Hope in Sight

Medical Technology Sep 7, 2020 5 min read
Modern customized medical technology together with Brazil’s health care program are bringing telemedicine to all people, allowing them to receive the eye care they need.

The older woman sitting two meters away from the television squints and moves her head forward in an attempt to see the screen clearly. Claudete José Custódio or (as everyone calls her) Dona Claudete loves the telenovelas on Brazilian TV. These are dramatic, but not overly convoluted stories of fate, power, and passion. For some time, it has been quite difficult for this 62-year-old woman to make out the actors’ faces, causing her to mix up the characters. “I need a new pair of glasses,” she says.

While in many countries this issue could be resolved by a quick trip to the local optometrist, the situation is more complicated in Brazil. First: there are not any ophthalmologists in the countryside or the poorer areas of the large cities. Second: the public health care system does not cover the correction of visual impairments. If you cannot pay yourself, then it is difficult to get a diagnosis and a suitable visual aid.

Telessaude is the new hope

In Porto Alegre, located in southern Brazil, all this is changing with the “Telessaude” program offering assistance to people like Dona Claudete. Visionary, customized medical and technological (data management) solutions from ZEISS are making this possible by connecting remote clinics via telemedicine technology. In this chapter of fighting poverty through progress, patients who are prepared to take a new approach to health care have the chance of achieving optimal vision.

There are not any ophthalmologists in the countryside of Southern Brazil where Claudete José Custódio lives.
There are not any ophthalmologists in the countryside of Southern Brazil where Claudete José Custódio lives. © Marcel Schwickerath

The eight-person team at the remote eye care clinic gives Dona Claudete a warm welcome. They ask if she is taking any medication or has diabetes. Looking slightly overwhelmed, the older woman responds by saying no. It seems as if she would rather be back at her humble home, where the world is extremely small, but also manageable.

She doesn’t have to wait for long. First, they measure her intraocular pressure. Then they analyze her visual field and the ocular fundus, i.e., the back of her eyes. With a data management system, all data are networked with the ophthalmologist’s computer.

There are not any ophthalmologists in the countryside of Southern Brazil where Claudete José Custódio lives.
There are not any ophthalmologists in the countryside of Southern Brazil where Claudete José Custódio lives. © Marcel Schwickerath
The diagnosing doctor, Dr. Aline de Araujo, is sitting in a darkened room in the center of Porto Alegre, one-anda-half hours away. Telemedicine and that is a major step in making healthcare accessible to all Brazilians. © Marcel Schwickerath
The diagnosing doctor, Dr. Aline de Araujo, is sitting in a darkened room in the center of Porto Alegre, one-and-a-half hours away. Telemedicine and that is a major step in making healthcare accessible to all Brazilians.
Claudete José Custódio is getting measured her intraocular pressure and her visual field and back of the eye is being analyzed. © Marcel Schwickerath

Diagnosis from far away

There’s just one thing: The diagnosing doctor, Dr. Aline de Araujo, is not at the hospital in Restinga. Instead, she’s sitting in a darkened room in the center of Porto Alegre, one-and-a-half hours away. An internet connection enables the doctor and patient to see each other on monitors allowing Dona Claudete see her test results on the screen in front of her.

When asked to read out N C V O Z in the middle row of the eye chart, it quickly becomes clear that Donna Claudete is suffering from presbyopia, an age-related change of her sight that has made it difficult for her to see sharp in near distances, for example for reading.

“Which is better?” asks Dr. Aline Araujo again and again as she remotely changes the lenses in the vision testing instrument. Dona looks intently into the device as if she were taking an exam. After 20 minutes, the doctor writes Dona Claudete a prescription remotely. At this particular moment, the vast distance seems to melt away. “Good luck with your new glasses,” says Dr. Aline Araujo. Dona Claudete says thank you, while attempting to hold back her tears of joy,

Dr. Aline de Araujo

This system enables us to help a lot of people who would otherwise fall through the cracks.

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Flatscreens and Microphones

One day later, at Telessaude’s site located on the 11th story of a high-rise in downtown Porto Alegre. Dr. Aline de Araujo is wearing a white lab coat and has a headset on. She is sitting in front of three screens: the one to the left shows the live image of the patient, the one in the middle the current measurement data from the hospital in Restinga, and the one to the right displays details from the patient’s digital medical file.
“Read out the letters at the top,” says Dr. Aline de Araujo. “Can you make out the middle row?” No. The patient, an older man, gives up.

This is a clear case of nearsightedness. And once again, Dr. Aline de Araujo writes her patient a prescription.

“This system enables us to help a lot of people who would otherwise fall through the cracks,” says the doctor. Telessaude has installed the technical equipment for networked ophthalmic practices at seven of its locations in the Brazilian state of Rio Grande do Sul. The private hospital Moinhos de Ventos, the local university, and the Rio Grande do Sul state government provided the necessary funding.

Dr. Aline de Araujo

Telemedicine has its limits, but it still covers a wide range of needs.

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More than 4.000 people treated

If a person seems to be suffering from a serious eye disease such as cataracts or glaucoma – as is the case with 20 percent of those treated – then the doctors refer the patient to a specialist. However, the telemedicine system is well-suited for diagnosing and treating pronounced astigmatism.
And that is a major step in making healthcare accessible to all Brazilians. “Telemedicine has its limits, but it still covers a wide range of needs.  

We studied where the eye care treatment options were falling short, and that’s where we installed ZEISS customized solutions,” says Dr. Aline de Araujo, right before turning to the next patient. On average, she needs about 20 minutes per case. Each day, 20 people benefit from this setup, and over 4,000 people have already received treatment via this method.

“We can give many people access to eye care!”

Dr. Aline de Araujo is one of the doctors working for Telessaude, the telemedicine program of the federal state Rio Grande do Sul in the south of Brazil. She explains how telemedicine works and how ZEISS products and software make her job easier while improving conditions for patients.  

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