In October of last year, the NGO Médicos da Amazônia undertook a mission with a special objective: to provide complete, free eye care to approximately 500 indigenous people from the Marmelos Village, in Amazonas.
The NGO offers health acess to Brazilian indigenous communities through specialized care, modern and advanced techniques and equipment, and highly trained professional, always respecting the ancestry of their cultures and values. Since its foundation, in 2015, it has carried out more than 64 thousand medical and dental consultations and procedures.
To document the patients’ fundus and anterior segment, the voluteer medical team used the Phelcom Eyer smartdevice. The device works in conjuction with a smartphone and performs high-quality retinal examinations in a few minutes without the need for pupil dilation. As it is integrated with the clooud, it automatically males the data available on the Eyercloud online platform for analysis by a specialist anywhere. In other words, it enables remote diagnosis.
“As well as being portable and not needing internet at the time of the examination, Eyer optimizes care and does all the documentation for patients, wich allows them to be followed up correctly. This is essential for any action in remote areas”, says ophthalmologist Jade Fernandes de Melo, one of the project’s volunteers.
The main retinal diseases diagnosed by the NGO were diabetic retinophaty, glaucoma, Age-related macular disease (AMD) and asteroid hyalosis, among others. The doctors also detected cataracts, refractive alterations and pterygium. The patients were referred to indigenous Health for treatment.
Melo evaluates the device as easy to use, self-taught, with excellent image quality and essential in primary care. “The Eyer can make a difference to many people’s lives by bringing ophthalmic access to remote communities with a lack of health infrastructure”, Melo believes.
Minutes. This is the average time that the Brazilian client, who value immediate feedback, wait for Phelcom’s customer support department to solve technical issues, clarify doubts, request support materials or schedule training.
In other countries, even if the customer usually prefers a different approach, requesting support via email, agility is still Phelcom’s trademark. “Normally, the foreign clients don’t call us as soon as the problem appears, but when they have time between their appointments.” explains Phelcom’s customer support analyst, Leonardo Chagas Pizzo.
To guarantee this agility, Phelcom chose to have its own local team in Brazil. “Unlike other services, our clients don’t wait in digital lines. We’re here to solve their problems quickly and try to reduce the bureaucracy”, says Phelcom’s technical support, Hygor Nunes.
As a result, the team has developed a close relationship with many clients. “Today, we are able to identify each person’s profile, being able to serve them in a personalized way, according to their necessities”, explains Phelcom’s customer support coordinator, Rodrigo Cabrera.
Phelcom’s customer support team in Brazil
Trainings
After purchasing a Phelcom Technologies product, the support customer team gets in touch to schedule online training on how to use the equipment and its on board technologies, such as the online exam management platform, EyerCloud and the artificial intelligence system EyerMaps, that accurately detects various changes in the retina.
“Eyer is a multifunctional fundus camera that offers a variety of features and it’s important to train our clients to make the most of all the device’s functionalities.”, says Phelcom’s customer support intern, Pablo Sathler.
However, training is optional. “We make our schedule available so that the client can choose the best day and time for them. Besides that, we also ask for at least two people to be present so that they can have the experience of making images with each other, aligning possible doubts about use.”, emphasizes Phelcom’s customer support analyst, Tatiane Fragalli.
Cabrera explains that, in addition to the initial training, clients can take as many courses as they wish during the one-year Eyer warranty period. “Often, clients want to ask questions about how to edit images or configure circuits, for example. So we prepare customized training courses according to their needs.”
Phelcom also continuously makes educational and support materials available to answer the most frequently asked questions, such as folders, videos in the form of information pills and infographics with detailed guidelines and practical tips to maximize the use of Eyer. To get access, just contact the Customer Support department via email support@phelcom.com.
For technical support, Phelcom uses a communication system for opening tickets directly on this link: phelcom.com/servicecenter, which guarantees more agility and transparency.
Tatiane Fragalli provides online training on how to handle the Eyer family of products.
Eyer
Eyer supports the diagnosis of more than 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, ROP, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile, Colombia and Japan.
It was recently approved in the United Arab Emirates and is in the regulatory process of being marketed in Mexico, Egypt and Saudi Arabia.
Portability, connectivity and integration with intelligent functions such as EyerMaps, together with the technology’s affordability, are contributing to increased access to retinal examinations.
