Welcome to Real Talk on AI and I care with your host, Dr. Scott Morris. And I'm co host, Dr. Rayhan Ahmed.
In each episode, we discuss current news, adding a little AI education, and debate innovative AI tools and topics that will change the industry. All right, welcome to another episode of Real Talk. I'm Dr. Rayhan.
I'm joined with my co host, Dr. Scott Morris. Scott, how are you doing tonight? Good, man.
Good. It's good to talk to you. So it was a jam-packed week. And we're not even talking about the SLOR myopia lenses, which I thought we were going to talk about.
But what I really want to talk about the news the week is that company, that I've been following for some time, and very, I think this is going to be, this is a momentous week for ophthalmology. This is the week that a company based out of California has actually been out from UCLA called Horizon Curgical. They released that they successfully completed their first in-human studies of their robotic cataract surgery platform. It's the first time robotic cataract surgery has come to us.
And it was successfully done. The surgeon is Dr. Great God, Uday Devgon, also based around LA. The company is led by a fantastic leadership team by JP Hoffsman, who leads the company.
So they did 10 cases all done successfully. For those of you who attended the AI and I care summit in Vegas, I showed the video of it. And this is always, when I'm writing shows, the video people are owing an eye, because the robotic arms come down. They make an incision on the cornea, do fecal multiplication, remove the lens, do IA, irrigation aspiration, put in viscola, put in the lens, take the viscola, so it does all parts of it.
It is all parts of the cataract surgery. It's just wild. It's the craziest thing. It's crazy.
It's fantastic. And so at this time, you know, through AI, it is monitoring entire, this is a safe procedure because you have OCT guided analysis of the anterior and posterior caps. So the prognosis exactly how deep it is, you're not going to go too deep. You know exactly where you are, how deep to make your groove.
And when to split the nucleus and how to aspirate it out. So it's a safe procedure. It was in cataracts. And it's just one of those things that I'm so excited about because this is a clear problem that's getting worse.
We have more patients that have cataract. Cataract surgery is already the most common surgery in the world. And the numbers are not in our, are not sort of in society's favor that you have fewer surgeons and more people needing cataracts. So how are you going to solve that?
Well, you scaled a surgeon. How are you going to scale the surgeon? Well, I think robotics, especially AI guided ones to make the outcome safe and predictable, really is part of the solution. So super excited.
For those, I have it all posted. It's all over LinkedIn. Again, the company's horizon surgical and super excited that they successfully completed these 10 patients. You know, Ray, and I have a question for you.
I sit there and I wonder, you know, it's like, so I agree, you know, such a short of ophthalmologist and there's just a crazy amount. I mean, I look at the surgeon, the cataract surgery I use in these booktops for months and months and months. And he does like 50 or 60 eyes a day and he's out booked out for months and months and months. And I wonder, you know, will, will, will surgeons use that for our more traditional, straightforward cataract surgery?
And then the really complicated stuff like I saw one today, it was like, you know, four plus cortical spoking really questionable zonules. I like that one. Man, I was thinking about this exact topic. I'm like, I wonder if robotics will be able to do that or is that still going to be in the hands of a really gifted surgeon who does it manually, but all of the kind of, you know, bread and butter really simple cataract surgery?
Is that going to be a robotic someday? And yeah, or or exactly, um, will, will that tough case be the gifted surgeon with the robot? Give or yeah, yeah, it's, it's not about, it's, it's about giving, having another tool in your tool, but and this is probably the one of the more momentous tools. I mean, when laser assisted cataract surgery came out and it tells you just, I think this is a bigger deal than that.
Really, I give for sure. Absolutely. You know, they say, well, you know, to just just make bad surgeons like average and, you know, after surgeons, great. But what it does, it increases the safety margin for parts of surgeon and very gifted surgeons.
And even tough cases, you use the tools that are available to you. So I could, you know, I don't know where they are. But maybe there are no bad surgeons now, right? I mean, isn't that ultimately the best thing?
That's all the certain lines. I think one of the guiding principles of this company in many is that we always talk about the art of medicine or the art of surgery. And sometimes come like, well, why do we, why do we say that? Shouldn't, shouldn't that show you turned on its head?
Shouldn't there be a science? Shouldn't like we demand that every patient gets the best outcome? Just to get the best precision. Should be precision.
Medicine, right? Not all forms. And precision. We have, yeah.
