Digital Revolution Transforming the Face of Ophthalmic Practice

The ophthalmic profession should broadly embrace the new wave of digital tools steadily making their way into clinical practice and which have the potential to greatly assist physicians in day-to-day patient care, said Béatrice Cochener- Lamard MD, PhD.

In a wide-ranging lecture titled “How the digital world is entering our practice”, Prof Cochener-Lamard focused on the diverse ways digital technologies such as telemedicine, machine learning, and deep learning with artificial intelligence (AI) are profoundly changing the healthcare landscape for the benefit of physicians and their patients.

Prof Cochener-Lamard began her talk with a reference to Harold Ridley, the great IOL innovator, who she said would probably have understood more than most the rich possibilities of embracing new technological tools such as AI and machine learning.

She noted that AI has been frequently misunderstood and misrepresented as a potential threat to the physician’s role in general and the ophthalmologist in particular.

“One of the key challenges to overcome is that of human acceptance. That means we need to communicate better on the subject of AI, educate doctors, stop demonizing AI, share and secure data of quality, invest health authorities, and let the doctors decide what to ask of AI, because the critical point is AI has to be designed to serve medicine and not to supplant the doctor,” she said.

TELEMEDICINE ON THE RISE

Prof Cochener-Lamard noted digital tools have already made a major impact in transforming healthcare in the wake of the COVID-19 pan­demic. She cited the massive upsurge in telemedicine applications that developed in France and elsewhere as a response to the need to see patients without exposing them to the risk of infection.

“We saw a real explosion of interest in telemedicine in France— which went from 1% of teleconsultations before the COVID-19 crisis to over 20% in April 2020, even if ophthalmology is not easily suitable to remote exam,” she said.

As well as remote consultations and delegating tasks between the various players in the visual sector, mobile consultation cabin use can also play an important role in helping screen and monitor the ocular health of populations in remote and rural areas.

She noted that web-based applications are also useful for research purposes. For instance, the University of Brest is currently piloting a smartphone-accessible application to evaluate ocular surface disease in patients with primary Sjögren’s syndrome in the framework of the NECESSITY European research project.

“It allows us to monitor the symptoms of the patient and their eyedrop use on a daily basis and to contact them directly as required,” she said. Once validated, the app will be adapted to other national health regulations and translated into six languages for use in the NECESSITY trial to define new clinical endpoints in primary Sjögren’s syndrome, Prof Cochener-Lamard added.

AI OUTPACING LEGAL FRAMEWORK

In terms of AI applications, Prof Cochener-Lamard said the technol­ogy is currently advancing faster than public health measures and legal approvals.

“We are facing key limitations in terms of bioethics, data protection, and the distrust of the medical community, which is afraid of doctor substitution and the transfer of competencies to other actors such as optometrists, opticians, or nurses,” she said.

She explained AI is particularly visible in three key domains in ophthalmology: registries and big data, imaging, and robotization. She detailed how each of these areas are transformed by AI but also highlighted some of the remaining challenges.

EMBRACING PROMS AND PATIENT DATA COLLECTION

Incorporating patient-reported outcome measures (PROMs) into registry data represents an important step forward in developing evidence-based guidelines for cataract and refractive surgery across Europe, she said, citing the PromCat France national cataract regis­try—which recently became part of the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

“Incorporating PROMs in our data is definitely the way to go in improving the management of our patients and improving our surgery,” she said.

As well as its increasing role in IOL power calculation and cataract workflow systems, Prof Cochener-Lamard said AI has radically transformed the automated recognition of ophthalmic imaging. Deep learning (DL)—a subset under the broad term AI—enables rapid detection and screening in several areas, such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, dry eye, and cataract.

While the pace of innovation shows no sign of slackening, a number of hurdles need to be surmounted to take full advantage of the advanced technologies now available to ophthalmologists.

“There are some limits that we need to work around. We need to ensure the collection of good quality data that is systematic and accessible. We need to count on the support of national health authorities and academic societies because we need to develop health data hubs and obtain access to electronic medical records worldwide. We also need to define an economic model for AI and guarantee the integrity and cybersecurity of our medical data, as well as ensure access to bioethics for doctors and patients,” she said.

Béatrice Cochener-Lamard MD, PhD is Professor and Head of the Ophthalmology Department in Brest University Hospital, France, member of the LATIM (Inserm 1101 – Laboratory of research in analysis and treatment of medical imaging), and Dean of faculty of Medicine and Medical Sciences at the UBO University. beatrice.cochener-lamard@chu-brest.fr

Tags: 40th Congress of the ESCRS, artificial intelligence, Ridley Medal Lecture