Results of Renovatio, a non-profit organization that brings visual health and prescription glasses to those who need them the most, saw more than 410,000 eye treatments in 25 Brazilian states and three countries. They also donated more than 180,000 glasses.
According to the Brazilian Institute of Geography and Statistics (IBGE), one in six Brazilians has a vision problem. With an adapted 100m² bus, transformed into two modern mobile eye clinics, Renovatio is able to serve medical deserts, such as remote towns, indigenous villages and riverside communities.
“We believe that the most difficult places to reach are the ones that need us the most. Today, 71% of Brazilian municipalities don’t even have an ophthalmologist,” says ophthalmologist and Renovatio’s medical director, Bruna Gil Ferreira.
Since 2022, Renovatio has been using the Eyer portable fundus camera to screen patients. They currently have almost 50 units. The main factors for choosing Eyer were its portability, the fact that it is a Brazilian product and the EyerCloud cloud platform, which allows exams to be stored and shared remotely and in real time.
“The possibility of sending the images for analysis and getting immediate medical consultations, even in remote areas, contributes to a more agile and effective assessment of patients. Sometimes I’m in São Paulo and I can access, in real time, the examination of a patient being treated in the Xingu Indigenous Park,” Ferreira points out.
Renovatio invested in Eyer because of the EyerCloud cloud platform, among other factors.
During the exams, the team evaluates the visual acuity, tonometry, keratometry and uses Eyer for fundus examinations. When Eyermaps artificial intelligence system detects possible retinal alterations, the patient is referred for a medical consultation with a specialist.
If an alteration is suspected, the AI generates a new image with a heatmap highlighting potential retinal abnormalities. The system can help detect diseases like glaucoma, Age-related Macular Degeneration (AMD), diabetic retinopathy, hypertensive retinopathy, vascular tortuosity, occlusions, papilledema, retinitis pigmentosa,nevus, and many more.
Ferreira points out that most social work in the ophthalmology area follows protocols based only on visual acuity and, as a result, other diseases are not diagnosed. “Including Eyer in our protocol has contributed greatly to identifying silent diseases that can go unnoticed in screenings focused only on vision.”
A child being examined with Eyer during a social action by the NGO Renovatio.
Chorioretinitis caused by toxoplasmosis
By storing all the fundus images in EyerCloud, Renovatio carried out a comparative study of the frequency of chorioretinitis scars caused by toxoplasmosis in different regions of Brazil.
In total, 9,648 fundus images were evaluated:
Distrito Federal (DF) – 2.496;
Tocantins (TO) – 2.426;
São Paulo (SP) – 1.862;
Minas Gerais (MG) – 1.602;
Rio Grande do Norte (RN) – 742;
Rio de Janeiro (RJ) – 502.
The majority of exams (89.04%) showed no alterations. Of the 10.95% of images with alterations, 7.09% contained suspicions and confirmations of chorioretinitis scars:
Tocantins (TO) – 62,7%;
Minas Gerais (MG) – 14,7%;
Distrito Federal (DF) – 10,07%;
São Paulo (SP) – 8%;
Rio de Janeiro (RJ) – 2,7%;
Rio Grande do Norte (RN) – 1,3%.
Among the results obtained in all states, there was a higher prevalence in women (74.7%) and a higher number of cases in the left eye (37.3%), followed by both eyes (33.3%) and then the right eye (29.3%).
It is also worth noting that the state of Tocantins had the highest incidence of the disease in the left eye (26.7%), in both eyes (17.3%) and in the right eye (18.7% of diagnosed cases).
The use of Eyer integrated with EyerCloud allowed Renovatio to carry out this important mapping, which can help with future management of toxoplasmosis, a pathology that can lead to loss of vision.
NGO Renovatio has already traveled to 25 Brazilian states providing free ophthalmic consultations and donating prescription glasses to those who need them most.
Eyer
Eyer is a portable fundus camera that works with an integrated smartphone to perform high-quality retinal examinations in just a few minutes without the need for pupil dilation.
Currently, more than 15 million tests have been carried out in Brazil, the United States, Chile, Colombia and Japan. The technology is also present in the United Arab Emirates and is in the regulatory process of being marketed in Mexico, Egypt and Saudi Arabia.
Phelcom recently launched Eyer2, a true visual examination platform that allows you to capture the posterior and anterior segments with high quality images.
With new embedded tools and improved functions, the new equipment makes it possible to capture various conditions of the anterior segment of the eye, such as blepharitis,eyelash alterations, meibomian gland dysfunction, styes, conjunctival tumors, eyelid tumors, advanced cataracts, foreign bodies, burns, corneal lesions and keratitis in general, caused by dry eye, contact lenses, infections and ulcers.
Portability, connectivity and integration with intelligent functions such as EyerMaps, together with the technology’s affordability, are contributing to increased access to retinal examinations.
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.
In 2019, Phelcom launched its first product in the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people throughout Brazil and in the countries where it is present and has been used in more than 100 community screenings.
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.
In partnership with the NGO Retina Global, doctors plan to perform digital retinal exams and retinal mapping in more than 15 thousand diabetic patients in the countryside of Sergipe.
