Artificial Intelligence and Optometry

In 20 years, will optometry as we know it exist? Will there be a role for optometry and how will it be delivered? Technological advancement is disruptive by its nature. Historically, it has resulted in radical changes to the type of jobs available and in demand. We are perhaps in the midst of an era of the most rapid technological evolution ever experienced. An obvious example of the pace of change is the advent of autonomous/self-driving vehicles.

In 2004, a piece entitled “Why People Still Matter” argued that driving in traffic is insusceptible to automation: “executing a left turn against oncoming traffic involves so many factors that it is hard to imagine discovering the set of rules that can replicate a driver’s behaviour”. Just 6 years later, Google announced that autonomous driving was a reality. Partially automated vehicles have since become widespread.

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Human refraction is particularly susceptible to obsolescence in the not too distant future

Computerisation has led to dramatic change and decline in employment in occupations mainly consisting of tasks following well-defined procedures that can easily be performed by sophisticated algorithms. Although the nature of optometric practice varies across countries and continents, few would argue that refraction and the management of refractive error remain the defining feature of the profession. Is there a future for human-performed refraction? Refraction, at its most basic form, is an algorithm.

It is tempting to try to reassure ourselves that refraction is more art than science. Or even a clinical skill that evolves with time and requires the human touch and is not, therefore, amenable to computer coding. Hopefully, without offending my many very highly skilled optometric colleagues, I would suggest that nothing could be further from the truth. In fact, we should concede that a robot might well eventually take over the practice of routine refraction, and use that knowledge as motivation to evolve and drive our profession in new and exciting directions.

It seems simply a matter of time before automated refraction is considered routine, perhaps delivered through the smartphone and coupled to an advanced 3D printer that can fabricate personalised spectacles instantly.

Even if that’s not the case, economic drivers are a powerful force for change so I would consider human refraction particularly susceptible to obsolescence in the not too distant future. A purely automated refraction would facilitate significantly enhanced flow of patients through the clinic, which would be commercially attractive. At some point, people will cease to pay the costs of visiting an optometrist because they can get a reliable refraction done more conveniently, quickly and cheaply elsewhere. Prescribing skills will not save practitioners from advances in technology.

Take prescribing of low visual aids as an example. Although still an important part of ophthalmic training and clinical practice, a smartphone or tablet with a real-time magnifying glass app has made many of the products, skills and services redundant. Refraction and spectacle dispensing are also not immune. Internet sales of spectacles and contact lenses are not new phenomena. Automated kiosks for refraction and dispensing are here, and online vision testing has also arrived (check out https://www.govisibly.com/). In the context of such change, it is difficult to predict how human-performed refraction can survive. It seems simply a matter of time before automated refraction is considered routine, perhaps delivered through the smartphone and coupled to an advanced 3D printer that can fabricate personalised spectacles instantly, or some other robotic, AI or technological advance we have yet to experience or conceive.

We must embrace AI and exploit the opportunity for optometry to mature as a profession and evolve to provide a different but enhanced healthcare role in society.

So how will optometry survive the disappearance of the very skill on which the profession was based? Although refraction may become fully automated and other areas of eyecare may experience a similar degree of technological influence, the profession of optometry should embrace the possibility that bots and AI can make us better at our jobs and more secure in our careers, not the other way round. Healthcare professions usually rank among those deemed least at risk of automation (see figure below from “The Future of Employment”).

The probability that optometry would become computerised was calculated at just 14%, lower than the majority of the 702 occupations assessed. That probability, however, depends on the profession’s response to AI disruption. Will optometry choose to utilise innovative technologies such as AI to improve patients’ outcomes, or will it remain fearful and reactive when it comes to meaningful change? We welcome the benefits of such a change in our personal lives. Likewise, professionally, we must embrace AI and exploit the opportunity for optometry to mature as a profession and evolve to provide a different but enhanced healthcare role in society. AI is likely to become commonplace over the next few years, helping optometrists and ophthalmologists with clinical decision-making and reducing medical errors and variability in patient care.

Graph from “The Future of Employment” by Carl Benedikt Frey & Michael Osbourne

From “The Future of Employment” by Carl Benedikt Frey & Michael Osbourne

A greater medical role for optometry is the obvious answer. There are significant challenges facing secondary care with the changing demographics in society, longer life expectancy and increasing variety and quality of treatment options available. Optometry can and should step in to evolve our role in a manner that allows us to become an integral part of future eye health service delivery. This needs enhanced training, a more significant role in medical prescribing and increased cooperation between the professions.

One of the biggest changes that technology has brought is the amount of data that is now collected and available to inform patient management. If human-performed refraction does become obsolete, and the “medical” role of optometry remains primarily one of data gathering and distribution to secondary and tertiary care, then we are expendable – and we could witness the slow demise of the profession.

Instead, let’s develop our business model, embrace and use technology rather than being used by it. Let’s evolve with the bots, so we don’t get left behind by them.

Suggested reading:
1. The Future of Employment – Carl Benedikt Frey & Michael Osbourne
2. The Robots have arrived – Dr. Peter Hampson. Optometry Today
3. How To Embrace AI Instead Of Fearing It – Jacob Morgan

James Loughman

James Loughman is the Clinical Research Director for Ocuco Ltd. An Optometrist with more than 20 years of clinical, academic, research and management experience, James recently joined Ocuco as Clinical Research Director. James is also presently the Director of the Centre for Eye Research Ireland, a research facility based in the Dublin Institute of Technology, the same university where he received his PhD in 1997; James oversees a portfolio of research including technology development and big data analytics projects alongside various clinical trials for the control of myopia, glaucoma and other blinding conditions.