And I think we are almost okay with some surgeries knowing that there's going to be variable outcome because there's variable patients and variable surgeons. There are various variable surgical centers. There's so many factors. But we should demand that everything should be excellent.
Every patient should get excellent outcomes. And to that, you do mention that you have a colleague who's doing a whole bunch. But imagine worldwide the shortage of ophthalmologists. They're countries that are literally less than 10 surgical ophthalmologists in the whole country.
Yeah. So it's going to be, they're going to be in multiple solutions. This is going to be, in my mind, a major part of the solution. And I'm really excited for this to get further along.
Obviously, this is the first in human study. And so they have a lot of, you know, there's a lot more work to do. But this is, this is really exciting. I think, you know, a true game changer.
This is truly a game changer. I think we're going to look back on this. And this is going to be, I hope this will be a very big advancement for surgical ophthalmology. Super exciting, super exciting, man.
All right. So all of you guys who are like, tune into our knowledge bite every week because you're like, hey, I want to learn, right? This is our knowledge bite. We try to do this in a minute or two.
Seems like the word of the week that keeps coming up in my vocabulary is multimodal. People keep asking, what does that mean? And I thought, well, it doesn't, that mean. I always think that's kind of stage 4.
But then enough people, smart people ask me, like, okay, maybe we don't know. So I thought I maybe do this. And so what does it really mean? And I said, so I only think about, I kind of been going back and forth, Rayhan, about how do we explain AI in the sense of the human body?
And, you know, we have eyes which are imaging. We have ears which are text, you know, audio to text. We have speaking or tongue or, you know, whatever you want to call it, verbal. We have all these things.
And, you know, the humans, we don't just see, I mean, we see and we hear and we feel and we smell and we taste and sometimes we do that all at once. And we just got down to my son made an amazing dinner and I was like thinking about this taco. And this is multimodal. I mean, you could smell it.
It was perfect, right? But we do all those things at once. And I think multimodal really means just simply using and understanding more than one mode of either communication or data or thought processing and I use thought processing and air quotes all simultaneously. You know, for AI, this is really kind of as we went into multimodal, it's a game changer because most of these early AS systems, they were very unimodal, right?
I mean, to think like GPT or most of the generic I things, those are text, right? And then there's image recognition model which works with images. Multimodal AI, which has kind of been the really big topic later, is design really to understand work on all types of data simultaneously. Like, so imagine you give it a picture, I always use that analogy of a cat or a dog, right?
So if you use a picture of a dog and you text and say, what's this animal doing? Well, multimodal can see the image of the dog, it can read the text. And if there's a video file, it can hear it barking or panting or wagging its tail or whatever, you know, it says, well, like the dog is sleeping on the couch. Well, it connects all of that visual information with linguistic information with, you know, all that different biosensory stuff that we think of, we just naturally assume, and we are the most complex intelligence systems on the planet, at least right now, and we're multimodal.
And so multimodal AI is starting to catch up and that just has the ability to kind of integrate all different kinds of data. And that's what's going to make not just now, but in the future, these AI models so powerful and versatile. I think about some of the robotics that you're seeing, you know, especially coming out of the Far East, that they're moving and they're sensing and they're doing acrobatics and they're talking and they're doing all the same time. That's multimodal, right?
There's lots of different stuff going on. It's close. It's getting close to how we perceive the world, you know, and I think it's going to allow systems, and especially systems that we interact with just to be more nuanced, I've got more comprehensive understanding what's going on. So, anyway, so hopefully I've learned a little bit about multimodal.
I just want you to think about it as when we're dealing with a whole bunch of stuff all at once, that's multimodal. We are humans as well as most animal kingdom, we're multimodal. Now that synergistic artificial world is becoming multimodal too. Exactly.
We're a multimodal and everything else is becoming increasingly multimodal, including the robots. So for a fireside chat, I wanted to talk about, and this is probably still an extension from Vision Expo West, and there's just something I'm seeing a lot of like in my LinkedIn feed and through emails. It's the idea, it's the bridge between, it's about the patient journey, and what's the bridge between retail and the doctor exam, and one place that's coming, it's the I, it's the kiosk, the I-based kiosk, which you know, to tell you the truth, I've actually not seen one in the flesh other than just like on pitch decks and sort of on, you know, on the internet. I'm not actually experienced one, but the idea is basically, you know, you go to your local grocery store and you see that there's a blood pressure cuff machine there and something that's like a texture weight.
