Michael Abramoff

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Michael David Abràmoff (born 1963) is an American neuroscientist, ophthalmologist, fellowship trained vitreoretinal surgeon, computer engineer, and entrepreneur. He is the Watzke Professor of Ophthalmology and Visual Sciences at the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa.^[2] Abràmoff is the Founder and Executive Chairman of Digital Diagnostics (fka. IDx Technologies, Inc.), of Coralville, Iowa, which was named one of the “150 Most Promising Digital Health Companies of 2022” by CB Insights.^[3]

Early life and education[edit]

Abràmoff was born in Rotterdam, the Netherlands, and receive­d his MD and MS (information theory) from the University of Amsterdam.^[4] Abràmoff was a research fellow in the Neural Networks lab at RIKEN, Tokyo, Japan. He was Director of R&D at Prodix SA, an image analysis company in Paris, France.  Abràmoff completed his ophthalmology residency at the University of Utrecht Academic Hospital, and his vitreoretinal surgery fellowship at Vrije Universiteit in Amsterdam.  Abràmoff did his graduate research, leading to a Ph.D. in machine learning, at the University of Utrecht.^[5]

Scientific and medical career[edit]

Abràmoff is the author of over 495 peer-reviewed research articles,^[6] and his work has been cited over 45,000 times, leading to an h-index of 77 and over 600 articles listed on Google Scholar.^[7]  Abràmoff is inventor on over 60 US and international patents and patent applications primarily related to machine learning, artificial intelligence (AI) and imaging^[8] Abràmoff was one of the early developers of ImageJ, the Java-based image processing program with millions of downloads. Abràmoff was the initiator behind the Iowa Reference Algorithms, a series of publicly available reference algorithms for OCT segmentation.^[9]

Abràmoff has been a strong proponent of the theory that diabetes complications in the eye and brain are neural, not vascular, in origin,^[10] based on his team’s earlier finding that microvascular biomarkers of diabetic damage in the retina only occur after neurodegenerative changes.^[11] Additionally, Abràmoff has been part of the Moonshot team (formally known as Restoring Vision: A JDRF Moonshot Initiative) from the outset.^[12] Abràmoff started working on autonomous AI for diagnosis of (retinal diseases) during his residency in 1997, which led to the publishing of Low Level Screening of Exudates and Hemorrhages in Background Diabetic Retinopathy in 2000 and many other papers .^[13] This research led to him receiving the nickname "The Retinator" in an Ophthalmology Times editorial in 2010,^[14] referring to the work he had done to create the first autonomous AI diagnostic system. Roughly a decade later, the medical community’s stance on healthcare AI had evolved, as evidenced by a 2019 American Medical Association (AMA) article on Abràmoff, titled This Ophthalmologist is Doing Health Care AI the Right Way.^[15]

Abràmoff began working with regulators, such as the FDA, in 2010 to develop a process by which to introduce autonomous AI in healthcare. During that time, with his coworkers he developed “metrics for ethics” as a concept, as well as an ethical framework for healthcare AI, which led to an ongoing series of papers published through the Foundational Principles of Algorithmic Interpretation workgroup.^[16][17]

After working closely with FDA for over 8 years under this ethical framework,^[18] de novo clearance was granted to the autonomous AI product, IDx-DR (now LumineticsCore™) on April 18, 2018, created by the company Abràmoff founded in 2010, Digital Diagnostics (formerly IDx) of Coralville Iowa.^[19] That marked the first time in history that an autonomous diagnostic platform was cleared by the FDA in any field of medicine,^[19] so that patients could legally be diagnosed by a computer rather than by a human (physician). Abràmoff credits this achievement as well the subsequent national reimbursement, coding, and quality measurement, as well as widespread support by all healthcare stakeholders, on the ethical framework for AI in healthcare.^[20] This work continues in close collaboration with both FDA and other US and international regulatory authorities as well as CMS and other payor organizations including publication of an ethically founded AI reimbursement framework.^[20]

Abràmoff is a founding member of FDA’s Collaborative Community on Ophthalmic Imaging (CCOI), which was formed in 2019.^[21] Abràmoff also chairs the Foundational Principles of Ophthalmic Imaging and Algorithmic Interpretation (FPOAI) Workgroup.^[17] In 2019, Abràmoff founded the AI Healthcare Coalition^[22] and serves as Executive Secretary, focusing on the policy implications of healthcare AI.

