Artificial intelligence, robotics and cyborgs: The future of research and technological development in ophthalmology

Fernández-Vigo, J.Á.; Fernández-Vigo, J.I.; Kudsieh, B.

doi:10.1016/j.oftale.2019.04.002

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The intensity of this transformation is surprising, and even more so the momentum it is gathering. In the digital environment, the indicator of activity is information passing through the Internet, and we have gone from a production of 130 exabytes in 2005–7910 exabytes in 2015. This acceleration is so fast that experts say that the passage of the third Industrial Revolution, i.e., that of mobile devices and digitalization, to the Fourth Industrial Revolution of connectivity and robotics is taking only a single generation.The concept of a company and the way in which services are provided is different. The first 5 companies in the world in stock exchange capitalization are technology-based: Uber®, Airbnb®, Amazon®, Netflix®, Facebook® or Spotify® operate in a completely unconventional manner. Bitcoin is a currency that has no physical existence. It is expected that 47% of conventional jobs will disappear.<a class="elsevierStyleCrossRef" href="#bib0070">3</a> For these reasons, we should reflect on whether we could see a form of practicing medicine in which service suppliers are not only physicians and that we will have to rely on or collaborate with other professionals. New technologies will require new experts and new skills. It has been said that the professions with the best future are those related to leisure, tourism and health. However, under the present format we will not be able to give response to the health demand of the society that is in the making.Experts say that the technologies constituting what is known as “the technological disruption” are 9: robotics, the Internet of Things, AI, mobile connectivity, the Cloud, self-driven vehicles, biotechnology, nanotechnology and 3-D printing.<a class="elsevierStyleCrossRef" href="#bib0075">4</a> And in the system in which digitalization, algorithms and data are the new mine (data mining) to be monetized, in which robotization will do a part of the work we do at present, where data processing will be carried out by AI with a speed and precision at least similar to what we have at present, as we have seen in ophthalmological diagnostics,<a class="elsevierStyleCrossRefs" href="#bib0080">5–7</a> we are obliged to ponder a number of questions that are repeated quite frequently in other environments: what role will we have? Where will the key of modern ophthalmology be? Which future technologies will be applicable to ophthalmology?In our view, there are at least 5 areas of engineering and ophthalmological developments that could come together. The first involves robotic engineering, that could improve ophthalmological diagnostic and medical and surgical treatment. Robotics is a branch of engineering that involves the design, manufacture and operation of robots. In the future, an operating theater will include robotization, machine learning (a process in which machines are able to learn), instrumentation, advanced imaging processing and data analysis. Nanotechnology and nano-robots will play a leading role in this area.The importance of robotics is demonstrated by its numbers. According to industry consultants, in 2020 robotics will generate up to 54 billion dollars and will change business niches in companies all over the world. The adoption of robots for automating processes will become almost universal in only 5 years. Robotics would be the best investment opportunity of the 21st century, in addition to being the fastest growing area in health, with a turnover of 18 billion.The second area refers to computer engineering, essentially big data and AI. It could become the fastest evolving engineering that will change all our systems. At present, mankind produces a vast amount of data. The Internet transmits 204 million emails in a single minute, 1.4 million Skype® calls, 2 million searches in Google®, 270,000 dollars in online purchases, etc. Data processing power is huge. Every day, Google® processes about 24PB of information, the equivalent of 160 trillion photographs per day. Watson, the cognitive supra-computer of IBM, is able to read 2 million pages of data in 3s.Big data and AI have sufficient memory and processing power to resolve most of our doubts in the very near future, ranging from diagnostics to the choice of the best surgeon for a specific disease.