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Innovation critical to meet future eye care needs
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Most innovations in ophthalmology originate from a challenge faced by a practicing clinician. It is the clinician in the arena face to face with patients and their problems who first recognizes the unmet needs and looks for answers. Disruptive examples of clinician-driven innovation include IOLs, phacoemulsification, YAG laser posterior capsulotomy, laser therapy of retinal disease, LASIK, anti-VEGF treatment for wet age-related macular degeneration, mechanical vitrectomy and all the MIGS procedures, to name only a few.
While it is definitely an ophthalmologist’s duty to diagnose and treat current patient eye disease with today’s available drugs and devices, I believe it is also the duty of the ophthalmologist to define the unmet needs for the preservation, restoration and enhancement of vision, both for the individual patient and for society as a whole. However, just recognizing the problems and unmet needs is not enough. The committed ophthalmologist, usually in collaboration with others, including scientists, investors, industry, our professional societies and, yes, even government agencies, needs to engage in the process of finding solutions to the problems identified. Then, once solutions are developed, the clinician ophthalmologist must help disseminate the new knowledge to colleagues. I call the process by which solutions to problems evolve the innovation cycle.
Innovation is the art of introducing something new. Research is not the same as innovation. In the clinical world, basic science research applied to an unmet patient need is innovation. The barrier between basic science research at the bench and useful treatments at the bedside requires the engagement of clinicians and is often called the translational gap. Innovation can be incremental, which is more common, or disruptive. Disruptive innovation often topples industry leaders and creates new ones. It is no small challenge to be an innovator, and the commitment required is significant in both time and capital. Yet, taking one’s own idea from concept to clinical reality can be extraordinarily rewarding personally, professionally and financially.
After 45 years of toil in the innovation arena, both pursuing my own ideas and helping others pursue theirs, I have developed a top 10 list of attributes for an innovation worth pursuing and funding with the necessary human and financial capital.
1. The innovation must resolve an unmet, poorly met or partially met need. Copycat “me too” duplicates have a commercial role to play, but they are not innovations.
2. The potential market size must be meaningful.
3. There must be a delivery channel for the innovation.
4. The inventor/innovator must protect the idea with patents or trade secrets to create a moat against competition.
5. The inventor/innovator must surround themselves with quality advisers and management.
6. The prior art and potential competition must be fully understood and evaluated.
7. There needs to be an exit strategy for a product or technology once developed.
8. A careful, thought-out business plan is a must.
9. Loved ones need to be on board and willing to tolerate the personal time and capital commitments required.
10. The timing must be right for the innovation. Some ideas are before their time and some are dead on arrival as other better innovations replace them before they are commercialized. Over the years I have found timing to be critical to commercial success for any innovation. For example, now is not the time to develop a better suture for cataract surgery or a solution to eye protection for those living on Mars.
There is a rhythm to innovation, with early prototype development, often failures to perform accompanied by learnings, and back and forth from research bench to research bench and then research bench to bedside. This is then followed by rigorous regulatory oversight and very expensive clinical trials. Then, commercialization. It is sad but true that many innovations that survive the huge investments of human and financial capital required to prepare them for commercialization will then fail in the marketplace.
The process is long and arduous, but also uniquely rewarding. Ophthalmology has generated some of the leading clinician innovators in medicine. We ophthalmologists can be rightly proud of that legacy. Unfortunately, we have also at times discouraged and obstructed those pursuing meaningful innovation. Innovation usually leads to changes in practice patterns and treatments, which can be threatening to some, but innovation in drugs, devices and care delivery models is absolutely critical in resolving our patients’ and our societies’ future eye care needs.
Disclosure: Lindstrom reports he has 40 patents.