Scanning the Eye Care Horizon

What major projects are you currently involved with?
 

Ophthalmology and vision research have been central to my career for over 20 years. Currently, I am building and training teams to support the growth of the companies and organizations that my husband, Farhad Hafezi, and I have founded. In Europe, we now rely on a trusted team to oversee the daily operations of our two ELZA clinics in Zurich – the original clinic located in an industrial area called Dietikon and our new site at the main train station (Zurich HB) in Zurich – as well as our medical device company, EMAGine, and the various activities linked to our research laboratory and non-profit organization.

Since 2021, Uzbekistan has been a major focus for my consulting firm, GroupAdvance Consulting. Our largest project at the moment is establishing the National Eye Institute, Uzbekistan (NEI-UZ), which has four primary objectives: medical education, clinical training, outreach/access, and research. Importantly, NEI will not only introduce modern technology to Uzbekistan, but also train professionals in its use. To ensure that the training is at the highest level, I have established a local medical device distribution company in Uzbekistan that prioritizes education and service training as core elements of the business.

My long-term goal is to set up a network of ophthalmic medical centers in Central Asia. Currently, I am in the daily operations in Uzbekistan, but I hope that my role will evolve into an advisory board member. Regardless of the role, I plan to support the development of future leaders, ensuring that they have the skills to manage daily operations. I will know if I reach the goal if the future network of medical centers will be locally managed as well as guiding many of the future leaders onto international career paths. Already, we see there are so many bright, multilingual, and eager young people in Uzbekistan, so I hope that this goal will be achieved soon.

You've been involved in developing new corneal cross-linking (CXL) technology into real-world applications. Can you talk about your vision for this technology?
 

Since 2012, Farhad and I have been joined at the hip in the development and commercialization of a CXL technology through a SMART approach: Small, Mobile, Affordable, Reliable Technology. Initially, our goal was to develop the technology, secure CE marking, and then expand internationally. However, when you create a start-up, your business plan changes on a daily basis. No one expected COVID-19 to have such a dramatic and substantial impact on the world. Despite these challenges, EMAGine launched its product into the international market in October 2020.

Now, four years later, EMAGine has established a distribution network in over 70 countries. While we made significant efforts to increase accessibility, diagnostic tools in some low-to-middle-income countries (LMIC) were still lacking. This void led us to develop another medical device for corneal screening and diagnosis, once again using the SMART approach. We created a handheld Placido-based topographer that used the camera and processing power of a smartphone to capture and process images to detect corneal irregularities. This prototype was tested in two Swiss clinics, and its imaging was comparable to modern devices such as the Oculus Pentacam and CSO Italia MS-39.

My vision for this technology is to facilitate early detection of the leading cause of preventable blindness – keratoconus – which is especially prevalent among children and adolescents, and to generate data for AI-driven diagnostics to reduce the risk of human error in interpreting diagnostic measurements.

What steps should ophthalmologists take before introducing new technologies or treatments into clinical practice?
 

Patient satisfaction is probably the most important aspect of building a successful clinical practice, yet it can be interpreted in many different ways. When considering the introduction of a new medical technology or clinical application in their clinical practice, ophthalmologists should consider the following:

• Has the proposed device/application been clinically proven through peer-reviewed publications?
• What alternatives are available? What benefits does this new option provide for patients?
• Do you have a sufficient patient base to achieve a relatively rapid return on investment?
• Do you fully understand how the new technology works? What additional training would be needed to fully understand the software or other components?
• Is the manufacturer or distributor reliable for service and support?
• Have you sought feedback from trusted colleagues about their experiences with this technology or application?

It is also essential to assess at each stage of development whether the end result will drive demand for the product. We must keep the customers in mind. Certain other elements need to be considered during the development process:

1. Are there existing alternative treatments or technologies to what you are proposing?
2. What is the end user willing to pay for this treatment?
3. Have you considered the specific requirements of any potential high-volume users?
4. Are there intellectual property (IP) rights related to the application (process or method) or consumable/device that can be protected?
5. Have patent searches been performed and freedom-to-operate reports been generated?
6. Have you decided on a selling model (B2B, B2C, etc.) for these products, applications, or software?
7. How steep is the learning curve for future users, and how will training and education be structured?
8. What do you as the investor want to ultimately achieve?

I also recommend incorporating “reverse thinking” – considering potential acquisition – when developing the business plan. This way, you will identify what brings value to the company, enabling you to focus on those areas as priorities. Sometimes, it has less to do with the technology itself and more with securing your IP.

What do you still hope to accomplish within the field of ophthalmology?
 

Besides the commercial success of my business ventures, I aim to accomplish three key milestones:

• Establish public policy for standardized eye and vision care as part of a future national healthcare program in Central Asian countries, grounded on the principles of modern medicine.
• Enhance medical education and clinical training for ophthalmology students in Central Asia and beyond by connecting them with an international network of key opinion leaders.
• Introduce optometry as a discipline in the Central Asian region to improve access to quality basic vision care at affordable prices.