Nathan Congdon on behalf of Orbis International




To create and implement an online training model to build capacity for glaucoma screening in low and middle income countries


The project

Glaucoma is the leading irreversible cause of global blindness. Though trials show that early treatment prevents most vision loss, only 10% of patients in low and middle-income countries (LMICs) with glaucoma are treated. A major reason is lack of good strategies to detect disease early. Diabetic retinopathy screening programs are increasingly used in LMICs, as part of which optic nerve photos are captured. These can help screen for glaucoma, but are not currently used for this purpose. The UK NHS online diabetic retinopathy grader training program is widely used in LMIC diabetic retinopathy screening programs; incorporation of training in glaucoma recognition would enhance global capacity for recognition of glaucoma. Adding material on recognizing glaucomatous optic nerves onto an existing global platform for eyecare training in LMICs would strengthen existing glaucoma training. The estimated 76 million people with glaucoma in 2020 can benefit from early detection using this model.

This project will create a training course, including materials for medical and non-medical personnel, practice slides, a formal test set, information on dangerous conditions and CME materials. This will be uploaded onto the global platform and the UK NHS training websites. Diabetic retinopathy graders will then be trained, and their accuracy tested.

The UK NHS site is sustained by modest trainee fees, ensuring both the survival of the site and the commitment of trainees, while the Vietnamese government has already committed to creating a national diabetic retinopathy screening program. This and similar national programs globally will broaden the impact of this project.

Project Update: As of now, an online course, “Learning to Recognize Possible Glaucoma from Optic Nerve Photos – For non-ophthalmic graders/ for ophthalmologists”, has successfully been developed, validated, and uploaded to Cybersight, Orbis’ online training platform. This is free-of-charge project has proven to be a good resource to train non-clinical graders to screen for glaucoma as effectively as trained ophthalmologists. This project has also demonstrated the usefulness of this course for cross training Diabetic Retinopathy graders for glaucoma detection, which could potentially help free up scarce clinical human resources for diagnosis and treatment. Overall, this program has raised glaucoma awareness and has promoted early detection and referral among non-ophthalmic graders nationwide. In the future, Orbis plans to investigate the impact of artificial intelligence (AI) screening technology on the efficacy of non-clinical graders in the detection of glaucoma.


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