Phelcom recently launched Eyer2, a portable fundus and eye camera that offers high-quality images of the posterior and anterior segments.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The first prototype project was born out of partner Diego Lencione’s interest in visual health, as his brother has had a condition that has severely compromised his retina and vision since childhood.
Doctor Iddi Ndyabawe, ophthalmologist and a passionate ROP specialist in Uganda, East Africa, was responsible for the very first ROP study in the country, published by BMC Ophthalmology in 2023. He’s currently involved in Adult Retina services as well, working in a screening project for diagnosing CMV Retinitis in HIV patients with meningitis admitted at Kiruddu National Referral Hospital and Mulago National Referral Hospital. He also offers Diabetic Retinopathy screening services to private patients at Kisubi Hospital.
Dr Iddi in the Aravind Eye Hospital Library, Coimbatore India
Dr. Iddi got to know about the Eyer Retinal Camera in February 2023, when Nurse Nancy Maria Douat Dietrich from Santa Catarina, Brazil came along with the high quality images device and joined the ROP screening activities at Kawempe National Referral Hospital.
“When Nancy saw my passion for ROP in Uganda, she communicated with Mr. Jose Augusto, CEO of Phelcom, who then sent me an Eyer Fundus camera by June 2023 as a support for my humble efforts in ROP “, recalls Dr. Iddi.
Dr Iddi training in laser therapy for ROP on an eye model
Dr. Iddi crossing the flooded roads to reach the village NICU to conduct ROP screening
According to Dr. Iddi, the main advantages of the Eyer Fundus Camera for his medical practice are:
Eyer takes clear resolution images for best diagnosis of posterior disease;
It is perfect at CDR assessment;
Eyer can easily pick out the hyperemic disc in optic neuritis that could easily be missed;
EyerMaps heat map is perfect in pointing where the clinician should pay more attention.
Dr. Iddi mentions as well that the portability and non-mydriatic use of Eyer Fundus Camera, which allows him to perform examinations in different scenarios. He recalls one particular Sunday when a relative came in complaining of reduced vision. He was able to discover a diagnosis of toxoplasmosis right there in his own home.
About the Eyer
Eyer Portable Fundus Camera
The Eyer is a portable fundus camera that works in conjunction with a smartphone and performs high-quality retinal examinations in a few minutes without the need for pupil dilation.
The technology supports the diagnosis of more than 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile and Colombia.
The technology’s portability and affordability democratize access to retinal examinations. It costs approximately six times less than a conventional tabletop fundus camera, which still needs to be integrated with a computer.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The idea for the first prototype was realized by Diego Lencione’s interest in visual health, as his brother has had a condition that has severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people across Brazil and worldwide.
In four years, the company has participated in more than 100 social actions and was recently named one of the 10 most innovative companies in Brazil by Forbes.
As a child, Phelcom’s Co-Founder and CTO Diego Lencione dreamed of becoming an ophthalmologist. His goal was to help people who suffered from retinal and vision impairment like his older brother, Welber Lencione.
Welber was diagnosed with high myopia when he was seven months old. During his childhood, it reached 17 degrees. The main difficulty with the disease is being able to see distant objects clearly. However, for those with high degrees of myopia, the symptoms are even more serious and have a significant impact on quality of life.
At school, seeing the small print on the blackboard was a real challenge for Welber. “For me to be able to see well, I have to get very close to my cell phone, computer or television. Without my glasses, I can’t even leave the house”, he explains.
High myopia can cause a series of eye complications and significant damage to vision. At the age of 11, Welber suffered retinal detachment in both eyes. At the time, he was admitted to the hospital for two months for treatment.
At 18 years old, he had another episode of retinal detachment, also in both eyes. However, laser surgery was available and he returned home the same day. Since then, he has had no further complications and his myopia has dropped to 11 degrees. “All this has matured me a lot. In the end, time goes by and things settle down”, he reflects.
Welber currently has a productive life full of achievements. He works as a security guard at the University of São Paulo (USP) for 18 years, has a 12 year old son named Andrew, is a regular reader and recently became a marathon runner.
Welber Lencione during a competition
Running
Welber says he has always loved sports. Seven years ago, he started running. “I don’t have any difficulties related to my eyesight. I feel 100% myself when I run”.
