equipment, RetCam®, lasers, cryotherapy equipment, brachytherapy equipment, orbital implants, ocular prostheses, conformers, radiation devices, etc.). This new site in Chile will be set up to closely mirror our successfully developed centers of excellence for retinoblastoma treatment in Guatemala, Honduras, Jordan, and Panama.

19.3Telehealth Technologies

Many telehealth services have been made available through the collaboration of ORBIS® International, St. Jude Children’s Research Hospital, and the University of Tennessee Hamilton Eye Institute (Fig. 19.5). With the assistance of ORBIS®

International, ophthalmologists and oncologists have access to ORBIS® Cyber-Sight (www.cybersight. org), a web forum enabling physicians at outreach sites to connect via the Internet with our experts, led by Dr. Matthew W. Wilson, to provide consultation and share clinical information (including images). After the case file has been submitted by a partner, a mentor receives e-mail notification, reviews the case, and provides immediate advice. This e-consultation program further helps to eliminate the avoidable blindness that retinoblastoma can cause.

St. Jude Children’s Research Hospital provides another Internet-based consult system. The www.Cure4Kids.org website allows health professionals to discuss difficult clinical cases with

colleagues via a secure online system. Physicians and international partner sites can submit a clinical case for review by a faculty member at St. Jude or other authorized expert with experience in that disease. The St. Jude expert then provides an opinion on the case via a secure, passwordprotected website that stores all messages regarding the case. E-mail is used in this system only to notify each party when a message is ready for review on the website. When a discussion is completed, the international physician can then close the discussion and archive the case online. The Cure4Kids site also provides retinoblastoma specialists, oncologists, and researchers at SJCRH and UTHSC a forum in which to hold live, bimonthly videoconference meetings with our established international centers of excellence to discuss retinoblastoma patients with advanced or complicated disease via St. Jude’s Horizon Live network. Additionally, in 2008, Cure4Kids added the Oncopedia to its website, creating a space for

health-care professionals treating patients with retinoblastoma and other cancers and catastrophic illnesses to interact with other physicians around the world and submit cases for expert panel review. Furthermore, presentations from the 2007 symposium, “Retinoblastoma: One World, One Vision,” have been placed on the Cure4Kids website. In addition to all of these telehealth collaboration tools, the International Outreach Program also brings physicians from Central America and the Middle East to Memphis for in-person skills transfer with the ophthalmology teams at both UTHSC Hamilton Eye Institute and St. Jude Children’s Research Hospital.

19.4Impact of the Program

All of this technology and access to consultation with leading experts in childhood cancers and other eye disorders have had a far-reaching

Mediasite live events & video archives

Hamilton Eye Institute

UT Health Science Center

Teleconferencing

Cure 4 Kids

St. Jude International

Outreach Program

Teleconferencing

Fig. 19.5 International outreach telemedicine services

Weekly grand rounds

Wide range of special events

Live Web

Conferencing

Oncopedia case discussion forums

Moderated online courses

Mentored

E-consultation

E-Learning

Video library & other resources

impact on the effort to prevent blindness. Numbers of patients successfully treated have increased (Fig. 19.6). Our center of excellence in Jordan merits special mention, as well. Before the program was established there, the mortality rate for retinoblastoma was 38%, and the enucleation rate for patients with bilateral disease was 92%. However, during the period of March 2003 to December 2005, when 37 patients were referred to the program, the only death was of a patient who arrived with metastatic disease after failing therapy elsewhere. Moreover, the ocular salvage rate for patients with bilateral disease was 58%.

Additional accomplishments of these programs to date include:

•Set up centers of excellence in Guatemala, Honduras, Jordan, and Panama and procured equipment including lasers, cryotherapy equipment, and RetCams® for these sites.

•Program established by Dr. Matthew W. Wilson, director of ophthalmic oncology for the Hamilton Eye Institute and St. Jude Children’s Research Hospital, for placement of brachytherapy plaques in Guatemala and Jordan.

•Partnered with ORBIS® Cyber-Sight, an Internet-based web e-consultation system (www.cybersight.org).

Fig. 19.6 Survival rates of retinoblastoma patients in Central America

•Helped establish physician referral program to Guatemala, serving patients throughout Central America.

•Initiated visiting ophthalmologist program at St. Jude/UTHSC.

•Established bimonthly Spanish/English interactive teleconferences via St. Jude’s Cure4Kids web conference system, Horizon Live (www. cure4kids.org).

•Completed public education campaigns for early diagnosis in Honduras.

•Established a protocol to procure tumor tissue.

•Partnered with Oncopedia, a Cure4Kids online encyclopedia for pediatric hematology/oncology cases, uploading retinoblastoma cases and video for access by Oncopedia users.

•Extended Hamilton Eye Institute telemedicine outreach program to Jordan and Vietnam, holding landmark video conferences with institutions in both countries (Fig. 19.7).

