posterior segment surgeries. I can only imagine the impact It has on surgical and hopefully visual outcomes as well, as it should improve the surgeon’s precision greatly intraoperatively. Additionally, digital images can be shared for consultation while at it. It ought to make teaching much easier as well.

Having said the above as an example, digital ocular pathology would come at a great capital cost to pool images and formulate algorithms for pattern recognition to improve diagnosis, consistency and access to expert opinion. There are data storage issues amongst others. I think the provision by, for example, the Remidio 5.0 fundus camera with its cloud storage for images are baby steps towards digitization and AI assisted patient management.
1. What are your tips for making the best use of technology in remote areas, where power and connectivity and staff education may be challenging?
Dr. Manisha: There is a device called arc light, which is battery operated but also has a solar charging option, a very light portable device for fundus examination. I feel teaching the health care personnel at the community level at least for fundal eye reflex screening in children ( at birth, at time of vaccination or when they visit when they are sick) holds significance for detecting amblyogenic risk factors early and then can be referred to eye care facilities.

Katie: We also talked during the live Q&A about supporting systems – uninterruptible power sources, satellite internet, compensation for staff who are trained on critical technologies – that have helped in certain projects.
1. How do you organize your documentation (SOPs, technology instructions), and how do you evaluate progress and quality within technology projects?
Katie: For Seva projects, we help with quarterly check-ins that ask about quantitative metrics and offer the opportunity to discuss what went well and where there are challenges. I’ve seen the most successful projects have clear leadership buy-in and they tend to follow common practices. So if you have an SOP for infection control, your retinal camera SOP could be found in a similar spot. That way all staff members have a common understanding of where to look for help.
1. How can technology improve the quality of eye care?
Katie: In the SCEH conversation, we talked about how the capturing of data (patients seen, returning patients, outcomes of treatment) was very helpful in sharing with the vision center staff so they could tell what had happened and compare against similar clinics. These types of electronic medical records assist in tracking visual acuity after cataract surgery, for example, or spectacles that have been returned in the optical shop.

Defining the key metrics and confirming you have a system that is properly tracking them can give opportunity for regular (e.g. monthly, quarterly) strategic conversations about the current status and necessary improvements.
1. There are groups adding free eye camps and awareness events in Nepal – what are some tips on how they can get the best results?
Dr. Manisha: In a survey sent out via google forms to the Pediatric Ophthalmologists of Nepal (total 40) to find about the status of pre-school vision screening in Nepal, response was obtained from 22 (55%). Out of them 13 (60%) responded that they have conducted the pre school screening, and out of them 10 (77%) said they do it via loose lens retinoscopy by ophthalmic assistants/ optometrist and 3 (23%) responded it was being done by community eye health workers using Snellen’s chart. Everyone responded that vision screening devices for preschool screening had not been used. This shows the gap area for pre-school vision screening in Nepal, traditional way of screening children using loose lens retinoscopy/ snellen’s chart is not feasible for pre-school children (3 to 6 years) and maybe using technology like Spot vision screener or other photoscreener device to detect amblyogenic risk factors in them holds significance.
1. As you evaluate technology partners, what are some factors to keep in mind?
Have a look at the blog post from SCEH or we’d love to hear what your ideas are!

Some helpful questions to consider:
- Who owns the source code and/or intellectual property (IP)?
- Who is responsible if there are infringements on someone else’s IP?
- If a technology partner can longer work with you in the future for updates or maintenance, do you have all rights to change partners?
- Who is responsible for acceptance testing? Or bug fixes within the initial use period?
1. Have we given a thought on smart phone fundoscopy, which I feel is something we can teach our residents to take fundus images with their own smart phones..
Katie: The AAO has a resource that can be located here: https://eyewiki.org/Smartphone_Funduscopy_-_How_to_Use_Smartphone_to_Take_Fundus_Photographs

There is also a 2024 review article which lists several adapters that can make your smartphone easier to use and offer better image quality. https://www.sciencedirect.com/science/article/pii/S0039625723001327
1. Can anyone explain the role of AI in these technologies? Is AI reliable enough to support a trusted diagnosis? And is AI currently integrated into any of the cameras mentioned today?
Katie: AI for retinal imaging is pretty mature, with some applications specific to diabetic retinopathy having regulatory clearance and therefore having proven safety and efficacy. Retinopathy of prematurity has also shown very impressive results. Other conditions (Glaucoma, AMD, opportunistic infections) have fewer options and varying degrees of research. https://www.sciencedirect.com/science/article/pii/S2162098924000975 offers a recent review.

Remidio, for example, does offer a commercial AI feature for their fundus on phone camera but it is focused on specific retinal conditions. So it’s critical to know exactly what the specifications for AI are and that you have adequate coverage to find conditions out of scope for the algorithm use.

