Seva Foundation Technology Blog

Category: Retina

  • World Sight Day Webinar 2025

    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.

  • Cameras & Connections: Pristine 5.0 in Africa

    Cameras & Connections: Pristine 5.0 in Africa

    Dr. Tamara Chirambo Nyaka joined the first Pristine 5.0 installation in Africa, attending the installation and training in Malawi with Seva consultants and a clinical partner serving patients living with HIV (PLWHIV). The concept, spearheaded by our African Program Officer, was to connect a local retina expert, Dr. Tamara, with the American consultants who played major roles in designing the camera as well as Vignesh, an expert from Remidio Innovative Solutions, who engineered, designed and manufactured the camera.

    The training was a success, offering access to retinal imaging where none had existed before. This offered a pathway to treatment for patients who were at risk for blindness from opportunistic infections, including Cytomegalovirus (CMV) Retinitis.

    But Dr. Tamara’s work did not stop there! When we found partners in Uganda with interest in expanding retinal imaging, we asked her to lead our training, establishing local expertise in both retinal imaging (which she had) and Pristine 5.0 (which she could get).

    Dr. Tamara traveled to Remidio’s headquarters in Bengaluru, India, to meet with key members of the team to learn detailed operation of the camera and get some practice. Perhaps most importantly, she reconnected with Vignesh and met Ashish, establishing important relationships with the technical experts who could help with future issues.

    Finally, we were joined by two of our partners in Uganda for a training when they received new Pristine 5.0 cameras. Our friends from Lira Regional Referral Hospital and Ruharo Mission Hospital joined Dr. Tamara in Lira for the first training in Africa not attended directly by Remidio experts.

    Ben, from Ruharo, noted,
    “The lesions we are now seeing on the Pristine are things we used to assume as normal but now we have been taught to stop and observe and describe , categorize and confirm these lesions.”

    Dr. Shamiim, who has championed multiple technology projects at Lira, wrote, “
    The purpose of this email is to extend my heartfelt gratitude to you all for the unwavering support and the kindness shown towards the people of Lango subregion. I am positive that these new developments will create a positive impact on the management of our patients henceforth.”

    What has emerged from Dr. Tamara’s work is a network of trained professionals who connect, primarily over WhatsApp, over difficult cases or technical challenges. They can find support from Remidio or retinal experts and encouragement to continue to find ways to use the cameras to do the best work for their patients.

    And we can’t wait to see what comes next from these conversations!

  • Pristine 5.0 – Getting Started

    Pristine 5.0 – Getting Started

    Seva is proud of our collaboration with Remidio Innovative Solutions and is placing 50 cameras with global partners to increase access to retinal imaging.

    This post is written for those wonderful collaborators who have already received their cameras on site. If you have questions about agreements, shipping or customs, please email Katie directly.

    Creating a login

    Once your camera arrives, Remidio will need to create a login for you. Please send an email address to Katie (that all camera users and image reviewers will use) to begin that set up. You will receive an email from Remidio with instructions at the email address you’ve provided.

    Downloading the app

    After the login is created, partners outside India will need help from Remidio to download the app on the iPad. This is because we’re still working on regulatory approval in most countries and Apple requires that approval before placing software on the official app store. (For users in India, the app is available since we have regulatory clearance!)

    Using the camera

    Remidio has helped us create a short video tutorial to provide an overview and general instructions. Time stamps are given for the sections below in case you want to re-watch specific topics.

    • Camera set up (1:26)
    • Power on and connecting iPad to camera (2:37)
    • iPad application & starting an exam (2:58)
    • Taking the first image (3:46)
    • Taking images of the second eye (5:22)
    • Creating a montage of multiple images (6:07)
    • Annotating images (6:33)
    • Reports & export (7:30)

    The full Instructions for Use are available below. We’re still working on translations to French and Spanish. If other translations would be helpful, please let us know!

    Pristine 5.0_Instructions for Use_finalDownload

    We’d love to hear what you think – what questions you had, tips you’d offer other partners or feedback on the process overall. Please comment below so we can share our learnings and accelerate access to retinal imaging!

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  • Retinal Imaging in Outreach

    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 & TitleFeature 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 DirectorHighlights 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.

