Show notes
Is eye care facing an overwhelming practitioner shortage, or are we looking at the future through the wrong lens?
Scot Morris, OD, and Rehan Ahmed, MD, break down VSP’s “Practice of the Future” report and the industry debate over how to handle an expected demand spike of 20 million additional eye exams a year.
They cover quantum computing, computing walls and how qubits and molecular simulation could change personalized treatment.
They also debate a contrarian vision for the “digital doctor”: remote diagnostic hubs, unbundling the routine eye exam, and whether the future needs more doctors or a different way of delivering care.
Transcript
Welcome to Real Talk on AI in Eye Care with your host, Dr. Scot Morris. And I'm co-host, Dr. Rehan 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, Scott. Good evening. How are you doing? I'm doing great, Rehan. Thanks. I'm looking forward to this. For the audience, I think we have some pretty interesting topics to cover today. Yeah, so for News of the Week, so last month, VSP Vision, they put out something that's called the Practice of the Future Report. We'll put a link in our show notes. It's at VSP.com slash innovation. It comes out of their Global Innovation Center, also called their GIC.
And I think it's really interesting because the way they frame the topic, and that's something we've talked about before, and it's something I think best discussed at a podcast that we did recently with Dr. Richard Edlow, or the Iconomist, who basically has said the following, and this is something we've heard a lot, that we are roughly going to need 20 million more eye exams a year than we did a decade ago. Why? Because of Asian population, myopia, demand for services. We're going to have the same number of doctors, more or less. We may have about the same number of optometrists, really not accounting for population growth, though, and certainly fewer ophthalmologists, if you can believe that, because we're just not graduating enough.
And there's a lot of burnout, and a lot of people are leaving the field. So essentially, demand curve is going way up, and the capacity curve is flat or going down. And so that report, the report's really, if you look at the different sections, it's going into that problem, and they sort of break it out into six rooms. And when you go and see the report online, it's really interesting because you sort of click through. They have different rooms. One's the pre-test room, which now they're imagining as a sort of flexible room that's partly remote, that may be run by non-clinical staff, then you have the exam lane. You and I talked about that before, Rehan, though. I'm not sure if a pre-test room is going to ever exist.
I mean, we've had some technology lately that it's going to be in your house, not in your office. Oh, definitely. And they actually get into that with some of the stuff in that home room. They talk about a subspecialty area, which I, for me, was the most interesting topic because I have not thought too much. You know, we haven't discussed that in a specific detail, but imagine an area that's really focused on expanding the type of care that eye doctors are now delivering. You know, a dry eye suite with all the bells and whistles, and even audiology. We saw some of that in Italy together from us learning all the products that they're bringing on.
Optical retail, think virtual try-ons, smart eyewear, really interesting AI-based tools for an important part of the business. The back office, which is something we've talked about a lot, but AI practice management, billing support, that type of thing. And then the home remote monitoring, at-home diagnostics, and the stuff that you were mentioning, basically expanding and extending the relationship that the physician practice owner has with the patient when they leave the building. So really, really interesting. They highlight a number of startups that are moving and shaking and trying out different things and laying out the future. Also, you know, we are very much into this. I've talked a lot about these topics, so I highly encourage our audience to check it out against that. BSP.com slash innovation.
And interested when you get a chance to take a look at it, Scott, hear your thoughts. Well, I'm super interested. You know, I've been doing a presentation called The Future of eye care for almost 25 years now. And it was funny because, in fact, Dr. Howard Purcell, who many of you know, has been on our real talk, has been on our podcast. We lecture with him a lot. You know, we did a talk almost 20 years ago on the future, you know, what the future practice looks like. And I think 20 years ago, we predicted where we're at right now. And I would have said that would only take us five to seven years and it's taken us 20. Now, I know that I know the curve is going to grow a lot faster.
And I think things are going to change much quicker than they ever have. But there's lots of hiccups in the practice of the future. And maybe we'll get into some of that here in a few minutes. But I think one of the challenges is still to this day, the practice of the future is going to be, and I know people are sick of hearing this, it's about data. We still don't have access to the data that's going to help drive the next evolution of what we do, at least yet. And that brings me to the knowledge bite, Rehan. You know, I've been having a lot of conversations lately. People ask me about quantum. Like, what does quantum mean? What does quantum computer?
