PETE’S BOGUS JOURNEY

Ophtherminator 3 - Rise of the Machines

“Bring back life form, priority one, AI in ophthalmology as potentially making my role as a clinician all other priorities are rescinded.” This leads me on quite nicely, in a Barry less viable. The AI is now so advanced that Film buffs will spot this as a chilling quote Norman kind of way, to AI in ophthalmology. it can also perform tasks which the clinician spoken by Ash (Ian Holm) from the classic “And why not?”. When I first started in cannot, such as determine a patient’s sex sci-fi horror movieAlien (1979). Ash (spoiler ophthalmology over two decades ago, there from a fundal photo. Worryingly, we do not alert) is a Hyperdyne Systems artificial were no computers in the clinic rooms known how the AI can do this, it just can. intelligence (AI) android, who acts as an in the department, and I was accessing AI is now able to perform superhuman antagonist and sleeper agent throughout the internet via my PC from home with feats through deep learning. For example, the movie. In this scene he reveals to Ellen a frustratingly slow dial up modem (Gen Go is a complicated game of strategy Ripley (Sigourney Weaver) that his secret Zers will need to Google) which kept on invented in China over 2500 years ago that mission on the voyage is to bring back the crashing mid page download. Since these requires intuition, creative and strategic alien intact at all costs and the crew and the Dark Ages there has been an exponential thinking. After several decades of limited cargo of the ship are “expendable”. rise in computer dependence in clinical success in creating a computer capable of I first watched this movie as a teenager, ophthalmology such that any prolonged playing Go to a reasonable level, Google’s and it was one of the first of a succession of spinning wheel buffering when performing DeepMind lab created the program examples from both movies and television simple tasks such as outcoming a patient AlphaGo. Through deep learning techniques which have contributed to my pretty much on the appointments system results in it was able to beat Ke Jie, the number 1 unshakable view that AI is bad. much pounding of the keyboard with fists player in the world, three times in a row Other examples include Westworld (1973) shouting “Just do it!”. in 2017. However, the follow-up program which sees Yul Brunner’s terrifying cowboy More importantly, especially in my AlphaGo Zero then became a Go master in android in a futuristic Western-themed subspecialty of medical retina, there just three days by playing 4.9 million games amusement park malfunction and start is a much greater reliance on medical against itself in quick succession. In a brief killing visitors. photography and digital imaging. I have to amount of time the program had gained all In War Games (1983) Seattle high school confess, I did scoff at the pixelated graphics the knowledge about the game which had student David Lightman (Matthew Broderick) (which were worse than Manic Miner on been accumulated over 2500 years and also uses his home microcomputer (IMSAI 8080) the ZX Spectrum) on the images from discovered things which were previously to hack into a US defence supercomputer the first Zeiss Stratus optical coherence unknown to humans. It takes me at least a known as War Operation Plan Response tomography (OCT) machine when it pitched week of not very deep learning to remember (WOPR). By playing the game ‘Global up in my department in 2006. However, to avoid a pothole on the road to work which Thermonuclear War’ on WOPR, David almost since then the technology has developed I successfully hit on a daily basis much to brings about World War III as the computer so rapidly such that I am now blown the delight of my local car mechanic. does not understand the difference between away by the quality of the scans from the reality and simulation. ubiquitous Heidelberg Spectralis OCT Will a robot take my job? And who can forget the classic movie machine, which have rendered my Volk 78D I have three teenage children who I am Terminator (1984)? Arnold Schwarzenegger macula lens ophthalmoscopy skills pretty hoping at some stage will have fulfilling and stars as a cyborg assassin sent back in time much redundant. enjoyable careers and eventually come off from 2029 to 1984 to kill Sarah Connor (Linda There is no doubt that the advancements the parental payroll. As they fill out their Hamilton), to prevent the birth of her son in imaging in ophthalmology have UCAS forms though, I am encouraging them Kyle, who one day will save humanity from transformed our ability to diagnose and to choose careers which are not likely to be extinction by a rogue AI defence network manage patients. Conditions which were replaced by robots. This can be checked on (Skynet) in a post-apocalyptic future. The previously hard to diagnose with a Volk websites such as willrobotstakemyjob.com common theme amongst all these films is ophthalmoscopy lens such as vitreomacular I have always considered that my role as hostile, malevolent and uncontrollable AI traction and perifoveal telangiectasia are an ophthalmologist specialising in medical systems. now instantly recognisable on the OCT retina as being fairly safe but with the rise of Readers may say “Well what about the scan images. However, there are clouds on AI, I am not so sure now. movie Weird Science (1985)”? Two geeky the horizon, as the gas attendant says to AI machines may eventually be able to high school social outcasts hack into a Sarah Connor at the end of filmTerminator : diagnose and formulate management plans government computer system and create “There’s a storm coming…”. for medical retina patients better than me. Lisa (Kelly LeBrock), a beautiful and Ground-breaking ophthalmology related But I reassure myself that any potential intelligent android woman with unlimited AI papers such as De Fauw, et al’s ‘Clinically future robot medical retina doctor will not powers. Lisa then takes the boys on a journey applicable deep learning for diagnosis have other skills such as be able to develop where they gain confidence and street cred, and referral in retinal disease’ in Nature rapport with patients or show empathy. They hold a cool party, take revenge on their Medicine (arising from a collaboration will not be able at the same consultation tormentors and get girlfriends. However, I with Google’s DeepMind) are being to examine the small lid cyst bothering the would counter argue that because Lisa has published with alarming regularity. These patient, view the peripheral fundus looking magical powers performing acts like creating papers are unsettling, not only because for a cause for an intermittent flickering light a Cadillac and a Porsche 928 out of thin air, they highlight the inadequacies of the and then list the best potential Celtic football this renders it not a believable android and local research studies and case reports manager replacements to a football mad therefore cannot be used as evidence against which I occasionally peddle to Eye, Acta Hearts fan patient. my argument that all AI is bad. Obviously, all Ophthalmologica and the Journal of Last But will future robot AI doctors be able to other AI movies are totally believable. Resort etc., but also because I perceive them perform better clinically than humans and

