Article

TREATMENT PLAN

IS UTOPIA IN OUR FUTURE?

Recently, I read excerpts from a speech given by Dieter Zetsche, chairman of the board of management of Daimler AG and head of Mercedes-Benz Cars Division. That’s the company, by the way, that claims to have developed the first self-powered automobile (Delahunty, 2017).

Among his ambitious predictions is that cars will be autonomous by 2020. That is, you will summon a ride service, like you do for Lyft or Uber now, but it would take you to your destination without the assistance of a driver. He also suggests that one consequence will be the lack of need for car insurance.

The logical extension in my mind was that the same paradigms are emerging in medicine. This may not be as revolutionary as you might think based on recent predictions and developments in medicine.

In Clark (2017), Vinod Khosla, co-founder of Sun Microsystems, is quoted as saying: “Machines will replace 80% of doctors in a healthcare future that will be driven by entrepreneurs, not medical professionals.” Subsequently, in Farr (2017), Khosla made this more specific prediction: “The role of the radiologist will be obsolete in five years.”

The Age of Automation

With 2020 approaching rapidly, what will be the role of ophthalmic providers? One element on the horizon is the automated assessment of the ocular fundus, specifically for diabetic retinopathy.

Investigators using a deep-learning protocol trained an instrument (read: software) that grades clinical diabetic retinopathy from an image in about 20 seconds (Healio.com , 2017).

Additionally, two other deep-learning algorithms have been reported as viable (Gulshan et al, 2016; Abramoff et al, 2016). One will be available in a commercial version soon after this article prints.

With new options becoming available, the decision for referral of vision-threatening retinopathy will become completely automated (Abramoff et al, 2016). And, automated diagnostic algorithms for other ophthalmic diseases will be just around the corner.

Adjusting Treatment Protocols

Armed with an accurate diagnosis, treatment protocols will follow—automatically. Just think of the possibilities. Maybe healthcare providers will no longer have to be concerned about malpractice claims. What a benefit that may be!

We are seeing automated refraction in clinics, mobile settings, and even online. Three-dimensional printing will produce spectacle prescriptions and contact lenses before the patient’s pupil recovers from the dilation.

Other new treatment modalities will also become available. Currently, topical treatments for acute and especially chronic diseases will be supplanted by advanced strategies.

For example, the cornea presents a formidable barrier to ocular drug penetration. For multiple dosings, how great would it be if sustained-release formulations could obviate the need for adherence to conventional regimens? Sustained-release formulations as well as implants such as mucoadhesives for topical and intracameral installation (Horvát et al, 2015) and nanotechnology applications are being developed (Lusthaus and Goldberg, 2016). On the nearer horizon are sustained-release injectables for intraocular pressure-lowering drugs (Lewis et al, 2017).

Summary

The future for ophthalmic providers will look very different within a decade. Like the prediction of Watson-like radiologic interpretations, automated fundus evaluation will replace the stereoscopic examination regimen.

Refined treatment modalities will displace the tedium of repeated topical drop administration. Instant spectacles will become available. And perhaps we will even see the elimination of professional liability.

Will the disruption of medicine as we know it be embraced by patients? And how will providers accommodate these changes? CLS

For references, please visit www.clspectrum.com/references and click on document #264.