How is it going to affect eye care? And I'm always like, man, I, you know, I think there's, that's one of those big hype topics that everybody's like, oh, we have quantum. We'll have quantum soon. I'm like, no, you won't. But so I want to go through what that means and how it might impact eye care. I'm not saying it's even impacted in my career span and maybe not even yours, Rehan, but somewhere down the road. So I think it's an interesting topic to cover. And it's going to kind of bridge nicely audience for what I think Rehan and I are going to talk about in kind of our fireside chat is, how do we solve that demand, that need for 20,000 new exams?
And we'll talk about digital doctors and how that all works. But let me get into that. 20 million, 20 million new exams. 20 million new exams. Excuse me, 20 million new exams. And what will the future, practice of the future have to look like to be able to do that? Well, one is we need a knowledge base that we simply do not have right now. But even if you have the knowledge base, you need the compute. And right now we don't have the compute on this planet to be able to do that kind of information sourcing. So people talk about quantum computer and quantum leap and all that kind of stuff. So what does that really mean? Well, you know, kind of as as eye care specialists, which all of us hopefully listening are our clinical world, the world we participate every day is, you know, we've talked about drowning all of this.
Dense data with the OCT and adaptive optics and all, you know, the future genetic profiling and how that's going to impact inherited diseases. And I mean, there's so much big information that's out there. But the problem is our classical computers that we think even our faster GPUs that are running GPT and Gemini and Claude and Grock and everything else now, they're still processing data sequentially. They're using binary zero and one bits, ones and zeros. That's they're still working the same way they've been working since the beginning of compute. Now, when you simulate how complex, let's say biochemical, right? We think about complex molecules bind to rhodopsin proteins, for example.
And then, you know, how does how do some of our oculomics predict some of these glaucoma progression or what's happening at the retina or all that kind of stuff? We simply hit a compute wall. So even though all that data may not be out there yet, but it's coming, do we have the ability to process? And the answer is no, we don't. We simply don't have the compute power to do that. Well, and that's where we enter into this theory. And maybe leaving theory and becoming true is quantum computing. So imagine walking into a clinic and this is where we're going to get into kind of digital doctors a little bit too. Walking into a clinic, knowing that the dystrophy you diagnosed this morning doesn't mean years of trial and error management to figure out what's wrong.
Because somebody else, somewhere in the world, is seeing that same way of retinal dystrophy. And you can see what's worked in that person versus other people. Then you get into things like curicones, right? I mean, which is, you know, affects anywhere between 0.1, you know, they say it's somewhere around 0.1% of the population. Well, there's a lot of curiconics out there in the world. And how do we know what technology works better for what demographic? Well, that's a lot of data, but it's also a lot of compute and a lot of knowledge sharing that has to go on. So if you think about what's happening is this quantum computer will build to simulate patients' exact molecular responses to certain mechanisms.
And remember when Ronnie was on a couple of miles, probably about a year ago, we were talking about digital twins and how we could use a digital twin to find out how things work. The problem with digital twins is we simply don't have the compute yet to really pull this off. But quantum computing might just be able to handle that kind of data. So what's happening, let's think about what quantum computer really means. And I'm going to use a topic that most of you are really familiar with, which is optics. You know, you're already familiar with polarized light and that kind of stuff. And I want you to think of classical compute, zero and one bit technology, like a light switch.
It's either on or it's off. That's all it is. Now, it's a series of light switches, maybe in the millions of light switches, but that's all it is on and off. Now, quantum computers use something different. They use qubits, and that's Q-U-B-I-T-S, qubits. And qubits are, how do I explain those? These are really not zero or one. They can be a zero and one at the same time. And that makes things much, much different. And I want you to think about, let me go back to optics. You think about the way light works, right? We all learned that light works as a wave and a particle. Well, quantum computer is both a wave and a particle, both a zero and a one, simultaneously.
And that leads to what's called entanglement. And this is where qubits become linked in not just 3D space, but potentially four dimensional space. That gets kind of complicated. Now, all of a sudden, your computational capacity isn't linear, sequential, zero and one, a series of light switches. Now, all of a sudden, it's three and potentially four dimensionally that grows exponentially. So your ability to handle millions and millions and millions of interactions in not milliseconds, but much shorter periods of that as these zero and ones flip back and forth or become, let's call it, zero ones. Okay? A light and a particle both. So now, this quantum computer, you're going to hear people talk about it online and go, oh, it's right around the corner.