    FeatureEyeRobo iFLASH-IRemidio FOP
    Field of view50 degrees40 degrees
    Resolution5 Mega-pixels
    Minimum pupil size3 mm3 mm
    DisplayTablet-sizediPhone-sized
    Patient responseVery positive! Patients appreciate the appearance and name (Robot) gives the impression of high-tech resources.TBD – camera not yet delivered
    Weight6 kg1.1 kg
    Size410 × 205 × 260 mm93 x 284 x 226 mm
    OperationAutomatic alignment, focus, exposure & captureAutomatic capture, 8 fixation points
    ReportsImages are transferred from camera on USB drive and manually uploaded to computers for reading and reportsImages are transferred to Remidio’s cloud-based, secure website for remote reading. Standard reports are also available via cloud.
    PricingNot publicly available but 50% greater than FOP in this projectNot publicly available but less than EyeRobo
    AvailabilityLocal purchaseEvaluation/demonstration through Remidio directly
    Service & Warranty1 yearEvaluation 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.

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  • Retinal Disorders: Algorithms for Referral

    Retinal Disorders: Algorithms for Referral

    Examinations of the back of the eye can be vital to treat patients before vision loss or other symptoms when considering multiple eye conditions:

    • Macular degeneration
    • Glaucoma
    • Diabetic Retinopathy
    • Other vision loss
      • Retinal vein occlusion
      • Retinal detachment
      • Retinal tears

    By providing 50+ retinal cameras, Seva is helping to expand access to imaging and collaborating on managing these new patients through the referral, diagnosis and treatment journey.

    We want to explore various patient journeys and will use an example of 3 friends who are aware of the risk for retinal conditions to illustrate the risk of missed imaging or narrowly-scoped referral algorithms.

    To explore the patient experience, imagine 3 friends, all of them female in their 40s, who live in a remote village.  Their names are Poppy, Iris and Lily.

    1. Awareness: The three women see an online announcement for an eye screening event and decide to go together.  They know vision risks may increase as they grow older and want to learn more and get their eyes examined.  Poppy had to work late and was not able to attend the screening as planned.  

    Poppy: We see the first divergence of paths as Poppy misses the retina imaging and has an unknown outcome.

    1. Retina image: There is a retina camera at the screening event as more portable, durable, affordable cameras are on the market.  
    2. Algorithm: There is not an ophthalmologist at the screening event so the team decided to use automated image analysis, like artificial intelligence algorithms, to screen people.  The algorithm been trained for diabetic retinopathy and properly refers Iris for treatment.  However, it is not trained for macular degeneration and Lily does not understand that “no diabetic retinopathy” is not equivalent to “normal.”

    Now the friends’ paths diverge.

    Iris

    IA.  Treatment: Iris is referred to the city hospital for treatment.  She makes the journey and is not able to afford anti-VEGF intravitreal injections but can get laser therapy to help her retinopathy.  She is also advised on how to better control her diabetes.

    IB. Follow-up: Iris returns to the city hospital for additional examination to confirm that her diabetic retinopathy has improved and is shown her retinal images over time to encourage her to continue managing her diabetes.

    Lily

    L.  Missed Referral: Lily’s evaluation by the algorithm indicated she did not have diabetic retinopathy but she did not realize her retina image should be evaluated for other conditions.  

    Lily needs clear counseling and to understand that different condition could be found later that requires follow up.  If she misunderstands or isn’t educated, she could believe that her eyes are normal and miss treatment and follow up.

    Seva invites your feedback! Have you used an algorithm to assist with referral or diagnosis? What are your priorities in selecting an algorithm for future use?

    Several companies have released algorithms for retinal imaging. Seva has not tested these algorithms but welcomes partner questions or feedback as we continue to explore this space.

    AlgorithmConditions ReferredCameras Supported
    ARDA, GoogleReferable DR or macular edemaCentervue DRS,
    Optovue iCam, Canon CR1/DGi/CR2, 
    Topcon NW using 45° fields of view
    Remidio Medios1. DR
    2. Glaucoma    		Remidio Fundus on Phone
    IDxDRMild to moderate DR in adults with diabetesTopcon NW400
    EyeNuk – EyeArtDRCanon CR-2 AF, Canon CR-2 Plus AF, and Topcon NW400
    AEYE 1. DR
    2. AYECS – comprehensive screening (Multiple conditions)    		Optomed Aurora portable handheld device

    Please comment below with your comments or questions – we’d love to hear what’s important to you!

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