It is a developing field. There are already AI-based Retinal imaging tools for diabetic retinopathy screening such as IDx-DR (Digital diagnostics, USA), EyeArt (Eyenuk), among others.
October 24, 2025

Retinal Imaging in Outreach

Eye care in rural areas of the Dominican Republic is challenging, with patients often not able to access preventive care until eye conditions, including glaucoma or diabetic retinopathy, are more severe. Seva is delighted to support the work of Dr. Gabriella Pena and the outreach team who travel to these underserved areas to screen and educate patients!

Instituto Internacional de la Visión (INVIS)

Based in Santo Domingo in the south of the country since 2009, INVIS manages a comprehensive eye hospital as well as a busy outreach program with 5-8 events each week to reach underserved communities in the Dominican Republic and Haiti.

Patients attending outreach screening previously lacked access to retinal imaging. Through this project, Seva is helping to equip 3 of the mobile teams with non-mydriatic retinal cameras to better assess patients within their communities.

Since many patients attending outreach events have not had access to eye care, the INVIS team works to evaluate visual acuity, anterior segment issues and provides referrals to patients who need to visit the city for a more comprehensive exam. Before this project, all patients with suspected retinal issues or higher risk were referred. Now, the team can quickly take retinal images which are read remotely and better advise patients whether they need to make the journey to the city.

INVIS manages the entire patient journey – from outreach to treatment and follow-up – through a community-based approach and building trust with patients and families.

Outreach events are hosted in the community – in schools, churches or other structures – with the support of local leaders. Locations are visited based on the population size and specific needs of each area. Some places, due to their high population density or the involvement of different community leaders, attract entirely different groups of people each time.

If the location is within a province, we may visit 2 to 4 times a year, depending on demand, as we often go to different sectors within the same province. In the city, the frequency depends on these same factors as well as the level of community engagement and interest.

Outreach Patient Journey

A patient arrives, is greeted and registers with a name and contact information.
Visual acuity is checked along by the promotor or a general physician with a brief examination of the eyes and documentation of complaints and medical history.
A retinal image is taken of each eye for every patient where possible. The INVIS team required a non-mydriatic camera to meet patient needs so that no dilation was needed. Therefore, there is no waiting for the pupil to dilate after receiving drops and patients can return to their work or home without light sensitivity.
In cases where there are long lines, the INVIS team will prioritize patients of older age or higher risk factors to receive retinal imaging.
An trained ophthalmic professional will provide a consultation on what was found during the screening, prescriptions for eyeglasses and, if needed, more information on the referral to the hospital for treatment.
During the events we usually provide reading glasses, and when available, we also distribute frames and sunglasses. While reading glasses are not always the ideal solution, they are greatly appreciated by attendees. People often attend these activities hoping to leave with something in hand.

Referral Patient Journey

INVIS schedules all patients from a community to visit the hospital on the same day. This way, they can share a bus, bring a caregiver or family members, all free of charge.
“This is often the only time some of them visit the city,” Dr. Gabriella shares. “So they may do shopping or visit relatives while on their trip. We also serve them pizza so that’s fun too.”
Once they arrive, patients are sent for additional examinations or their procedures – cataract surgeries, glaucoma treatments or other care.
Diabetic retinopathy is a major focus during our hospital visits. We emphasize the importance of early detection and timely treatment to prevent vision loss. When a retina specialist is available, patients are evaluated and offered a follow-up appointment for treatment, as procedures are not performed on the same day. If the specialist is not present, the consultation is still scheduled free of charge, and the treatment is offered at a significantly reduced rate compared to standard market prices, ensuring accessibility for all patients.
Glaucoma treatment begins with prescription eye drops. If the condition does not respond well, surgical options are considered, depending on the severity and individual needs of the patient.
Once all treatments are finished for the community members, the bus returns them home.
Follow-up care: If no pathology is found, patients leave with a scheduled annual appointment. In cases where treatment is needed—especially surgical—we try to group patients from the same outreach on the same day. This allows them to share transportation or enables us to assist with transportation.

There are multiple outreach teams and INVIS currently has 1 retinal camera, with plans for another 2 to increase access.

Name & Title	Feature Priority
Enmanuel Almonte, Executive Director	– Portable & Durable: The camera is transported almost daily. – Non-mydriatic: Dilation does not fit into the outreach workflow. Patients requiring dilation are referred to the hospital.
Dr. Gabriella Peña, Outreach Director	– Patient-friendly: As trust is built with communities, screening events should be kind and welcoming, as should the technology used. – Easy to use: INVIS staff managing outreach are busy – the camera should be easy to use, from set-up to capturing images to transferring images for reading
Dr. Ramon Escaño, Medical Director	Highlights the usefulness of EyeRobo in clinical practice, emphasizing its value not only in patient diagnostics but also as an educational tool. “EyeRobo is incredibly helpful for demonstrating any findings to our residents. It allows us to visually present the conditions we encounter in real-time, making it easier for them to understand and learn about various pathologies,” he shares.
Dra. Vargas, Outreach team, Camera operator	“We really like how practical and easy it is to use the EyeRobo. It makes the process of capturing images for diagnosis much smoother, saving us time. It’s a user-friendly system that helps us focus on the patient rather than worrying about complicated settings or operations.”

