Eyeworld

EW FEATURE 35 giving you most of the time for free. Sometimes people reject your device for very good reasons, as if the de- vice isn't good enough for them. Sometimes you will find in this re- jection issues you have to work on and improve. Every rejection is an opportunity." By 2003, Optonol had improved upon the implantation procedure. It took some time to convince those who previously rejected the device to give it another go, but eventually the EX-PRESS mini shunt caught on. The company was sold to Alcon in January 2010. "We knew that this was a good device. We knew it was a success story," said Mr. Yaron. "The question was how big you have to be with marketing. In order to sell a device these days you need marketing. If we wanted to make it big, we needed a big company to take it, and Alcon is a wonderful company. We were too small and understood we could- n't do it by ourselves." Mr. Yaron left Optonol in 2011. He has since started a new company, but not in ophthalmology. His best advice to budding innovators is if you have an idea, pursue it. "It could be a good solution the world will benefit from," he said. "Statistically, you will probably fail, but it's important that those who have ideas try to get them into the market. The world needs new ideas." Eugene de Juan, M.D., and ForSight Labs Dr. de Juan is an ophthalmologist, academic, and innovation Renais- sance man. He's had his hands in a little bit of everything from aca- demic research and development to a small business out of his garage to a full-fledged ophthalmic device in- cubator called ForSight Labs. At Johns Hopkins University, he was co-director of vitreoretinal sur- gery and developed 100 or more in- struments, such as flexible iris retractors. He also ran the Micro- surgery Advanced Design Labora- tory, or MAD Lab, where he worked with a team of engineers, post docs, technicians, machinists, and young doctors to invent technologies and procedures such as minimally inva- sive transconjunctival surgery. "There was an idea that I pushed that there must be a way of simplifying the opening and closing of vitreoretinal access to the vitreous cavity for retinal surgery, much like clear corneal sutureless surgery for cataracts," he said. "We worked on that for about 3 years. On one hand it was a minor change, but it was a minor change that saved roughly 15 minutes at the beginning of the op- eration and 15 minutes at the end of the operation." It also lessened the post-op re- covery time, eliminated the astigma- tism induced by the sutures, and improved the patient experience. "It's now become the standard practice for vitreoretinal surgery," he said. "That's an example that proba- bly [resulted in] 20-plus innovations just in the one change of going from a conjunctival incision to a suture incision to no conjunctival incision and no sutures for vitreoretinal sur- gery." Dr. de Juan left Johns Hopkins and the MAD Lab about 10 years ago and moved to the University of Southern California, where he cre- ated the Doheny Retina Institute. The Institute was focused on devel- oping innovations for treating blind- ing retinal disorders through retinal transplantation, macular transloca- tion, robotic surgery, and retinal im- plants. "We tried to organize the group much like a business but within an academic structure," he explained. "We took on business-like structures and titles. We were actually quite productive there. But it was too much to try to do. You can't create a pure business within a structure like a university." Six years ago, Dr. de Juan left the Doheny Retina Institute to begin ForSight Labs. In addition to acting as founder and vice-chairman of For- Sight, he works part time at the Uni- versity of San Francisco, where he holds the Jean Kelly Stock Distin- guished Chair in Ophthalmology. "As you live life you learn a lot of things," he said. "One thing I learned is universities are wonderful places that are quite fertile with ideas and young minds and efforts. They are perfect at putting smart people, particularly students and professors, together. But they are non-commercial organizations. They are really for teaching, and discovery and research secondarily." ForSight Labs is an ophthalmic incubator that develops new compa- nies designed to target a major prob- lem within ophthalmology. An incubator can mean many different things and come with a variety of services, from help with business ba- sics to intellectual property manage- ment. In this sense, an incubator is a company that develops other com- panies and technologies. "We call it an incubator, but it's really serial entrepreneurs starting one great company every 12 to 18 months," Dr. de Juan explained. "We tend to focus on a significant unmet medical need within the area of ophthalmology—glaucoma, dia- betes, drug delivery, corneal dis- ease." ForSight has started five compa- nies since its inception. The first was called Transcend Medical, which centered around the CyPass Micro- Stent device for glaucoma.The sec- ond company, called Vision2, developed a punctual plug drug-de- livery system, and after about a year of development, the company was purchased by QLT Inc. A third company, Nexis Vision Inc., is developing next-generation ocular surface technology. The first application targets the global corneal refractive surgery market. Fi- nally, the fourth and fifth compa- nies are called Vision4 and Vision5. Vision4 is in the beginning stages of tackling retinal disease, and Vision5 is evaluating a variety of technolo- gies for other unmet needs in oph- thalmology. Each venture ForSight creates is a single-device company. Like Mr. Yaron, Dr. de Juan stressed the importance of focusing a com- pany's efforts on one device at a time. "ForSight creates companies to solve big problems. One big problem solved is good enough, right?" he said. "If you're going to build the Taj Mahal, you need to worry about every detail of building the Taj Mahal because that's complicated enough. If you're going to build something magnificent and it's worthwhile to do so, it's worthwhile to have the team focused on it." In addition to his experiences on an academic and incubator level, Dr. de Juan has attempted and actu- ally succeeded at the most difficult type of innovation possible: starting a company totally from scratch in his garage with his brother-in-law. Literally. "The hardest way is doing it yourself, deciding you're going to start a company with your brother- in-law out of your garage because he knows how to spell business and you know how to spell ophthalmol- ogy, so you've got everything cov- ered," Dr. de Juan said. "I can tell you, you shouldn't do that. It's not good thinking. But on the other hand this was really successful. I made a lot of money, but not with- out near-death experiences. My brother-in-law went without pay for almost a year." Obviously, not everyone will have Dr. de Juan's success, which is why it's important to enter entrepre- neurship carefully and responsibly. As Dr. de Juan advised, don't expect to make a million on your first med- ical device. The realistic expectation is the idea will flop. But that doesn't mean you should sit on your hands either. "The worst thing you can do is nothing," he said, echoing similar thoughts that Mr. Yaron had on the subject. "If someone steals your idea and it gets to the patient and makes millions of patients better, is that so bad? We have to have that kind of mentality that our primarily goal is to make people better and enhance their quality of life. If that's our pri- mary goal, the business goals typi- cally follow." If you do have an idea, Dr. de Juan recommended writing it down and discussing it with some trusted friends. Don't be too concerned about someone hijacking the idea and making a million. That rarely, if ever, happens. "Just give the idea away al- most," he said. "Write it down, try to protect it as best you can, some- how get a date on it. Then con- tribute it to a company or colleague, someone that can do something with it. If you enjoy innovation, you're good at it, and people like what you've done, then you'll have the opportunity to do more." EW Editors' note: Dr. de Juan is the founder and vice-chairman of ForSight Labs. Mr. Yaron is the co-founder of Optonol. Contact information de Juan: gene@onefocusventures.com Yaron: ira@mitralix.com February 2011 November 2011 Innovation in ophthalmology

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