This week I have the pleasure of having a guest co-host, Dr. Max Perique, a long time friend, Max. We've known each other for many years and he is a listener reached out to me and he's been enjoying the podcast and he is such a key opinion leader in refractive surgery. I thought it'd be great to have him on.
So Max, thank you for joining us. Thank you, Rayhan. I really appreciate being here and I'm super excited about this podcast. Yeah, we have a good discussion today, a couple topics that I think you'll have particularly insight into.
So Dr. Perique is the founding partner of Advanced Ophthalmology Institute. I started private practice which then rolled up with NVision in Southern California. He's based out of, I'm very jealous based out of La Jolla, California.
I just went with my kids to San Diego and I told my wife, you know, why are we living in Texas? The real Southern California where it's at. So Max, I am jealous but you're good friends, I don't feel that bad. Yeah, come by anytime, visit anytime and wish I had your text rate.
So interestingly, Dr. Perique was previously the team ophthalmologist. I didn't know they even had that for the San Diego, well previously San Diego Chargers and Los Angeles Chargers, any interesting stories, I guess, without breaking hip-hop that you could share with us? I always wanted to be an orthopedic surgeon and this was my calling by doing ophthalmology for the Chargers.
I felt like I got my eye fixed and I got my sports and ortho fixed in at the same time. So it was good. One sad story I guess is if the Chargers, San Diego Chargers had gone to the Superbowl, which they didn't in my 14 years there, then all the medical staff including the ophthalmologist and even the dentist, we would all get team Superbowl rings, but unfortunately team never made it. Well, yeah, I've had a couple years late, I guess, since you left.
But hey, maybe there's another role for you with the football team or one of the other professional teams there. So let's just jump right into the news of the week because I am so happy to have you because this is right up your alley. This is big news, sort of breaking news, at least yesterday I believe. And that's of course that Aukon is buying star surgical for 1.5 billion, which is about a 50 percent, I think Max Wright, it's a 50 percent premium over the stock price.
So yeah. Yeah. So yeah, it was incredible because this is something, you know, I've been, I do a lot of star surgical, I do a lot of my sales down here in San Diego. And so I've been following this stock specifically for several years, always wondering why the price kept going down while the product was on an upswing, especially the last year, year and a half, two years now.
And at least in the United States. And yeah, go ahead, what a story. What a story, yeah. And this is, I mean, you know, at time because there are a lot of surgeons you included, you know, I don't have any experience with the UICL, but I know a lot of surgeons who love it here in Texas.
And I believe, you know, you're a big fan too. Especially with the high myelps, are patients who aren't great laser candidates. Now it's part of the Aukon ecosystem. And of course, this is the AI and I care podcast.
It's not, it's not a surgical podcast, but, you know, anytime there's a big deal like this, especially recently, I love looking at it through sort of an AI strategic angle. Unlike if there's a data play, is there an ecosystem play, you are in the thick of it with star Aukon in the various sort of surgical platforms. I know you know them well. So where do you see this in particular, sort of thinking about data AI?
Is there an angle here? Are we are we stretching? Yeah, I think there's a strong angle that I, you know, first of all, the story broke last night probably this morning when most people really heard about it. And you know, I mean, so we're going to look at this as, okay, few things.
Number one, I use the Aukon laser, the EX500 to do a laser surgery. I've been using for a number of years. So we know an Aukon is the major platform in the United States for laser surgery. So they know how the Aukon is very aware of how many laser cases are being done in the US.
And even outside the US, but let's say the US just by knowing how many cards the surgeons are buying and using. So they have that data point at a very high certainly level. Number two, now they're going to have this, and then the implants, the, as we know, they have one of the dominant forces for a feco-emulsification cataract surgery. Their lenses are widely used, especially the lifestyle lens, the panoptics, and now the panoptics pro.
And so they're going to have that data point in terms of cataract surgery and refractive lenses and how many cases are being done with their fecos and their lens implants and their lifestyle lenses. So that's a data point that they're going to have easy access to. And now once they get this star data, they're going to actually know how many ICOs are being done in the United States. It was publicly traded, not probably, probably already no news, but they'll have very good idea of that.
Even so they're going to have a good, just literally they're going to have a good idea of what's going on in the refractive surgery space from younger demographics to older demographics just because they control such a large percentage of the market share of refractive surgeon in the United States with these three big products. That's easy. I think what would be really helpful, the way I look at that from an AI standpoint would be, so if Alcon can provide surgeons and even patients, let's say patients, tools to now plug in their data. They get their demographic data, what's their age, what's the refractive what's all the different details about their eye and their goals and etc.
etc. I think you can just run, if they run a good AI algorithm, you can actually figure out which is the best product for their eye and Alcon would basically control all three products that you would most likely need either. LASIK, ICO or an implant, and in Troncolon's implant. So I think they can pretty much provide the tool that would direct how the customers get their surgeries done.
