HEALTH CARE AND ARTIFICAL INTELLIGENCE
The media has been full of scary predictions about artificial intelligence (AI) lately – how it may destroy the mankind by next decade, if it is not controlled now. Mixed opinions from experts, government and scientists leave us uncertain about future.
Within the last three years, artificial intelligence has become an integral part of our society including health care. It appears to improve efficiency, reduce errors and curtail costs of health care system. Let us look at some of the disciplines where it is making an impact.
Biggest beneficiary has been radiology department. AI has trillions of prior data and images to compare with the current image whereas a human radiologist can remember only a few hundred ones. Hence, it can pinpoint the abnormalities faster and more accurately. It can predict potential development of cancer in certain spots, even when it is not obvious to naked eye. It can prioritize pending files so that abnormal X-rays are read first to reduce actionable reporting time. In addition to reading and reporting the result, it can incorporate the report in the patient chart automatically so that all other providers can also read the results immediately.
Next beneficiary has been pathology department. Again, the manual reading of a slide by the trained pathologist is not a comparison to AI reading. Much higher accuracy, analysis, recommendations and predictions are provided faster by AI. Laboratory results are analyzed and synthesized to make recommendations in addition to just reporting.
Outcome of several surgical procedures have improved with use of robotics, endoscopic and other minimally invasive techniques. Incorporating AI has further improved the results and reduced errors. Even before scheduling the surgery, AI can outline the prognosis, planning of surgery, and potential complications. 3D images of the operative site and abnormal tissues can be created allowing rehearsal virtual surgery ahead of actual surgery. During surgery, it can follow the progress, warn potential mistakes before they happen based on the trajectory. It can warn vicinity of important structures such as bile duct, ureters, arteries and veins. It can predict time of completion, prognosis and need for further treatment.
Pharmaceutical industry has gained momentum with faster research, development of medications, vaccines and treatment protocols. Fields of immunotherapy, molecular biology, targeted/gene therapy are making big strides in treating cancers and autoimmune disorders. Many cancers are now being cured with less invasive or deforming surgery with combination treatment with such medications.
Practice of primary care physician is being enhanced with comprehensive chart analysis, synthesized chart creation, treatment protocols and patient management. Faster patient summaries and documentations have saved average of two hours in a workday. Patients can get personalized instructions and other information on their health matters. Tele-medicine is being enhanced with faster and clearer responses. ICU monitoring, remote monitoring and wearables have made nursing care better.
Dermatology is now easier by predicting nature of skin lesions. Polyps noted during colonoscopy are assessed to know if they are malignant or not. Retinal scan by an ophthalmologist can predict impending disorders. Quick and accurate interpretation of EKG, echo cardiogram and other scans have become available.
Hospital administration can obtain reviews and cost projections, hospital bed occupancy, procedure outcomes, mortality and morbidity rates and compliance reports for regulatory bodies, saving cost and improving efficiency. Coding, scheduling, insurance authorizations and budgeting are streamlined.
Medical education has become easier with instant information made available on request. Web seminars and zoom meetings have become commonplace. Virtual dissections instead of cadaver dissections have simplified anatomy lessons. Research, preparation of speeches or presentations, obtaining references, creating tables or graphs may be done faster. Medical students can look up any topic or question and get full answers and references instantly.
On the negative side, AI can make mistakes too, often in a convincing fashion. For example, it can easily create fake news/videos and misinform people. Students can cheat on exams instead of studying. It may hamper proper intellectual development/learning and performance by humans, especially affecting youth. Most youngsters have already lost their handwriting ability with advent of digital world. Reading books and learning the hard way are becoming less common. Plagiarism may become rampant and unrecognizable. Major setbacks can happen to the originality in music, art, literature and science.
The fear that robots and AI will replace doctors is unfounded. No machines can ever replace humans and human interactions. Empathy, emotions and personal communication are integral parts of the practice of medicine.
No doubt, the final decision on patient care should always be with human doctors and not machines. Science will always advance and cannot be stopped. We humans must control and use it wisely. Future of medicine will not be doctors versus AI; it will be clinicians who use AI responsibly for better care.Dr. Venkit S. Iyer, MD, FACS, is a retired General and Vascular Surgeon. He has authored four books – “Decision making in clinical surgery,” “Aging well and reaching beyond,” “The Clinic” and “Geriatrics Handbook.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
EYE CARE
September Is Healthy Aging Month: What Are Your Eyes Trying to Tell You?
By Arun C. Gulani, MD, MS
September is Healthy Aging Month, a good reminder that living longer should also mean living well and few things influence our independence and enjoyment of life more than our vision. Yet one of the most common mistakes we make as we get older is assuming that every change in eyesight is simply part of aging.
Our eyes do age, of course, and they do so at many different levels. The tear film that coats the eye can become unstable, the cornea can change, the natural lens gradually loses its ability to focus and later its clarity, the gel inside the eye changes, and the retina and optic nerve become more vulnerable to certain diseases. Some of these changes are completely normal. Some can be improved. Others can be early warnings of conditions that deserve attention. The important thing is knowing the difference.
Presbyopia (reading vision)
For many people, the first noticeable change arrives sometime in their 40s. The restaurant menu starts moving farther away and the print on the phone suddenly seems smaller. This is usually presbyopia, the normal loss of our ability to focus comfortably at nearby.
