ASCRS 2024: MIGS data is outpacing "human intelligence," driving calls for AI

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David Lubeck, MD, talks about the biggest surprises from ASCRS in the glaucoma space

At the 2024 ASCRS meeting, Ophthalmology Times Europe spoke with David M. Lubeck, MD, a refractive surgeon and glaucoma specialist from Chicago, Illinois. Dr Lubeck detailed highlights from the meeting, including his presentations on the minimally invasive glaucoma surgery (MIGS) space, the need for artificial intelligence (AI) to offset the limitations of "human intelligence," and the long-lasting impact of canaloplasty procedures.

Editor's note: The below transcript has been lightly edited for clarity.

I am David Lubeck, from Chicago. I'm speaking to you on the last day of the 2024 ASCRS in Boston. This has been a very busy meeting. I've been unexpectedly busy and focused primarily on MIGS and within MIGS, the canaloplasty space.

My three paper presentations, two of them were various aspects of the iTrack global data registry. The registry has become a very important part of my thinking, about not only canaloplasty, but the entire MIGS space. For this procedure, it is now the largest single data set, which has begun prospectively and is generating more and more data and sub data sets, which previously we didn't have. And so we were mostly working on conjecture, and theory.

We're at the point that our human intelligence, or HI, is almost no longer able to sift and sort and make the best sense of the data that we're getting. The session yesterday afternoon, when all these MIGS papers were being presented. Everything, different procedures, combined procedures, various scenarios, different surgeons, all had fairly similar results. So, pressure reductions of between 20 to 30%, medication reduction by at least 50%, but not always to zero. Didn't matter the paper or the topic, the data sets were almost almost interchangeable. So, I would like to see somebody build an AI engine, which is going to be specifically focused on MIGS procedures, and then the analysis of these larger data sets to give us much more nuanced and specific information about treatment paradigms in this space.

The things that are surprising to me, again, canaloplasty–I do mostly canaloplasty for a number of reasons. I'm surprised now at the longevity of effect. There's data at now 6 and 7 years out that it is still providing effective pressure lowering. Specifically in this last session, the most impressive thing to me, or the thing that surprised me, was that one presenter showed a study where up to four MIGS procedures were done in combination, in the same procedure. And the results of four surgeries was not that much better than one or two or three. So there's so much we don't understand that, again, I don't think as human intelligence, we're getting right yet.

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