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Inspiring Innovation

Can you tell us a little about your career journey so far?

My career journey has been rather unorthodox! During my ophthalmology residency, one of the things that I noticed in our area of South Carolina there was very little care for people with ocular cancer – so I went to Wills Eye Hospital for a couple of years of training in ocular oncology, then came back six years ago to create an ocular oncology practice where I also do some medical retina work.

In parallel with that, I earned two degrees – one a Master’s of Business Administration, the other a Master’s of Applied Economics. Together, they ultimately led to my role at Lexitas, a contract research organization solely dedicated to ophthalmology. I began there as Chief Medical Officer, but about six months in, I became CEO, a position I’ve held for over two years now.

I feel like I have the best job in the world because I get to work with a lot of different biotech and pharma teams as they develop amazing new medicines and devices to treat patients with serious eye conditions. I think of us as a product development organization because we partner with companies to get their products all the way from animal studies to approval. At any one time, we’re working on 30 to 40 products – so it’s challenging, but a lot of fun!

I also still see patients on a part-time basis. I do that because I love it and it keeps me connected to our ultimate mission at Lexitas, which is to get more safe and efficacious medicines to patients.

What are your thoughts on the relationship between ophthalmology patient care and industry?

I think everybody’s goal is to develop new medicines to change the lives of our patients and, to do that, you need a sustainable business model. Without industry, there would be significantly slower development of new products. Just look at what Eylea and Lucentis have done. They have been transformational! Solutions to those problems would not have happened as rapidly or effectively without industry support.

After all, as a doctor, if I don’t have medicines to give to patients, I can’t do much. There’s no treatment for geographic atrophy right now – but, because of industry working with academia, there may be in the future. I think that industry is fantastic at identifying good science and putting significant resources behind it. We (rightfully) must run extremely rigorous trials to prove that medicines are safe and effective before they reach patients, but that’s a risky, expensive, and time-consuming process that is very hard to be done without industry support.

There are challenges, of course; there will always be a degree of profit motivation! After all, the promise of a substantial return is why investors are willing to put tens of millions of dollars on the line to develop products. It’s entirely reasonable for everybody involved to be rewarded for the risks they take and for the innovations they create – but (rarely) it can get out of hand when people try to exploit the system. Unfortunately, when that happens, it erodes the trust between industry and society – so it is critical that there are checks and balances within the system. They can come from government, industry, or even individual physicians. Doctors need to be willing to call colleagues and industry when it gets out of line...

What do you think of the current models for drug financing in ophthalmology?

We’re fortunate in ophthalmology that early-stage venture capital funds, such as Ex-Sight Ventures or Infocus Ventures, sometimes come in to help fill gaps in the development process. Funds like these fulfill a critical role by providing Series A capital to companies that have a great idea,but need a funding boost to finish their first study. It’s an incredibly high-risk scenario – most drugs never reach the approval stage. The availability of early stage capital has been a game-changer in ophthalmology over the past couple of years and we are very fortunate to have amazing early stage venture capitalists willing to invest in our area.

The next step in the process comes with a bigger check, usually from venture funds that have identified ophthalmology as a key investment area. These are critical for getting proof-of-concept data. After that, you’re looking at funding phase three, at which point the risk is generally lower and more around the commercialization of the product. Traditionally, this has been done in ophthalmology by either a strategic acquisition or the public markets – going into an IPO. Unfortunately, the IPO market has had a hard time over the past year and that situation will likely continue for another year or more. This has created a gap that will inevitably be filled by strategic acquisitions. We know, for a host of reasons, that large, publicly traded pharma companies have healthy balance sheets, giving them the ability to engage in strategic mergers and acquisitions as the valuations in the IPO market have fallen.

I think that, for the investment community, ophthalmology is interesting because we are a niche investment area. We’re not oncology or cardiology; we’re a smaller segment of medicine, but one that has been supercharged by some amazing successes. I mentioned Eylea and Lucentis earlier; another example would be Spark Therapeutics’ LUXTURNA or Horizon’s TEPEZZA. For a small specialty, we have a lot of great success stories. Those successes have led to a significant increase in venture capital funding.

What do you think of the increasing prevalence of AI in ophthalmology?

I think AI and deep learning algorithms can transform the way we deliver medicine. Right now, our diagnostic capacity is limited by the patterns humans can recognize in images (for example, OCT scans to diagnose retinal diseases). AI, deep learning, and machine learning offer the opportunity to build algorithms that can personalize medicine by detecting patterns that we as physicians are not able to see. Just look at diabetic eye disease; some patients respond well to VEGF inhibition, others respond well to inhibition of the inflammatory pathways, and some progress despite treatment. I think there will be a revolution when computers can examine all the data – genetics, visual acuity, sensitivity – and create an algorithm that predicts which patients will respond to which treatments.

How cool would it be if we could distinguish the patients who are likely to respond from those whose condition is likely to progress? It makes sense to try to get the right medicine to the right patient at the right time and I think computers will be an integral part of that endeavor.

What have been the biggest ophthalmology innovations in recent years – and what’s on the horizon?

We’re moving away from some broad treatments, such as steroids, and toward precise treatments that address the underlying pathophysiology of a disease. For example, we have multiple steroid-sparing immunomodulating drugs in trial now. Immunology has been an amazing field for oncology and rheumatology over the past decade or so, and ophthalmology is next. The immune system plays a role in almost every retinal disease, so why not see what we can gain by targeting it?

Another example of the trend toward precision medicine is LUXTURNA, a gene therapy for RPE65-associated retinal dystrophies. Its approval opened up a treasure chest of development and we now have many companies working on incredibly precise genetic pathway modifications for a variety of inherited retinal diseases. These targeted treatments that address the true underlying pathophysiology of disease are where ophthalmology’s future lies, at least from a retina standpoint.

What do you think is the best thing about working in ophthalmology?

The best thing about being an ophthalmologist is the amazing impact you can make on patients. Our patients come to us because they’re going blind. It’s an incredibly serious thing and I consider myself doubly privileged because I not only see the patients and the impact treatment has on their lives, but also get to be involved in a small way in developing those treatments.

What are some of your interests outside ophthalmology?

I have four kids, so I spend most of my time playing with them. That’s what I really enjoy when I’m not at work. So that’s my life: caring for patients, developing new treatments, and hanging out with my family.

If you weren’t an ophthalmologist, what would you be instead?

It was really late in medical school that I fell in love with ophthalmology. Before that, I was interested in pediatric cardiology. So that’s probably what I would be doing if I weren’t in ophthalmology. If I weren’t in medicine, though, I have no idea what I’d do – I probably wouldn’t be good at anything else!

What was the moment that made you realize, “Ophthalmology is for me?”

When I was rotating through the ophthalmology clinics at the Medical University of South Carolina (MUSC), there were two physicians, Charles Beischel and Joe Lally, working in general ophthalmology at MUSC. Working with them, I saw firsthand how they impacted people on an almost immediate basis and in a really deep way. They were both steady, consistent, and helped patient after patient day in and day out.  The impact their treatment and surgery made on patients was amazing to see.  Later in residency, they, along with many others, taught me what it meant to be a surgeon. The precision, focus, repetition, and constant refinement you need to foster in order to achieve excellent, consistent results. I’ve watched them, and many others, truly change people’s lives with their care. Those two people and their clinics were all it took to make me go all in on ophthalmology.

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About the Author
Jon Greenaway

After almost a decade working in academic writing, I wanted to find a new challenge that would let me keep telling stories, learning new things and experiencing the excitement of scientific innovation. That’s what makes The Ophthalmologist a perfect fit for me.

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