A Helping Hand in Neuroadaptation

Artificial intelligence may represent an essential tool for enhancing neuroadaptation in patients undergoing cataract and refractive surgery. Although it is a practical aid that can be implemented in the day-to-day clinical practice, it will never replace the ophthalmologist’s role in the patient journey.

Speaking at a symposium on “Patient-Centred Functional Classification: PROMs and Clinical Relevance,” Biljana Kostovska MD, PhD, said that there are many neurological processes for patients trying to adjust to a new visual output. These processes are sensory adaptation, cortical plasticity, binocular integration, attention, and perceptual learning.

“Over time, the brain gets better at focusing on useful visual information and reducing the impact of unwanted visual effects,” she said. Halo, glares, and other photic phenomena are common in patients implanted with an intraocular lens, especially the premium variety. Patients will notice that something went wrong, that their vision is not what they expected from their surgery, she noted.

Professor Kostovska said patients implanted with multifocal lenses are particularly susceptible to photic phenomena and often have a harder time with neuroadaptation because they are adapting to a completely new way of seeing across multiple distances during daily activities such as screen use, watching television, or driving a car. A positive neuroadaptation process can be of utmost importance for these patients, especially in the presbyopia group, she said.

In such a delicate and difficult postoperative phase, patients may be tempted to seek frequent consultation with the eye doctor for reassurance. However, this is not always possible, and a lack of response can be perceived as disinterest, indifference, or unresponsiveness, which negatively impacts patient satisfaction and the refractive outcomes.

According to Professor Kostovska, a solution for these patient needs can be found by implementing an AI-assisted conversation support system. AI can support these patients through neuroadaptation by explaining what they are experiencing, providing answers to any of their questions, and reassuring them when they express concerns about their surgical outcome. Moreover, it can help identify when symptoms such as photic phenomena are part of the normal neuroadaptation process, explain the cause to the patient, and therefore reduce their anxiety. Prof Kostovska emphasised that AI should also be trained to accurately determine when to suggest whether a patient should consult the professional. Meanwhile, she said AI can provide the ophthalmologist some useful information about the patient between follow-up visits.

Although she believes AI can be useful for this neuro adaptation process, Prof Kostovska stressed the technology remains as a tool rather than a replacement.

“AI cannot replace the ophthalmologist,” she said. “I see it as a kind of digital companion during the neuroadaptation period, while ophthalmologists should of course remain responsible for their clinical decisions. The main goal is not to replace the doctor, but to give patients more support between follow-up visits.”

Biljana Kostovska MD, PhD is an Ophthalmic surgeon at Sistina Ophthalmology Hospital in Skopje, North Macedonia.