Al Pacino’s famous line from The Godfather Part III—“Just when I thought I was out, they pull me back in”—turned out to be more memorable than the movie itself. For optometrists, it seems the opposite statement is true. Every time optometry looks to be in the mainstream network of medical care, someone or something tries to pull you back out.
The American Diabetes Association just formally endorsed artificial intelligence (AI) use in disease screening efforts. As described in one of the news stories in this issue, the organization’s latest standards document says AI systems that detect diabetic eye disease “represent an alternative to traditional screening approaches.”
That’d be you, of course.
Optometrists are now pretty well accepted as the ideal entry point into the healthcare system for new eye disease cases, given the sheer number of practicing ODs and the preponderance of primary eye care performed by the profession. When someone’s eye health starts to go awry, you’re the nation’s first responders. But even vital services are vulnerable to the threat of disruptive technology.
A good deal of your diagnostic responsibility is simply looking at an unusual presentation and asking, “Is this something? Or nothing?” It’s the first big fork in the road for the patient, and you’re the person who steers them one way or the other.
But if there’s one thing computers excel at, it’s binary decisions. Tech firms are busy feeding enormous datasets into ever more sophisticated pattern recognition algorithms to answer that something/nothing question. Without you.
The problem isn’t so much the technology—AI-powered diagnostics have great potential to help—but rather the ways it might be used to do an end run around optometry. The worry is that automated screening tools set up in retail locations will just bypass optometry and steer disease suspects right to ophthalmology practices. If AMD or diabetic retinopathy patients have to end up in an ophthalmology practice to receive treatment anyway, the argument goes, why not just send them there in the first place?
Whenever that argument surfaces, it’s important to remember optometry’s competitive advantages over ophthalmology: affordability and access. Especially when the work is triaging brand new patients and educating them about their condition, an AI-to-OD ‘referral’ makes a lot more sense.
All this makes it incumbent upon you to keep sharpening your diagnostic skills, which is the theme of this issue. We present five feature articles on the art and science of making that something-or-nothing call with far greater sophistication than a chunk of silicon ever could.
Consider, for one, this article on medical history taking. It distills years of training and clinical experience by a VA optometrist into a cogent narrative simplifying the vast, interconnected world of systemic disease and the eye. And I think that’s really something.