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, add in a little AI education, and debate innovative AI tools and topics that will change the industry. Hey everyone, this is Scott and Rayhan. We are very fortunate. We are riding a bullet train right now between Venice and Milan with one of our friends Dr.
Carl Speer. Carl's agreed to sit down with us and have a real talk about what the future of innovation looks like and what some of the challenges are. Carl, it was the owner and founder of Sight and Sun I Works in the Panhandle of Texas. He transitioned from that as the director of Professional Affairs for Alcon from 2010 to 2018, as well as one of the self-eased regional managers for VisionSource.
He kind of changed careers a little bit. He became a commander or was a commander in the United States Air Force in 2018 to 2022 and took us some time off to help protect our country. He now in one of the then he moved to Transition is a Senior Vice President for I Care North America for Esloria Laxatica, which led him to his current role as the Chief Medical Office for Esloria Laxatica. And that's what brings us to Milan as Rayhan and I are getting to view some of the Eslor technology as we look forward to the future of innovation and technology.
We get to see behind the curtain a little bit about some of the things that Esloria Laxatica has to show. Carl's also the President-elect of the American Academy of Automatry and we'll take that role starting in October of this year. So Carl, welcome to the show. Alright, now thanks Scott.
Thank you guys for joining us in Italy. We've had a good week. It makes us feel your thoughts, actually. We've seen some really interesting technology and maybe not what our audience always thinks of and we think about diagnostic technology.
We've seen some amazing things in terms of what Laxatica labs could do. We saw automation yesterday about how frames are manufactured, processed and distributed that is absolutely mind-blowing, looking what I think was a decade in the future, seeing that, what do you think, Granam? I mean, a whole floor of robotics and machinery that was just mass production beyond your wildest dreams. Yeah, Carl, thank you so much for having us out here.
It's been really a great pleasure learning about company and learning about you and getting your background and just being so impressed. One thing that Scott that impressed me yesterday was just the scale and that's a word I think that's a more of a script. The mass scale, yeah. Is the scale and the integration of all the various service lines that you guys are doing.
And a true logistic and engineering feat. I mean, I see engineering and I think about that and then what I saw yesterday just absolutely blew my mind in terms of what the floors of Laxatica look like in terms of frame manufacturing, distribution was absolutely breathtaking to watch that type of stuff work. So, you know, you said at scale and in the other piece that vertical integration phase, I think that's sort of a core of what we're doing in Laxatica having that vertical integration and sometimes that gets made into this really bad thing in the market. Vertically integrated, maybe they can be able to explain what you mean by vertical integration.
Because you know, you redefined what I thought of as vertical integration yesterday when you started thinking, I think of vertical integration. Let's own diagnostic technology and let's own service providers and let's own insurance. But you took it down to a completely different level of thinking about it from the standpoint of a frame hinge. And then what's the story from that point?
I mean, I could, you know, we do an implicit talk about Mr. Delback, you know, his history starting with, you know, building hinges and building glasses and then owning distribution and then owning retail and then segue in now into instruments and bet tech. The merger with Laxatica and S and look so we could go through that. But I think, you know, the vision that he had before the company was going and we saw it yesterday and we talked even in the manufacturing how he was always thinking 20 years down through it.
And the facility we saw yesterday started as a traditional, you know, small distribution facility. But literally 20 years before all the automation and all he had that vision and it was one of the last things that happened, unfortunately before he passed and never left yet. One of our last conversations where they have been to Sedica, he's been to Sedica, he's seen the plant and he was so proud. He should be proud.
He thought 20 years ahead on that is mind-numbing for me. I can't think what I'm aware of, or I'm just thinking of it. The true visionary and changed what we do as an industry. I think that for all of the audience, you know, I think we, for most of you, we look at frames and we sell frames, we sell lenses and we do medical diagnostic tests.
But, you know, I heard a great quote the other day that everything we accepted normal was once somebody's dream. And you know, that somebody that made it happen and Mr. Delveque made a lot of things happen that we now take for granted and seeing that yesterday makes me understand it. When that box shows up of frames, what was actually behind all of that is truly magical.
