Eyeworld

73 OPHTHALMOLOGY BUSINESS It's not all that bad. In the fu- ture most ophthalmologists will still be compensated at levels somewhat higher than the wages enjoyed by other intelligent knowledge workers: PhD historians, nuclear physicists, entomologists, and the like. These individuals are as brilliant as you and have learned to be as fulfilled as you are today, but in ways that are more economical. While they are underpaid in the context of their brains, dedication, and train- ing—as you will one day be—they have survived, as will all of those ophthalmologists-to-be who are now preschoolers as this goes to press. As gruesome as this may sound for you (and your young children now bound for medical school), it's nothing like what's in store for the roughly 40% of American workers today who will become a permanent underclass when their jobs are off- shored or automated. The growing 1% vs. 99% inequality we are seeing today is just a foretaste of what's to come, when workers will cleave into those who are good at building and working with intelligent machines, and those who will be replaced by machines. All the technology that's needed to replace the cognitive dimension of medical eyecare—branching logic trees, algorithms, and the rest—is readily available today. Robot oph- thalmic diagnostics just isn't here yet because the market is too small compared to other interesting seg- ments of the economy like automat- ed stock trading. But soon enough, artificial intelligence will shrink the market value of squishy human oph- thalmologist brains. Most of the data inputs needed to work up a patient (history, vision, pressure, images, etc.) are already gathered by machines and techni- cians. We are not far off from a day when the suspected diagnosis and prospective treatment plan is already on the monitor when you first enter a new patient's exam room, just awaiting your confirmation or revision. Of course, that delicious, pro- foundly gratifying manual, surgical dimension of ophthalmology will remain human-dependent for many more years. But not forever. Cata- ract surgery is now so routine and present in such industrially high volumes, and increasingly machine- assisted, that it will yield soon enough, and perhaps before many other surgeries, to labor substitution by dexterous, clever, machine-guid- ed technicians. Along the way, we are likely to see some very unaccustomed permu- tations on how eyecare is delivered. Homeowners now use Internet list- ings to rent out overnight rooms to strangers, and private car owners are now running app-based pirate cab services. Is it impossible to imagine an era when some underemployed ophthalmologists and optometrists start making house calls or seeing patients for cash in a converted spare bedroom? EW DRY EYE NEVER FELT SO GOOD. Artificial tears aren't always enough to alleviate the symptoms of dry eye. Give your patients a new perspective with Bio-Tissue's family of options for facilitating quality healing on the ocular surface in mild to severe cases. Go beyond hydration to rejuvenation — and see dry eye from a whole new point of view. THE HAPPY EYE COMPANY For more information please visit: www.biotissue.com 8305 NW 27th Street, Suite 101, Doral, FL 33122 • 888.296.8858 • www.biotissue.com • Bio-Tissue, Inc. 2015. All rights reserved. April 2015 Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979, with offices in San Diego. He can be contacted at 619-223-2233 or pintoinc@aol.com. About the author

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