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  • Comprehensive Ophthalmology, Retina/Vitreous

    Review of: Foundational considerations for artificial intelligence using ophthalmic images

    Abràmoff M, Cunningham B, Patel B, et al. Ophthalmology, February 2022

    This review of available evidence on artificial intelligence (AI) and its potential use in health care suggests that AI is poised to have significant positive impacts in ophthalmology. Careful consideration of associated bioethical concerns, however, and the generation of standardized principles are critical to its success.

    Study Design

    The development of AI and other machine diagnostic systems in clinical practice requires a deeply rooted foundation in bioethics. This paper summarizes evidence presented during the Collaborative Community on Ophthalmic Imaging inaugural meeting (September 7, 2020) and compiles the key issues that must be considered when developing a platform for the use and implementation of AI in ophthalmology.


    Based on available evidence, the authors determined that AI has the potential to improve health care access and patient outcomes while decreasing disparities, lowering cost, and enhancing the care team. However, to realize these gains, an accepted and standardized foundation of bioethical principles is necessary. This foundation must include clinical considerations (i.e., intended use, impact, output, user, and use environment) as well as considerations of ethical principles (i.e., nonmaleficence, equity, autonomy, transparency, explainability, and validity).


    In 2024, we have more information about the evolving concerns surrounding AI than we did in 2020. This could potentially warrant a new meeting or summit to reevaluate these concerns.

    Clinical Significance

    Cooperation among AI creators, industry, ethicists, clinicians, patients, and regulatory agencies may be difficult but is key to facilitating rapid innovation of AI technologies and their successful implementation in clinical medicine. If global collaboration and adherence to bioethical principles are successful, AI could promote fundamental improvements in health care, including increased quality of care, decreased disparity, and lower overall costs.

    Financial Disclosures: Dr. Courtney Crawford discloses financial relationships with Genentech, Regeneron Pharmaceuticals (Consultant/Advisor, Lecture Fees/Speakers Bureau); Alcon Laboratories, Allergan, DORC International (Dutch Ophthalmic), Ocular Therapeutix, Oculus Surgical (Consultant/Advisor); Apellis, Iveric Bio (Lecture Fees/Speakers Bureau); Intelligent Retinal Imaging Systems, Topcon Medical Systems, Welch Allyn (Independent Contractor).