35 EyeWorld Asia-Pacific | March 2025 REFRACTIVE SURGERY “While the journey toward widespread use is in its early stages, the path forward is clear and filled with promise, emphasizing the importance of ongoing research, education, and technological development in refractive surgery.” Renato Ambrósio Jr., MD, PhD software grades the severity. Currently, only topography and tomography devices have AI capabilities. “Devices such as the Ocular Response Analyzer [Reichert] to measure corneal biomechanics and OCT to perform epithelial thickness mapping don’t have AI,” she continued. “A clinician relies on their expertise and published data to determine whether the results of these tests are normal or abnormal. This is an area where technology can be improved to include AI. Additionally, there could be improvement in creating a software that integrates information from multiple testing devices and benchmarks that against a data set of normal and abnormal corneal tests performed with these multiple devices. This multimodal benchmarking could be especially helpful when findings from one or several devices are mildly abnormal.” AI For Ectasia Risk Screening Renato Ambrósio Jr., MD, PhD, said Stephen Klyce, PhD, led groundbreaking work in the 1990s that used AI to help diagnose keratoconus.1 Since then, AI in refractive surgery screening has expanded. “The characterization of the inherent susceptibility of the cornea for biomechanical decompensation and ectasia progression2-4 has to be considered along with the impact of the LVC procedure.5 While this concept relates to the two-hit hypothesis, including intrinsic and extrinsic factors,6 AI’s ability to analyze complex datasets and identify subtle patterns by considering multiple features instantaneously makes it a valuable tool for improving accuracy and inclusivity in refractive procedures. This individualized approach improves sensitivity for safety and specificity for higher inclusivity of refractive procedures,” Dr. Ambrósio said. Dr. Ambrosio said we don’t have data about how widespread AI use is for ectasia risk assessments in refractive surgery screening, but he thinks it’s limited. “Ectasia is a very severe and feared complication of LVC. While detailed data on its prevalence is not fully available, its incidence has reduced. The potential for AI to enhance ectasia risk assessment is significant,” he said, adding that adopting AI-based ectasia risk assessment tools is an opportunity to improve clinical practice. “Key factors include increasing awareness and education among clinicians, obtaining regulatory approval, ensuring data privacy and security, and developing cost-effective solutions. Addressing these barriers can promote the benefits of AI, leading to broader adoption and enhanced patient safety.” Though rare, Dr. Ambrósio said he thinks using AI for determining ectasia risk scores is an “absolute must-have in refractive surgery.” Besides LVC, keratoconus detection is essential in refractive cataract surgery as it impacts IOL selection, quality of vision, and the strategy for corneal enhancements.
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