The Open Ophthalmology Journal




ISSN: 1874-3641 ― Volume 13, 2019
EDITORIAL

Teaching Ophthalmology for Machines



Thiago Gonçalves dos Santos Martins1, Maria Carolina Francisco Kuba2, Thomaz Gonçalves dos Santos Martins3
1 Federal University of São Paulo São Paulo Brazil
2 Casa de Portugal Portugal
3 Piedade Hospital Rio de Janeiro Brazil


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 127
Last Page: 129
Publisher Id: TOOPHTJ-12-127
DOI: 10.2174/1874364101812010127

Article History:

Electronic publication date: 29/06/2018
Collection year: 2018

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 743
Abstract HTML Views: 926
PDF Downloads: 507
ePub Downloads: 466
Total Views/Downloads: 2642

Unique Statistics:

Full-Text HTML Views: 403
Abstract HTML Views: 320
PDF Downloads: 187
ePub Downloads: 152
Total Views/Downloads: 1062
Geographical View

© 2018 Martins et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.







Ophthalmologic care is scarce in many parts of the world. Without early diagnosis and timely treatment, patients with ophthalmological diseases eventually reach advanced stages of the disease, such as blindness.

Ophthalmology teaching in medical schools has been reduced over time. For example, in the United States, the compulsory study of ophthalmology in medical schools decreased from 68% in 2000 to 30% in 2004 [1Quillen DA, Harper RA, Haik BG. Medical student education in ophthalmology: Crisis and opportunity. Ophthalmology 2005; 112(11): 1867-8.[http://dx.doi.org/10.1016/j.ophtha.2005.05.005] [PMID: 16271315] ].

It is expected that all doctors and nurses should know about pediatrics and internal medicine. The same does not apply to ophthalmology. The same could be true for nursing. Approximately 98% of medical doctors will not be the specialists in ophthalmology which makes it important for all physicians to learn basic ophthalmology [2Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol 1998; 33(1): 3-7.[PMID: 9513765] ].

In 1996, a survey conducted in Canada found that more than half of the curricula of medical schools in that country did not have a mandatory internship in ophthalmology [2Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol 1998; 33(1): 3-7.[PMID: 9513765] ]. In the United Kingdom, the average duration of medical curriculum of ophthalmology is 7.6 days, with 21% of medical schools not having compulsory education in ophthalmology [3Baylis O, Murray PI, Dayan M. Undergraduate ophthalmology education - A survey of UK medical schools. Med Teach 2011; 33(6): 468-71.[http://dx.doi.org/10.3109/0142159X.2010.540594] [PMID: 21355698] ]. The same could be true for nursing curriculum. Therefore, the resolution of all ophthalmological problems is concentrated in about 2% of trained physicians. In some countries, there is an aggravating factor including the unequal distribution of the medical doctors within the territory [4Gupta RR, Lam WC. Medical students’ self-confidence in performing direct ophthalmoscopy in clinical training. Can J Ophthalmol 2006; 41(2): 169-74.[http://dx.doi.org/10.1139/I06-004] [PMID: 16767203] ].

Physicians and engineers are currently working together to improve early ophthalmology diagnosis and follow-up. Algorithms are created for what is being called machine learning to assist medical decision-making and improve medical care. With the aim of providing better health service to populations, research has been done to develop new protocols of care that involve the use of artificial intelligence as a new tool for physicians to diagnose their patients more effectively and quickly [5Schor P. Doctors don’t break even. Arq Bras Oftalmol 2013; 76(2): v-vi.[http://dx.doi.org/10.1590/S0004-27492013000200001] [PMID: 23828479] ].