<a class="elsevierStyleCrossRefs" href="#bib0080">5–7</a> The areas of action for big data will comprise nearly all sectors of the health industry, including routine clinic practice, medical and surgical procedures, personalized and preventive medicine as well as public health, in addition to R&D&I for medicaments and remote follow-up for patients and chronic patients. It is estimated that by 2030 AI will contribute 15.7 trillion dollars to the global economy.The third area involves cyborg engineering, an acronym that is derived from cybernetic organism. Cyborg engineering is based on the combination of an organic body with an inorganic device. The development of sensory bionics (particularly artificial bionic vision, hearing and touch), for movement and for the brain will be used to repair, substitute and even improve human capacities. The European Parliament is already legislating and defining “human enhancement technologies” as modifications designed to improve human capacities through the intervention of new technologies in the human body. This requires the coordination of highly complex and multi-disciplinary teams including biomechanics, neuroscientists, biophysicists, mechanical engineers, biometrics and tissue experts.<a class="elsevierStyleCrossRefs" href="#bib0095">8,9</a>The development of microchips and artificial vision through epiretinal, subretinal, suprachoroidal, perioptical, cortical devices as well as beyond the optical pathway such as through lingual stimulation, the ability to stimulate vision through hearing by the transformation of sounds, etc. have a promising future, to the extent that we cannot understand the lack of news about current developments.<a class="elsevierStyleCrossRefs" href="#bib0100">9,10</a>The fourth area of engineering could be applied to ophthalmology: computer simulation that will substitute experimental models, hydrodynamics, graphical expressions, prototyping, models, etc. Together with robotics, 3-D printing will be one of the main attractors of investment and will have a spectacular development in the creation of instruments, processes and other devices.Finally, the fifth area is genetic engineering, which possibly is the furthest away from ophthalmology but we thought it wise to include it here due to its transcendental importance together with editing and reprogramming, gene and cell therapy and the latest novelty, CRISPR/Cas9 technology.Continuing with our line of thought, we believe that technology development options for ophthalmology will involve the adoption of bioengineering as an extraordinary broad and prolific field of action, without forgetting typical sources of knowledge such as clinic and experimental investigation.We do not ignore that this transition will be complex because it will require a departure from our comfort zone, what Thomas Kuhn defines as normal science,<a class="elsevierStyleCrossRef" href="#bib0110">11</a> and will require broadening the frontiers of research programs with radical changes including new technologies, new languages, new methodologies, new partners or colleagues, new interests, associations with companies, startups, etc. However, we do not aim to cause alarm. Conventional ophthalmology will always have a role to play and new technologies will reach our specialty in the midterm due to their high costs. Ophthalmologists will still be in demand due to the progressive aging of the population and the prevalence of chronic diseases. Quite the contrary: demand will increase with technology-enhanced ophthalmology as occurred with the development of refractive surgery.In the above context, some of the actions to be carried out could be summarized in 2 categories, involving institutions and scientific societies, universities and hospitals as well as leaders, university teachers, department heads, directors of centers and institutes, among others.The management body of the SEO could propose the creation of a section on new technologies with appropriate sessions at the national Congress just like the research section was established 30 years ago to provide support and visibility to the incipient activities of investigators and still maintains its full validity. In addition, free updating courses, symposiums and awards should be promoted and extended to the scientific societies of specialties and Autonomous Communities.Universities and hospitals should adapt academic merits and broaden the limits of investigator programs to give priority to patents, registrations, utility models and development of applications in addition to conventional publications.Research should be guided through doctoral theses and programs, graduate papers and of course the inclusion of multidisciplinary teams, particularly engineers.It is also key to involve private enterprises that will doubtlessly feel motivated by the wealth of exchanges they could have with investigators, technologists and ophthalmologists. In the future, the wealth of a country will be measured by its investments in innovation and scientific development.Institutions and professionals should make a joint effort. Our future is in our hands." 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ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Indexed in:

PubMed/MedLine, Scopus, EMBASE, IBECS, IME, SCIELO, BIOSIS, SENIOR, COMPLUDOC

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Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.2

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.247

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.263

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Journal Information

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Vol. 94. Issue 7.