Telemedicine, Apl.de.ap save Filipino infants from blindness

Apl.de.ap and Dr. Thomas C. Lee discuss a patient’s diagnosis with the help of long-distance visual communication technology. ASIAN JOURNAL PHOTO

LOS ANGELES — One afternoon in April, Apl.de.ap sat in front of a screen projecting a magnified image of a girl’s eye. Beside him, Dr. Thomas C. Lee, a pediatric ophthalmologist who heads the Vision Center at the Children’s Hospital Los Angeles (CHLA), pointed out various parts of the organ–the pupil, iris, sclera.

In this “telemedicine suite” equipped with cameras, computer screens, and other viewing devices, Dr. Lee examines children from anywhere in the world, usually remote locations, and advises doctors how to diagnose and treat them.

Dr. Lee’s virtual exam room today is more sophisticated than when he started five years ago with one web camera to Skype with doctors in Armenia and train them how to treat retinopathy of prematurity (ROP), a rare eye condition that causes abnormal blood vessel growth in the retina from excessive oxygenation. If not tended to within 48 hours of birth, it could lead to blindness.

Telemedicine is progressively becoming a common practice that connects medical professionals from one location to another, using communications technology (two-way video, email, smartphones, etc.) in an effort to improve a patient’s health status.

“You have a baby in an ICU and [the doctors] take a photograph of the baby’s eyes and then they send that image to us and we’ll review it and send our recommendations,” Dr. Lee said. “There’s another type of telemedicine that we’re working on to develop where we actually get to talk to the patient and we look in their eye and have a conversation with the referring doctor, telling them what we think is going on.”

Telecommuting doctors

In some cases, Dr. Lee doesn’t see patients too far away. CHLA works with several hospitals in the Los Angeles area to accommodate the telecommuting doctors, which saves them travel time and increases the number of patients they can see a day.

“This whole thing is very scalable, meaning we can put this technology anywhere that we want and with the bandwidth of all these different countries increasing, we now have the speed on the Internet to stream these images in high-definition,” he said.

After simulating a patient diagnosis, Dr. Lee and Apl went to the Newborn and Infant Critical Care Unit (NICCU) to visit a newly born, premature baby boy, who received a 20-minute, noninvasive laser treatment that stops the disorganized growth of the retinal blood vessels and prevents blindness.

It takes about a week to see a response, but the treatment has a 90 to 95 percent success rate and can alter the child’s trajectory dramatically, according to Dr. Lee.
For Apl, witnessing the technology that could keep children from going blind or suffering from other eye diseases hits close to home.

Close to home

Way before he became Apl.de.ap of internationally recognized, multi-awarded group The Black Eyed Peas, he was Allan Pineda Lindo of Angeles City, Pampanga, born with nystagmus, a condition that causes involuntary rapid eye movement. On top of having vibrating eyeballs, Apl is nearsighted and legally blind, which all contributed to hindrances to learning and self-esteem, and confidence issues growing up.

“I was so embarrassed that I had to stand so close to the blackboard that kids would say, ‘Allan, get out of the way,’ but worse, some teachers themselves were not very encouraging. They believed that kids who were visually impaired couldn’t amount to anything,” Apl said.

At 14 years old, Apl moved to Los Angeles through Pearl S. Buck International to get treatment for the eye disability, and was adopted by a lawyer named Joe Ben Hudgens. From there—and it’s a story that Apl has widely and proudly shared—he met William James Adams (aka will.i.am) in high school and the two bonded over hip hop music and dancing, leading to the formation of The Black Eyed Peas.

Despite his eye disability, which prevents him from seeing clear details, Apl has been able to perform complicated dance routines and tour around the world with the group, including the 2011 Superbowl Halftime Show, by using sounds as a guide and for forming mental images.

It wasn’t until 2012 when he underwent an operation that implanted artificial corrective lenses in his eyes, which has helped him see farther away.

Paying forward

With the care and generosity Apl has experienced, he is paying it forward through the Apl.de.ap Foundation International, which focuses on education programs for youth in the Philippines.

To date, the foundation has built 15 schools throughout the country, and a computer laboratory and recording and music studio in his hometown of Angeles City. The foundation also sponsors 14 scholars, who are in the top 10 percentile of their class at Angeles University.

In 2014, the foundation formally introduced the Campaign for Filipino Children, an initiative that addresses health concerns of children in the Philippines.

The first project under the campaign is “Apl of My Eye,” a two-year partnership with Dr. Lee, CHLA, and the Philippine Academy of Ophthalmology sponsored by Western Union to address ROP in the country and better equip and train doctors to treat the condition.

“We started with the Armenian Eye Care Project in the country of Armenia [in 2009], which was just starting to build these neonatal intensive care units without fully understanding how to take care of some of the children when they got old enough and survived to get this disease, retinopathy of prematurity,” Dr. Lee said.

Doctors in Armenia had little experience dealing with ROP; however, within the first year of training, Dr. Lee and his team were able to get them to the level of proficiency and skill seen in the United States.

Innovative technology

“The fact that Dr. Lee was doing it using some very innovative technology really spoke and appealed to Apl. They had this idea to actually bring this concept, training and technology to help the kids and families in the Philippines,” Michael Sampiano, director of annual and major gifts for CHLA, said.

There are 26 doctors in the Philippines who can currently diagnose and treat ROP, but they’re all based in Metro Manila, which creates a disadvantage for premature babies with the condition in rural and hard to reach areas especially.

“If a child does not get this treatment and diagnosis, [he or she] can go blind within 48 hours. Imagine there’s a child in the Philippines and it takes two days to arrange for transport into Manila, by the time the child gets to Manila, it’s too late,” Sampiano said.

Through fundraising concerts and events, the foundation is on its way toward raising $650,000 to buy and send RetCams (retinal imaging systems to screen for ROP) to four pilot facilities: a central training hospital in Manila, and hospitals in Pampanga, Iloilo and Davao.

“The Campaign for Filipino Children is perhaps the most important project that the Apl.de.ap Foundation International now has, and for one good reason, because it’s personal for Apl,” said Ted Benito, the foundation’s executive director. “It honors the commitment he made to try and diagnose, treat childhood blindness in premature children in the Philippines.”

Premature babies

About 30 percent of premature babies in the country develop ROP, but by training at least six to ten medical practitioners in each of the four hospitals, 4,380 premature babies can be saved from the impairment.

Dr. Lee is scheduled to travel to the Philippines in the fall to meet with a network of doctors assembled by the Philippine Academy of Ophthalmology and will lead training sessions with them, including reviewing images coming through the RetCams.

In addition to seeing patients via live-streaming, he also diagnoses and treats patients on Facebook.

“We are using social media to help us train doctors in Armenia; they can just friend the site and they can get access to the training. We can get experts from all over the world involved,” he said.

“So what we do is get onto Facebook and onto the [page called] ‘Virtual Exam Room’ and the camera that you saw, these are children in Armenia right now in an ICU and we will make comments on what we think they’re seeing. There is a lot of opportunity for us to train doctors and get doctors from all over the world to comment. It’s sort of like crowdsourcing,” Dr. Lee explained.

Though the privacy laws are more stringent in the Philippines than in Armenia, Dr. Lee is looking at how he can use a socialized platform to assist more doctors.

“I believe that all children have the right to live healthy and productive lives,” Apl said in a video for the campaign. “They have the right to go to school, acquire skills, dream about their future, experience love and become contributing members of their society.”

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