But so, you know, in this talk, we talk a lot about what innovation looks like. And I think that we saw a little bit different concept of innovation yesterday in terms of, as you said, vertical integration of frames and lenses and all types of things. But, you know, Carl, you and I have had many discussions of, in the past and we've had some fabulous discussions on the train today about what innovation looks like. And so, you know, if you can project into the future, Carl, what do you see as some of the most innovative things coming down the pipeline?
And at the same point, what are some of the challenges that we as an industry, as providers, as doctors, have to overcome? Yeah, so I'll take a little bit of a roundabout way there because this one thing is, I'm meeting Ray Han talked about yesterday. So I think, first of all, when we talk about a, I think, we typically think the clinical application, I think what people need to understand is how that's being applied everywhere. So one of the things we talked about yesterday is, with even our frame manufacturing that we're using computer vision in all the manufacturing process in order to visualize that.
Yeah, I know, because we're in a much more facilitated, to ensure quality and a standardization and computer vision is easy, right? It's the most mature of all the AI's because computer vision, after everything that happened 9-11, all the governments dumped tons of money into facial recognition and computer vision. So that AI is so advanced and now we're looking at ways to incorporate it. Well, what we saw in terms of machine vision yesterday and just in terms of sort capacity and you know, thousands of different kinds of frames, all being distributed to show up in a box in an office somewhere across the world, all done by machine vision, mechanized, automated technology, it was spectacular.
Like, it's not something sitting or sorting one frame at a time. It is thousands of frames per minute being distributed and placed and sorted and sent. Crazy. And then we're using AI and Ray, I think you got to see it at the switch meeting back in Orlando.
We're using AI in manufacturing. So a lot of people don't think about our progressive lenses and how we're implementing AI in that. We use a process called AI-20, twin-in, T-I-T-W-I-N-E, and so basically when we do your measurements we do all the electronic digital measurements. We can load that in and essentially we create a twin of your eyes.
What they look like, what's the pupil distance, what's the color, what's the shape, and then you know, totally aggregated data from the millions of patients we see globally every year. We can take how people use their eyes, how their pupil changes, and then we literally use the array of twin-in that aggregated data. We're customizing how we make that progressive in a way that it's made specifically for your eye. And actually we make it for the right eye and we make it for the left eye and they're not necessarily the same.
So think that that's where we are in the level of personalization for making lenses for people is... I'm a dumb country, but it blows my mind. Well so in addition to that, tell us what else when you look at not just what Eslor Laxatica has coming out when you look at innovation as a whole, what excites you and what makes you go, well this is going to be a challenge. Yeah, so you know the reality, all the AI excites me and I've been fortunate to be around that space for the last 18 years with people that really know it, certainly a lot more than I do.
And the trick to say this all the time on the top, but there's more than enough AI today and generating the AI if you get the image sets, whether talking about diabetes, hypertensives, which have good end points, easy to get the AI. The hard part is the clinical implementation and for your listeners and for doctors in practice, you've got practice, you're in practice, a wise guy practice. It's like the hard part is implementing it in and not creating six more steps. In my mind it doesn't have to create this real efficiency, but it can't add burden to a system that's already overburdened.
So we're working hard to figure out how to implement this in a seamless way with the instrumentation and honestly whoever figures out implementation wins, the technology is there because talked to a million people in your podcast, which is great by the way, I'm an avid listener and listen for all the competitions. But now you do some great stuff. Well thank you, thank you. We try to educate the audience and make them think about what the future looks like and what steps they had you never taken.
You know, we were just having, we had that last week in the podcast, two weeks ago talking about how workflow implementation is going to be the key to this no matter if you're talking about operational AI or talking about diagnostic AI or talking about the future of maybe evidence-based medicine and how that looks. I do think it's exciting without a doubt, which is kind of why right hand, and I do this every week is we're always fascinated by wow, what did we learn this week and what have we seen in some of the new technologies. But so what do you think if you look at and go, okay, let's look at three great technologies coming down the pipeline. Obviously we just saw some amazing from an optical vision solutions perspective.