Well, it's not. I mean, Google's been working on it. A couple of Chinese companies have been working on it. And the problem is they've spent billions. In fact, the big quantum computer that Google's working on is now almost a trillion dollars to build this quantum computer. A trillion. T, like our national debt. T, right? Sorry, I couldn't let that one slide. But, you know, is that this isn't science fiction. Like these devices exist, the biggest problem they have. Just like our data centers, we're trying to figure out how to keep them cool. Quantum computers emit a tremendous amount of heat and they have to work at almost absolute zero. And it's hard to keep anything at absolute zero.
And so I want you guys to kind of keep paying attention to this. I mean, these physics of light, wave and particle, zero and ones, that technology is there. It exists. They're able to make it work for just seconds at a time. And as they can figure out how to cool these things and keep them at absolute zero, like, I don't know, in space, which is absolute zero. Maybe we're going to figure out how to have quantum computing. Wow. That is really fascinating to think about where we are on the Gartner Hype cycle with AI. And I think quantum computing is just on a different time scale. I sort of agree with that. It's got very interesting to talk about.
I hope one day to play with a quantum computer, who knows, right? The way technology goes. I do think we're going to see it in our lifetime. I don't know if we're going to see it in medicine necessarily. But I do think we're going to see it being used actively in our lifetime. Yeah. One thing I'm most curious about quantum computing is how it deals with encryption and encryption all are going to go away because quantum computing is just going to burn past anything we encrypt in our banks. You know, we're going to need more than a new password for our banks. Oh, you're going to be past little factor identification. But, you know, it's funny because my older son, you know, we talked before he was an electrical engineer.
And one of his classmates, when he was at school, that was his PhD focus was quantum computing. And I asked him, you know, he's now at Stanford working on quantum computing out there. And I asked him, I said, well, you know, first of all, how far do you really think it is? And he goes a decade, maybe two. I said, well, that's super interesting. I said, well, what about security? He goes, well, the only thing that's going to break a quantum computer is another quantum computer. He said, because security, this thing is moving so fast. By the time you figure out where it was, it's already 10 steps past it. Right. So the only thing you're going to be able to keep up is another quantum computer.
So until we have multiple quantum computers, security won't be a problem. Then as soon as we have multiple security becomes another big problem. But that's going to be way past my pay scale. I have a feeling. Yeah. So I think for the fireside chat, we're talking about an interesting topic. I love the phrasing that you came up with, Scott, called a digital doctor. And I think it's a nice connection between what I started with the news of the day and what you're talking about quantum computing, because we're kind of imagining, you know, we're made out of organic material. Computers are made out of, you know, it's like you had mentioned. And this new digital doctor made it some weird combination of like a quantum, like a qubit or like half human, half robot cyborg.
Maybe that's what we're talking about. Maybe not. But I want to get your sense on the digital doctor. I mean, what were the problems we're dealing right now are there. Like we, like I said, in the news, there's too much demand and too little capacity. And so that's where we think the digital doctor can come and help. So I always love when I hear people say that. And I, you know, I know, Rand, you and I actually talked behind the scenes. We're actually kind of the same page on this. But for the audience, I think that everybody who says that is just absolutely flat wrong. And the reason why is because of digital doctors, we are going to have to change workflow.
When you take history out of the exam room, out of the four walls of the clinic, you'd say 10 to 12 minutes. When you take pre-test out of the clinic room, when you take doctor consultation out of the rooms, out of the four walls. When you potentially take diagnostic testing, like Sootlamp, and then we talk about autonomous Sootlamps. I mean, I see a day way before quantum computing when, and I think we did a podcast this on digital diagnostic testing centers, you know, remote diagnostic testing centers were, you know, in Denver where there's 150 practices. Do we really need 150 OCTs? Do we really need 300 Sootlamps or 450 Sootlamps? Or could we do this differently?
And so I think that our capacity per provider is going to dramatically increase in the next decade. And so I look at it and go, I see on average of 35 to 40 people a day now in a six hour time period. I think in a couple of years we'll be able to do 80 or 90, no problem, because you will be focused on, hey, what do I really need to talk? Can some of the pre-education be done before I get and talk to the person? Am I going to become more of a consultant than an everyday, you know, patient contact person? I don't know the answers. I don't have a crystal ball on that. But when I hear the, oh, we need three times more doctors, I'm like, I don't think, I don't agree with that.
