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Q&A: Vasilios Papastefanou

The consultant ophthalmologist at Royal London Hospital and London Claremont Clinic shares his views on OCT and whether AI will ever replace clinicians

02 Apr 2019 by Selina Powell

How would you describe the impact of optical coherence tomography (OCT)? 

The impact is exponential. We have an abundance of information now. Swept source gives us a better view of the choroid and the deeper layers of the eye non-invasively. OCT angiography means we have a safer and quicker diagnostic pathway for the patient. On many occasions in the past, one would have to reschedule for a fluorescein angiogram which may delay the pathway. With OCT angiography, you can arrange it quickly and get as much information as possible.

What tips would you provide to someone who is new to OCT angiography?

The clinician needs to be well familiarised with the platform that they are working with. All of the different companies have their quirks and additional information that they require.

The second thing that anyone who gets involved with OCT angiography should know, is to deal with artifacts that can be misleading. At the end of the day it could create concern among patients and increase anxiety. These are issues that can happen in clinical practice with other modalities too. It is something that needs to be taken into consideration.

Some commentators within optics are concerned about an increase in false positives as OCT becomes more popular. What is your view on this?

I do not subscribe to this. It’s better to have a false positive than a missed positive. It is good to have a low threshold for an ocular problem that could have an effect on vision and quality of life and refer promptly.

Having said that, what is important at the end of the day, apart from having a low threshold, is to have knowledge. There is a learning curve and there are things that any optometrist who is using OCT should be familiar with.

“I view AI as a very valuable tool, but I find it difficult to conceive that it would be a replacement of the special doctor and patient relationship; especially for cases where patients have serious conditions that need to be followed in the long-term”

Do you think artificial intelligence will replace the role of a clinician?

Artificial intelligence (AI) will be invaluable in helping practitioners learn more. To ask whether it will eventually replace the clinician is a logical train of thought following the development of a tool that can produce a suggestive diagnosis. In my opinion, it will not. I view AI as a very valuable tool, but I find it difficult to conceive that it would be a replacement of the special doctor and patient relationship; especially for cases where patients have serious conditions that need to be followed in the long-term.

AI cannot really substitute that sort of ongoing interaction. There are other issues – like the establishment of trust. Certainly, AI can help with the screening process of patients, but in essence, I do not think it will replace clinicians.

Image credit: US Navy (banner image)

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