The athlete has been taking part in competitions in and around São Carlos (SP) for three years. To prepare, he trains in his own neighborhood, day in and day out, in the company of some colleagues. In January, he achieved something he never had before: he completed a marathon in Ribeirão Preto (SP).
Welber finished the last 100 meters of the Ribeirão Preto Marathon alongside his son, Andrew.
Welber reveals that he wants to do it again, but in the famous “São Silvestre International Race”, which takes place every year on December 31st in the city of São Paulo. The obstacle? “It’s a very bad date,” he jokes.
Inspiration
During Welber’s first surgery, Diego was four years old. He had to spend days away from his beloved brother and his mother, who stayed with her firstborn for two months in the hospital.
Throughout his childhood and adolescence, Diego followed his brother’s journey: “When I grew up, life took me into other areas and I ended up studying Physics. At university, I specialized in optics and, before I knew it, I was already working in research and development of ophthalmic equipment,” Diego recalls.
Phelcom’s Co-Founder and CTO, Diego Lencione, with his brother, Welber Lencione.
This gave rise to Phelcom and the idea of creating Eyer -a portable fundus camera that aims to help combat severe visual impairment and blindness. The first tests performed with the first prototypes were on Welber’s eyes. “It was an unforgettable moment. We created something that allowed us to clearly see the changes in his retina and that it would soon be useful for many other people as well. Many times throughout Phelcom’s history, I’ve found myself returning to this time, especially in the company’s most difficult moments”, he reveals.
His brother continues to be a source of inspiration for Diego. Recently, the youngest brother performed a new retinal examination on Welber with the help of EyerMaps, an Artificial Intelligence (AI) system that runs on board Eyer and detects any suspected retinal abnormalities with high accuracy.
The AI pointed to the presence of something new in the back of Welber’s eye. “My brother even suspected a new retinal detachment. But with further tests, the ophthalmologist concluded that it was a kind of membrane that had grown there and that it didn’t affect his vision”, he says, relieved.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The Lavinsky Clinic in Porto Alegre (RS) uses the Eyer portable fundus camera to take images of the posterior segment. The equipment is used more frequently in one of the units where optical coherence tomography (OCT) is not an option.
“For example, in cases of glaucoma, the OCT exam provides fundamental structural information for diagnosis and progression, but only the photo shows findings such as optic disc hemorrhage. By combining the two tests, we can better diagnose and monitor the progress of the disease. In this way, retinal imaging is essential for glaucoma analysis”, says glaucoma specialist, researcher from Wills Eye, and coordinator of the Diagnostic Unit at the Lavinsky Clinic, Fábio Lavinsky.
Fábio Lavinsky is a glaucoma specialist, researcher from Wills Eye, and coordinator of the Diagnostic Unit at the Lavinsky Clinic.
The images taken with the Eyer can be accessed on the EyerCloud online platform, allowing for complete documentation, patient follow-up and remote reports.
The fundus images help to identify other retinal problems as well. “That’s why Eyer can be differential in the diagnosis of glaucoma, as it takes an exceptional picture”, he points out.
Retinal image of a patient diagnosed with glaucoma taken with Eyer.
Retinal image of a patient diagnosed with glaucoma taken with Eyer.
Lavinsky also uses the EyerMaps artificial intelligence (AI) system, embedded in Eyer, which detects potential retinal abnormalities in real time. If a suspected abnormality is identified, the AI generates a new image with a heatmap highlighting potential abnormalities in the retina. “For clinics that don’t have OCT, this can be a guideline for ordering the test.”
The ophthalmologist points out that AI does not yet accurately identify changes in the optic nerve such as cupping, however, Eyer offers tools for diagnosing the disease.
Stereophoto and CDR – Cup to Disk Ratio
The stereophoto is a video created by Eyer based on the superimposition of retinal images with the nerve and macula in the center of the image. This way, doctors can have a clearer view of the region of interest for diagnosing glaucoma.
Stereophoto taken with Eyer.
The Cup to Disk Ratio (CDR) tool shows the percentage ratio between the optic nerve and the excavation, a measurement which, together with other clinical and diagnostic findings, can indicate the presence or risk of the disease.
