EWAP MARCH 2023 3 Machine intelligence is the last invention that humanity will ever need to make.” – Nick Bostrom Well, this may not be literally true, but one thing is for sure—artificial intelligence is no longer merely a buzzword. It is everywhere around us. It has already made headway into healthcare and is being used for several diseases such as breast and lung cancer screening, cardiovascular risk assessment, planning of treatments, managing medical records, and administrative tasks. Even in ophthalmology, AI is making its foray, especially in the screening of diabetic retinopathy and glaucoma. However, currently, most of us, as ophthalmologists, do not understand AI. As a result, the domain continues to be ruled by the technology professionals, who will in the future build algorithms and models that will dominate and define a lot of day to day processes in our clinical practice. This issue of the EyeWorld Asia-Pacific highlights an AI algorithm developed using the LOCS III classification system for cataracts. This is only one example of how AI can be used by clinicians to make our daily tasks more automated, thereby removing the repetition in our practices, and allowing us, as clinicians, to focus on problems that require our unique skill sets and attention. Now is the time that we acknowledge the role of AI and be active partners with industry in developing AI models and algorithms that can help us all enhance our potential. On the same note, this issue also talks about newer areas, including a functional classification of MIGS, the current status on pharmacotherapy for presbyopia, and the merits of using the Barrett True K formula for post refractive surgery eyes undergoing cataract surgery. All in all, the message is clear—be open to newer technology, including digitization and artificial intelligence. Instead of considering these as our competitors or roadblocks in our traditional thinking, we must gear ourselves and our practices up to work hand in hand with them. EDITORIAL EyeWorld Asia-Pacific • March 2023 • Vol. 19 No. 1 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific • China • Korea • India One of the most interesting trends covered in the issue is the increase in interest in modest monovision, in part related to a great opportunity for blended vision when it is used within the context of new extended depth of focus (EDOF) IOLs. I have used monovision for decades and have xtolled the virtues of this approach as an alternative to multifocal IOLs. It is important to preserve binocular acuity and ereduce asthenopia by limiting the targeted level of myopia in the near eye. An ideal target for modest monovision is –1.25 D as stereoacuity is well preserved and there is less chance of reduced binocular contract sensitivity and asthenopia. However, while this level of targeted myopia will provide excellent intermediate acuity, total spectacle dependence is expected in approximately 30% of patients. And yet despite this limitation, patient satisfaction is extremely high; total spectacle independence in the context of multifocals may not have been the best parameter to address the success of a presbyopic solution from a patients’ perspective. The advent of EDOF IOLs offers a great new opportunity to utilize modest monovision as the extended depth of focus allows overlap of the distance in the near eye resulting in true blended vision and a continuous range of focus without the dysphotopsia typically encountered with trifocal IOLs, particularly those based on a refractive principle. EDOF IOLs can of course be used without monovision and still provide excellent intermediate acuity, but the synergy of utilizing myopic defocus in one eye greatly improves the potential for spectacle independence. A range of myopic defocus can be utilized with a target as low as –0.50 D extending up to –1.50 D, although a target of approximately –1.0 D is considered ideal in this context. The extended depth of focus will better preserve distance vision with the same level of myopia as well as additional reading ability. My personal experience is primarily combining modest monovision with the Rayner EMV lens, which from the outset conceived that the principle of aspherical aberration was ideally suited to combination with a modest level of myopia; the clinical results detailed by Yeo Tun Kuan in this issue confirm the utility of this approach. Modest monovision can of course be utilized with other EDOF IOLs but the impact of myopic defocus will vary depending on the ocular principle as the EDOF group is not homogeneous but includes lenses based on different optical principles. Myopic defocus may impact the contrast as well as the likelihood of dysphotopsia with some other EDOF IOLs. I hope the increasing availability of EDOF IOLs will encourage surgeons to consider the use of this powerful optical mechanism to address presbyopia and experience the magic of modest monovision. Abhay Vasavada Trending in Ophthalmology Deputy Regional Editor EyeWorld Asia-Pacific
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