Eyeworld

I AUGUST 2020 | EYEWORLD | 43 Contact Habash: ranya@habash.net Trubnik: valerietrubnik@yahoo.com keep reinforcing these lessons so the machine learns better, and that will come with time and repetition, Dr. Habash said. Dr. Trubnik also noted potential limitations, particularly being careful that you don't have confirmation bias with such a large sample size of data. She stressed the difference between association and causation. Just because you find the association doesn't mean it leads to some- thing and you have to act upon it, Dr. Trubnik said. When talking about deep learning, Dr. Trubnik said there is a "black box" for how AI comes up with a diagnosis; there may be questions from patients on how the diagnosis was determined. "You develop a relationship with the patient and explain things to them, but if the diagnosis is coming from a machine, they may question how you arrived at the diagnosis," she said. Dr. Trubnik added that for big data to be useful, a lot of images are needed, and some- times there aren't enough to yield accurate information. Also, when sharing information, she said, sometimes it's hard to know if the data is all equal. Additionally, she said that rare diseases may be difficult to diagnose with AI because there is not enough data to recognize them. Specifi- cally relating to glaucoma, Dr. Trubnik said that arriving at the same definition of glaucoma may be a challenge. "The other thing is if the AI is screening fundoscopy or OCTs, usually it's utilizing a 'binary classification,' so it will say 'yes glauco- ma' or 'no glaucoma,' but when I examine my patient, I can also pick up cataract, epiretinal membrane, etc.," Dr. Trubnik said. "So far, they haven't been able to do that accurately with AI because when they incorporate multiple vari- ables, it's not as accurate at predicting." Going back to the gym analogy, Dr. Habash said, "Technology helps us lift the weight, but we're still the ones doing the work. AI and telemedicine won't replace us, but they will augment us." About the doctors Ranya Habash, MD Bascom Palmer Eye Institute Miami, Florida Valerie Trubnik, MD Ophthalmic Consultants of Long Island Lynbrook, New York Relevant disclosures Habash: Microsoft Trubnik: None Dr. Habash conducts a telehealth hybrid visit with a glaucoma patient. She is doing a live video slit lamp exam with the tech, so she is seeing the whole exam, reviewing the OCT/IOP, etc., and talking to the patient throughout. Source: Ranya Habash, MD

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