But not every change in reading vision should automatically be blamed on age. Dry eye can make vision fluctuate, changes in blood sugar can alter focus, medications can affect vision, and subtle changes in the cornea or natural lens can also make yesterday's glasses seem inadequate today.
Dry eyes
In fact, one of the most overlooked parts of good vision is the tear film. Before light enters the cornea, passes through the lens and eventually reaches the retina, it first encounters this incredibly thin layer covering the surface of the eye. If that surface is unstable, the image entering the eye is already compromised. This is why someone may see clearly immediately after blinking and then become blurry again seconds later. Our screen-filled lives can make this worse because while concentrating on computers and phones, we tend to blink less frequently and less completely.
Cataract
As we move through our 50s and 60s, another familiar complaint emerges: “I can see, but I don't see as well at night.” Headlights become brighter, halos appear around lights, contrast decreases and driving in rain or darkness becomes less comfortable. These symptoms may come from the tear film, shape of the cornea, astigmatism, size of the pupil or changes developing in the natural lens. Eventually, that lens can become cloudy enough to be called a cataract.
Cataracts are a normal part of aging for most people, but simply having cataract does not necessarily mean it needs to be removed. What matters is how it affects the person's life. Someone may have a visible cataract and function beautifully, while another person with a seemingly modest cataract may struggle tremendously with glare or night driving. More importantly, not every older person with blurry vision is blurry because of the cataract. The tear film, cornea, retina and optic nerve all contribute to the final image. The eye must therefore be understood as an entire optical system rather than as a collection of individual parts.
This also explains why “20/20” doesn't always mean perfect vision. The familiar eye chart measures an important aspect of sight, but it cannot completely describe contrast, glare, night vision, depth perception, optical quality or how comfortably the two eyes work together. A person can read the 20/20 line in a brightly illuminated examination room and still know that something about their vision is not right.
Your Healthy-Eyes Checklist
As you age, pay attention not just to how much you can see, but to how you are seeing:
- Reading: Are you simply needing more distance or light to read, or is the print becoming distorted or disappearing?
- Night driving: Are headlights suddenly producing more glare, halos or starbursts? Is your confidence driving after dark changing?
- Fluctuating vision: Does your vision clear after you blink and then become blurry again? Your tear film may be contributing.
- One eye versus the other: Cover one eye and then the other occasionally. Is there a new or significant difference?
- Straight lines: Do doorframes, window blinds or lines of print suddenly appear bent or wavy?
- Flashes and floaters: Longstanding floaters are common, but a sudden shower of new floaters, flashes of light, or a curtain or shadow across your vision deserves prompt attention.
- Peripheral vision: Are you bumping into objects or becoming less aware of things approaching from the side?
- Double vision: New or sudden double vision should not simply be dismissed as aging.
- Pain or redness: Significant pain, persistent redness or redness associated with decreased vision deserves evaluation.
- Your overall health: Diabetes, blood pressure, cholesterol, medications and inflammatory conditions can have an impact on the eyes.
Perhaps the most useful question is simply: Is this change gradual, or did something happen suddenly? Sudden changes generally deserve greater urgency.
Some age-related eye diseases are particularly important because they may initially give us little warning.
Glaucoma
Glaucoma, for example, can gradually damage the optic nerve and peripheral vision while central vision remains excellent.
Age-related Macular Degeneration
Macular degeneration affects a different part of the visual system — the central retina —and may cause straight lines to look bent or distorted or make reading and recognizing faces increasingly difficult.
Diabetes
Diabetes can affect the tiny blood vessels of the retina, sometimes before a person notices any meaningful change in vision.
The eye is also remarkable because it can provide clues about what is happening elsewhere in our bodies. Blood vessels and nervous tissue can be observed directly through the eye without an incision. Diabetes, high blood pressure, inflammatory and autoimmune diseases, and even certain medications can leave clues there. Occasionally, what appears to be an eye complaint may even originate neurologically. Sudden double vision, loss of part of the visual field, or visual changes accompanied by weakness, facial drooping, difficulty speaking or an unusual severe headache should never simply be attributed to getting older.
So, what can we do to help our eyes age well? Much of the advice is reassuringly familiar because healthy eyes are connected to a healthy body. Don't smoke. Exercise regularly. Control blood pressure, cholesterol and blood sugar. Protect your eyes from excessive ultraviolet exposure. Eat a balanced diet rich in vegetables, fruits, healthy proteins and appropriate sources of omega fatty acids rather than depending on a cabinet full of supplements. Give your eyes breaks during prolonged screen use, pay attention to persistent dryness, and know your family history particularly for glaucoma and macular degeneration.
Most importantly, don't automatically accept a change in vision because of the number of candles on your birthday cake. Aging may explain many changes in our eyes, but it should not become an explanation for everything.
September's Healthy Aging Month is ultimately about much more than adding years to life. It is about maintaining independence, mobility, confidence and our connection with the world around us and vision play an extraordinary role in all of them.
Our eyes will age. That is inevitable. But blurry vision is not a birthday, glare is not a diagnosis, and loss of sight should never simply be accepted as the price of getting older.
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com