And I think today we're going to see a little bit more about diagnostic AI when we get to the experience center. And then you know we've had a lot of conversations over the course of this week on you know what does that look like in terms of the next step which is how does AI go into what makes our job easier, what gives us more evidence-based medicine, how's that translating, value-based medicine, what does it look like for coding. You know when you look at those and go what are the three big cogs you see in terms of technology coming down the pipeline. Yeah so you know I'll say one and it doesn't quite fit into the AI because it's a little bit more traditional but I think it's going to be pivotal, pivotal, cornerstone across all of our care.
It's going to be remote access care and whether that is you know patient goes to the office and the doctor's remote whether in the future that's the patient's at home doing some things and there's a doctor at home or some combination of those different. It's just because we've got an access issue. If you look the number of botanologists is flat at that 18,000 it's not going to grow. The number of optometrist you know you listen to it's 48,000 but in reality the number of full-time equivalents is probably the lowest it's ever been because they're not practicing.
We talked a little bit about Texas yesterday, Texas I think they said it's got 234 counties, 114 don't have any eye care. I'm in Florida and Florida you got 64 counties, 13 of them don't have any eye care at all, 23 of them don't have ophthalmology. So you know there's these big vacuums in the rural areas part of a group and it looks at just rural health care. Rural health care is in trouble.
It is in trouble. You can see actually I get I get actually excited about some of the stuff outside of eye care. The more people than the book. We've been talking more a little bit with a company that does essentially emergency rooms and new health care all through remote access telemedicine reads on hey is it something you can locally or does it have to travel.
So remote access for me is going to be a county sort of a foundational piece and then on top of that now you're going to start layering sort of the foundation of AI at least in clinical care which is imaging. And you know OCT imaging, fundus imaging that can be I've said it and we've talked about it. I've never at least not today a fan of autonomous AI and see too many things you can miss. So I'm in favor of clinical AI that is basically AI's medical assistant that look AI for diabetic retinopathy is better than all that would be.
It's getting there for hypertension and get there for other disease states. Well coma macular is a lot harder because they don't have a heart in like diabetes it is what it is. Like the three of us. But I think maybe we'll establish a heart in point one of these days right.
I think so I think it will get there and then when we get to those the value in AI is as that medical assistant and then also as a virtual consultant. So as the AI reads it as you have an experienced doctor on the back in and evaluating it where in a clinic you can get the read out and say the patient's got this. Here is the CPT code. Here's the diagnostic code.
Here's the follow up plan. I think one of the big things in that is I think a lot of times it's over as optometrist anyway we overrefer. Same thing probably in the computer. I think primary care is the same.
Yeah exactly so that can really be a benefit is if if you're using AI you're looking at diabetic and optopatients and you can just reassure the clinician hey this patient you don't need to refer follow it up in three months this patient yeah this one needs to go and be seen within x time period. They'll help on the retina and will have clogged up because they get over referred to and it'll also help sort of build that confidence I think in optometrist on what they can truly manage because they can do a lot more than a lot of times we do. I think that you know we I guess it was two or three podcasts ago we did a talk about augmentative versus autonomous AI and I think our what we're hearing is much like Rayhan and I said is I don't know if autonomous AI is the future I mean augmentative where it's a tool to to coexist with our experiences kind of where it's at so what I heard from that whole conversation is the where we provide care it's about to change. It's got to there's just you know the population's grown the population's aging not only that I know in our clinics we're seeing younger patients look more and more disease absolutely.