Eye News | JUNE/JULY 2021 | VOL 28 NO 1 | www.eyenews.uk.com PETE’S BOGUS JOURNEY

also develop relationships with patients and So I would like to ask those carrying ‘Can robots trust human beings?’”. The show empathy? out research into AI in medical retina to robot successfully hitchhiked across Margiotta Food and Wine is an upmarket please try and hold your horses and slow Canada, Germany and the Netherlands chain of minimarkets in Edinburgh. Recently it down a bit, at least until I can retire to to international acclaim. However, its they trialled a robot called Fabio, developed that nirvana of a villa in the sun that most attempted hitchhiking traverse of the by a team from Heriot-Watt University, at of us dream about. I have already done my USA from Boston to San Francisco was their flagship store. The robot would greet time (weekdays, weekends, bank holidays, prematurely cut short when it was customers, cracking jokes and offering hugs etc.) back in the day seeing red eyes in eye “stripped and decapitated” in Philadelphia, and direct customers around the shop to casualty as a trainee. In the words of Uncle Pennsylvania. It was destroyed beyond find items they were looking for. However, Pete (Charlie Chuck) from the TV show The repair and the head was never found. following initial successes, after a while they Smell of Reeves and Mortimer: “Don’t send Maybe HitchBOT was just unlucky found the customers started to avoid the me back to t’dark place”. If not, I’ll be coming and this would not have had happened robot. Eventually, when the manager told after your medical retina android like Arnold anywhere else. If the television series Fabio it was fired, it replied “Are you angry?”. Schwarzengger’s Terminator and uttering It’s Always Sunny in Philadelphia is More importantly though, the staff at the the immortal words: representative of the type of characters that shop were upset and one started crying when “Hasta la vista, baby” populate the city then maybe I can believe the robot was boxed up and taken away, that. But there is a small glimmer of hope thereby showing that they had developed an Postscript: Ophtherminator 4: that there is some resistance to a post- emotional attachment to the robot. Salvation apocalyptic AI robot future. Harry, both consultant VR colleague and cycling companion, would love to see The resistance my medical retina job plan replaced with a I recently discovered that my personal SECTION EDITOR computer algorithm, so that I would then crusade against the AI robots to prevent slide down the career snake and see out a latter stage career change to Deliveroo the rest of my days sitting on a perch in eye cyclist may not actually be required. It casualty consulting a steady stream of red appears the rise against the machines eyes. In fact, he never loses an opportunity has already begun. Peter Cackett, to wind me up about this and has even HitchBOT was a Canadian hitchhiking Medical Retina Consultant, helpfully identified a potential location for a robot developed at Ryerson University, Princess Alexandra Eye Pavilion, Edinburgh, UK. community hub in an out-of-town shopping Toronto. Professor Zeller designed the E: [email protected] centre for me to do some outreach “itchy, robot “to learn about how people interact burny” red eye clinics. with technology and ask the question,

Eye News | JUNE/JULY 2021 | VOL 28 NO 1 | www.eyenews.uk.com