Eyeworld

26 | EYEWORLD | DECEMBER 2023 ASCRS NEWS by Liz Hillman Editorial Co-Director YES CONNECT About the sources John Hovanesian, MD Harvard Eye Associates Laguna Hills, California Shawn Lin, MD Assistant Professor of Cataract and Refractive Surgery Associate Residency Program Director Medical Director UCLA Stein Eye Center Calabasas Los Angles, California James Wang, MBA General Partner Creative Ventures Oakland, California that counts all the scalpels and forceps in the surgical field (using a camera and AI software), making sure all are accounted for at the end of surgery. The line starts to get blurred with clinical aids that start making recommendations, Mr. Wang said. "I've seen an oncology AI that suggests drug cocktails or treatment plans that are most likely to fit a specific oncology patient. It's not making a recommendation, it's not prescribing any- thing, but it's giving some statistical correlations based on what they've seen with genetics, based on what they've seen with medical history," Mr. Wang said. John Hovanesian, MD, envisioned similar AI tools for ophthalmology. He was involved in creating MDbackline, which originally helped physicians automate patient communications. Its first embodiment, Dr. Hovanesian said, did not involve AI, but Alcon, which purchased it in 2022, is working that into the system. "[MDbackline] was designed to be situa- tion specific," he said. "If you asked the patient a question, it would respond with educational material that was appropriate. It wasn't AI but it was algorithmic. The advantage of using a sys- tem like that and why I created it was not just so we could save time in the clinic but also to give us insights in a structured way on patient sentiment. For example, there are a lot of ther- apeutic areas where we don't know well how products work. … We need to collect data on which characteristics have the best outcomes, and we need to turn that around and take those outcome characteristics and apply them to incoming patients." Dr. Hovanesian said Alcon is in the pro- cess of integrating MDbackline into its digital workflow, which is an evolving ecosystem with AI and structured logic to help physicians with cataract surgery. Dr. Hovanesian said technology like this could be used for pharmaceuticals as well. He said when patients come in with dry eye, for example, they're often prescribed a drug. Physi- cians, however, don't routinely collect feedback on how these drugs work in the real world outside of formal studies. We have all read about ways artificial intelligence (AI) will change the landscape of diagnostics and treatment in ophthalmology. I wanted to explore a different perspective in this article. Diagnostic and treatment innovations are still very much in the experimental phase and subject to unknown regulatory hurdles. What is most exciting to me about AI, including develop- ments with ChatGPT, are the potential for these tools to save us time as clinicians and improve our delivery of care. Software that assists in practice management and patient communications can be implemented rapidly into existing workflows. Problems to be addressed include: reducing the burden of clinical documentation, communicating more efficiently, and writing educational content for patients. These products could reach us much sooner than algorithms that help us make clinical decisions or machines that help us perform surgery. In this article, I wanted to focus our attention on opportunities to leverage AI to streamline our practices. —Shawn Lin, MD, YES Connect Editor W hen ChatGPT started making headlines, all sectors of the workforce experienced renewed interest in and discussion on how AI would change their profession, medicine included. Elements of AI have already made strides into medicine, and ophthalmology specifically, for some time. Ophthalmology in many ways is ripe for AI due to it being an image-heavy field with large datasets. 1 While there's the potential for AI in diagnostic areas, James Wang, a partner at the early-stage venture capital firm Creative Ven- tures, which focuses on healthcare among other areas, said this application faces more regulato- ry hurdles. Where he thinks ophthalmology— and healthcare as a whole—will see applications for AI are in clinical aids and front-of-the-office areas. There are already tools that use AI to func- tion as digital scribes, for example, Mr. Wang said. He also said there are some AI systems in the OR. One company, he noted, has a system AI inroads in ophthalmology

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