Last year, the NGO Retina Global was interested in developing a social project to diagnose and treat diabetic retinopathy in Brazil. The North-American institution acts to create sustainable solutions in controlling retinal diseases in poor areas all over the world.
Thus, the partnership with the ophthalmologists Fernando Malerbi and Gustavo Melo gave birth to “Iluminar”, a project to track and treat diabetic retinopathy in 13 municipalities in the backlands of Sergipe. The group chose the region for its history of poorness related to drought and lack of ophthalmological assistance in public health.
Up to now, more than 700 people have undergone retinal exams in the cities of Itabi, Graccho Cardoso and Canindé de São Francisco. “Approximately 150 patients have been submitted to a new retinal mapping exam with the team of retinologists on site. From those, 50 were sent to laser photocoagulation treatment”, highlights one of the project leaders, ophthalmologist Gustavo Melo.
The joint efforts count on two healthcare technicians, around ten workers from Basic Healthcare Units (UBS) from each municipality and four volunteer ophthalmologists, part of them sending remote reports.
Retinal images are made with Phelcom Eyer smartdevice. Coupled to a smartphone, the equipment carries out high quality exams, in a few minutes without need of pupil dilation. Integrated to a cloud system, it makes data available automatically in EyerCloud online platform. This way, a doctor can generate a report from anywhere in the world.
“Eyer allows optimizing time and costs by tracking the diabetic population in the countryside so that they do not need to move to the cities that have equipment and specialists. Non-midriasis is another advantage, since 90% of the cases do not need to dilate the pupil”, explains Melo.
The smart device also offers the joint efforts of an artificial intelligence that identifies diabetic retinopathy and other eye diseases with more than 95% sensitivity in just three seconds. After that, the exam is sent to the ophthalmologist for checking and reporting. The AI is at the final test stage.
Next Stage
This month, the Project will be at Poço Redondo. It aims to provide care for 15 thousand diabetic patients in 13 cities in Sergipe, in a period of two years.
“The great differential is optimization of time, essential for early diagnosis, so that chances of diabetes-related blindness lower considerably. Raising awareness of both the population and public managers about the efficiency and lower cost of this way of tracking diabetic retinopathy may stimulate the creation of health policies to treat this disease and others that affect the retina”, analyzes Melo.
Retina Global is an international, non-profit organization that seeks to enable sustainable solutions for the care of retinal diseases in underserved areas around the world.
Currently, the institution has projects in Central and South America and in Asia. It has already implemented programs in Tanzania, Kenya, Bolivia, Belize, Bahamas, Burundi, Ethiopia, Haiti and Brazil.
The NGO, in partnership with the project Iluminar, tracked and treated diabetic retinopathy in 13 municipalities in Sergipe hinterlands.
The team used the Phelcom Eyer, a smart, medical device, to carry out high-quality retinal exams (without having to dilate pupils) and make images available for remote diagnosis.
Recently, the organization has used the equipment again to track retinal diseases in Kericho, a town in rural Kenya, Africa.
Learn more about the project of Retina Global in Kenya, with the support of Eyer.
Retina Global in Kenya
For two days, the volunteer team from Retina Global made an initial evaluation, and then referred the patients for fundus exams with Eyer. Both the images and patients’ histories were
immediately available in the Eyer Cloud online platform.
Specialists in retina, based in the United States, made the reports. In total, 26 people were found to have retinal abnormalities, including a child and one young adult. “With that, we could diagnose quickly and start early treatment”, said the leader of Retina Global project in Kenya, Diane Steinhilber.
“We will keep using the equipment to identify and select the patients in need of specialized retinal care”, she highlights.
Lack of access to eye health
Steinhilber explains that the great challenge of this project is the lack of a retina specialist in this rural area of Kenya. Patients who need specialized treatment are referred to hospitals in Nairobi, the country’s capital, which is located roughly five hours away.
“To see a doctor, they face an arduous and long trip, as well as the time away from their jobs and families. Screening through Eyer allows us to quickly refer patients that are in real need of care in specialized centers”, she states.
As some patients have difficulties to get to the hospital, the project plans to send a trained team on community missions. Moreover, the project searches for a portable machine for laser treatment, as well as tools to carry out other kinds of therapies, such as intraocular injections and surgeries.
“Our team evaluated in detail the best way to implement a project that is able to provide exams and information on retinal care and also one that is sustainable in the long-term”, she says. Therefore, the project in Kenya was divided in phases to be implemented over five years.
Eyer use in Kenya
Retina Global team in Kenya took part on a remote training to learn how to handle the technology. “Eyer is extremely easy to handle. It is possible to promptly identify the images, quickly create patient database and send the photos to the doctor in the United States for review and reporting”, she says.
The project leader also highlights another advantage of Eyer: it not only has data for patient follow-up and continuous care, but also is a way to obtain information on the prevalence of retinal diseases in the region.
“Without Eyer, Retina Global would not have even started in Kenya. Further than using it in more local communities, we plan to include it in other projects to take place around the world”, she finishes.