INVIS staff acquired the EyeRobo camera locally and are expecting delivery of the NM-FOP soon. A third camera will be purchased based on the results of their evaluation.

Feature	EyeRobo iFLASH-I	Remidio FOP
Field of view	50 degrees	40 degrees
Resolution	5 Mega-pixels
Minimum pupil size	3 mm	3 mm
Display	Tablet-sized	iPhone-sized
Patient response	Very positive! Patients appreciate the appearance and name (Robot) gives the impression of high-tech resources.	TBD – camera not yet delivered
Weight	6 kg	1.1 kg
Size	410 × 205 × 260 mm	93 x 284 x 226 mm
Operation	Automatic alignment, focus, exposure & capture	Automatic capture, 8 fixation points
Reports	Images are transferred from camera on USB drive and manually uploaded to computers for reading and reports	Images are transferred to Remidio’s cloud-based, secure website for remote reading. Standard reports are also available via cloud.
Pricing	Not publicly available but 50% greater than FOP in this project	Not publicly available but less than EyeRobo
Availability	Local purchase	Evaluation/demonstration through Remidio directly
Service & Warranty	1 year	Evaluation unit

This project is still in progress but early indications are that increasing access using EyeRobo has been successful!

Patients have responded positively to the high-tech solution, finding it fast and easy to use. They also like the name as Robo translates to Robot in Spanish.
INVIS staff have not had issues with the camera operation but are looking for better ways to manage image transfer and reports. Conversations to optimize that workflow are ongoing.
The camera has been used at 15 events to image 600 patients.

Screening Kids with Spot

It can be difficult to assess the visual acuity of young children – they don’t read typical eye charts and can become distracted or give unreliable results. But detecting and correcting visual problems before age 5 can make a huge difference for children in communities where eye screenings are uncommon.

“Correcting vision in children can increase their lifetime earnings by up to 78%, breaking the cycle of poverty.” (Seva & IAPB)

Bharatpur Eye Hospital (BEH)

BEH has operated since 1987 in the Chitwan District of southern central Nepal. Serving a catchment area of approximately 2 million people, BEH is comprised of the base hospital, 3 secondary hospitals and 18 Eye Care Centers.

Problem: In places like Nepal, standardized childhood vision screening interventions are often lacking or absent outside of school settings.

We aim to establish and evaluate an efficient vision screening program to detect preventable vision loss in school-aged children in Nepal.

A community-based program would have two main benefits: first, the capability to screen pre-school children (i.e., ages 3-5 years), and second, enhanced communication with parents.

Eye care often involves multiple steps for patients. Mapping their journey enables us to better understand challenges where technology may add value.

Staff members provide the critical connection between patients and technology. We’ve asked the team at BEH to share their learnings below.

Team Member	Success	Challenge	Potential Solution
Dr. Manisha Shreshtha, Pediatric Ophthalmologist	Early detection & treatment enable children to reach their full potential	Time management and workload given OPD flow	Economic study New economic study on childhood screening generating adult attendance
Gopal Bhandari, Optometrist	Managing wonderful project with various stakeholders; hiring and monitoring ophthalmic assistants	Convincing leaders of the impact to the community and hospital
Sadhan Bhandari, Bachelor in Public Health	Working with kids and guardians was a new experience	Some challenges keeping family interest during awareness campaign	Kids present information through art or videos Multiple stations to optimize efficiency
Devaki Acharya, Ophthalmic Assistant	Some parents couldn’t afford glasses; Others were happy they found out the child’s eyes could be treated in time	Some children didn’t cooperate well or lacked focus and may need multiple screening attempts	Prizes for screening – attempt other technology solutions that are easier for smaller children?
Deepak Yadav, Ophthalmic Assistant	School and tole personnel were supportive and positive; Door to door screening helped find children who did not attend events	Excluding kids at events who didn’t meet the study criteria; Some parents didn’t trust the study or indicated children had no disorders	Plan resources to add siblings, friends or others Get leader input before approaching community – educate and influence
Prakash Malla, Ophthalmic Assistant	Good coordination in study team; positive & helpful community and parents	Tracking children who moved; inability to travel safely during rainy season	Offer broad advertisements and community involvement

The Welch Allyn Spot Vision Screener was selected for BEH’s project based on colleagues’ recommendations.

Indications: Myopia, hyperopia, astigmatism, strabismus, anisocoria
Training: 30 minutes to learn; easy to teach new team members, including those without eye care backgrounds
Portability: Light-weight and easy to carry, making it available for a variety of screening settings
Power: Rechargable Lithium battery, expected lifetime 2.5 years
Results: Summary report in seconds
Engagement tools: Lights and sound
Data management: USB or Wifi export