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Unmet corneal needs attracting investment, innovation
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In a previous commentary in the July 25, 2017, issue of Ocular Surgery News, I briefly reviewed the innovations occurring in the field of corneal transplantation that are discussed in greater detail by my colleagues in the accompanying cover story. In that commentary, I suggested that these innovations would challenge our current 50-year-old system of eye banking and lead to change and consolidation. That thought generated a storm of controversy.
In several previous commentaries, I have discussed the almost magical power of the innovation cycle in combination with the investment of adequate human and financial capital in resolving the unmet needs of our patients. In the innovation cycle, an unmet need is recognized, usually by an astute clinician seeing patients in the trenches. Then, solutions to that unmet need start as ideas in the minds of innovative clinicians and the scientists who collaborate with them. These ideas are first tested on the research bench and in animal studies and later translated to first-in-human clinical trials. Much learning occurs in the process. Once a solution to an unmet need appears promising, it is tested for safety, efficacy and comparative value with the currently available treatments in demanding and expensive regulatory trials. For the one in 20 ideas that makes it through bench research, human clinical trials and regulatory barriers, there remains the ultimate test. The ultimate test is a successful clinical launch and adoption by dedicated altruistic physicians toiling daily to do the best thing for each individual patient. These physicians are very demanding and in general take no prisoners in their adoption or rejection of new devices and drugs when treating their own patients. Many promising ideas that achieve regulatory approval fail in the unforgiving crucible of broad clinical acceptance and adoption.
The innovation cycle is expensive and time consuming, but it is only through innovation that we can resolve the unmet needs we physicians and our patients face every day. Innovation can be incremental or disruptive. Incremental innovation is easily adapted to by most physicians and the institutions and companies that support them. Disruptive innovation is another story. As the name suggests, it is disruptive to physicians, institutions and companies. Disruptive innovation has been defined by some business experts as innovation that topples market leaders, including practitioners, companies and other institutions engaged in the field.
There is no doubt that some of the innovations being pursued in the field of cornea, while potentially extraordinarily positive for the patient with a visually significant corneal disease, dystrophy or degeneration, are also likely to be disruptive to some. Innovation and change always offer opportunity for those who embrace it but, sadly, pain and disruption for those who do not.
If only a few of the amazing preclinical and early clinical innovations mentioned in the accompanying cover story are successful and become commercially available worldwide, we corneal surgeons and the companies and institutions that support us will experience disruptive innovation with all of its ramifications, positive for some and negative for others.
Disclosure: Lindstrom reports he is a consultant for Alcon, Bausch Health, CorneaGen, Johnson & Johnson Vision and Zeiss.