EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1271537
I AUGUST 2020 | EYEWORLD | 37 "This may identify a subset of risk factors, including forceful eye rubbing, that lead to early topographic change, which can then, if the behavior is not altered, develop into more advanced ectasia," he said. Put another way, Dr. Wallace said, "the hope is that a machine like Delphi could offer the best real-time clinical interpretation to guide diagnostics and possibly therapeutic decisions." In general, Dr. Wallace said he thinks AI will exceed human ability looking at single stud- ies one at a time. "In terms of understanding the contrib- uting factors to ectasia, AI may help us point to or identify risk factors that now perhaps are underappreciated. We also intend our system to be capable of real-time difference mapping in the cloud, which should greatly augment early detection." From an imaging standpoint, Dr. Wallace pointed out that Placido reflectance is more sensitive than Scheimpflug elevation mapping for the front surface of the eye and should be able to identify smaller, more subtle irregu- larities than possible with Scheimpflug-based systems. "Dr. Ambrosio makes some excellent and valid points, which I wholeheartedly agree with, on relevance of posterior surgical imaging," Dr. Wallace said. "There has been spirited debate about the relative merits of Placido vs. Scheimpflug for anterior surface imaging and the verdict is already in." Corneal topography is an area where neural networks have already been used for assisted diagnostics. Neural networks, Dr. Wallace ex- plained, are fixed-size datasets that help derive comparatives for normal and abnormal diagno- ses. The challenge with an open system, as with AI, is that you can't expect that it's going to work in the same way as a closed neural net, Dr. Wallace said. "Any dataset needs to be somewhat curated so that bad data cannot pollute a good pool. That means finding and eliminating testing and sampling artifacts along with other sources of bad data," he said. continued on page 38 About the doctors Renato Ambrósio Jr., MD, PhD Director of cornea and refractive surgery Instituto de Olhos Renato Ambrósio Rio de Janeiro, Brazil David Wallace, MD Medical director and CEO LA Sight Founder and managing partner Intelligent Diagnostics Los Angeles, California