When most people consider artificial intelligence (AI), their thoughts can easily drift to futuristic applications with no immediate benefit. But then all they have to do is glance down at their wrists and see AI in action, as the smart watch they sport monitors their heart rate, steps taken, calories burned, miles biked, and more. Aditya Mehta, MD, a comprehensive ophthalmologist at the William Beaumont Army Medical Center in El Paso, TX, sees AI’s potential in ophthalmology playing out in real life.
He reviewed AI applications that have current clinical utility during the AAO’s 2019 annual meeting in San Francisco. Here’s a sampling:
1. Ullman Indirect. This app is designed to improve the quality of smartphone fundos- copy. “I love that you can adjust the exposure and ambient lighting at the same time, which is exactly what you need in order to take great photos,” said Dr. Mehta, who has used the app to assess pseudodendrites, medial ectropion, and more. “I show the photos to patients so they know exactly what I am operating on.”
2. toriCAM. Developed by Australian ophthalmologist Dr. Graham Barrett, this app helps determine the axis of corneal limbal marks prior to inserting a toric intraocular lens (IOL). The app enables clinicians to avoid malposition and, thus, potentially improve outcomes.
3. OCTaVIA. The OCT Visual Atlas offers OCT reference material, as well as corresponding OCT images for multiple retinal diseases. It covers more than 75 retinal diseases and provides useful links to the AAO website for further reading.
Dr. Mehta noted that these apps are not FDA approved but have been clinically validated by physicians.
3D Printing in Ophthalmic Surgery
3D printing in surgery is an area that is less practical than the apps Dr. Mehta reviewed— but not by much. After listening to Andrea A. Tooley, MD, you come away thinking this type of AI technology might be on the verge of breaking through. “3D printing for surgical applications is not the future—it is the present,” said Dr. Tooley, Assistant Professor of Ophthalmology at Mayo Clinic in Rochester, MN.
She acknowledged that ophthalmology has been a bit slower to adopt 3D printing, but trailblazers in other specialties are clearing a path for eye care professionals. She sees a future, “where it will be possible to 3D print corneas and conjunctiva.”
Early adopter specialties include neurosurgery, cardiovascular surgery, and orthopedics. 3D printing is also being used in face and middle ear transplants.
Dr. Tooley explained that the technology is being used for surgical models, surgical guides, and patient-specific implants.
Here’s a rundown:
• Surgical models. “The technology is used outside the operating room for surgical planning for very complex cases,” she explained. “You 3D print the exact anatomy and practice surgery.” Cardiovascular surgeons use it to practice septal hypertrophy and neurosurgeons use it for complex aneurism.
• Surgical guides. “You take these into the operating room with you. Studies show that 3D printed surgical guides not only decrease operating room time, but also im- prove surgical accuracy.” They have use in orbital surgery and facial reconstruction.
• Patient-specific implants. These are customized for each patient and designed to be left in the body. Dr. Tooley noted that utility has been demonstrated in patients with hemifacial microsomia. “We can 3D print a custom implant that matches the more normal side of a patient’s face. When we implant it, it fits exactly with the patient’s anatomy.”
These inroads excite Dr. Tooley, who said she thinks that 3D printed glaucoma valves and even custom IOLs may not be that far off.
Mehta A, Tooley A. Spotlight in artificial intelligence and new technologies for the ophthalmologist. Presented at: AAO 2019 annual meeting; October 12-15, 2019; San Francisco, CA.