EyeWorld India December 2020 Issue

DEVICES EWAP DECEMBER 2020 51 W ith increasing applications for artificial intelligence (AI) in ophthalmology, experts discussed ways that it might be applied to the field of glaucoma. Valerie Trubnik, MD, said she thinks the retina field is “a little ahead of the game” when it comes to AI. However, there could be uses for it in glaucoma, though Dr. Trubnik noted that “glaucoma makes for a very complicated diagnosis” because there are so many modalities involved. At this point, Dr. Trubnik said AI is being used more for screening and diagnosis and added that fundus photos and OCT are probably easiest to use, but visual fields can be included as well. With the growing number of glaucoma patients, “we need a better and faster way to sort through these images,” she said. Ranya Habash, MD, stressed the multifactorial nature of glaucoma, noting that there is a lot of gray area and decision- making involved, making it uniquely suited for AI and telemedicine. When you can coalesce all that information, examine it, and interpret it with an algorithm, it’s helpful in guiding the diagnosis, she said. Dr. Habash also highlighted the ability to integrate datasets that synthesize demographics, age, race, medical history, family history, etc. Those are all important factors in formulating your response to the patient sitting in front of you or on the other side of the computer screen, she said. An AI algorithm would help give direction on target pressure and figuring out risk of progression with all of these factors taken into account. She described the potential of AI as like “having a spotter in the gym,” helping integrate all the info in real time. Eventually we will be able to give our patients a real-time risk score, she said. Dr. Habash added that with the use of AI, a patient could be tested in the optometrist’s office for high risk or high progression, which would help determine when the patient needs to be expedited to the specialist’s office. This can help prioritize high-risk patients to get them in faster for quicker intervention. A telehealth consult with the glaucoma specialist would be a natural extension in these cases. The realm of remote monitoring combines both AI and telehealth, Dr. Habash said. There is home IOP monitoring, home OCT (coming on the market soon), visual fields for home monitoring, and fundus photography. Dr. Habash said that there could be exponential growth when an algorithm is developed for diagnosis based on paired data from visual fields, fundus, and OCT. Retina may be the first step, she said, because there are fewer factors involved, and it’s more of a linear relationship between an OCT and what you do for patients than in glaucoma. But that’s exactly what makes AI and telemedicine so valuable when it comes to glaucoma, Dr. Habash said. Dr. Habash pointed to recent work she’s been doing with Microsoft looking at fundus photography of optic nerve images and OCT images to start training AI models. This type of algorithm can become more robust and reliable if we can use different datasets from around the world, she said, including different geographic backgrounds, race, ethnicities, socioeconomic situations, etc. Dr. Habash added that there may be potential challenges with AI. “We’re just going to Opportunities for artificial intelligence in glaucoma by Ellen Stodola Editorial Co-Director AT A GLANCE • Physicians say AI will allow them to coalesce a lot of information, examine it, and interpret it with an algorithm to help in guiding a diagnosis. • Telemedicine also factors into AI and glaucoma, with home IOP monitoring, home OCT, visual fields for home monitoring, and fundus photography potentially playing a role. • Possible limitations of AI in glaucoma are the complex nature of the disease and the amount of images needed in order to yield accurate information. 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 Habash: ranya@habash.net Trubnik: valerietrubnik@yahoo.com Dr. Habash conducts a telehealth hybrid visit with a glaucoma patient. She is doing a live video slit lamp exam with the tech, so she is seeing the whole exam, reviewing the OCT/IOP, etc., and talking to the patient throughout. Source: Ranya Habash, MD