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Dr. Wong is a Diplomate of the American Board of Optometry and a member of the AOA Ethics committee and ASCO Ethics SIG. He is a past president of the Maryland Optometric Association, and an appointee to the American Medical Association’s Physician’s Cons
Artificial intelligence (AI), deep learning algorithms, and convolutional neural networks (CNN) have changed optometry, health care, and 21st-century society.
Computer-aided diagnosis (CAD) utilizing evolving, diverse databases are using complex, trained CNNs1 to further the diagnosis and management of glaucoma, diabetic retinopathy, age-related macular degeneration (AMD), and refractive conditions such as keratoconus, pellucid marginal degeneration (PMD), and other corneal ectasias.
Previously by Dr. Wong: Innovative mobile technology targets low vision
The modern field of optometry will move exponentially toward the intersection of disruptive technologies, especially AI, as we progress into the 21st-century. Autonomous robots, automobiles, facial recognition on smartphones, and smart global positioning systems (GPS) have become integral to everyday life.2,3
As the fields of neural and cognitive science converge, it is important for ODs to understand the ethical and legal implications involved in utilizing these new technologies in day-to-day practice.
The growth of AI in optometry and health care needs to be understood and appropriately utilized by ODs today.4
Indeed, changes in the optometric workforce will occur as roles evolve. The ability to use innovative technology, digital thinking processes, and critical thinking will create new opportunities in eye care as ODs move further toward “data analysis” and away from “data collection.”5
Related: How artificial intelligence can transform eye care
AI is accurate for what it does well, and poor for things it is not trained to understand (such as congenital optic nerve anomalies not in a database, or age ranges not in its software).
Therefore, an OD’s ability to properly use AI should be the focus- not the growing fear that ODs’ jobs will be replaced. AI allows ODs the opportunity to improve patient outcomes for the global healthcare community.6
It is my contention that the skills acquired from an education in the humanities will be the most important determinants in providing future high-quality optometric care.
Being competent in the use of innovative technologies is a must that will include critical thinking and the ability to manage complex cases in real time. Patient communication and education skills involving cultural competence, language, and alternative forms of communication (such as mobile technology)7 are also critical.
Related: Intersection of artificial intelligence with epigenetics
Adapting to change
The proper recognition of ODs’ common “humanity” with patients mandates that they understand how AI can alter traditional models of the “professional-patient” relationship.
Codes of medical ethics have never fully addressed the obligations of ODs, physicians, and other healthcare providers to veracity or truth-telling.8
Certainly, the Optometric Oath and Hippocratic Oath have emphasized the virtues of honesty and truthfulness.9,10
However, conflicts with beneficence have historically led to a variety of different methods in the management of a patient’s medical information, including limited disclosure, staged disclosure, and nondisclosure.11
AI has already changed patient education and communication in all areas of health care. Patients are now using technology to better understand their own medical information and to ask more informed questions. The human and language skills needed to discuss fundus photos, data in optical coherence tomography (OCT), wavefront aberrometry, and corneal topography constitute an imperative for the profession of optometry to provide high-quality, compassionate patient education and patient care.12
Related: Use technology advancements to modernize your practice
Advancements in practice
AI based on deep learning algorithms has been applied to OCT, visual fields, and medical imaging (fundus photography) to detect glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD).13
AI is being applied to wavefront aberrometry to improve the diagnosis and management of keratoconus and other corneal ecstasias.14 Data is being collected around the world to facilitate the accurate diagnoses of these conditions. Nidek’s Refractive Power/Corneal Analyzer OPD Scan III utilizes AI protocols,15 and future expansion of these capabilities are undoubtedly in optometry’s future.
In an era of technological advances in health care, ODs’ communication skills will be highlighted. ODs will potentially be spending less face-to-face time with patients, which can lead to a breakdown in the doctor-patient relationship.
Strong communication skills are vital to maintain patient satisfaction and provide optimal care. AI should be used and analyzed correctly, and ODs have a duty to ensure that patients are educated properly. ODs must not only be able to use technological advancements but also maintain the foundation of doctoring: caring for patients.
Related: Why in-person care and technology must partner
In-person patient care
Research has shown that patient satisfaction increases with length of time spent with their doctor.16
With the advent of the electronic healthcare system, studies have also shown doctors are already spending an increased amount of time on the computer in place of providing quality patient care time.17,18 ODs need to ensure proper training on new technological advancements so they increase the quality of care for patients-not inhibit it.
Despite the rate of technological advancements in optometry and AI, the human relationship between patient and doctor remains the most powerful tool a provider possesses.19
In order to properly care for patients, ODs need more than clinical skills, knowledge, or the latest technological advancements. Patients need doctors who are thoughtful, professional, kind, trusting, understanding, and caring.
