EyeWorld Asia-Pacific December 2020 Issue

DEVICES EWAP DECEMBER 2020 49 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 intelligence 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 postoperative information. “If we were to get large datasets 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 published 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 underexplored.” 1 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 assumption. We make a lot of assumptions based on surgeon factors that are averages across large groups … or perhaps many of us are customizing 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 presbyopia-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.” “Combined with an appropriate artificial intelligence model, big data allows for the calculation process to be greatly expanded in terms of its breadth and depth,” Dr. Hill said. “For example, many current methods mostly limit possibilities to situations that are already understood, and manual optimization methods significantly limit the number of solution options. Artificial intelligence is well-suited to real world problems for which ideal models are not available. This approach also has enhanced sensitivity for identifying and 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. by Liz Hillman Editorial Co-Director Artificial intelligence to improve cataract surgery outcomes This article originally appeared in the August 2020 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Hill: hill@doctor-hill.com Solomon: kds@cepmd.com Diagram of the architecture of a neural network used to calculate IOL power. Source: Warren Hill, MD