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6.27.2017

UM Medical Team Brings Life-Changing Eye Care to Remote Galapagos Island

It all started with a conversation between University of Miami Provost Thomas LeBlanc and Dr. Richard Lee of Bascom Palmer Eye Institute at a Faculty Senate event.

The provost told Dr. Lee about an amazing experience he had had visiting a UM undergraduate program on Isabela Island in the Galapagos. He urged Lee to visit the island during a planned trip to Guayaquil to speak at an educational meeting of the Ecuadorian Society of Ophthalmology. The provost offered to connect Lee with the Intercultural Outreach Initiative there, which had been founded by a UM student.

Several months and three trips later, Lee and a few colleagues and students have brought comprehensive eye care to an island that never had any before, providing glasses that opened up new worlds, treating vision problems with medications and surgery, and preventing future eye disorders in the island’s children.

At the same time that they are serving the deeply grateful residents of the island of Isabela, the team is developing new strategies and new technologies for providing continued eye care in other places that have never had access to that care.

“People trust us with one of their most valuable things — their sight,” said Richard Lee, M.D., Ph.D., associate professor of ophthalmology, cell biology, and neuroscience. “For us to do something so small as to give them a pair of glasses that changes the world for them is huge. Some of the people cried when they got their glasses — for them it’s life-changing.”

Isabela is the largest of the Galapagos Islands, and it’s remote, with about 3,500 residents, including 300 children. Many people are fishermen or farmers, or work in tourism. Lee discovered that the island had two small clinics staffed part-time by interns, but no ophthalmologist, no optometrist and no optical shop.

Lee’s longtime commitment to medical missions inspired him to round up equipment and colleagues and begin what he calls the Darwin Eye Project (DEP) to bring vision screening to Isabela — with a commitment to cover the entire island and provide glasses for everyone who needs them.

And it turned out there was a LOT of need. The fishermen and farmers have extensive eye damage from the sun and the wind.

“Teaching them about sunglasses and artificial tears goes a long way,” said Lam Phung, M.D., who just graduated from the Miller School of Medicine and will be starting an ophthalmology residency. Phung went to Isabela during her fourth year as part of the Darwin Eye Project, which was among her inspirations for a career in ophthalmology. “The work we did was very impactful.”

The UM connections are extensive, as well.

“On our first trip we really lucked out,” Lee said. “There were four people on the prop plane to Isabela, and two were faculty from UM’s Rosenstiel School of Marine and Atmospheric Science. It was a complete coincidence.” The Rosenstiel faculty gave them suggestions for seeing the island, and the connections continued: “One of our ophthalmology residents who went to Isabela for the DEP brought some marine research equipment they needed — it had nothing to do with vision care.”

Raquel Goldhardt, M.D., associate professor at Bascom Palmer, had a “special reason” for traveling to Isabela with the DEP team.

“I’m Brazilian, so I have a strong connection with South America overall,” she said. “My whole thing was to go to South America and give something back.”

Goldhardt, who screened and treated the children, sees the mission as a dramatic example of the effectiveness of mobile technology in preventing disease and improving quality of life in isolated, economically deprived environments.

“These international vision screenings serve as platforms for immediate and further interventions,” she said, “whether for treatment in the short and long term at the community level, or expanded to national eye care delivery to address the public health issue of vision loss.”

For Goldhardt and her colleagues, nothing could be more rewarding. “When you see all the smiles, all the thank-you’s, and all the hugs, you know you’re helping them,” she said.

There is a small hospital on Isabela, with an operating room that had never been used. It proved useful to the Bascom Palmer team because it has no windows and so is naturally dim enough for eye exams. Goldhardt did vision screenings in a school bathroom for the same reason.

On the latest trip this year, the DEP team screened children for amblyopia, the most common cause of permanent, irreversible blindness – which is often preventable if detected and treated early. Children with amblyopia prefer one eye over the other, and brain connections are not made in the eye that isn’t used so that eye loses vision permanently.

“We screen for amblyopia because some of them just need glasses,” Lee said. “We do a lot of surgeries, but glasses, worldwide, are the cheapest, most expansive, and most effective way to make a difference in vision.”

In two days, the team screened 260 kids, a few of whom needed surgery and others who needed glasses. They have one more school to go, and then they will have covered all the children on the island at risk of amblyopia.

“That’s the whole idea,” Lee said. “We have high throughput — a very efficient system — because we’ve been doing this here in South Florida for years” at vision screenings in underserved communities.

“It goes hand in hand with a project I have to tackle the issue of international blindness and sight impairment. This is the Portable Ophthalmologist Project, where we’re identifying and developing technologies that you can put in a suitcase and become a doctor’s office that you can take around the world. Every piece of equipment we used in Isabela we brought ourselves.”

Some of it will be used on trips to Haiti and other places with significant need and little to no eye care.

“We are working on new vision screening and correcting strategies and developing new technologies, or otherwise we just run the same wheel,” Lee said. “At some point we have to break out of that and create a new wheel. If we are really successful, I should be able to move on and say here is the infrastructure you can follow up on.

“So we will cover this entire island, get a base line for everybody, and then the Ecuadorean Society of Ophthalmology can go to Isabela every year and follow up on these patients.”

The Darwin Eye Project is just one cog in the global outreach of UHealth and Bascom Palmer. That outreach is helping hundreds of patients, training scores of physicians, and inspiring the doctors of tomorrow.

“As an undergraduate I went back to Vietnam, where I was born, and did a volunteer mission taking care of disabled kids,” Lam Phung said. “That was a moment that helped me realize I wanted to pursue medicine. I have always had a passion for international mission work.”

Phung is eager to return to Asia to give back to her homeland. She is particularly attracted to the power of providing care in out-of-the-way areas. “I want to go places where not many people have gone before,” she said. “That’s why Isabela was appealing to me.

“To be able to set up a vision screening for these people was a very touching experience,” Phung said. “When I walked around in town on Isabela, everyone recognized me. They offered little gestures, little hugs, and you could tell how much they appreciated our being there.”

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