Business career[edit]

Abràmoff founded three companies, EyeCheck, a teleretinal diabetic retinopathy screening company in Amsterdam, the Netherlands,^[23] and i-Optics, an ophthalmic device company. ^[24]

In 2010, Abràmoff founded IDx Technologies, Inc., which has since rebranded as Digital Diagnostics^[2] of which he is currently Executive Chairman.

In October 2017, in a Congressional Briefing sponsored by the Science Coalition, Abràmoff joined a panel of companies that, like Digital Diagnostics (then IDx), spun out of U.S. research universities. The panelists highlighted to lawmakers the value of putting federal funds toward academic research.^[25]

In January 2018, the results of a pivotal clinical trial, for the first autonomous AI in primary care were submitted to FDA,^[26] exceeding its pre-specified superiority endpoints for diagnostic accuracy. FDA assigned the LumineticsCore (then IDx-DR) system breakthrough device status for expedited review. In April 2018 FDA granted De Novo authorization to market this product in the US.^[27]

Abràmoff has been dubbed a "Renaissance Man" by Retina Physician ^[28] for creating a simple and more efficient process of autonomous AI for the retina that is in the best interest of the patient. ^[29]

In 2018, Abràmoff testified for the Federal Trade Commission on AI Predictive Analytics Through Real World Applications.^[30]

In 2022, Abràmoff co-authored, A Reimbursement Framework for Artificial Intelligence in Healthcare,^[20] culminating years of research. The paper served as a catalyst for several advancements in the healthcare sector preceding its release and has continued to influence developments thereafter, including:

• The creation of CPT® category I code, 92229, by the Editorial Panel of the American Medical Association (AMA), allowing, for the first time, automated diagnosis of diabetic retinopathy. ^[31]
• An update to the American Diabetes Association’s (ADA) Standards of Care, declaring AI systems an alternative to traditional eye exams for people with diabetes. ^[32]
• An update to the Healthcare Effectiveness Data and Information Set (HEDIS), supporting the use of autonomous AI for eye exams for people with diabetes. ^[33]
• Coverage of CPT® code 92229 by the Centers for Medicare and Medicaid Services (CMS). ^[34]
• The publication of Foundational Considerations for Artificial Intelligence Using Ophthalmic Images, which was co-authored by Abramoff and established a foundation for the implementation and measurement of ethically founded autonomous AI in healthcare.^[17]
• An update to the language regarding CPT® code 92229 by CMS, replacing “automated diagnosis” with “autonomous diagnosis” when referring to retina imaging.^[35]

Personal life[edit]

Outside of the world of medicine and science, Abràmoff served as an interviewer for Spielberg's Shoah Visual History Project.^[36] He contributed to the Vance Integral Edition. ^[37]

Honors[edit]

