The ophthalmologist at the crossroads: The new technologies and the frontier of knowledge

Fernández-Vigo, J.A.

doi:10.1016/j.oftale.2017.02.005

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Ortiz, V. Galvis, A. Tello, J.J. Miro-Quesada, R. Barrera, M. Ochoa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ortiz" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Galvis" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Tello" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Miro-Quesada" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Barrera" ] 5 => array:2 [ "nombre" => "M." 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Fernández-Vigo" "autores" => array:1 [ 0 => array:4 [ "nombre" => "J.A." "apellidos" => "Fernández-Vigo" "email" => array:1 [ 0 => "jose.fernandez-vigo@fernandez-vigo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro Internacional de Oftalmología Avanzada, Madrid and Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Área de Oftalmología, Universidad de Extremadura, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El oftalmólogo en su encrucijada: las nuevas tecnologías y la frontera del conocimiento" ] ] "textoCompleto" => "Regrettably, I must admit the lack of divination powers. But, despite my poor analytical and prospective capacity, I am sufficiently curious and bold to open a discussion even after admitting I have no knowledge on the subject.I would like to ponder a number of signs that allow us to feel a transformation coming upon us and propose a debate about the future that will enable us to reach the starting line of an undoubtedly fascinating road that will radically change our professional world and our lives as well.It is necessary to think in order to avoid following the well trodden path, to develop a different perspective adapted to our environment that would allow us to identify a new path, assessing novelties in order to visualize the future and to avoid its negative consequences. We must think because we should not forget that science and philosophy go hand-in-hand. They have always done so and therefore we can surmise the moral obligation of using our imagination, which is none other than the ability that has made us species of sapiens.Getting now to the point, on what grounds do I sustain my proposal? Very simply, that in the next few years ophthalmology will undergo transcendental changes that will make our specialty, and neurosciences in general, absolutely unrecognizable. Very little of what we know will remain.Analyzing the historical evolution of our discipline in the past 30 years, we can appreciate developments that changed substantially, although nothing comparable to the turn around it will experience in the next decades.Who or what would be the drivers of said transformation? Some developments are already here, becoming part of all our activities and producing rapid changes at all levels. These are a number of new disciplines and technologies ranging from the already standard information technology up to artificial intelligence and vision, including robotics, nanotechnology, bionics and cybernetics, all under a common denominator which is digitization and new concepts such as trans-humanism, Big Data and dataism.<a class="elsevierStyleCrossRefs" href="#bib0035">1–4</a> Most of us have only superficial knowledge about some of these disciplines but almost nobody can imagine to what extent it could change our lives.To complete the hypothesis, I will say that I firmly believe that we will likely witness the substitution of the ophthalmologist in the present form. We will be assisted and progressively substituted by language-machines. As of that time, only an elite will survive, and they will be in charge of creating knowledge because the application thereof would be entrusted to machines. Those who do not strive for excellence will be only pawns that will mechanically repeat without any critical interest the knowledge developed by said elite, a small group that will retain the ability to imagine and consequently to create. The amazingly precognitive phrase by Einstein, “imagination is more important than knowledge”, will achieve its full meaning.Accordingly, let us broaden our perspective and raise our outlook. Let us analyze our evolution as humans and extrapolate that evolution to our activity as vision sciences professionals.Harari Y.N., a professor of Jerusalem University and expert in historical macroprocesses, has become renowned after publishing an essay 2 years ago with a novel approach about the evolution of humanity which has become an influential best-seller.<a class="elsevierStyleCrossRef" href="#bib0055">5</a> This year he published Homo Deus, a much more controversial exploration of what the future could bring.<a class="elsevierStyleCrossRef" href="#bib0060">6</a> In accordance with scientific and technical developments, said author proposes highly suggestive and groundbreaking possibilities with a key conclusion, i.e., that the human being will become a sort of superhuman as a direct consequence of the application of the following concepts: all organisms are algorithms, algorithms can be represented in mathematical formulas and for this reason we will know ourselves better and will be able to perfect ourselves. One of his proposals, which is conclusive and particularly painful for us, is that life is the sum of a number of actions where human errors generate a large number of problems. For instance, diseases are caused by unhealthy living habits, traffic accidents are caused by bad drivers and diagnostic errors are caused by physicians who did not follow protocols, missed something