Well, why not have an eye exam there, a fundus exam or a refraction or something else, some part of the eye exam. And so I wanted to sort of talk about that with you Scott, maybe this is a little provocative and just talk about where we are going. But we've never shied away from provocative, my man. We don't, we're seeing more of this, you know, there's several companies that do this, really amazing starters, you know, founders and startups comes like I check.
Glow check is the old I check and I know Scott, you were part of one of, and of course I bought, they raised a ton of money and they're, of course, in this space as well. They sort of point of care kiosk. And it's, you know, some of them are trying to do the whole exam. Some of them do parts of the exam, which you know, I think is is a also a smart way to do it in terms of sort of decomposing the eye exam to various parts, either it's a retina photo or a sutlam photo or a refraction and or, you know, an auto refraction.
I think that's kind of super interesting, you know, whether however you feel about it, it's definitely, it's already here, it's not that it's coming, it's already here. And so Scott, I want to, is this, are we democratizing eye care? Are we decentralizing eye care? What are your thoughts?
You know, I go back and forth on this and you know, this technology is drawn for almost a decade. I mean, I think I'm closer to 12 or 13 years. And I think you hit on a really good point, Rayhan. And I always, when people ask me this question, like, well, what about kiosk?
Because I'm like, well, I think it's a mixed bag. I think the kiosks, they have advantages, right? The advantages are, they're probably getting people in to some model like a kiosk that may never have had an exam and may never go get an exam. And that's, you know, if that leads us down the path of them going, hey, something's not right.
We need to go see a doctor to have us check down. That gets more people into the eye care funnel. That's all wonderful. I love that part, right?
And, but I think, so, I love that part. My concern is, it's like what I do used to do health screenings for like these health fairs. People come back and, you know, I'd see them in the grocery store, you know, or you'd hear them going, yeah, I had my exam, the health fair. And I'm good for three years.
And I'm like, we checked your vision and, you know, I direct up the almost go. That's not, that's not an exam. And so I'm always a little nervous also to people go, that's an exam because it's not. You know, so I think there's, I think that's a fine line to walk.
And, you know, I'm not the most politically correct person as most people who listen to this know. So I probably will get myself in trouble on this, but, you know, the reality is, is that I think if all you're doing is a refraction, I think you need to be very clear. This is not an eye exam. This is a refraction.
And that's a whole another subject we can go into, Rayhan is, can you do a refraction remotely? And I think the answer is for 90, 95% of people, absolutely positively. It works wonderful. But there's a small group of people who have fixation spirit or some other binocular issue, or they have some type of pathology that's preventing them.
Now, who do we all see in our offices? You know, an ophthalmology, you see way more pathology than many of the top teachers do, but many of the top teachers are seeing people that, you know, to have other things going on. And there's coming into CS because it's not just a visual correction situation. So I do think, you know, when you say democratize or maybe de-democratize, I'm not sure which way I want to go with that because I think if you're just doing the refraction, I don't consider that an exam.
But I still think it's important because does that mean that bringing somebody's walking around as a minus two going on fine and they're kind of making it driving? I mean, I had a lady come in today, she was a new patient. She's a minus 225, has never worn glasses and is 50 years old. She goes, but I see great up close.
I'm like, what do you do for Littings? She's on my computer all day. I said, how do you get to work? And she goes, why drive?
And I'm like, God help me. You know, so I'm like, oh my gosh, I said, do you think you have problems? She goes, no, I see great. We put it the vision.
She's 2080. And I'm like, you're not great. You know, so if it helps get those people correction to help make them more safe on the road, I think it's a wonderful idea. Right.
I think that, but we're also seeing technologies that are more than just refracting systems, right? They're also going to be, they're going to have topography. They're going to have the ability to look at aborometry. They're going to have the ability to do a funnest exam, you know, or at least a visual retinal screening exam.
They might be able to do some basic visual perimetry. You know, I think when we start taking some of these diagnostic technologies, we start putting in, and let's call it a kiosk. I think that's great. The problem always with the kiosk has been we have no interaction from doctor to patient.
And that's a kiosk. I kind of hope with a definition. I'll be curious what you think of this rayon. I think a kiosk is a place you go at a bunch of testing done.
