This month’s cover feature speaks to the future of refractive surgery. It’s on how micron-precision biometry and exquisitely sophisticated computer modelling of the cornea will soon enable refractive surgeons to plan, optimize and very accurately predict the outcomes of their surgery entirely in silico. Upfront has a story on a patient receiving the Second Sight Orion I – a visual prosthesis that directly stimulates the visual cortex. That’s something that’s been envisaged since the pulp science fiction days of the 1920s, but is now reality. But I believe some of these advances are, in part, thanks to consumer technological advances, as well as stellar academic work.
Apart from the military background of Scheimpflug imaging, almost all of the principles behind ocular biometry are examples of “stellar academic work.” But increasingly, I’m seeing advances – across all of the eye – coming from smarter use of the data that these instruments provide. Better algorithms, leveraging historical patient data and normative databases… I’d also argue that in essence, OCT angiography comes from information from scans that was ignored before, but now its value is recognized, processed and displayed. Stellar academic work all round, right? Let’s look closer at the Orion I. The device directly stimulates the visual cortex and is powered and controlled wirelessly, via induction coils – similar to wireless mobile phone chargers or the RFID chips that enable Apple Pay or Android Pay in your smartphone (and enables data transfer in the Alcon/Google smart contact lens). This is the culmination of great research work, but like Captain Theodor Scheimpflug’s principle, it was never developed with medical applications in mind. RFID’s predecessor devices had defense and espionage applications in the 1940s and 1950s. Only now is it coming to ophthalmology. But really, this editorial is about computing power. I could have easily written this editorial on a Pentium PC from 20 years ago. But I couldn’t browse modern websites, watch Netflix or browse Amazon’s Deals of the Day on such a puny PC. Things have changed. I’d argue that this increase in computing power has been partly driven by consumer demand for faster computers to do such mundane things like media consumption, and to use Facebook without much in the way of lag. And that power has propelled academic and industrial research: image processing algorithms that might once have needed a week’s worth of supercomputer time can now be achieved in minutes thanks to off-the-shelf graphics cards designed for videogamers. We’re now at a stage of planning and simulating surgery and its outcomes in silico. You’re able to do this, in part, thanks to these consumers.
Mark Hillen
Editor