out or simply were distracted while doing their work. However, said author also includes a positive note, which is that everything has a solution and that science will facilitate instruments that will do away with all those wrong decisions. The world will undergo a radical change produced by said algorithms in association with big data and artificial intelligence.Life is an ongoing processing of data. Algorithms will be used to define us and (here comes another groundbreaking concept) will get to know us better than we know ourselves, thus diminishing the validity of the classic humanistic Socratic principle of “Know Thyself”. This gives rise to a number of questions: will these algorithms be so reliable that we can put our lives and properties in their hands? Will they take decisions for us? For Harari this is already becoming a reality that will begin to extend with shocking consequences that will cause major sociological problems.In Sapiens, the first book of Harari, he describes the cognitive revolution and its importance as a differential factor in the evolution of hominids toward the homo.<a class="elsevierStyleCrossRef" href="#bib0055">5</a> The ability to imagine, to make up fables and stories, is defined as a transcendental fact in the evolution of mankind.Of course we are algorithms and someday we will be defined as mathematical formulae. While I was writing this article, I learned that Hugh Herr had been awarded the Princesa de Asturias award for Scientific and Technical Research due to his contributions to bioengineering, the innovative combination of artificial intelligence, neurophysiology and robotics. As the director of the Biomechatronic Group of the Massachusetts Institute of Technology (MIT), Hugh Herr has developed a new type of intelligent prostheses that can be controlled by the brain, thus achieving an unthinkable and impossible feat a few years ago, i.e., man-machine integration. For this purpose, mathematical models were developed (algorithms again) that describe the way in which the nervous systems controls the bionic appendices that produce a natural movement pattern. As Einstein, the viewpoint of Herr is that the key lies in the laws of nature and in human imagination as these are the only true limits of the eternal quest toward increasing our nearly infinite capacities.But let us return up to the argument. Technology will prevent medical errors. This also has a negative side to it as it entails that excellence in studies will serve no purpose. Machines will give us everything. We have a very real example with femtophako. We no longer have to learn and carry out capsulorhexis, this is now performed by the laser. These devices make us all equal, and therefore what is the purpose of studying and practicing? What difference would there be between mediocrity and excellence? Is it true that in the end we would have a social class made up by a small elite of creative and imaginative scientist-technician ophthalmologists who will design new devices and those who will be the “operator ophthalmologists” who will only apply what the others design? Doubtlessly, the main beneficiaries would be the patients because the human factor would be removed as a source of errors, which as we all know are quite frequent.The above-described evolution will be comparable to that of self driven motorcars. At first sight, self driven cars can never be as good as an excellent driver under perfect conditions. However, if the driver is not excellent or, being excellent, is not in perfect conditions, would we prefer to cross on the road a car driven by Google® or Tesla® with all the guarantees these devices involve, or with a tired, perhaps drunken driver who is distracted with the radio or texting a WhatsApp® message, a suicide driver, a youngster exceeding speed limits, or even a patient with macular degeneration. For the time being, Tesla® and Google® defend the imperfections of the new system by saying that their project is only “an aid for drivers” and that it does not intend to substitute them, but we all know that is precisely their ultimate objective.And whoever may be as clumsy as to resist this evolution, whoever rejects progress, will suffer a fate similar to that of Kodak®, one of the largest analog photography companies of the past century that disappeared because it refused to adapt to digital technologies. Paradoxically, they pioneered digital photography but refused to develop it in order to avoid damaging their own core traditional business. Their case is one of the largest fiascoes of the modern economy and is studied in all business schools.But far from the business logic and coming back to our educational and scientific endeavors we should take this seriously, always bearing in mind the advice given by Saint-Exupéry: “we do not know the solution for future problems, the only thing we can do is awaken sufficient intelligence to resolve them”.If we accept the above hypothesis, the next challenge is to answer the following questions: how will ophthalmology evolve? What changes will it undergo? How can we get on board that trend? And, taking up again the initial question, what lies in store for us? If our dear editor considers it appropriate, a second part of this letter will discuss some possible replies to the above questions and assess the technologies and disciplines that should be followed closely in the next few years…. Or is it months?" 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ISSN: 2173-5794
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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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