We often talk about on this podcast that data is a new oil and here, exactly how you laid it out, we're really talking about the entire patient journey from a young patient who, you know, LASIK, it's sort of typical LASIK or maybe they're a strong myopic, myopic and they're not a good candidate, then the Alcon fits with them too. And then of course, Sephora lifestyle lenses, recatur X surgery, as patient good older. So they have the entire sort of surgical patient journey in the, in sort of a data ecosystem. And so you mentioned patients, do you think, what about for surgeons?
What about in terms of predicting Iowal calculations, malt prediction, more personalized refractive tools for surgeons? Do you see that as a potential option that they could explore? Yeah, I hope so. I hope they do that because for surgeons, we always are looking for better data and better outcomes.
That's always the name of the game to get the best outcome possible. So any tools they provide doctors, we would take, I think that would require us data sharing with them, our outcomes and things like that. So that comes down to EMRs and providing data. So I don't know, that might be a little bit trickier I can see, but probably doable.
But I think from the patient standpoint, they can drive business because if the patient just goes to let's say an optometrist office or you're not the malnest office and just ask for a copy of all their records, all their data. And then you put that data into a some type of program, an AI driven program. It'll pretty much tell you and then you just type in like, what's the best procedure for my eye based on this data? Then whatever pops up, it's going to be now come, it's an outcome product.
So it's in their best benefit. It removes them to actually create this tool for patients. And that's really interesting. And I know a lot of companies are already considering this, but instead, and this is probably, I think, really well into our next topic.
But why even make your own data or your own capital or no website? You could do that. Or you just feed it into chat GPT. And I'm sure open AI and cloud, you know, anthropic and Google at Gemini, they are engaging these larger data rich organizations like Alcon because they probably want their products to be surfaced on when someone types in, you have a 25 year old who types on chat GPT.
I'm a minus 10. What are my options for seeing better? It probably makes a lot of sense for that to be surfaced quickly. And I'm sure Alcon be interested in getting that information to the patient.
Yeah, I think that's going to, you know, it's going to happen. It's happening now, actually. I think patients are already doing that now. It'll just accelerate.
Yeah, yeah. And that goes really well into our next topic. So every week we do, news of the week, and then a fireside chat. So, and this is a topic, Max, that you brought up to me.
It's about, because we're all used to Dr. Google, right? This is a page comes in and they, they Google search day and they got some information from WebMD or A or some other website and they bring in that you have a conversation. And you had mentioned to me when we were talking last week in preparations that, you know, I'm getting now patients with not Dr.
Google, but Dr. Chat GPT or whatever Dr. LLM that they're, they're using. And that's presenting sort of a different, unique set of challenges.
Some may be good, but some may be not as good and more challenging to the decision. So walk us through, maybe you have an example or two or walk us through your thought process. What sort of happened? What do you think and how should physicians respond?
Yeah. So let me, you mentioned one data point that caught my eye in just a few weeks ago that really stopped me thinking. So apparently on, on Bing and co-pilot, they, it's something that they published. So they said they get 50 million health inquiries per day on Bing and co-pilot.
I'm pretty, by people all user and you people who are using that 50 million right now, that's amazing. And you know, they're asking, well, that's one data point. That, that, that was kind of amazing. And then number two, I remember maybe about a year and a half ago, my father had a, like, eyelid thing.
And you know, you went a parent or a family, really close family member calls you, you know, they say, my eye hurts or something, you kind of blow it off a little bit. Just because you know, that kind of listens to you anyway. But I was like, all right, Dad, sure, send me a photo of what it looks like. He sent it to me a photo.
And, and I just put it in chat to you, PT. And I asked what, what's going on here? And it actually gave the exact answer I was going to tell my dad, like, giving to the more contrasts as clean it, put some tears in your eyes. If it doesn't get better, give me a call.
We'll take a look at it. And, and so it was interesting. It was the exact answer. And this was a year and a half ago.
So I just basically just sent that to him by phone by text. And so here you go, Dad, just chat to PT. And it's, it tells you the answer. Perfect.
And if it doesn't get better, give me a call. And that was like my first, he's like, and I paid for your med school. It will, I mean, the photo to me didn't, he was telling me his eye was red. And this and that, I didn't even see the photo with the image just picked it up.
So I, with those two things alone, I was like, wow, it makes sense. Why would a patient not just take a photo with their iPhone of their tourism or, you know, whatever else is going on their, I, me on their entire surface. Or why would they not ask for a copy of their OCT or their retina photo that they're paying X dollars for optos, you know, whatever, you know, wherever they get in Dan. And they don't understand it anyway.