Algorithms are simple commands for computers to make their own decisions. In order to develop the algorithms, a multidisciplinary team of doctors, engineers and mathematicians determine how computers can be useful for medical diagnosis by considering a huge database provided by physicians. The research for the development of such algorithms is already advanced in the area of oncology with the use of Watson, an IBM supercomputer that is able to use and interpret data generating hypotheses. Most importantly, this technology provides the opportunity to learn, aiding medical doctors in decision-making processes. Machine learning classifiers considered as input empirical data predicted the features of the data. Machine learning has been applied to speed the process of testing hypothesis. It uses an extensible set of structured and unstructured content sources as well as broad range of pluggable search and scoring components that allow integration of many different analytic techniques. Machine-learning is used to learn the weights for combining scores from different scorers. This analysis produces hundreds of features. These features are then combined based on their learned potential for predicting the right answer. Improving diagnostic accuracy and speed can directly improve quality of care in patients as well as reduce the overall cost incurred in this process by health care systems. Watson will assist healthcare practitioners in evaluating a set of hypotheses [6Ross MK, Wei W, Ohno-Machado L. “Big data” and the electronic health record. Yearb Med Inform 2014; 9: 97-104.[http://dx.doi.org/10.15265/IY-2014-0003] [PMID: 25123728] ].

In ophthalmology, research in the area of ​​artificial intelligence seeks to assist the health care professional in 1) screening of ophthalmological diseases in regions lacking specialized professionals and 2) follow-up of chronic diseases. Computers have been programmed to compare images of patients with chronic diseases such as glaucoma and diabetes that can lead to blindness if not diagnosed and treated properly. IBM Watson has used the machine learning technique with the development of algorithms to identify signs of bleeding in retinal photographs of patients with diabetic retinopathy, which are captured and analyzed by a “neural” network created for image recognition and analysis. A neural network is composed of multiple layers of nodes: an input layer, one or more hidden layers, and an output layer. The computer will improve its performance from new images that are provided for analysis. Researchers report that the computer spends 20 seconds to analyze the image and has an accuracy of 86% in its severity rating of diabetic retinopathy [7Schatsky D, Ronanki R. Cognite technologies for healthcare plans 2015. https:// dupress.deloitte.com/ dup-us-en/ focus/ cognitive-technologies/ artificial-intelligence-health-plans.html]. In the future, this technology will enable the patient to be referred early to the ophthalmologist and assist in the remote monitoring of patients. Recently, there have been several studies reporting on deep learning algorithms in development for the detection of diabetic retinopathy. The use of deep learning in the treatment of diabetes and important since 30 to 40% of patients do not adhere properly to treatment [7Schatsky D, Ronanki R. Cognite technologies for healthcare plans 2015. https:// dupress.deloitte.com/ dup-us-en/ focus/ cognitive-technologies/ artificial-intelligence-health-plans.html]. Another important use of algorithms in ophthalmology was for the use of IOL in cataract lenses, in order to increase its accuracy [8Potvin R, Hill W. New algorithm for intraocular lens power calculations after myopic laser in situ keratomileusis based on rotating Scheimpflug camera data. J Cataract Refract Surg 2015; 41(2): 339-47.[http://dx.doi.org/10.1016/j.jcrs.2014.05.040] [PMID: 25661127] ]. Another example in ophthalmology was the development of the Retmaker for the follow-up of diabetic retinopathy. The investigators found that the Retmarker achieved acceptable sensitivity for referable retinopathy compared with manual graders while being more costeffective options [9Tufail A, Rudisill C, Egan C, et al. Automated diabetic retinopathy image assessment software: Diagnostic accuracy and cost-effectiveness compared with human graders. Ophthalmology 2017; 124(3): 343-51.[http://dx.doi.org/10.1016/j.ophtha.2016.11.014] [PMID: 28024825] ].

The algorithms are not for the purpose of contributing to but not replacing the physicians' decision making. In addition, with the technique of machine learning, the computers themselves begin to learn from their accumulated experience as well as their users. The learning machines are already used in our daily lives. The suggestion of a movie to watch or a book to buy is based on previous research that taught the machine about our preferences. That way, the computer is already able to single-handedly profile our preferences. As seen earlier, this same technique is very useful in health research, helping doctors make decisions based on large databases (Big Data) given by the computer. This is a small step towards the construction of intelligent machines, but they are already capable of learning from new experiences, which is a fact that is to be taken into account in the medical education of future physicians, who can add this interaction with the machine to their academic education.

