Do you love your work? Not satisfied with the status quo? Do you enjoy solving problems? If you answered “yes” to these questions, you may have the perfect qualities for innovation.
Sprinkle in some chronic insomnia, an uncanny capacity to multitask, a willingness to accept negative feedback, an inability to say no to any opportunity that comes your way and you could end up being one of the greats in ophthalmology.
Our craft is passed down from one generation of eye surgeons to the next. In training, we become ophthalmologists through tradition and applied medical science. In residency, I operated the phaco pedal with my left foot because of tradition and injected intracameral antibiotics at the end of surgery because science has proven its worth. The goal of any medical training program is to produce physicians who practice within the standard of care.
But what is the standard of care, and who decides what it is? The standard of care is a generally accepted benchmark for the management of patient disease that is widely used by healthcare professionals; we can all agree that the standard of care from decades ago is certainly not what it is now. Ophthalmology has iterated and innovated an innumerable amount over the past 50 years, and changes in “standards of care” have been largely driven by innovations by practicing ophthalmologists.
Our ever-evolving consensus on what works best and what doesn’t has led us to where we are today. Innovation doesn’t mandate its development in a well-funded biotech startup or an academic ivory tower. It’s also important to remember that innovation does not happen in a vacuum. We borrow ideas and concepts, apply them in new ways and augment them for our own purposes. And ideas can come out from anywhere.
A lightning bolt of innovation struck ophthalmologist Charles D. Kelmen, MD, while he was having his teeth cleaned in a dentist’s chair. After seeing the dentist use an ultrasonic device, Dr. Kelman went on to invent a device that could break up cataractous lenses and remove them without a large incision. He’s now known as the father of phacoemulsification.
In many cases, the path to achieving something impactful beyond the patient in your chair ironically begins with the patient in your chair. Taking a history, performing an exam and creating a treatment plan presents an opportunity to ruminate upon one of my favorite mantras: “Question everything.” Why is it that we do what we do? Being in a constant epistemological crisis is one of the greatest tools of innovation. Realizing this can be truly freeing. A critical eye opens your mind to pushing the boundaries of patient care.
I have no claim to fame as a young ophthalmologist, and I frankly feel a bit of impostor syndrome when writing about innovation. By my count, my failures as an innovator have far exceeded my successes. Collaborating with optical engineers to apply plenoptic imaging technology to capture fundus images? Fail. Creating imaging biomarkers to quantify subretinal fluid density and associated treatment response for patients with central serous retinopathy? Fail. Using vibrational anesthesia to distract patients during intravitreal injections? Clinical success (but commercial fail)! The list goes on and on.
Despite these failures, the ideas keep coming. They come from seeing patients in clinic, reading journals, attending conferences, working with industry and engaging with colleagues and mentors. Opportunities to improve upon what we do abound. On the suggestion of a cornea colleague, I recently scleral-fixated a light-adjustable lens for a patient who had a dislocated multifocal toric IOL. Amazingly, it worked!
Inspired by retina specialists in Mexico and Japan, we are now infusing dilute betadine into the vitreous cavity to treat difficult cases of endophthalmitis. Taking a cue from my anterior segment colleagues, I perform most of my vitreoretinal procedures under local anesthesia without anesthesiologist support. I’m proud to say that these incremental innovations in patient care have truly made a positive impact on patient satisfaction and outcomes. Sharing these ideas through publications and presentations have given them wings.
With any innovation in medicine, new potential risks are salient, and it’s important to consider unintended consequences. Don’t be afraid to discuss your novel ideas with mentors, partners and even your malpractice insurer. Present and publish work that validates the ideas you have. The peer-review process can be very enlightening. However, in conversations with industry professionals and patent attorneys, I’ve learned that any ideas with commercial potential should be documented and legally protected before sharing openly.
It's one thing to have an idea and a very different thing to execute upon it and prove its worth. Bringing innovation to fruition requires a combination of ingenuity and grit. Taking the leap to push my own boundaries and evolve what is considered “standard of care” is driven purely by a desire to improve outcomes for individual patients and our profession.
Our field needs every practicing ophthalmologist, young and mature, to question everything we do. With that mindset, we can express our passion through innovation and cure blindness in ways never before imagined.
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About the author: Murtaza K. Adam, MD, is a young ophthalmologist at Colorado Eye Associates in Englewood, Colo. See a video of Dr. Adams at AAO 2022. |