Eyeworld

I AUGUST 2020 | EYEWORLD | 39 by Liz Hillman Editorial Co-Director What AI could bring to cataract surgery In general, if datasets were large enough with quality input, Dr. Solomon said they could be analyzed and used to take cataract outcomes "to an entirely different level." "Right now, when we are doing cataract outcomes, there are a lot of assumptions that we base our outcomes on. The good news is we've gotten so much better with our outcomes today than 10 years ago, but we make an as- sumption. We make a lot of assumptions based on surgeon factors that are averages across large groups … or perhaps many of us are customiz- ing our own surgeon factors," he said. If big data/artificial intelligence is someday employed, Dr. Solomon said cataract surgery could potentially be offered with LASIK-like outcomes and/or better decisions could be made for patients with unique modifiers like post-refractive surgery, for which type of pres- byopia-correcting IOL best suits a patient, for best astigmatic treatment. Warren Hill, MD, cautioned that big data alone won't improve outcomes, "unless it is also paired with an optimal calculation method." "B ig data is going to take us to a new level, and I think many recognize that's where we need to go," said Kerry Solomon, MD. Is big data and artificial intelli- gence where it needs to be to aid surgeons in improving cataract surgery outcomes? Not yet, according to Dr. Solomon. "We don't have big databases [for cataract surgery]," Dr. Solomon said, noting that he's talking about datasets with millions of eyes with various diagnostic, preoperative, and postopera- tive information. "If we were to get large data- sets of just a fraction of the 2 million cataracts done per year … we would be able to take our outcomes to a whole new level because there's so much more we could learn. But right now, those datasets don't exist." As Goh et al. put it in a review article pub- lished in the Asia-Pacific Journal of Ophthalmology: "Cataract is one of the leading causes of visual impairment worldwide. However, compared with other major age-related eye diseases, such as diabetic retinopathy, age-related macular degeneration, and glaucoma, AI development in the domain of cataract is still relatively underex- plored." 1 Artificial intelligence to improve cataract surgery outcomes continued from page 38 At a glance • Artificial intelligence (AI) is making inroads in cataract surgery to improve outcomes, namely through IOL choice and power calculations. • There are several IOL power calculation formulas that are based on analysis of large datasets analyzed by AI. • To realize the true potential of AI in cataract surgery, experts think much larger datasets are needed. About the doctors Warren Hill, MD East Valley Ophthalmology Mesa, Arizona Kerry Solomon, MD Carolina Eyecare Mount Pleasant, South Carolina continued on page 40 possible to distill all of our collective infor- mation into a few thousand lines of code and make a machine that can do it better," he said. Closing thoughts Dr. Wallace made some points about the use of the term "intelligence." He said intelligence is "information that is thoughtfully used or innovatively assessed to create new ways of thinking or new ways of analyzing that weren't possible or weren't done before." As such, he pointed out, a machine isn't, in and of itself, "intelligent." "We all know machines have extraordi- nary memory and processing power, but they don't have intelligence. They have the ability to execute instructions programmed by humans," he said, noting that's why he prefers the terms "augmented intelligence" or "machine-en- hanced analysis." Dr. Wallace said that AI may not make doc- tors better at what they've spent their careers doing. "AI is not necessarily the answer. It's the thoughtful use of information by thoughtful people gathering good data, the right way, and putting it together that helps the massive pro- cessing power of current computer technology to draw smart conclusions from much bigger datasets than humans could ever grasp and process," Dr. Wallace said.

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