So just the load on the disease the medical eye care is growing so fast that in our traditional way of providing care it's not going to work. No have enough optimal this we don't have enough optometrist so we're going to have to figure out how do we add use technology sort of as this force multiplier that multiplies the capabilities of the OD's uses insular staff to let them do what they do I remember so Scott I know you were the clinical editor of optometrist management for a long time before you were Walt West Walt was yeah and I remember an article that Walt wrote and this had this 20 plus years ago and it actually was talking about cardiology and he's like hey optometrist needs to get optometry needs to get out of the data collection business they need to be critical thinkers clinical thinkers he's like what would you think if you went to the cardiologist and the cardiologist was the guy that came in and did your blood pressure and did your EKG and did all the data collection right because that's not the way that we need to we need to transition from data collection to critical thinkers and well and I think I'm going to add to that I may totally agree and we've had numerous talks about this is that Rayana and over the podcast is not just we've not become data gathers and become interpreters we also become data communicators because the world's changing so now we're we went from the where cares happening to what kind of care we're actually providing and I think that is a big transitional shift that needs to happen and I think it's starting to happen but I think we have a long ways to go and and that's in my mind I mean we get away from the core level patients a good comprehensive exam how we do it where we do it all those things we just don't have the band needs to do it anymore and also do the medical we need to do and so it's going to evolve I don't know what it is I love to use that word evolve because that's exactly the word that's common-mind as we have to evolve as an industry we have to evolve as like us as a company there's you know we we've sort of went very public with a couple of things we want really public that one we're going to be an open platform our global CEO Mr. Malarie's philosophy is look it's our role in the industry that if we can develop and have tools and resources that can be open and everybody can use we want to do that and two we're going to and there's a little bit at the beginning it's like yep we're going to shift over and you know more medical and more of health care shift a little bit from eye care eyewear to more medical care eye care and while there's other they're changing this like we're evolving and and and we're just adding back to vertical integration we're just adding the next logical piece in the care delivery cycle in the delivery and and need to fill that boy and people you know that's a lot of Zodiacan you guys want to do that because you want to cost money right now ultimately we will provide care patients and you know we'll do that internally but we want to work externally we're working with all the different organizations we've got people on this trip with us from from the AOA from Seaco from the schools from them and we want to be collaborative with everybody and supportive and a lot of that's going to have to be you know on an education level what do we have to I think you know we talked about it before is like I don't think maybe you know most optometrist understand the why and and we've got to do a better job as a company you guys got to do a better job everybody's got a platform is going to a better job why this is not necessary to evolve yeah some people trying to force this on us this is got to evolve this way to take care of patients we've got more work to do at times we've got a lot of work to do so you guys have a great platform and it's and it's also a peaceful lesson to your credibility a lot more than I do understand I don't know I'm just the industry shield on their top can I know I love hearing about your journey your personal journey and all the you know where you sort of on all the stories that cross been sharing with us this trip and the advices and the sort of the military sayings and that that we're getting one thing to speak about the patient journey is the recent announcement of the lens crafters surgical approach in Pennsylvania which I'd love to hear about and talking about the patient journey of you know starting with nothing about the company history starting with frames and classes and iCare and now moving into surgical so we just talk a little bit about the thoughts there the plans and and sort of the overarching vision of that yeah so it you know it's funny uh mention mr. dole back yo and him looking ahead before uh first time that that I had a chance to meet with him was eight years ago right when I started and we talked then a lot about remote access and what was going to happen future of iCare not enough for fighters uh and at that time eight years ago nine years ago he was very clear that uh as a company we would evolve more onto that medical space uh unfortunately he passed away in 2022 but that that vision that he had this is sort of the beginning of the execution of that uh we absolutely see that uh there's got to be this integration of optometry and ophthalmology uh you know everybody doing their part in order to provide the right patient low patient journey uh you guys know go deep into OBS but office-based surgery uh is sort of this this trend that's happening I think the latest number of scene is like 15% or so of cataract surgeries are happening now office-based uh because the ability to get in hospitals and ASCs sometimes difficult uh and it can provide actually a very customized patient journey