• 2022 AI Champion Award 2022, Artificial Intelligence in Medicine (AIMed)^[38]
• 2022 Gold Fellow, Association for Research in Vision and Ophthalmology (ARVO)^[39]
• 2020 University of Iowa Faculty/Staff Startup of the Year Award^[40]
• 2020 MedTech Breakthrough Award: Best New Technology Award - Diabetes Management^[41]
• 2020 Named in James Gardner's keynote address Key persons who have advanced the understanding of diabetic retinopathy to the Societa' Oftalmologica Italiana
• 2019 Fellow, Institute of Electrical and Electronics Engineers (IEEE)^[42]
• 2019 CB Insights AI Top 150 list^[43]
• 2019 America's Cultivation Corridor, Iowa Biotech Leader Award^[44]
• 2019 Ophthalmologist Top 10 Powerlist of Top Inventors^[45]
• 2018 UI Carver College of Medicine Wall of Scholarship^[46]
• 2018 Discover and Innovation Award, University of Iowa Research Foundation^[47]
• 2018 Silver Fellow, Association for Research in Vision and Ophthalmology (ARVO)^[48]
• 2016 Investiture, Robert C. Watzke Retinal Research Professorship
• 2016 Charles D. Phelps Memorial Award for Glaucoma Research^[49]
• 2013 Young Investigator Award, Macula Society^[50]
• 2011 President's Innovation Award, American Telemedicine Association^[51]
• 2010 Senior Member, Institute of Electrical and Electonics Engineers (IEEE)
• 2010 Sessions Chair, World Ophthalmology Congress, Berlin, Germany
• 2010  Achievement Award, American Academy of Ophthalmology
• 2010 Winner, John Pappajohn Iowa Business Plan Competition
• 2010 Winner, University of Iowa Entrepreneurial Center Elevator Pitch Competition (with Dr James Folk)
• 2008 Annual Medical Education Award, University of Iowa
• 2004 P.J. Leinfelder Award. Best seminar delivery by a fellow: "Functional imaging of the retina.” Sponsored by Department of Ophthalmology and Visual Sciences, University of Iowa.
• 2003 PG Binkhorst Award, "Objective Measurement of Motion in the Orbit"
• 2002 3M-Jonkers Award and Medal of Honor. Best scientific publication over preceding 3 years. "Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances" Sponsored by 3M-Jonkers Foundation.
• 2001 New Venture Award, McKinsey Inc. / Verbond Nederlandse Ondernemers, Award for Best Business plan, Netherlands
• 2002 3M-Jonkers Award^[39]
• 1998 Mielet-van Coehoorn Foundation Award
• 1997 F.P. Fischer Foundation Award
• 1996 RSNA Cum Laude Award, Congress of the Radiological Society of North America ^[52]
• 1990 Peter Reichertz Prize for best young researcher, European Federation for Medical Informatics
• 1989 Science and Technology Agency (STA) Postdoctoral Fellowship Award, Ministry of Education, Tokyo, Japan

Selected publications[edit]

