Medical digital twins: pioneering a paradigm shift in glaucoma care and beyond

To the Editor, Digital technology is a highly potential approach to increase medical quality. Recently, several excellent studies published in International Journal of Surgery confirmed its beneficial impacts on the therapeutic stratification[1], surgical decision making[2], and efficacy prediction[3]. For instance, digital medicine can effectively decrease the incidence of in-hospital complications for patients with complex periarticular fractures[2]. A novel digital assessment provides valuable information regarding the responses to adjuvant chemotherapy and immunotherapy for gastric cancer. These findings give us a great inspiration, that is, medial digital changes the traditional therapy paradigm. In this context, medical digital twins (MDTs) have garnered much attention in recent years. MDTs combine diverse health data streams and disease modelling to produce a dynamic copy of a patient that guides the clinical team toward personalized treatment while alleviating workload[4]. As a long-time practitioner of clinical work, traditional clinical assessments often lack personalization and rely on standardized processes that may not meet the diverse needs of patients, especially for cancer patients or chronic illness[5]. Therefore, we have consistently supported the adoption of computational modelling to advance chronic eye disease management. The precision medicine based on multimodal data and disease modelling will advance policy discussions by integrating disruptive elements, such as targeted disease examples, interactive diagrams, and analytic-mechanistic fusion. From our glaucoma nursing practice, we applaud the potential of MDTs to reshape evidence, enhance bedside utility, and provoke high-level debates. We outline these merits below, using anonymized cases to demonstrate practical relevance. The benefits of medical digital for fracture and cancer patients effectively span acute and chronic conditions, enabling generalization to areas like glaucoma without more additional data[2,3]. This counters disease silos in policy writing and supports extension to glaucoma’s gradual course, marked by pressure variability, optic nerve changes, and field loss. For example, in a 58-year-old man with open-angle glaucoma (pressures 20–28 mmHg), optical coherence tomography showed fiber layer thinning influenced by altitude. MDTs could harmonies sensor and genetic data to simulate beta-blocker tweaks, anticipating a 5% slower cup-to-disc progression over 3 months. This innovation questions reliance on randomized controlled trials, inviting debate on shifting to n-of-1 models and guiding policy toward patient-centric funding. Building on this, the framework diagram’s depiction of interactions – data linkage, simulation, interface, and synchronization – accommodates adaptive noise correction in imaging, linking primary and specialist care[4]. In glaucoma, artefacts in fundus or topography scans often skew results; the diagram implies real-time fixes through coupled methods. Consider a 65-year-old woman with glaucoma and cataract, where noise caused 15% pressure misreads – the MDTs approach could refine post-trabeculoplasty forecasts to 14 mmHg stability, curbing inflammation. This fosters discussions on evolving imaging norms from static to dynamic, with policy calls for accessible tools in underserved areas. Furthermore, the fusion of analytics and mechanistic modelling extends prediction to counterfactual scenarios, refining surgical assessments in ophthalmology. For procedures like laser trabeculoplasty, it models fluid dynamics with lifestyle inputs. In a 52-year-old man with normal-tension glaucoma, simulations could compare outcomes, projecting a 10 mmHg drop and 30% slower field loss, adjusted for smoking. This challenges population statistics, sparking ethical talks on bypassing trial hurdles via individualized evidence and urging regulatory adaptations. Overall, this framework elevates MDTs as a driver of precision medicine, especially in glaucoma. These cases reflect our enthusiasm for its roll-out: partnerships could test expansions, reshaping systems for equitable, simulation-led care. This issue deserves recognition as a policy milestone, with scope for ongoing dialogue.