- Integrating innovations into clinical practice
- Innovation and perseverance
- ‘Unexpected Bottlenecks in Glaucoma Innovation’
- The Winning Pitch Challenge
Eyecelerator @ AAO 2024 took place on Thursday, October 17, ahead of the 2024 American Academy of Ophthalmology (AAO) Annual Meeting. Stephen McLeod, MD, CEO of AAO, kicked off the programming, discussing how Eyecelerator plans to expand on themes across all areas of the eye, with programming to include sessions on the anterior and posterior segment, as well as regulatory pathways. The goal is to meet the broadening needs of our innovation community, he said.
Gil Kliman, MD, Eyecelerator Program Director, said this is “by far the largest innovation meeting for ophthalmology in the world.” One of the key things of Eyecelerator is the culture of collaboration and bringing everyone in the field together with the common goal of speeding up innovation, Dr. Kliman said, adding that, by serving our constituents, we hope to get to millions of patients who can benefit from the innovations that we can move forward faster.
Integrating innovations into clinical practice
Reginald Sanders, MD, led a session on the impact of practice dynamics on innovative therapies. He first shared a presentation on barriers to technology in ophthalmology.
Dr. Sanders mentioned what he considers some of the unique barriers in ophthalmology: unclear clinical benefit, technical limitations, regulatory hurdles, financial barriers, disrupting established practice, and cultural resistance.
The bottom line, he said, is better patient care. In the end, there is only one reason we do this, and any new technology needs to achieve this benchmark. It’s not possible until you identify all the potential barriers and solve them.
He then moderated a panel with David Eichenbaum, MD, J. Michael Jumper, MD, Cathleen McCabe, MD, Erin Powers, Lejla Vajzovic, MD, and Charles Wykoff, MD, PhD.
Discussing the best advice to give to a company looking to commercialize a product to anticipate potential barriers, Dr. Eichenbaum said you need to listen to the prescribers; the customers will show you the way. If you have a product that seems wonderful internally and you bring it out to the community, follow their lead because it’s going to require the organic adoption of the community to be a commercial success.
Dr. Wykoff echoed these thoughts, saying that it’s important to talk to as many people as you can. He noted that he’s seen a lot of companies go wrong because they have a core group that they talk to and miss the bigger picture. You also should make sure you’re addressing a true unmet need for patients, he said.
Ms. Powers said that she sees it as an “education of collaboration.” Industry is educating surgeons on new technology and application, and surgeons are educating industry on actual application, and you need a good cross section to understand what the success will look like.
Dr. Jumper said there may be times when industry has an idea for an incredible product but there are big barriers for surgeons, like when they are going to find OR time to use this or how they will get reimbursed. These are things that we have to work together on, he said, adding that big societies can also help in these efforts.
Dr. Eichenbaum said he finds that barriers will become self-evident rapidly after commercialization. The things that come up early as problems remain problems, he said, cautioning that it’s important not to ignore the early issues.
Discussing potential barriers to technology adoption in the OR, Dr. Jumper said when you are the boots on the ground in OR, these great technologies may be difficult to incorporate. New, expensive products may be a hard sell.
Dr. Vajzovic said another barrier is introducing large equipment into the OR space and identifying workflow in the OR. You also must have clinical advocation for the new technology.
Dr. McCabe said cost becomes a big issue, particularly how you justify the price of technology.
It’s important to partner and collaborate to come up with data to back this up.
The times when industry and the medical field work best is when we’re working together in a positive way for the patients, Dr. Jumper said.
Dr. Eichenbaum added that the value needs to translate to the patients. They need to see out-of-pocket costs going toward something they see as a true life benefit.
Innovation and perseverance
The inaugural Eyecelerator Innovation Award was given to Leonard Schleifer, MD, PhD, President and CEO of Regeneron, and George Yancopoulos, MD, PhD, President and Chief Scientific Officer of Regeneron. They had a discussion with Robert Avery, MD, and Allen Ho, MD, about their experiences.
Dr. Yancopoulos stressed that this is one of the hardest businesses in the world. There are thousands of biotech companies, so the odds of coming up with a drug are against us. He noted the importance of “shots on goal.” We decided to come up with platforms to give shots on goal, he said.
A larger panel discussion featured Dr. Schleifer, Dr. Yancopoulos, Pravin Dugel, MD, Cedric Francois, MD, PhD, David Guyer, MD, and Dan Schwartz, MD.
Dr. Dugel said one of the hardest things as a physician is saying, “I don’t have certain skills and need to learn those skills.” When you’re a leader in a company, the hardest thing to do is to trust
‘Unexpected Bottlenecks in Glaucoma Innovation’
Nathan Radcliffe, MD, and Oluwatosin Smith, MD, moderated a panel discussion focusing on glaucoma and factors that may slow or block innovation. Panelists included Gus DeMoraes, MD, PhD, MPH, Kate Hunt, Rajesh Rajpal, MD, Andrew Stewart, and Ramin Valian.
