Improvement and Innovation
For ophthalmology to progress, we need to take care of both.
“Innovation” is difficult to define precisely, but it has a noble, grand feel to it. As such, it’s a marketer’s dream. In my view, a lot of what is being termed innovation in ophthalmology would be more accurately described as incremental improvements to existing technology. For example, the FDA is adding better-trained staff and now offers fast-track assessments of new drugs and devices; this sounds like a practical improvement to me, but not an innovation – as it is sometimes presented as being. Similarly, innovations “in the cataract workflow” and “in titanium-handled instruments” are likely to be welcome developments, but they sound more like improvements than innovations.
This is not meant to be disparaging; in fact, the opposite. Improvements can be made by all of us, safely and (relatively) cheaply. And the combination of incremental improvements from multiple sources can amount to an innovation. Many problems are suited to such approaches. Think, for example, of the 75 percent of adult patients do not comply with their prescribed therapeutic regimens, including the 57 percent who admit that they forget to take their medications altogether. It’s going to take multiple incremental improvements to get patients taking the correct dosage of the correct medicine at the correct time; and what an impact it will have once we’re there!
Of course, there have been numerous “proper” innovations in ophthalmology over the past couple of decades, such as the revolutions in cataract, refractive and vitreoretinal surgery, and the transformation of the outcomes of patients with wet AMD. These developments have all been built on a single-minded focus on a novel solution, first by an individual and then from a team or a dedicated small company. This approach to innovation is a high-investment, high-risk pursuit, as a glance at the stem cell article on page 35 illustrates. Today it’s especially tricky, as the number of venture capital funds investing in health care is just one-third of what it was pre-2008. Hopefully the nadir has been reached and things will start to improve – as ophthalmologists are going to need two or three revolutions in the next decade to keep pace with demand.
My request: a focus on improvements to match that on innovation.
Richard Gallagher
Editorial Director