Related: Educate, don't sell to patients
These qualities could become more difficult to create and optimize for future ODs if the healthcare model is moving toward delivering care virtually. Such characteristics are best developed over time through fostering of the doctor-patient relationship. ODs must continue spending time developing quality relationships with patients to deliver the highest quality of care.
Perhaps there will be a shift in optometric education as technology advances. There might be more of a need for data analysis, less need for data collection, as well as an increased need for interpersonal skills (such as empathy, compassion, and bedside manner).
Related: How I built a customer service-centered practice
How do ODs ensure the doctor-patient relationship does not suffer with the advent of this technology?
Optometric education will need to address these interpersonal skills so future generations of ODs are able to adequately educate patients on findings and ensure quality of care.
AI and technology will bring to the forefront the important principles of patient education, empathy, and personal contact with patients (virtue ethics). Innovations in technology should allow ODs to have more personal contact and more time to improve outcomes for patients-not to improve productivity.
There will always be a business of health care, but the challenge for the optometric profession is for ODs to place the well-being of all patients as their first priority.19 Read more by Dr. Wong
1. Ruyu Qi S. Deep learning in ophthalmology-How Google did it. Medium. Available at: https://medium.com/health-ai/deep-learning-in-ophthalmology-using-128-175-retinal-images-59814e8a3f68. Accessed 5/9/19.
2. Heisler Y. Apple is working in new technology that’ll take Face ID to the next level. BGR. Available at: https://bgr.com/2019/03/15/face-id-vs-twins-subepidermal-imaging-veins-blood-vessels/. Accessed 5/9/19.
3. Institute of Physics: Physics in Society. How does GPS work? Available at: http://www.physics.org/article-questions.asp?id=55. Accessed 5/9/19.
4. Wong T. How artificial intelligence may transform optometry. Optom Times. Available at: https://www.optometrytimes.com/category-47287/how-artificial-intelligence-may-transform-optometry. Accessed 5/9/19.
5. Wong, T. Hackathon series puts focus on digital eye care. Optom Times. Available at: https://www.optometrytimes.com/modern-medicine-feature-articles/hackathon-series-puts-focus-digital-eye-care. Accessed 5/9/19.
6. Steenwyk N. Artificial Intelligence, Meet Global Health. Duke Global Health Institute. Available at: https://globalhealth.duke.edu/media/news/artificial-intelligence-meet-global-health. Accessed 5/9/19.
7. Tirado M. Role of mobile health in the care of culturally and linguistically diverse U.S. populations. Perspect Health Inf Manag. 2011 Jan1;8:1e.
8. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York. Oxford University Press, 2013. Print.
9. American Optometric Association. The Optometric Oath. Available at: https://www.aoa.org/about-the-aoa/ethics-and-values/the-optometric-oath. Accessed 5/9/19.
10. North M. National Library of Medicine. Greek medicine: The Hippocratic Oath. Available at: https://www.nlm.nih.gov/hmd/greek/greek_oath.html. Accessed 5/9/19.
11. Beauchamp TL. Informed Consent: Its History, Meaning and Present Challenges. Cambridge Quarterly of Healthcare Ethics. 2011 Oct;20(4):515-523.
12. Wong T, Lee C. Using technology, medical informatics in patient education. Optom Times. Available at: https://www.optometrytimes.com/optometry/using-technology-medical-informatics-patient-education. Accessed 5/9/19.
13. Ting DSW, Pasquale LR, Peng L, Peng L, Campbell JP, Lee AY, Raman R, Tan GSW, Schmetterer L, Keane PA, Wong TY. Artificial intelligence and deep learning in ophthalmology. British J Ophthalmol. 2019;103:167-175.
14. Lopes BT, Ramos IC, Salomao MQ, Guerra FP, Scallhorn JM, Vinciguerra R, Vinciguerra P, Price FW, Price MO, Reinstein Dz, Archer TJ, Belin MW, Machado AP, Ambrosio R. Enhanced tomographic assessment to detect corneal ectasia based on artificial intelligence. Am J Opthalmol. 2018 Nov;195:223-232.
15. Nidek. Nidek launches the OPD-Scan III VS Refractive Power/Corneal Analyzer. Available at: https://www.nidek-intl.com/news-event/news/entry-2838.html. Accessed 5/9/19.
16. Borawski E, Gross DA, Stange KC, RD Cebul, Zyzanski SJ. Patient satisfaction with time spent with their physician. The Journal of Family Practice. 1998 Sep;47(2):133-7.
17. Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med. 1999 Jan;14(Suppl 1):S34–S40.
18. Lurie N, Rank B, Parenti C, Wolley T, Snoke W. How do house officers spend their nights? N Engl J Med 1989 June 22; 320:1673-1677.
19. Bain LE. Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino. Philos Ethics Humanit Med. 2018 Apr 10;13:4.