Mr. Stewart said he thinks it’s a mistake to look at innovation at any specific point in time. After you develop something, you’re not finished innovating, he said. You’ll innovate when you bring it to market, commercialization, in explaining the value proposition, etc. There’s innovation at every stage of the lifecycle.
Panelists were asked what they’d like to change about FDA collaboration and clinical trials while still maintaining safety and efficacy. Dr. DeMoraes said he’d like to see quicker channels of communications, which would help answer concerns more quickly. The agency does a great job of maintaining safety for patients, he said, but it would be helpful if they could communicate what they want to see more quickly. Dr. Rajpal agreed that early feedback is critical.
Ms. Hunt noted how she thinks the United States has progressed more rapidly than other areas of the world in terms of thinking about interventional glaucoma. There has been a change in surgical mindset and intervening with less invasive MIGS methods. America has adopted this beautifully, she said, but other pockets of the world are behind.
Commenting on how companies decide on where to spend their funds, with the caveat that some companies do more in the glaucoma field than others, Dr. Rajpal said we have the ability to offer pharma, laser, and surgical options that treat early-, mid-, and late-stage glaucoma. Speaking about Johnson & Johnson Vision specifically, he noted that the company has historically had a severe, end-stage product only. But we’re now realizing that we have to offer other products that align with what we already do with our customers, our surgeons. For example, surgeons who are using some of the IOL products may also be treating early- to mid-stage glaucoma, he said.
The Winning Pitch Challenge
Vance Thompson, MD, and John Berdahl, MD, moderated the popular The Winning Pitch Challenge. Three finalists presented during the session.
First place: Avnish Deobhakta, MD, Avant Sciences Inc.
Dr. Deobhakta presented on evapRet, a retinal tamponade. Existing retinal tamponades are not ideal, he said. Tamponades are used to stabilize the retina during retinal detachment repair, both during and after surgery. Liquids must be removed, and gases do not tamponade the inferior retina. Liquid tamponades are especially not ideal because they are difficult to remove, and there is potential for retention, inflammation, and subretinal migration.
Evaporative heavy liquids are ideal, he said. The liquid turns into gas within the eye, and there is no requirement for removal, as it is eliminated in the same manner as gas. As a surgical tool, retained evaporative heavy liquid will never occur by design, and he said this can provide superior and inferior tamponade. There is also the possibility of immediate use within the clinic itself, without a trip to the OR.
evapRet is a first-in-class evaporative retinal tamponade. Dr. Deobhakta said it offers a number of benefits: optically clear, heavy, evaporative, animal tested, non-toxic, safe synthesis, flow chemistry, and proprietary. Market opportunity for retinal tamponades is growing. evapRet is highly competitive. It is cost effective at scale and offers many benefits over other options, he said.
Second place: Brandon Kingrey, MD, OphthoScope
Dr. Kingrey presented with Jibran Sharieff, MD, on their smartphone fundus photography technology. The problem is that non-ophthalmologists cannot examine the optic nerve easily, they said. The direct ophthalmoscope is difficult to use, and life-threatening and vision-threatening disease can go undiagnosed.
OphthoScope is a smartphone attachment that allows anyone to perform fundus photography. The images can be sent for telemedicine or AI review, and it can help diagnose life-threatening and vision-threatening conditions.
The product is affordable, and it can be manufactured for less than $5. It’s also easier to use than the direct ophthalmoscope, they said, and there are no dilating drops (pupillary dilation is not necessary). It stands out from the competition because it’s inexpensive and easy to use, allowing for wide adoption, Dr. Kingrey said.
Third place: Allen Eghrari, MD, MPH, GloVD
This product is an OVD composed of fluorescein-conjugated hyaluronic acid. Dr. Eghrari noted the need for this product because of the problem of retained viscoelastic leading to elevated IOP following surgery.
OVD is almost impossible to visualize, he said. Wouldn’t it be great to see your OVD? He noted there have been some prior innovations looking at this.
This new product would let you see OVD even through corneal edema. He also noted that the fluorescein does not significantly affect OVD material properties or stain IOLs. He noted that the product is supported by a provisional patent.
The OVD market size is $2.7 billion and expanding every year, and 94% of global market share is held by six companies. Dr. Eghrari noted three target segments this product would be targeting: premium IOL cases, glaucoma (high risk) cases, and trainee cases.
Editors’ note: The speakers at Eyecelerator have financial interests with various ophthalmic companies.
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