Expert panelists: AI, telemedicine already part of practice
NEW ORLEANS – Artificial intelligence and telemedicine are already embedded in today’s eye care practice, but the human component will never be replaced, according to panelists discussing imaging and diagnostics at the Ophthalmic Innovation Summit, held here during SECO.
“As a human, it takes years of experience and thousands of patients to get really good,” panelist Satya Reddy, MD, said. “AI can look at tens of thousands of data points and determine glaucoma change, high myopia. AI can correlate all that data likely faster than we can based on access to a lot of information.”
Eric Schmidt, OD, FAAO, referred to an article in the American Journal of Ophthalmology about deep learning and its ability to detect glaucoma.
“Deep learning was better in early glaucoma but equal to humans in progressive glaucoma,” Schmidt said.
The deep learning instrument looks at tens of thousands of images beforehand, he said.
“Sounds like a human,” Schmidt continued. “Why is someone a glaucoma expert? Because they’ve seen a lot of patients. It’s an algorithmic creation. Human beings aren’t algorithms. We can understand their inner needs when they’re in the chair. Deep learning in AI won’t ever replace that.”
Reddy agreed: “Patients look up things on the Internet, but they still want to come in and talk to the doctor for confirmation. [AI] may allow patients to be more aware and take control of their care.”
Schmidt noted that AI is already built into glaucoma software, in glaucoma progression reports, for example.
Moderator Joseph J. Pizzimenti, OD, FAAO, asked the panelists if they believed telemedicine was friend or foe to doctors and patients.
“I don’t think it will be that much of an issue,” Reddy said. “I don’t think most patients are going to be able to set it up for themselves. Blood pressure monitoring is done sporadically at home.”
“It’s good for patients, especially if you’re in western Texas and you don’t have a retinal specialist,” Schmidt said. “But the bigger elephant in the room on telemedicine is reimbursement. If I’m taking time out of my day to look at an image another doctor sends me, I’ll do it, but I’d probably do it more enthusiastically if there’s a code and I could get reimbursed.”
Mohammad Rafieetary, OD, FAAO, said, “We will have to embrace telemedicine. Cardiologists are letting patients wear something on their wrist and using that information. Home monitoring of medical parameters is nothing new; a thermometer has been used at home for years to check body temperature.”
Reddy believes telemedicine will be more widely used in the developing world.
Pizzimenti agreed that telehealth screening may help patients gain access to comprehensive optometric care.
He asked the panel if OCT angiography facilitates their medical decision making and improves patient outcomes.
“Why should optometry embrace OCTA?” Schmidt said. “It allows us to keep our patients in our office without questioning whether they need therapy. Even for retina people. The ability for us to see choroidal function is almost the Holy Grail, and now we have the ability to do that.”
“OCTA is not going to replace angiography with contrast dye; they’re two different things,” Rafieetary said. “It’s in its infancy; we have to learn more. The more tools we have, the better we can manage patients, but we have to know how to utilize these tools.” – by Nancy Hemphill, ELS, FAAO
Asaoka R, et al. Am J Ophthalmol. 2019;doi.org/10.1016/j.ajo.2018.10.007.
Pizzimenti J, et al. Imaging and diagnostic innovation spotlight. Presented at: Ophthalmic Innovation Summit; February 21, 2019.
Disclosures: Pizzimenti reports he has received consulting fees from Carl Zeiss Meditec. Rafieetary reports he is a speaker and advisory board member for Heidelberg Engineering and Optos, a speaker for Notal Vision, a paid panelist for the Angiogenesis Foundation and a clinical investigator for Genentech, Novartis, Opthea, Regeneron and Regenxbio. Reddy reports no relevant financial disclosures. Schmidt reports he has received speaking fees from Carl Zeiss Meditec and Optovue.