So one of the just asked for a copy of this picture, take it with their phone. Matter of fact, I tell my patients, go ahead, you can just take, use your phone, take a picture of the OCT if you want. I mean, I mean, they're so curious. And then they can just, they're just going to go home and chat to PT.
Right. I mean, what else are you going to put on Gemini on the OCT? And say, what's going on here? And it'll give you, you know, whatever comes up.
Yeah. Yeah. And I've seen that too where they'll have a fundus photo and, you know, they get it and you start showing them. They take a picture of it.
And I'm very open. I let patients do that. But yeah. And they're going to go back.
And so do you have any? Oh, hey, so what are some of the good sides? I mean, the good sides obviously, patients are more engaged. That's always a good thing to prepare.
They're invested in their health. They're interested in, in what you're doing, right? They see an OCT is like, oh, cool, doc, like this is actually something. This is my, you know, these are the layers of our retina.
Where are, and so that's like the good thing. Obviously that we, we, we, we are supportive of that. That's great. That's what you did for your own debt.
But where can this go sort of sideways and start really causing some issues? Yeah. So here's where it's going on. This is, this is what is kind of evolved to, or at least it's drawn my attention.
So now when patients come in for consults, you know, we're talking about they sick or I C L or lens implant consults who reflect of lens exchange consults. That's what I do all day long. Those four things. And they ask them to come in for a consult.
You know, we're required the data like we always do. But they've already done a lot of their research. They've done heavy research, especially when they're going to pay a lot of private, you know, their, their cash money for this. They're going to do heavy research.
And they're no longer, first of all, you know, if you do a Google, the Google search now with the AI mode goes automatically to like Gemini or something. So they're already getting AI knowledge when they do their search before they ever walked into the room into your office. Number one, number two, the AI actually gives them questions to ask. Like when you see the doctor, do you make sure you ask him or her about the following four or five things?
So they're already stacked with knowledge about what's going on. But then on top of that, what questions they should ask and make sure you answer. And then you know, that just go and then you know how it goes the more more questions you ask, they add more more questions, it generates for you. So and they also give it suggested answers.
And so they're already stacked with a fair amount of knowledge or information, which they probably don't fully understand. Right. I probably acknowledge you in sort of air quotes type of thing. Yeah, right.
Totally. And then they come in your office. And the worst case here was like last week for me was a woman came in with a three ring binder. And you just, you know, question after question.
I don't even think she knew which I mean, when she asked me do I prefer hydrophilic or hydrophilic lenses, I knew she had no idea what we're talking about. And you know, like it was just it was just question after question. And you know, you know, we can't spend an hour per patient. And if you how do you so my question has become to you and all people who are kind of following this space, how do we as providers like, you know, succinctly answer these questions, you know, be you don't want to be you want to still be informative, you still want to be you want to still provide the engagement back to the patient and show that you're interested.
Some of the questions are very good. And and they're deep and it takes a little while to get into. And the question is, how do you do all that in, you know, 15, 20 minutes or however many minutes you've allocated and still make them feel like they got all the answers they wanted and and then continue on with their journey with you or whatever and their surgical progress. Like it's it's difficult.
It's really difficult to stay on a timeline and answer the questions. And if you get too curt with them, you know, you're getting a negative review somewhere. Sure. Sure.
Yeah. No, I like I think and we sort of face this a little bit with with Dr. Goober, right before the world of LLM and patients coming in with a lot of, you know, information from maybe like very reputable sources like WebMD or doc simmity, but maybe also some not as reputable sources and you're like, what are you talking about and then you have to educate them. But here it's different.
I feel like with LLM because it answers in such a and such a thordate of way, like it's very believable. And I think that's part of that's part of the the difference that we have with this LLM world that it comes back and it sounds like an expert and sometimes it I mean it says good as an expert sometimes not always at hallucinase. I mean, there's definitely problems. Literally, chat GPD says at the bottom it can make mistakes.
Please check and for an info. So, but who actually does that? So I think there's like interesting differences that are unique with chat GPD. I mean, you asked like how do you solve for?
I don't know if anyone's really figured that out. I mean, the first thing that came to my mind is that well, use AI to quote, quote, quote, quote, quote, against AI. I mean, because it makes the most sense. I know who certainly providers, I mean, in our what we do not have the time, but optometrist optimal is to to spend hours with patients or staff 40 deep, right?
But if there was a tool that like a like an Ellen that was like a ophthalmology or optometrist rapper to tell them where it had a domain expertise and it knew what it was talking about and had guard rails. And I know several companies that are sure work on this exact type of product where they could ask questions and they could go hours and hours and hours and never and Ellen never gets tired and they could ask these questions. And it could be personalized to say, you know, to you, right? I think I think that makes a ton of sense, you know, and that that's definitely a huge category of a potential tool that people can use.