• T.Y. ALVIN LIU, HUANG, J., LEHMANN, H., WOLF, R. M., ROOMASA CHANNA, & ABRÀMOFF, M. D. (2023). 261-OR: Autonomous Artificial Intelligence (AI) Testing for Diabetic Eye Disease (DED) Closes Care Gap and Improves Health Equity on a Systems Level. 72(Supplement_1). https://doi.org/10.2337/db23-261-or
• Abràmoff, M.D.; Tobey, D.; Cher, D. (June 2020). "Lessons Learned About Autonomous AI: Finding a Safe, Efficacious, and Ethical Path Through the Development Process". Am J Ophtahl. 214: 134–142. doi:10.1016/j.ajo.2020.02.022. PMID 32171769.
• Abràmoff, M.D.; Lavin, P.T.; Birch, M; Shah, N.; Folk, J.C. (August 2018). "Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices". npj Digital Medicine. 1 (1): 39. doi:10.1038/s41746-018-0040-6. PMC 6550188. PMID 31304320.
• Parekh, Prashant K; Folk, James C; Gupta, Priya; Russell, Stephen R; Sohn, Elliott H; Abràmoff, Michael D. (March 2018). "Fluorescein Angiography Does Not Alter the Initial Clinical Management of Choroidal Neovascularization in Age-Related Macular Degeneration". Ophthalmology Retina. 2 (7): 659–666. doi:10.1016/j.oret.2018.01.002. PMC 7055156. PMID 31047374.
• Shah, Abhay; Lynch, Stephanie; Niemeijer, Meindert; Amelon, Ryan; Clarida, Warren; Folk, James; Russell, Stephen; Wu, Xiaodong; Abramoff, Michael David (April 2018). "Susceptibility to Misdiagnosis of Adversarial Images by Deep Learning Based Retinal Image Analysis Algorithms". Proceedings, IEEE International Symposium on Biomedical Imaging. IN PRESS.
• Lynch, Stephanie K.; Abràmoff, Michael D. (2017). "Diabetic retinopathy is a neurodegenerative disorder". Vision Research. 139: 101–107. doi:10.1016/j.visres.2017.03.003. PMC 5659971. PMID 28408138.
• Abràmoff, MD; Lou, Y; Erginay, A; Clarida, W; Amelon, R; Folk, JC; Niemeijer, M (2016). "Improved Automated Detection of Diabetic Retinopathy on a Publicly Available Dataset Through Integration of Deep Learning". Invest Ophthalmol Vis Sci. 57 (13): 5200–5206. doi:10.1167/iovs.16-19964. PMID 27701631.
• Sohn, EH; van Dijk, HW; Jiao, C; Kok, PH; Jeong, W; Demirkaya, N; Garmager, A; Wit, F; Kucukevcilioglu, M; van Velthoven, ME; DeVries, JH; Mullins, RF; Kuehn, MH; Schlingemann, RO; Sonka, M; Verbraak, FD; Abràmoff, MD (2016). "Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus". Proc Natl Acad Sci U S A. 113 (19): E2655–E2664. Bibcode:2016PNAS..113E2655S. doi:10.1073/pnas.1522014113. PMC 4868487. PMID 27114552.
• Abràmoff, MD; Folk, JC; Han, DP; Walker, JD; Williams, DF; Russell, SR; et al. (2013). "Automated analysis of retinal images for detection of referable diabetic retinopathy". JAMA Ophthalmol. 131 (3): 351–357. doi:10.1001/jamaophthalmol.2013.1743. PMID 23494039.
• Niemeijer, M; van Ginneken, B; Cree, MJ; Mizutani, A; Quellec, G; Sanchez, CI; Zhang, B; Hornero, R; Lamard, M; Muramatsu, C; Wu, XQ; Cazuguel, G; You, J; Mayo, A; Li, Q; Hatanaka, Y; Cochener, B; Roux, C; Karray, F; Garcia, M; Fujita, H; Abramoff, MD (2010). "Retinopathy Online Challenge: Automatic Detection of Microaneurysms in Digital Color Fundus Photographs". IEEE Trans Med Imaging. 29 (1): 185–195. CiteSeerX 10.1.1.608.3699. doi:10.1109/tmi.2009.2033909. PMID 19822469. S2CID 13770952.
• Abramoff, Michael D; Garvin, Mona K; Sonka, Milan (2010). "Retinal Imaging and Image Analysis". IEEE Reviews in Biomedical Engineering. 3: 169–208. doi:10.1109/RBME.2010.2084567. PMC 3131209. PMID 22275207.
• Garvin, MK; Abramoff, MD; Wu, X; Russell, SR; Burns, TL; Sonka, M (2009). "Automated 3-D Intraretinal Layer Segmentation of Macular Spectral-Domain Optical Coherence Tomography Images". IEEE Trans Med Imaging. 28 (9): 1436–1347. doi:10.1109/TMI.2009.2016958. PMC 2911837. PMID 19278927.
