Shift to VR, AR, AI, robotics inevitable for ophthalmologists
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For many senior ophthalmologists, including me, the entry of virtual reality, augmented reality, AI and robotics into our lives and practices is intimidating.
I remember having discussions with many senior ophthalmologists in Minnesota in 1980 when I returned to the University of Minnesota department of ophthalmology faculty after 2 years of fellowship, newly trained in phacoemulsification and posterior chamber lens implantation. At that time, all my senior ophthalmic surgeon colleagues in Minnesota were performing intracapsular cataract extraction surgery and implanting anterior chamber or iris-supported IOLs or, in many cases, no IOL at all with planned contact lens or spectacle optical correction. I immediately created local training courses to transfer the knowledge and skills I had learned, but many senior ophthalmologists nearing retirement were hesitant to learn a whole new way of doing cataract surgery on their private patients in the last few years of practice. With humility and concern, I suggested that those who would retire within 5 years could likely continue with their current practice patterns, but those planning to be active cataract surgeons a decade later would have to learn the new way of doing cataract surgery, retire or transition to medical ophthalmology. I believe the same is true today concerning virtual reality (VR), augmented reality (AR), AI and robotics.
First, a few definitions. In VR, we enter a new three-dimensional world, feeling we are someplace else and no longer at home. We enter the VR world as an avatar and can interact with other avatars around the globe without leaving home. The primary application of VR today is gaming, and the application of VR to gaming is active and entrenched. I see the primary application of VR for we ophthalmologists to be education, in which we can interact with colleagues throughout the world in VR-driven educational events from the comfort of our own homes or offices. The application of VR to education will be positive for we ophthalmologists and industry but challenging for our professional societies as travel to distant meetings to interact and share knowledge with our friends and colleagues will become less necessary.
With AR, we remain in our current location, but our ability to perform a task or acquire timely information is improved. I see AR and AI in the future enhancing every ophthalmologist’s performance in the office and the OR. We will learn to use AR to make more accurate diagnoses, develop personalized treatment plans and perform superior surgery. AR will allow us to provide more and better care to patients. AR and AI will combine with the use of collaborative robots to improve our diagnostic and procedural outcomes. With AR, AI and collaborative robots, the ophthalmologist will remain the critical caregiver, but their ability to help patients will be enhanced.
Now, a glimpse at the future. An AR headset will be placed on the patient in the waiting room. The headset will register the patient and perform the majority of the core diagnostic tests required, including visual acuity, refraction, motility testing, pupil evaluation and a visual field. External, slit lamp and fundus photographs will be performed with miniaturized cameras, uploaded to our electronic health records and analyzed by AI, with primary and secondary diagnosis provided. With technology currently in development, nearly every test done today by one of our ophthalmic technicians will be able to be performed with VR or AR goggles. After registration and testing are complete, the patient will be provided appropriate education for their AI-determined diagnosis through the VR/AR goggles as well. A few tests will still require a trained technician, such as the measurement of IOP or tear film osmolarity, but depending on the patient’s needs, many complex tasks, including biometry and IOL power calculation, will be completed while the patient wears the VR/AR goggles.
The ophthalmologist will still be required in the office, but they will spend more time talking with patients and finalizing personalized treatment plans and less time examining patients and gathering data.
In the OR, the ophthalmic surgeon will harness the power of AR, AI and collaborative robots to make every surgical procedure better, safer and more reproducible from one patient and one surgeon to another. We have already entered the era of AI-enhanced robotics with excimer and femtosecond lasers that are actually robots collaborating with a surgeon to make certain steps in refractive corneal and refractive cataract surgery better, safer and more reproducible. A surgeon working with a collaborative robot enhanced with AR visualization systems and AI will progressively improve outcomes, taking ocular surgery to a new level, increasing patient demand and the surgeon’s ability to meet that demand.
In my opinion, every ophthalmologist practicing a decade from now will rely heavily on VR, AR, AI and collaborative robots. This will represent a brave new world of practice dynamics compared with today, but the ophthalmologist of the future will be more efficient and proficient in providing quality office-based and surgical eye care to the ultimate benefit of their patients.
The prudent ophthalmologist with 5 or more years left to practice will immerse themselves and become expert in VR, AR, AI and robotics as the winds of change are beginning to blow, and there is no stopping them.
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