That's a rule comes to mind and sort of what what I'm thinking about it. But it's because it's it's definitely a problem. And I'm not sure that we are prepared for it. And I agree with you, Rayon, because when they do their query on a large LLLM that doesn't have those guard rails like you talked about.
So they're just going on the general one. Yeah, you're your confidence interval of getting the right information is much lower than if we were able to so yeah, we'd like to direct them. I agree with you if we can direct them to a a platform that we can all agree upon that's excellent. That would be great, right?
Because then you can at least feel like the data is maybe 97 98% good as opposed to 70%. It's a 30% that's wrong that really creates the problem. And you know actually, so that's what I think what happens right now, Rayon when they come in for the exams is they're they're testing you whether you do know you're information. And then B, if you say something that's too far off what they researched off their AI, then it makes them think maybe I should get another opinion.
Right. Because now they don't know is it the doctor or is it the AI or you know, we so doctors have certain things they might angle like a Alcon patent opix pro over a you know, Johnson and Johnson and B&L lens because that's what their surgery center has. So there are other things that maybe are under that surface that you know, the patient's going to stumble upon maybe a little bit more accidentally than anything else. But there it is, you know, and it creates a conflict.
All kinds of conflicts come out. And and the patient is just going to get confused in this conflict. And that's what I just you can see it. It's already happening.
I'd say I'll say today I saw two to three patients who just told me right up front. I already went through Chachy PT and here's a couple things I need to know doc and fortunately for me they just went straight to that. And once I was able to answer those three or four questions they're ready to you know, book their surgery. So that was actually a good thing.
But other ones it's the opposite. You know, the ones who are a little bit more anxious or want to be exhaustive in their research, you know, however you want to phrase that, those are the ones who just can't, they can't just they can't ask enough questions. Can't give enough answers. And so you're just basically unfortunately for them, they're going to be stuck in neutral, you know, and because I just can't decide who to trust and how to how to how to give that trust up.
So yeah, and you know, and I think that we were just at the tip of this beer type of thing because you know, right now it's still most people I mean, I interact with my LLN in an audio way, but I think in the future, I mean, we're going to be wearing pins or me glass smart glasses or watches where there's going to be sort of an always on recording thing. And I'd really wonder if that's going to how it's going to impact the physician patient relationship. And I could see again positive and negatives there. If you're always being recorded and you're always being everything is being fed into their personal chat GPT from their fundus photographs to their I will colleagues to everything.
I mean, on one hand, it's very empowering to the patient. You don't want to be paternalistic, but and then say, well, they, you know, they they may not know all these things, but on the other hand, there is just it becomes a lot of noise there. And you really wonder if we have the efficiencies to address that. And so I don't know if we have any answers here, at all, but I think this is a really interesting problem that's beginning to be surfaced as these tools become more widely used.
And yeah, you know, when there's an interesting problem, there's a problem. And you can see how these are going to all butt heads everywhere. There's going to be a great solution. You know, that's the beauty of it that there's a probably a market opportunity here.
You already made come up with a couple of ideas, which I think you would just expand on, but I think the problem would be let's keep our consult time and say, right, you know, we got to make sure we can still do this exam in a certain amount of time. Still be very good to the patients and answer their questions so they feel they can trust the doctor and move forward with their procedures. And and and and so that and so basically increase efficiency for the patient, but also for the doctor. And that's that's what we're looking for in the education part of it on that inner encounter.
And that's I think that's looking for that. Yeah. And I think on the whole, I mean, you would agree, I think, AI on the whole, a vast net benefit, but it's interesting to see any new technology. You're going to have these negative externalities, right?
When things start being used and we're like, huh, I didn't think it would be used that way. And so it's just interesting. So you would agree that net, we're in a huge net positive for health care. Oh, yeah, I love it.
I love it. I really do like it. It's the velocity of change is absolutely astounding. I mean, really, it's how fast things are changing every day.
And in the ice space is maybe just a hair slower, but in AI in general, I think it's, you know, it's just we're just talking about I care and AI, I just have financial legal and, you know, everything else. I mean, it's astounding how fast this is changing and you know, I don't know, I don't even know how the medical students, you know, I think we're going to have to retrain medical students and ophthalmology residents and just everybody. The whole process is going to have to change from ground up because it's different. It's different.
It's different than when, I mean, you went through the process. Yeah, extremely, extremely different, but it's an exciting time. More information, more technology. And of course, what we're hoping for is better outcomes for our patients and family, for instance.
So that's what we're here for. Thank you so much, Dr. Perique, for joining us at Real Talk at the AI and I care podcast. And please check out AI and I care.com.
We do have our annual AI and I care event at Division X, but West coming up in September. So please check out the website to get more information there. And thank you. And we'll talk to you next time.
Thank you so kind of man. I love the awesome. Thank you.