Better by Design

You’re an inventor. How do the ideas come – are they the result of lots of discussions, or are they just rays of inspiration entering the brain?

Rays of inspiration often come from many discussions and collaborations. I am part of the Chandler-Grant lineage of glaucoma-trained ophthalmologists. Chandler and Grant trained dozens of glaucoma specialists, including David Epstein and Joel Schuman, and their original teachings espoused the importance of being a clinician-scientist, and working collaboratively. I remember David Epstein explaining to me that all I need to do is listen to my patients to hear what problems are most in need of solving. I was also fortunate to train with Joel Schuman, who was part of the team that brought optical coherence tomography (OCT) to ophthalmology, and he was constantly thinking of new ways to approach old problems.

I think I am a product of my environment, as I was certainly encouraged to actively think through patient-centered problems, and not accept the “status quo”. Once our team identifies an unmet need, the problem is discussed in a collaborative atmosphere of MDs and PhDs, and we work together to find the best solutions. Often we fail, but we simply pick up the pieces and look for a new course. Sometimes we succeed in identifying a new surgical treatment or imaging approach, and this opens up doors for our team and our patients. I see my translational research as an integral part of who I am: a caretaker of patients.

You hold quite a few patents – what advice do you have for other ophthalmologists hoping to make their idea a reality?

The single most important piece of advice I can offer to current and future inventors is to never give up. Receiving a patent is often the culmination of years of research and hard work: many of the tools we take advantage of today, like phacoemulsification and OCT, are the product of a decade or more of laboratory research, and a lot of trial and error. I receive emails and phone calls from students or colleagues who want to discuss new ideas that they thought of when in the surgery or clinic, but over the past decade, I would estimate that only 1 in 50 of these initial ideas survived the first “roadbump” and carried forward to a point of further discovery. Make your persistence part of everyday life: persistence is the magic that takes a fleeting idea and pushes it towards a course that might lead to a real invention. When translating your research and inventing something new, you cannot expect rapid gratification. In my opinion, every patent issued should have a line at the top that reads: “Your persistence paid off!”

Of course, nobody can do this kind of work in a vacuum, and seeking proper advice is a cornerstone to advancing science towards patient care. Finding a mentor who can help guide your path through the minefields of prototype building, patent applications, fund raising and clinical trials is extremely important.

My final piece of advice centers on the idea of the “Go No-Go” decision. During the invention process, we always consider if what we are building is meeting our expectations, and if our original idea still holds promise as a solution to an unmet need. Sometimes we have to be honest with ourselves and come to the difficult realization that our idea is either not as novel or as practical to implement as we thought. This can be very difficult, given how invested teams are in their work.

Have you worked on a drug or device that you thought was going to be the next big thing… and it wasn’t?

More often than not, yes. I have many devices sitting on the shelf that I thought would be “the next big thing” but ended up being leap-frogged by another technology, or just not working as expected. But sometimes something special happens, and our product concept becomes a reality and helps patients around the globe. Two examples of this are the Kahook Dual Blade (KDB) and the Harmoni Modular IOL System. When I was working on a device to harvest trabecular meshwork for imaging, we quickly saw the potential for the KDB device as a surgical tool to decrease intraocular pressure. I was excited from the very early phases of development, because we recognized the elegant simplicity of our approach and the potential to reach all corners of the globe with a cost effective and energy independent procedure. The Harmoni Modular IOL System is another product that I was excited about from day one. 

You’ve made the Power List twice now. How does it feel?

Being named on the 2015 Top 40 Under 40 list was an honor, and the announcement garnered a great deal of attention in both my professional and personal circles. I even had some patients who found the list online and emailed to congratulate me! Being named on the 2016 Top 100 Power List – among those who I have admired since my early training in ophthalmology – is an honor that I am still processing and finding hard to articulate. 

I consider it to also be a tribute to the success of our group here at the University of Colorado, where we have created an environment of true collaboration and patient-focused research that I believe is second to none. Our translational research has reached tens of thousands of patients, and we’re just getting started.

What would you consider your greatest career highlight so far?

The greatest highlight – from an invention standpoint – is usually the device that I am developing at any one moment. I have received a tremendous amount of satisfaction from launching products that were born in the lab. It is hard to top that feeling, especially because the joy is shared with so many close friends and colleagues. One achievement, not related to research, that comes to mind is my work on the 5th edition of Chandler and Grant’s Glaucoma textbook, a text which has been viewed for many years as one of the seminal glaucoma textbooks. The last edition had been completed more than a decade ago, and the 5th edition update required a tremendous amount of work over late nights and weekends. I was thrilled to work with so many talented clinicians, including Joel Schuman, to refresh previous chapters and insert new knowledge.

What is your current research focus?

My device lab focuses on several aspects of treating ophthalmic diseases, ranging from glaucoma treatment devices to novel IOL materials and designs. We have also started new programs centered on drug delivery and ocular surface disease therapies with transformative potential. These are high risk and high reward projects that are in early clinical studies, but I hope we can share more details in the coming year.

What’s exciting you about ophthalmology right now?

The current atmosphere of innovation coupled with a refusal to accept the current state of affairs in ophthalmic care is very exciting. Multiple technologies are now coming to the market that we could only dream of when I was in residency, for example, next generation femtosecond laser technology. I think new femtosecond lasers will offer increased precision and energy efficiency, streamlining what needs to be done in the operating room and optimizing patient flow. I am anxious to try the new capsulotomy devices that are coming to market soon, like the Zepto from Mynosys and ApertureCTC from IBMD, since I have had a great interest in this arena with our own VERUS ophthalmic caliper. New optic technologies, like the Symfony IOL from AMO, are also getting a great deal of attention outside of the US and I am looking forward to providing this technology to my patients. From my own work, I am excited to share results of ClarVista’s Harmoni Modular IOL from several studies around the globe. It is worth noting that industry leaders in ophthalmology are significantly changing their approach to R&D and how they interact with small companies and inventors, and this is providing more opportunities to partner and impact patient care in a more meaningful way.

Where do you see yourself in 10 years?

I hope that components of my day-to-day work life will be much the same in 10 years. I enjoy seeing patients and performing surgery, both in the US and around the world. I also feel that our device development infrastructure at the University of Colorado has matured to the point that we can focus on game-changing technology using an effective system. This was a decade long effort, and I hope we can enjoy the fruits of our labor for the next 10 years and beyond. I do see myself getting more involved with different aspects of our startup companies, including learning more about the business side which I find tremendously interesting. I am sure the next 10 years will hold some surprises, and I hope to find opportunities to continue to grow professionally.

Any advice for the Malik Kahook of 10 years ago?

If I could make a call to myself 10 years ago, I would simply say: “The road ahead might seem long, but the lessons learned and life experiences are well worth the effort.”