Prior to the Charles D. Kelman, MD, Innovator’s Lecture, which was delivered during the Saturday on the Main Stage session, April 26, Reay Brown, MD, a dedicated innovator and glaucoma specialist, spoke about the philosophy of innovation and how it requires a little bit of delusion.
First, he shared a story of how one of his daughter’s professors, world-renowned neuroscientist Willoughby Britton, PhD, called him deluded. He said he’s not sure what he did to give her that impression, but he has since learned that the term isn’t entirely negative. Being deluded involves irrational optimism, divergent thinking, believing things others don’t, thinking you can make a difference, and not giving up, Dr. Brown said.
Source: ASCRS
In relation to innovation, there are two “deluded” steps, Dr. Brown said: 1) identifying an unmet need that others have missed and 2) thinking that you are the one who can fix it.
“The philosophy of innovation means asking basic ‘why’ questions that no one else has. It doesn’t have to be complicated,” Dr. Brown said.
He then shared some of the “deluded” innovations that he and others researched and created many years ago that did not reach success initially but more recently are having their time to shine. He said he went into glaucoma because he thought surgery, particularly trabeculectomy, could be improved. It was a risky operation with “way too many steps,” he said. As such, he created the idea of using an internal trephine instead. This was a 15-year project with published papers, a start-up company, and public promotion for what he thought would be a better glaucoma operation. “But we had little commercial success,” he said. Some of this was due to a lack of needed tools, and no companies wanted to invest.
Fast forward to 2019 when Dr. Brown saw his movie of this technique being played at an ESCRS meeting. The company Sanoculis brought back this idea, calling it MIMS (minimally invasive micro sclerostomy). “Thirty-five years later,” he said, his initial idea has come back.
Dr. Brown quoted futurist Ray Kurzweil who has said most inventions fail not because they don’t work but because timing is wrong. Another example Dr. Brown presented was EyePass, the first bypass device inserted into the human eye in 1999 that was targeted toward patients with advanced glaucoma. The company went bankrupt during Phase 3 clinical trials. Years later, Glaukos had the first trabecular meshwork bypass device approved by the FDA, targeting a larger market (mild to moderate glaucoma). This shows that successful innovation needs a big market, Dr. Brown said.
Other innovative ideas that didn’t take off at the time of their inception but now have other successful iterations are adjustable IOLs (talked about by Dan Schwartz, MD, 30 years ago, Dr. Brown said) and devices to deploy smaller eye drops from medication bottles.
So where will future disruptive innovations come from? Not big companies—they don’t like disruption, Dr. Brown said. Inventive surgeons who consult for many companies are not likely the source for disruptive innovation either. Fortunately, “there are still many independent innovators, deluded people with courage who want to solve big problems,” Dr. Brown said.
He said innovators need to see things differently.
“It’s like a belief about seeing the future before it’s visible,” Dr. Brown added. “Most innovations don’t begin with evidence; there is none. Most innovations begin with belief.”
Financial disclosures
Brown: Sight Sciences