That's not interactive. I think telemedicine models and diagnostic testing centers where they have interaction with providers. That I think is just a, you're still having an exam. It's just you're not having it in the same location as the provider.
And I do believe that's going to be a big part of the future. I mean, I do think that, and we've had this talk before around, is that, you know, I'm the last doctor for two hours to the southwest of me. Those people are driving, I mean, I'd a guy to drive today two hours and 15 minutes to come see me. And I felt bad going on.
I need to have something out there that these people can tell a medicine with me when they're having issues. And so I do think, especially in the more rural areas or the ability to have an exam, what about those people who work all day? And they have to take off a work or people working two jobs. And they're having problems.
And they're like, hey, their availability is 11 o'clock at night. I think if you're in an urban area and that's the setup, there's some of huge advantages of having telemedicine and diagnostic testing centers. But I do think those are different than just kiosk. But that's just my opinion.
Yeah, yeah, I think, you know, the kiosk, I think in a retail setting, makes a ton of sense. It's all about what problem it's solving. And to your point, that the patient you saw who needed ever fra- I mean, she needed the glasses to see better. She thought she was seeing, well, she could have been, you know, one could imagine a different reality where she had access to a type of eye exam.
I mean, I would also want to challenge, what do we mean by eye exam? You know, I feel like this is a big one. Yeah, that definition, I really wonder if it's outdated at this point. I mean, because the eye exam of a retinal specialist is very different than an eye exam recording, especially, it's very different than an aqua plastic.
You know, like they're doing MRD, MRD ones and twos and looking at thyroid, you know, the ex-all, they're doing her tell on people, you know, I'm, I'm, I'm using the same basic codes saying this is what I'm doing, but they're doing some building that, you know, maybe building a comprehensive eye, visitor or whatever, you know, and so, I was with the new technology we have. And then you wonder, like if someone's doing a, an ocular mixed base assessment using AI, it's that couldn't be part of our conference exam. Are we, if we're doing an assessment for Alzheimer's through a retinal photo, like what is that? I don't think it should be, right?
But I think if someone is doing like a wave guy, a aborometer, you know, like a highly, you know, or different types of imaging. And so, I do, I do think the eye with our technology over the past 20, you know, 20 years with AI and now robotics, you know, what the eye, it's kind of, I think an outdated concept a little bit. And so, I don't wonder about that. No, I agree.
You know, you and I talked about this maybe two months ago on this talk on this podcast is that, you know, the challenges we're still using the same CPT codes, we've been using for, you know, 40 years. And the reality is CPT codes just aren't good enough anymore. I mean, having a five digit numerical code, or even you could say a four digit alphabet, with a, you know, five digit alphabet numeric code, they just can't code everything anymore. And I think there's, we're going to see, I mean, I know we're going to see coding systems that are just more intricate.
I agree with you. I think, you know, a retinal exam should be paid different than a corneal exam, which should be paid different than a well care exam. But right now, we have to use all the same darn CPT codes until we can, you know, go to eight or 10 or 12 digit codes and look at all this separately. I think we're stuck with this, this quandary of what is an eye exam.
I, you brought up the great point. I mean, we got there to the kiosk model, but there's, there's the theoretical question of the day, what is an eye exam? Yeah, and my point really is that we should not say, we should not decrease access in the name of saying what is an eye, what is an eye exam. And saying that patient you described who needed a refraction didn't get one because it was probably maybe it was too hard for her to come in and get quote unquote, full eye exam.
Maybe she was working. Maybe she had a nine to five job, maybe all sorts of other reasons. Maybe she couldn't, you know, had to go driving the two hours. You couldn't drive because you couldn't see.
See. See. Right. But, but you know, imagine if there was something at her's local CBS for long Marines or Walmart, you know, so, so yeah, I look at this is a highly, I am under no, this is a contentious issue, but I, you know, I think we're both pro access, pro technology, pro, it's in the best interest for for the patient, especially the last one, especially the last most importantly, the last one and society.
And so, so I'm really interested. I think AI enabled kiosk based medicine is going to be it's coming. It's one of those things. It's it's it's it's looking at it right now.
People are going to want the convenience and when you can get technology that's better than some of the providers that are out there, then you have to wonder, you know, maybe it's going to be just fine. On that note, we don't shy away from controversy's got. So, look for look for us on AI in iCare.ai. We publish regularly and book for the talking to you in a week.
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