With just a few clicks and by selecting the circles that outline the nerve and the excavation on the device’s screen, Eyer not only calculates the CDR, but also the neural RIMA measurements and the ISNT graph, metrics that support the diagnostic interpretation of the exam quickly and more accurately.
CDR – Cup to Disk Ratio tool built into Eyer.
Education
Lavinsky is currently in the United States working as a researcher in imaging and ophthalmology at Wills Eye Hospital in Philadelphia, Pennsylvania. But he is also a member of the medical faculty at the University of Vale do Rio dos Sinos (Unisinos), in São Leopoldo (RS).
As well as bringing better clinical results for patients, he believes that Eyer can help teach future doctors. “The Eyer should be like a stethoscope for medicine. Courses should have devices in internal medicine teams and in other related specialties to take pictures of patients with systemic pathologies with ocular repercussions, in the classroom, as well as promoting discussions with students about findings”, he reflects.
Lavinsky explains that the direct ophthalmoscope has a very small field of vision. Although it has some advantages, such as three-dimensionality and showing the optic nerve clearly, the Eyer comes out on top because it has excellent optics and high-quality images that can be viewed digitally by several students. “More specifically, the Eyer should be part of the semiology course. It would be fantastic, something almost revolutionary in education.”
For the doctor, the technology should not only be used in the field of ophthalmology, but also in those where diseases have ocular manifestations, such as endocrinology, cardiology and neurology. “Using EyerCloud, ophthalmologists could provide diagnostic support to colleagues in related specialties. This would greatly speed up the diagnosis and management of important ocular complications, having a positive impact on patients’ clinical outcomes”, he says.
Fábio Lavinsky has no commercial relationship with or receives compensation from Phelcom.He was interviewed for this article because of his expertise and experience in the medical field, with the aim of sharing relevant information about glaucoma and ophthalmic technologies.
The doctor Gustavo Rosa Gameiro, a PhD student in ophthalmology at Unifesp, was selected by the Brazilian Academy of Sciences (ABC) and the Ministry of Science, Technology and Innovation (MCTI) to participate in the 8th BRICS Young Scientists Forum. The event occurred from July 31th to August 8th in Gqeberha, South Africa.
BRICS is a group of five developing countries focused on mutual economic cooperation: Brazil, Russia, India, China and South Africa.
Gameiro was one of the six Brazilian scientists nominated to take part in the panel “The future of education, skills and skill sets”. The PhD student points out that education entered the BRICS agenda with great force this year. “In my presentation, we discussed applications of basic models and the use of the Eyer portable fundus camera with artificial intelligence for teaching ophthalmology based on the results of our workshops,” says the doctor, the youngest member of the Brazilian delegation at the event at 27 years old.
Gustavo Gameiro used the Eyer portable fundus camera in his project presented at the 8th BRICS Young Scientists Forum. Photo: personal archive.
Gameiro explains that the first approach to diseases such as glaucoma, Age-Related Macular Degeneration (AMD) and diabetic retinopathy in primary care is often carried out by the newly qualified clinical doctor.
“However, studies reveal that they have a huge deficit in the teaching of ophthalmology during their degree, compromising the correct approach and prognosis of these cases. This can lead to insecurity in referring or treating patients with ophthalmic complaints,” he explains.
Workshops
The workshops took place with undergraduate students from Unifesp and the Albert Einstein Israelite Institute for Education and Research and were supported by the ophthalmologists Thiago Gonçalves Martins and Paulo Schor, Gameiro’s PhD advisor. The Eyer portable fundus camera and the EyerMaps AI system were provided free of charge by Phelcom Technologies for the project.
“With the EyerMaps AI resource, which uses a heat map to highlight areas of the retina with possible alterations caused by different pathologies, we were able to teach and correct the student’s interpretation findings at the same time as captured by the fundus of the eye,” says the doctor.
“The clarity of the images is absurdly incredible. We did exams on our colleagues and we were able to see every detail of the retina, optic nerve and vessels. Transforming large, heavy devices like a fundus camera into portable ones makes the doctor’s life much easier, because we can go to the patients and achieve better results,” says Unifesp medical student Suellyn Alves, who took part in the workshop.
Gameiro goes further: “Perhaps we need to change the paradigm of only teaching students how to acquire images using ophthalmic equipment. We need to focus on how to interpret them and manage these exams, organizing them in the cloud, for example. and with the Eyer, you can easily teach interpretation and management” he says.