•European School of Oncology invited those involved in our outreach program to take part in their weekly grand rounds during live, interactive webcasts (www.e-eso.net). The topic of the first interactive grand rounds: “Retinoblastoma in developing countries: how telemedicine may help.”

•Invited on site visit to Santiago, Chile, to determine what equipment will be needed

there to closely mirror our successfully developed centers of excellence in Guatemala, Honduras, Jordan, and Panama.

•Currently expanding Hamilton Eye Institute telemedicine applications using new Mediasite technology to permit physicians at other universities, hospitals, and eye institutes to participate in live Internet broadcasts of grand rounds and other events.

Our next goal in this ongoing international

outreach campaign is to establish monthly ophthalmology grand rounds with our international sites throughout Central America. A major step in accomplishing this objective was initiated in January of 2010 with the acquisition of a new telehealth communications system at the UTHSC Hamilton Eye Institute. The installation of the new Sonic Foundry Mediasite system will allow us to share private webcast links enabling health professionals anywhere in the world to attend events held in the Freeman Auditorium at the Hamilton Eye Institute, witnessing presentations by our faculty, residents, and visiting guest speakers live via the Internet. After these live events have transpired, they will be stored in the media section of the UT Hamilton Eye institute website (www.eye.uthsc.edu) and can be viewed at any time. The ability to attend these events will provide an additional layer of involvement for physicians at our centers of excellence through which

they may enhance their proficiency in managing pediatric eye tumors.

The Hamilton Eye Institute at the University of Tennessee Health Science Center will continue to support and further develop the retinoblastoma international outreach program in its partnership with the St. Jude Children’s Research Hospital international outreach program and ORBIS® International. As our regional centers of excellence develop greater expertise, they should be able to help develop other programs in their respective regions while they continue to grow through our continual collaboration and sharing of advances in ophthalmology research.

Acknowledgments

United States

Eugene Helveston, M.D.

Ophthalmologist-in-Chief

ORBIS International

Al L. Ueltschi

Chairman

ORBIS International & FlightSafety

International, Inc.

Lynda Smallwood

Senior Manager, Cyber-Sight

ORBIS International

Matthew W. Wilson, M.D., FACS

Professor of Ophthalmology

UT Hamilton Eye Institute

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

James C. Fleming, M.D., FACS

Philip M. Lewis Professor of Ophthalmology

Director of the Orbit Center

Hamilton Eye Institute

UT Health Science Center

Memphis, TN

Raul C. Ribeiro, M.D.

Director, Leukemia/Lymphoma

Director, International Outreach

St. Jude Children’s Research Hospital,

Memphis, TN

Judith A. Wilimas, M.D.

Medical Director

Referring Physicians Office and Domestic

Affiliate Program

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Carlos Rodriguez-Galindo, M.D.

Pediatric Oncologist

Dana-Farber Cancer Institute/

Children’s Hospital Boston

Boston, MA

Ibrahim Qaddoumi, M.D., M.S.

Director of Telemedicine

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

George Vélez, DHAc, M.B.A., CFAAMA

Administrative Director

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Gaston K. Rivera, M.D.

Medical Director, Chile Program

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Yuri Quintana, Ph.D.

Director, Education and Informatics

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Richard O’Brien

Educational Technologies Administrator

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Jorge I. Calzada, M.D.

Ophthalmologist

Hamilton Eye Institute

UT Health Science Center

Memphis, TN

Sandra Luna-Fineman, M.D.

Pediatric Hematologist/Oncologist

California Pacific Med Center-Davies

San Francisco, CA

The Richard T. and Josephine Arkwright

Foundation

New York, NY

Robert B. Carter, M.B.A.

Executive Vice President & Chief Information

Officer

FedEx Corporation

Memphis, TN

Blanca Phillips

Coordinator and Ophthalmic Photographer

UT Hamilton Eye Institute

International Outreach Program

St. Jude Children’s Research Hospital

Memphis, TN

Lee A. Thompson, M.A.

Publication Specialist

Hamilton Eye Institute

UT Health Science Center

Memphis, TN

Guatemala

Federico Antillon-Klussman, M.D.

Pediatric Hematologist/Oncologist & Medical Director

Hospital de Oncología Pediátrica Guatemala City, Guatemala

Margarita Barnoya, M.D.

Ophthalmologist

Hospital de Oncología Pediátrica

Guatemala City, Guatemala

Mauricio Castellanos, M.D.

Pediatric Hematologist/Oncologist

Hospital de Oncología Pediátrica

Guatemala City, Guatemala

Guillermo Chantada, M.D.

Pediatric Hematologist/Oncologist

Department of Hemato-Oncology, Hospital JP

Garrahan

Buenos Aires, Argentina

Panama

Ernesto Calvo, M.D.

Ophthalmologist

Clinica de Ojos Orillac-Calvo

Panama, Republic of Panama