I don't agree with that. Yeah, it's definitely, look, that's what we've talked about as well. That's a contrarian position. And Dr. Edzlow, the economist, basically agrees, I think, with the DSP view of we're going to need, it's the golden age for optometry and eye care providers is here because there's just so much demand. I think what you're describing sort of is a contrarian view, which I think is an entirely defensible approach. It's kind of like the Black Swan idea is that, you know, we're all wrong or many of us are wrong saying, no, no, we're actually not going to need more doctors. We need fewer doctors because we will have excess capacity skills and tools that will enable the provider, like you said, to 10X their abilities.
So, you know, and that's not an optimistic view for if you're a second year medical student or optometry student interested in eye care. Man, I don't know if that's something that people would be excited about, but that doesn't necessarily change with the future. But that doesn't mean that reality is not going to occur. That doesn't mean that. I would say, I mean, there's a lot of cataract surgery, you know, are you going to need as many ophthalmologists doing general cataract surgery? I don't know. I don't know, especially, but, you know, I would push back a little bit. One point is maybe patients will reject the idea of a digital doctor. Maybe they will say at the end of the day, maybe insurers will too.
And maybe, you know, there will be all sorts of legislative regulatory issues that come up. So, I don't know if neither of us can predict the future, but I think it's very it's very believable to think that providers are going to have many more tools. But it's also believable to say people will want to be able to see the doctor. But what does that really mean? And can we define that in a different way? So, I love this idea of a digital doctor because it's not, it can mean all sorts of different things, depending on the context and the problem we're trying to solve. You know, I think we add into that, Rehan, you and I talked about this a couple months ago about, you know, uncoupling the exam for general general exams.
You know, are we really need to do a comprehensive exam on everybody every year? Not really. I mean, I'm not sure that's necessary. Right. So you have that. Number one. Number two is maybe we aren't seeing people back as often because we're much better at diagnosis and treating disease with true evidence based medicine in the first place. So maybe you're not going to see as a patient two or three doctors before you get the right answer. Or maybe you're not seeing the same doctor four times to get treated for this disease because we have a very, you know, targeted, specific to your genetic, your phenotype, genotype treatment where now, hey, we can fix it in one.
Now, all of a sudden, you've totally changed how many visits, how many returns happen. Right. And that's where that knowledge base, which we don't currently have, you know, could change the frequency of visits. And now all of a sudden, do you really need 20 million or do you need half that? Do you need 10 million? And then when you take some of that out of the lane and you're not taking 40 minutes when a patient's in the office, but maybe they're in the office for 10 or maybe we're having a consultation like this. I see a day when I might have a consultation with a person with a patient four times a year versus one time a year because I'm doing this right now where we're having a Zoom call for the audience.
You guys hear this is audio, but right on it, do this as a Zoom call. Why couldn't I have a 10 minute talk with a patient four times a year? That's 40 minutes, by the way, same time I spend with them in the office. Yeah, one last point. It's interesting you mentioned the whole sort of decoupled eye exam or the unbundled eye exam. They say we're going to need 20 million more eye exams per year compared to the last decade. But again, you know, what really is an eye exam? So I could also see it's oculomics. If it really is coming to fruition, I can imagine a day where you're getting a bunch of retinal exams, maybe one every six months, because you're really looking at those retinal vessels or the corridor.
A corridor flush or some change to monitor for Parkinson's or Alzheimer's or cardiovascular disease. And you're actually monitoring the retina to get a signal on something else. That could be possible. Picking up diseases way earlier, so you're not dealing with end stage disease that takes all those visits. But you're actually maybe able to more proactively treat people because we're catching them so much earlier. You may be doing more quote unquote exams because you may just be doing a ton more retinal photographs. But those are different types of exams and what we're sort of talking about. So yeah, all this to say is not sure. We will see. I think the wise advice is listen to our podcast.
Read the stuff. We have a bunch of contrarian viewpoints on. Really interesting speaker series, I think, coming up. It's all available for free at AI and I carry dot com. You could reach out to us at Rehan. And I care. Or Scott SCOT one T and I care. Another great episode. Scott, I think it's really tickled my brain and a lot of interesting things to think about. Thank you so much, everybody. I hope you learned a little bit. And as Rehan said, we tickled your brain a little bit made you go. I wonder what the future will look like.