With the satisfactory results of the workshops, the doctor reveals his desire to expand the project and turn it into support material for teaching ophthalmology throughout Brazil.
Brazilian delegation during the 8th BRICS Young Scientists Forum. Photo: personal archive.
“Eyes to the Future” contest
Gameiro is also working on a new project at the same time: evaluating the impact and follow-up of the projects presented in the “Eyes to the Future” contest, held by the Brazilian Association of Academic Ophthalmology Leagues (ABLAO), in partnership with Phelcom and with the support of the Brazilian Ophthalmology Council (CBO).
The competition seeks to teach students and encourage leagues to develop extension activities aimed at creating educational and/or assistance projects with the objective of reducing blindness due to posterior segment pathologies. To accomplish this.Phelcom provided 20 Eyer units with access to the EyerMaps feature and the EyerCloud cloud system.
The competition selected 10 projects and the top three will receive an Eyer. “It would be very interesting if we could permanently leave a portable fundus camera with each of the 10 leagues. We’re going to work on getting sponsorship to buy the seven remaining devices,” says the doctor.
“After the Academic Leagues were selected, we spoke to ABLAO’s president Luís Sabage and realized the need to evaluate and follow up on the projects submitted. Our future goal is to increase the number of ophthalmologic leagues, medical students and patients reached by the outreach projects developed,” he explains.
Furthermore, based on the results obtained in the “Eyes to the Future” contest and the points for improvement found, Gameiro intends to structure an online ophthalmology course for medical students and general practitioners, covering basic eye examination techniques, the use of artificial intelligence platforms and the interpretation of retinography images.
The doctor points out that traditional equipment for evaluating the fundus of the eye, such as fundoscopy performed with an indirect ophthalmoscope and condenser lens, is relatively difficult to handle, requires lengthy training, has a learning curve and depends on the examiner for evaluation. Besides, most of the time it doesn’t allow photographic recording of the retina for later discussion and review.
Alternatively, there is the conventional fundus camera. However, it is expensive to purchase. “Capturing images of the retina is extremely important for more accurate assessment and for monitoring the disease and treatment. It also plays a fundamental role in the training of new professionals through the presentation and discussion of findings in a group, allowing students and doctors to compare their exams and review the results,” he says.
The Eyer portable fundus camera is an extremely advantageous option in several aspects:
It makes it easy to capture high-quality images of the retina without much prior training;
Lightweight and small (it fits in the palm of your hand);
It does not require specialized labor;
Relatively more affordable than a traditional fundus camera;
It is non-mydriatic, shortening the examination time and avoiding possible adverse effects (visual discomfort, photophobia, keratitis and increased intraocular pressure);
Through telemedicine, it sends the images to the cloud, enabling remote diagnosis.
For Gameiro, the Eyer can have a significant impact on medical education. “The device can be used by medical students as a practical learning opportunity, demonstrating clinical cases and monitoring the progression of eye diseases over time, as well as stimulating interactive discussions between students and teachers, encouraging research projects and cases and facilitating access to and recording of a wide variety of cases,” he points out.
The equipment also has on-board artificial intelligence, which can be a reliable and cost-effective option for screening retinal and optic nerve pathologies using algorithms built on extensive databases.
“These algorithm models are able to predict the risk of alteration and thus notify the examiner of the need for follow-up with a more qualified specialist. In this way, the use of AI, together with deep learning and telemedicine, can represent an effective long-term solution for screening and monitoring patients in primary health care,” he concludes.
About the Eyer
Eyer Portable Fundus Camera
The Eyer is a portable fundus camera that works in conjunction with a smartphone and performs high-quality retinal examinations in a few minutes without the need for pupil dilation.
The technology supports the diagnosis of more than 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile and Colombia.
The technology’s portability and affordability democratize access to retinal examinations. It costs approximately six times less than a conventional tabletop fundus camera, which still needs to be integrated with a computer.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The idea for the first prototype was realized by Diego Lencione’s interest in visual health, as his brother has had a condition that has severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people across Brazil and worldwide.
In four years, the company has participated in more than 100 social actions and was recently named one of the 10 most innovative companies in Brazil by Forbes.
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