Phelcom Eyer
Phelcom Eyer is a portable fundus camera that works to carry out high-quality fundus exams in a few minutes without the need of pupil dilation.
Integrated to an online platform, Eyer Cloud, the data is automatically sent and can be analyzed by a specialist anywhere in the world. That is, it allows remote diagnosis.
More than that, its embedded artificial intelligence provides smart features to help medical diagnosis and the capture of retinal scans. On the other hand, the portability and affordability of the technology democratize the access to retinal exams. The Eyer is about 10 times more affordable than a desktop fundus camera, which still has to be integrated into a computer.
Phelcom Technologies developed the technology, which is currently present all over Brazil and in countries such as the United States, Japan and Chile.
In January this year, ophthalmologist Korn Malerbi boarded an expedition towards a special destination: taking free medical care to three indigenous reserves in the State of Mato Grosso. “I was invited to join a team of doctors who already takes periodical actions in these locations”, tells Malerbi.
The group consists of physicians of the Department of Social Medicine, from the USP Medical School (Ribeirão Preto), and the Department of Endocrinology, from Paulista School of Medicine, Unifesp.
The expedition counted on four specialists in the following areas: ophthalmology, endocrinology and preventive and social medicine.
Malerbi explains that the reserves Sangradouro, Meruri and São Marcos present high rates of diabetes mellitus. “This disease may trigger various other health conditions, such as diabetic retinopathy. In case it is not detected and adequately treated in time, this ophthalmological alteration may lead to blindness”, he clarifies.
In order to identify the disease and other possible disorders, the doctor carried out retinography and applanation tonometry. 193 indigenous people altogether were evaluated, from Xavante and Bororo communities, during eight days of work.
More than diabetic retinopathy, exams found cases of cataract.
Eyer
The ophthalmologist utilized Phelcom Eyer handheld fundus camera to perform the exams.
The equipment is state-of-the-art in portable retinography for prevention and diagnose of eye-related diseases.
It works attached to a smartphone and performs high-quality retina exams in few minutes, without need of pupil dilation. Synchronized to cloud, it automatically provides data to the online platform EyerCloud, so that they can be analyzed by a specialist anywhere over the world. That is, it enables remote diagnostic.
“It was a great experience with the equipment, mainly because of its portability and ease of access”, evaluates Malerbi.
He reminds of his involvement in other projects with the fundus camera, also for diagnosing diabetic retinopathy. “I believe Eyer to be very relevant for this kind of action, representing an important alternative for mapping and tracking diseases in populations from remote areas”, he finishes.
Ophthalmologist used Eyer to carry out exams and solve doubts on diagnostics.
Imagine a floating hospital with medical and dental offices, surgical center, complete ophthalmological room, analysis lab, medication room, vaccination room and infirmary beds. More than that: equipments for examinations as X-ray, electrocardiogram, mammograph and treadmil ergometer.
This is São Francisco Boat Hospital, built to take health and medical care to more than 1 thousand riverside communities in the Amazon Region. Associação e Fraternidade São Francisco de Assis na Providência de Deus, a Brazilian charity organization, idealized the boat and made dozens of expeditions in 2019.
One of them was in the municipality of Terra Santa, in Pará, from October 21 to 30. The expedition counted on several volunteers in different healthcare areas, such as ophthalmology, pediatrics, oncology, psychiatry, dermatology, plastic, orthodontics, inter alia.
Ophthalmologist Mariana Lafetá was one of the volunteers in that trip. “Each specialist has an office on boat and we travel from town to town offering medical care to the population. We consulted 4,052 people altogether”, she tells.
Regarding eyes, the doctor emphasizes that the main disease diagnosed was dry eye syndrome. Moreover, there were many cases of refractive errors, cataract, presbyopia (known as eyestrain), pterygium (known as surfer’s eye), blepharitis and meibomitis – these latter affecting glands around the eyelids. There were also cases of glaucoma and, in a very low rate, diabetic retinopathy.
Eyer
The doctor took Phelcom Eyer handheld fundus camera to the expedition. “Due to the great number of patients, I chose to use the device just in cases of diagnostic doubts and patients with glaucoma. Being able to email exams to the ones who had email addresses was interesting. This way, they could use them in future consultations”, emphasizes Lafetá.
The ophthalmologist says the equipment is easy to use and practical. “It is easy to carry out exams, take photos, find them among files and store afterwards. We can also send or print images, which I consider very interesting, besides getting to access them from anywhere with internet connection. I really liked it”, she analyzes.
Phelcom
“Eyer’s main goal is to democratize and take access to healthcare to locations presently suffering from infrastructure deficit in the area, such as of specialists and equipment. With portability, accessible prices and the possibility of remote diagnose, via cloud, we can help healthcare professionals to assist more people”, say startup Phelcom Technologies founders, José Augusto Stuchi, Flávio Pascoal Vieira and Diego Lencione.
According to the first World Report on Vision, developed by the World Health Organization (WHO), 2,2 billion people around the world have a vision impairment. From this sum, 1 billion cases would be avoidable or remediable, such as myopia, cataract, glaucoma and hyperopia.
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