very high-touch journey for patients um one of our retail brands once crafters opened one uh in exten Pennsylvania uh we already actually had one within our team vision group in Illinois uh the practices used to be uh Jamie Rosen, Jamie Johnston Rosen's practices up there uh and so those are sort of the first you know dip the toe in the water how can this work uh I think over time it'll evolve not exactly sure how uh but but working toward an integration model with optometry and ophthalmology is going to be uh important that we're all working together uh certainly our acquisition of Potoverg yeah uh with with you know what they do with spectralis no CT and retina and even in primary care uh you probably know they've got a digital scope that's uh what's without oculars that you use and if you haven't seen you can get chance to play with it uh i bet that's tomorrow yeah uh and it's it's incredibly digital it's not a conversion uh that uh is now being sold in the US and so there's gonna be more and more that integration and and that's where you know to delegate optometrics get either part uh in the flow right into the surgery and uh i've been lucky for so many great ophthalmologists over here and you mentioned you know here about me basically okay Karl can't keep a job he's he's not a little bit of everything he's like yeah i can't keep a job but of course i don't i don't just enough about everything to be dangerous so okay can you talk a little bit more about that i would look to learn a little bit more about you and um your story is you kind of make fun joke about that but truly i think that's your superpower's ability to connect truly you have an ability to see the landscape in a way that other people can't you know it's better be lucky than good i've been so lucky uh you know in my career as fortunate scott you mentioned um to go to opal homo and do a residency there to stay and teach for a few years as fortunate happen to be there when the first uh TLC center opened uh and i saw how optometrics you know in ophthalmology work together to take really good care of patients real early in my career was able to run uh lead there and run a co-management center in florida before i opened a private practice and had private practice history 20 20 years and grew them and you know we we brought in an employed ophthalmology in 2000 in our practices and basically vertically integrated the practices just doing our surgeries is a little a little close network that we did i was fortunate to all that private practice time uh to work with you know almost every company in one way or the other either some consulting or working with them work with vision solars when we're vision source practice so really just fortunate to be around uh good people at the right time so i i take always say like i hadn't had an original thoughts since 1996 but i've still won a lot of ones and and i didn't tell my team what i very fortunate now you to see all the different things and see how i can fit together for patients and for for the profession and that's where i'm hoping that uh you know warm here i can help help at least provide some input on hey here's the things we really need to do to help providers help patients in the ankle but i can't keep it down it's basically it well so caro we always try to finish these these talks up with something really thought provoking when we cover this kind of a combination between innovators and real talk today so we're kind of doing really probing your brain here but you know if you look forward and go what does the world look like in five to ten years what what do you think it looks like i mean no none of us have a crystal ball right but as you said just a second ago you see a lot of different technologies that that many of us our audience doesn't see you know it doesn't even hear about and so when you look at how that might be packaged right if there was a crystal ball and you could look for it what would it look like yeah so i'll still once again never had an original idea so i'll still uh still sort of what Michael howl gogo say had it in a former wife or a company had a chance to work with them a little bit and he said look a i's not going to replace providers but providers that use a i are going to replace those that don't i don't necessarily know that's true but i do know and look this is this has been true my entire career people that lean in and adopt the technologies that are available are always going to do better for themselves and for their patients so i don't exactly what it looks like but i know that every practitioner that leans in and whether it's new technologies in treatment which diagnostics whether it's AI integrated or not the doctors and lean in use the existing technologies adopt them early are going to be the ones that are the most successful not only for their practice but for their patients and ultimately in practice that was always my say is like look if it's good for the patient it's good for the practice so a lot of the technologies are good for both lean into them and adopt them totally gradually stare out into the Italian countryside thinking about you know where the sort of industry has come from and so where we're going with those with those words to wrap up i think that's a fitting way to describe if we just do right by patient that's our that's the north star and everything else will follow for that thank you everyone for joining us on this edition of real talk thank you doctor Carl Spirer for joining us and we really appreciate your insight you're intellect and it is great comic sense of who we are and where we're going you've been listening to real talk an AI and iCare your weekly podcast to keep you informed about AI technologies revolutionizing iCare