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.

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.

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.

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.”

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

• 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.