The first person to develop algorithms was Euclides, in century III A. C., which was long before the invention of the computer. It was developed in his work of The Elements (300 BC) as a simple and efficient method of finding the greatest Maximal Common Divisor (MCD) between two non-zero integers. The MCD of two integers is the largest integer that divides both without a remainder. The Euclidean algorithm is based on the principle that the MCD does not change if the smallest number is subtracted from the largest [8Potvin R, Hill W. New algorithm for intraocular lens power calculations after myopic laser in situ keratomileusis based on rotating Scheimpflug camera data. J Cataract Refract Surg 2015; 41(2): 339-47.[http://dx.doi.org/10.1016/j.jcrs.2014.05.040] [PMID: 25661127] -10Simonite K. IBM’s automated radiologist can read images and medical records 2016. https:// www.technologyreview.com/ s/600706/ ibms-automated-radiologist-can-read-images-and-medical-records/].

For a long time, algorithms were created by mathematicians for mathematicians. Now they are created for computers with the assistance of multidisciplinary professionals, such as in the health field, who seek to facilitate and improve medical care in regions where there is an uneven distribution of physicians and ophthalmology team members [11Ludovico J, Bernardes R, Pires I, Figueira J, Lobo C, Cunha-Vaz J. Alterations of retinal capillary blood flow in preclinical retinopathy in subjects with type 2diabetes. Graefes Arch Clin Exp Ophthalmol 2003; 241(3): 181-6.].

REFERENCES

[1] Quillen DA, Harper RA, Haik BG. Medical student education in ophthalmology: Crisis and opportunity. Ophthalmology 2005; 112(11): 1867-8.[http://dx.doi.org/10.1016/j.ophtha.2005.05.005] [PMID: 16271315]
[2] Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol 1998; 33(1): 3-7.[PMID: 9513765]
[3] Baylis O, Murray PI, Dayan M. Undergraduate ophthalmology education - A survey of UK medical schools. Med Teach 2011; 33(6): 468-71.[http://dx.doi.org/10.3109/0142159X.2010.540594] [PMID: 21355698]
[4] Gupta RR, Lam WC. Medical students’ self-confidence in performing direct ophthalmoscopy in clinical training. Can J Ophthalmol 2006; 41(2): 169-74.[http://dx.doi.org/10.1139/I06-004] [PMID: 16767203]
[5] Schor P. Doctors don’t break even. Arq Bras Oftalmol 2013; 76(2): v-vi.[http://dx.doi.org/10.1590/S0004-27492013000200001] [PMID: 23828479]
[6] Ross MK, Wei W, Ohno-Machado L. “Big data” and the electronic health record. Yearb Med Inform 2014; 9: 97-104.[http://dx.doi.org/10.15265/IY-2014-0003] [PMID: 25123728]
[7] Schatsky D, Ronanki R. Cognite technologies for healthcare plans 2015. https:// dupress.deloitte.com/ dup-us-en/ focus/ cognitive-technologies/ artificial-intelligence-health-plans.html
[8] Potvin R, Hill W. New algorithm for intraocular lens power calculations after myopic laser in situ keratomileusis based on rotating Scheimpflug camera data. J Cataract Refract Surg 2015; 41(2): 339-47.[http://dx.doi.org/10.1016/j.jcrs.2014.05.040] [PMID: 25661127]
[9] Tufail A, Rudisill C, Egan C, et al. Automated diabetic retinopathy image assessment software: Diagnostic accuracy and cost-effectiveness compared with human graders. Ophthalmology 2017; 124(3): 343-51.[http://dx.doi.org/10.1016/j.ophtha.2016.11.014] [PMID: 28024825]
[10] Simonite K. IBM’s automated radiologist can read images and medical records 2016. https:// www.technologyreview.com/ s/600706/ ibms-automated-radiologist-can-read-images-and-medical-records/
[11] Ludovico J, Bernardes R, Pires I, Figueira J, Lobo C, Cunha-Vaz J. Alterations of retinal capillary blood flow in preclinical retinopathy in subjects with type 2diabetes. Graefes Arch Clin Exp Ophthalmol 2003; 241(3): 181-6.

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Advertisements


Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open