• Garvin, MK; Abramoff, MD; Kardon, R; Russell, SR; Wu, X; Sonka, M (2008). "Intraretinal layer segmentation of macular optical coherence tomography images using optimal 3-D graph search". IEEE Trans Med Imaging. 27 (10): 1495–1505. doi:10.1109/TMI.2008.923966. PMC 2614384. PMID 18815101.
• Niemeijer, M; van Ginneken, B; Russell, SR; Suttorp-Schulten, MS; Abramoff, MD (2007). "Automated detection and differentiation of drusen, exudates, and cotton-wool spots in digital color fundus photographs for diabetic retinopathy diagnosis". Invest Ophthalmol Vis Sci. 48 (5): 2260–2267. doi:10.1167/iovs.06-0996. PMC 2739583. PMID 17460289.
• Niemeijer, M; van Ginneken, B; Staal, J; Suttorp-Schulten, MS; Abràmoff, MD (2005). "Automatic detection of red lesions in digital color fundus photographs". IEEE Trans Med Imaging. 24 (5): 584–592. doi:10.1109/tmi.2005.843738. PMID 15889546. S2CID 15175837.
• Niemeijer, M; Staal, J; Van Ginneken, B; Loog, M; Abràmoff, Michael D (2004). Fitzpatrick, J. Michael; Sonka, Milan (eds.). "Comparative study of retinal vessel segmentation methods on a new publicly available database". Proc SPIE Med Imag. Medical Imaging 2004: Image Processing. 5307: 648–656. Bibcode:2004SPIE.5370..648N. doi:10.1117/12.535349. S2CID 43922199.
• Abramoff, Michael D (2004). "Image processing with ImageJ" (PDF). Biophotonics International. 11 (7): 36–42.
• Abràmoff MD, Blodi B, Folk JC. Autonomous AI confers patient level clinical outcome of diabetic retinopathy and macular edema. (Proceedings Macula Society, Virtual) February 7, 2021)
• Char, D. S., Abràmoff, M. D., & Feudtner, C. (2020). Identifying Ethical Considerations for Machine Learning Healthcare Applications. The American Journal of Bioethics, 20(11), 7–17. https://doi.org/10.1080/15265161.2020.1819469
• Guo, Z., Kwon, Y. H., Lee, K., Wang, K., Wahle, A., Alward, W. L. M., Fingert, J. H., Bettis, D. I., Johnson, C. A., Garvin, M. K., Sonka, M., & Abràmoff, M. D. (2017). Optical Coherence Tomography Analysis Based Prediction of Humphrey 24-2 Visual Field Thresholds in Patients With Glaucoma. Investigative Opthalmology & Visual Science, 58(10), 3975. https://doi.org/10.1167/iovs.17-21832
• Hansen, M. B., Abràmoff, M. D., Folk, J. C., Mathenge, W., Bastawrous, A., & Peto, T. (2015). Results of Automated Retinal Image Analysis for Detection of Diabetic Retinopathy from the Nakuru Study, Kenya. PLOS ONE, 10(10), e0139148. https://doi.org/10.1371/journal.pone.0139148
• Bogunović, H., Kwon, Y. H., Rashid, A., Lee, K., Critser, D. B., Garvin, M. K., Sonka, M., & Abràmoff, M. D. (2015). Relationships of Retinal Structure and Humphrey 24-2 Visual Field Thresholds in Patients With Glaucoma. Investigative Ophthalmology & Visual Science, 56(1), 259–271. https://doi.org/10.1167/iovs.14-15885
• Lee, K. (2012). Distribution of Damage to the Entire Retinal Ganglion Cell Pathway. Archives of Ophthalmology, 130(9), 1118. https://doi.org/10.1001/archophthalmol.2012.669
• Staal, J., Abramoff, M. D., Niemeijer, M., Viergever, M. A., & van Ginneken, B. (2004). Ridge-Based Vessel Segmentation in Color Images of the Retina. IEEE Transactions on Medical Imaging, 23(4), 501–509. https://doi.org/10.1109/tmi.2004.825627
• Abramoff MD, Staal J, Suttorp MSA, Polak BC, Viergever MA. Low level screening of exudates and haemorrhages in background diabetic retinopathy. Proceedings of the 1st International Workshop on Computer Assisted Fundus Image Analysis. Copenhagen, Denmark, May 29–30, 2000: 15.

References[edit]

External links[edit]

• Michael Abramoff at the Roy J. and Lucille A. Carver College of Medicine