In 2024, data-driven tools will shape cataract and refractive surgery

It has been an eventful year for cataract and refractive care. In September, the European Society of Cataract and Refractive Surgeons (ESCRS) hosted its annual meeting in Vienna, Austria. Just a few weeks later, leaders from that congress made their way to the United States for the American Academy of Ophthalmology (AAO) meeting in San Francisco, California.

During the refractive surgery subspecialty day at AAO, participants were able to attend a forward-looking ESCRS symposium online or in person. Oliver Findl, MD, MBA, FEBO, president of the ESCRS, moderated the event alongside Burkhard Dick, MD, secretary of the ESCRS.

Prof Findl took time to speak with Ophthalmology Times Europe about the highly successful ESCRS meeting, his AAO presentation “Impact of artificial intelligence (AI) for optimising refractive outcomes,” and the data-driven tools that are changing the industry. Here is what he had to say about the bright future that is just around the corner in 2024.

Spotlighting AI at AAO

During the AAO symposium, Prof Findl used his presentation to showcase results from the ESCRS IOL calculator. The AI-driven tool has been a cornerstone project of the ESCRS during Prof Findl’s presidency. To contextualise its development, he started the AAO symposium by discussing the steep increase in the fascination with AI. Since 2017, there has been a drastic uptick in research with a focus on AI applications in ophthalmology.

Some of those AI ventures include data-driven, predictive formulae for IOL power calculation. Deep learning models, Prof Findl said, offer a unique set of benefits, such as their strength in predicting axial lens position after cataract surgery. Like other new tech developments, the introduction of new AI formulas presents an opportunity and a challenge. “It’s very cumbersome to visit all these websites and enter axial length, keratometry axes and so forth, several times,” he said. “It’s repetitive, very boring, and sometimes you make mistakes when entering the data.”

Figure 1. The ESCRS IOL calculator applies multiple formulae.

The ESCRS IOL calculator uses web-scraping technology, similar to websites like Expedia that can show multiple airline flight listings at once. “The ESCRS calculator allows you to enter data once, then compare seven of the most modern online formulae and their outputs,” Prof Findl said. The formulae include both data-driven and optical approaches, and hybrid combinations that use both methods for IOL power prediction. Although the ESCRS team knew the project had value, they have been surprised by how rapidly refractive surgeons have adopted its use, Prof Findl said. “We’ve seen that the ESCRS calculator has a lot of clicks per week. The uptake was really surprising to us,” he said. And there is more to come, he added: ESCRS just launched a toric calculator that works on the same principle, and Prof Findl hopes to have a post-refractive version of the calculator ready next year.

ESCRS meeting provides sneak peeks of what physicians value most

Prof Findl was proud to report record attendance for the 2023
ESCRS meeting, with over 16,000 attendees. Of that figure, more than 10,000 attendees were doctors and health care professionals, and nearly 6000 registered as industry professionals. It was the largest ESCRS congress on record and one of the largest meetings in ophthalmology this year.

Among the highlights, Prof Findl said, was the subspecialty day held on Monday, 11 September, with a focus on the digital operating room. Programming throughout the day indicated a strong trend toward new applications of data in the surgical theater. “We have the diagnostic data, which we get preoperatively, now conveyed in the operating theater,” he said. “We can seamlessly and, from a workflow perspective, efficiently get that information into the surgical theater, whether it’s incorporated into a microscope or just there on a screen.” Prof Findl said that the 'digital Monday' served two main purposes: to show doctors what digital tools are available for their use right now, and what they should keep an eye out for in the coming months. When physicians know what their options are, and how they function together, they feel more empowered to harness a fully digital workflow.

“In the next few years, I think we’ll see new ways of accompanying the patient digitally, from pre-op assessment to postoperative care,” Prof Findl said. Based on current workflows, a patient could access informational materials prior to surgery, add documentation of the procedure’s intricacies to their patient record and follow up with their physician as needed with questions or concerns. As the aging population grows, these digital workflows may even become an expectation, Prof Findl said.

“The baby boomers are coming into the age of cataract. They all have smartphones. They’re not scared of computers,” he explained. “And I think that if you embrace the digital tools available for the patient, the patient will feel more taken care of, even though doctors, nursing staff and technicians have less and less time per patient.”

Big data, small changes: applying data day to day

Data are driving significant change throughout cataract and refractive care, and not just in the areas where data-focused applications are already robust. Prof Findl pointed to the Sustainability Index for Disposables in Cataract Surgery (SIDICS) project from the ESCRS as a unique way of approaching environmental outcomes of surgery. “We developed a sustainability index for disposables in cataract surgery,” he said. The calculator, another free tool on the ESCRS website, allows doctors to calculate the carbon footprint of a cataract pack and compare it to a “sustainable benchmark pack.”

Figure 2. SIDICS compares cataract packs to a sustainability benchmark.
(Images courtesy of ESCRS.org)

That number is developed from a wide range of sustainability efforts across the continent. “We really try to find the lowest common denominator of the cat packs which are out there in many centers throughout Europe, from university-setting hospitals [to] public hospitals and private centers,” Prof Findl said. That global lens has helped highlight ways in which the common cataract pack falls short of minimised environmental impact. With readily-available data driving the conversation, Prof Findl said, there is no reason for doctors in Europe to avoid the sustainability question any longer.

“We all need to reevaluate. What do we really need?” he said. “Do we need a drape that goes down to the feet, where we’re operating on somebody and it’s just cataract surgery?” The calculator is designed to be user friendly, using the list that comes standard with every cataract pack to provide comparisons to the benchmark. “If you reduced your pack a little, that’s something which can make a real difference,” Prof Findl said.

The challenge European surgeons face together

These small-scale applications of big data can have a huge impact. But throughout 2024, Prof Findl said, one major challenge in the cataract and refractive space will be effectively collecting and applying data. Language differences and regulatory distinctions make large-scale data collection more challenging in Europe than in the United States, and this will continue to be an obstacle for making the most of data-driven tools like AI. “Different languages, different electronic medical records and different cultures can impact data collection as well,” he said. Prof Findl said that the IRIS Registry in the US is an example of large-scale data collection that may simply be out of reach for European practitioners for the foreseeable future.

One way to utilise data despite that obstacle is by getting into as much detail as possible. “We’re looking for slightly more niche applications, where we try to have detailed, raw data from diagnostic tools,” Prof Findl said. Focusing on a hyperspecific area like topography or tomography allows physicians to collect the widest data set available, from as many sites as possible.

These data can be used to try out different algorithms and AI models as a basis for developing diagnostic tools. Patience remains a vital virtue when collecting data. “We are working in that field, but it remains a major challenge in Europe,” Prof Findl said.

Oliver Findl, MD, MBA, FEBO | E: ofindl@googlemail.com

Prof Findl is founder and director of the Vienna Institute of Research in Ocular Surgery and chairs the Department of Ophthalmology at Hanusch Hospital, Vienna, Austria. He is president of the European Society of Cataract and Refractive Surgeons.