#1. There’s no consensus on the best way to invest in innovation Some, like Ralf Kuschnereit from Carl Zeiss Meditec, believe that you need a balanced research and development portfolio. “Bets” can be small and quick (like improvements to a device) or long-term and big – for something truly disruptive. Calvin Roberts (Bausch + Lomb): “Mid-sized companies need to be agile and clever.“ He also said, that you should “balance your portfolio by risk, rather than by speed.” Murthy Simhambhatla’s (Abbott Medical Optics) view was that “Things have changed, now there’s no reward for incremental innovation.”
#2. Femtosecond lasers are almost certainly the future of cataract surgery From the surgeon’s perspective, Sheraz Daya (Centre for Sight) stated: “Once you go femto for rhexis, you don’t go back – as you can lose the feel of the manual rhexis if you’re not careful.” Julian Stevens (Moorfields) viewed femtosecond lasers as “pretty good”, with a great benefit being the ability to do intrastromal incisions. Patients perceive lasers as “good”, according to Allan Crandall (Moran Eye Center) and that “US advertising drives patients to clinics with femtosecond lasers.”
#3. Reimbursement is the issue that needs to be overcome before femtosecond-laser assisted cataract surgery becomes widespread. In essence, no play, if insurers won’t pay. Matteo Piovella (President of the Italian Ophthalmological Society) explained that “Femto reimbursement is impossible in my country” – politics. Béatrice Cochener (University Hospital, Brest) empathized: the French Ministry of Health trial looks like “it will be hard to demonstrate a robust health-economic benefit of femto-cataract surgery.” Soon-Phail Chee (SNEC): put it bluntly: “It’s simple – you need to show femto is safer than manual rhexis – and better – before insurers will pay.”
#4. Patients age – you’re fixing the problem as it is today, not as it will be tomorrow. Manage patients’ expectations! Sheraz Daya: “Current interventions are short-term. But the cornea changes, as do the effect of LRIs. Perhaps we should be thinking of the longer term?” Julian Stevens noted one aspect of presbyopia treatment: “Time passes. People get older. They come back!” #5. Gene and stem cell therapy are set to transform the outcomes of patients with ophthalmic disease... sooner rather than later. Majlinda Lako (Newcastle University) looks past the technical aspects: “Growing stem cells – those issues have been overcome. The regulatory hurdles are the next challenge.” Interestingly, the biggest advocates of this kind of research aren’t necessarily the charities: Sir Peng Khaw (Moorfields) noted that “Patients are often the biggest advocates of getting stem/gene therapy trials funded.” The metrics of success are hard to identify with gene and stem cell therapy – what outcomes should be used? Keith Martin (Cambridge University) explained that the overall impact of the therapy on peoples’ lives is what matters. “Many funders now want quality of life measures as efficacy outcomes in their clinical trials of gene and stem cell therapies.” Finally, Peng Khaw raised the stakes: “Stem cell regenerative therapy is as disruptive and game-changing as anything Apple or Google do.”
