Industry Leaders Discuss Collaborative Care, Consolidation, and More

By Thomas G. Daniells, Robert Dempsey, David Taylor, and David Gibson

During the American Optometric Association’s annual meeting in Boston this year a group of industry luminaries met for a wide-ranging discussion on the eye care industry. The group was convened by The Intrepid Eye Society, a diverse group of emerging thought leaders in optometry with a goal of promoting excellence and growth in the field. Intrepid’s initiatives include advancement of optometry through innovative thought sharing on topics related to future medical therapeutics, diagnostics, practice development, research and development, and collaborative care with ophthalmology.


AOC: How can industry more effectively collaborate with key opinion leaders (KOLs)?

Thomas G. Daniells: Medical meetings are not as well attended as they once were, so we are getting creative in our collaborations with KOLs. We’re leveraging technology to get our content into the marketplace. We’re blogging, we’re producing videos. We’re doing everything to be where the doctors are—on their devices. We’re not stopping use of the traditional approaches and tactics, but we are adding these things to our mix.

Robert Dempsey: It is critical to tap the expertise of KOLs, to get their insights and feedback on our strategies from an educational perspective and from a clinical trial perspective. The give and take is critical for KOLs as well. The relationships are mutually beneficial.

David Taylor: I find that attending smaller meetings is much more conducive to participating in thoughtful discussions with leaders within the specialty. The atmosphere is more relaxed, so the setting engenders a more intimate opportunity to spend quality time with KOLs and build relationships. For example, I find that the Optometric Glaucoma Society meeting is an excellent opportunity to meet with key leaders in an atmosphere that fosters dialogue.

David Gibson: We aim for an intersection of goals in our work with KOLs. We look at what we want to achieve from an industry standpoint and what the medical professionals with whom we collaborate want to achieve, and we figure out where those goals meet. The point is to see if we can find a common theme on a big idea. Essentially, we’re figuring out what the professionals’ practice goals are and where and how they feel comfortable advancing and sharing their knowledge with our users.

AOC: What are the most pressing issues and challenges facing industry in the coming years?

Mr. Gibson: There is a major trend toward consolidation throughout medicine, and optometry is not an exception. Practices are being purchased or are selling out to larger groups. There is widespread concern that if doctors do not have a stake in the game—if they don’t have an ownership position—they may have less motivation to put forth extra effort in areas such as speaking at medical meetings or getting involved in legislative issues through their state associations. Looking forward, this is a major concern for the profession because consolidation is not going to abate; if anything, it’s going to ramp up.

Mr. Taylor: Regulatory issues and government intervention are among the leading challenges. We are paralyzed by regulations; for instance, the Physician Payments Sunshine Act is a burden to industry­—especially smaller companies. In addition, it is becoming increasingly difficult to get a product approved by the FDA. Companies in a lot of other countries that we are competing against make devices, but they can make them a lot less expensively, and they don’t have the regulations that we do. There’s not necessarily anything that any of us can do to alter what happens outside the United States, but within the US, we can and should make sure to pressure politicians and regulatory authorities using appropriate vehicles for doing so.

Mr. Dempsey: As the “silver tsunami” of patients turning 60 grows, the prevalence of ocular disease is increasing. It’s imperative for industry to work at solving these diseases, so it behooves us to invest more in research and development. A lot of innovation is coming through smaller companies, and we’re going to see some very innovative technology going forward. As optometry handles more and more of the medical model, it’s going to be vital for optometrists to provide guidance to industry.

Mr. Daniells: A major challenge facing premium technology companies is the downward pressure on price. This goes back to working with KOLs to help their peers appreciate that value is found at the intersection of quality and price. We need our thought leaders more than ever, to educate the market on importance of quality outcomes. Equally important in these challenging times is supporting companies that give back to the profession. There are many companies that are competing on price but are not delivering the outcomes. For industry to keep moving forward, we need to support investment in research.

AOC: It is more difficult and expensive than ever to develop drugs and shepherd them through the regulatory process, and the pressure is high to push prices down. Despite these challenges and others, are you bullish about the future?

Mr. Gibson: I am extremely bullish, especially on optometry. As the supply of ophthalmologists remains flat, optometrists can seize the opportunity to provide more primary care. There are also so many unique products coming to market. Just in the dry eye space alone there is a ton of innovation. It’s an area where optometry plays a critical role, and, from a patient-care and revenue standpoint, the potential is unlimited.

Mr. Taylor: I am optimistic as well. Here’s an example of why: Unlike most of the rest of the world, the United States has yet to adopt the widespread use of automated phoropter technology. Probably only 10% to 15% of US eye care practices use automated phoropters, which means there is great potential to market those units to thought leaders who both appreciate technology and understand the efficiencies inherent in even routine examination equipment.

Mr. Dempsey: We’re very confident about the future. Shire got into this space in 2013 because we believed there was tremendous opportunity. A recent article in the Wall Street Journal pointed out that the eye is the sixth most funded area of venture capital. In the eye care sector, industry is bullish and venture capital is bullish, and there are significant unmet needs. This suggests that, despite the challenges, this is a very good situation to be in for all concerned.

Mr. Daniells: I am bullish as well, but with the caveat that we have a lot of work to do. Young professionals are in a great place to take advantage of the opportunity to practice full-scope optometry; now we just have to motivate the rest of the profession to raise their game and embrace the confidence necessary to treat and not just refer.

AOC: Looking at the future, what might be the next disruptive technology or conduit to groundbreaking change?

Mr. Gibson: There’s a device from Smart Vision Labs that patients can use to get their refraction without the help of an optometrist or technician. The unit can be housed in an optical center that sells eyeglasses, and the glasses can be dispensed there or the consumer can take the information provided by the device and use it to buy glasses online—completely bypassing the optometrist. I think this is dangerous from an eye health perspective, but also scary from the standpoint of losing patient flow through the office. Millennials are comfortable using devices like this, and they will be the ones to adopt this technology first. These devices enable patients to avoid seeing eye care professionals until something goes wrong with their eyes. This is clearly disruptive technology that will play a role in the future of this profession, particularly with this generation.

Mr. Taylor: Devices and apps that measure lens power and refraction, such as Opternative, are ubiquitous, but I don’t think any of this technology is ready for prime time. Although millennials may be eager to accept these do-it-yourself digital options, who is to say what pathology is being missed in these people who are forgoing a visit with an eye care professional?

Mr. Dempsey: On a more positive note, we need look no further than the benefits of gene therapy for game-changing developments on the therapeutic side. For example, gene therapy has sight-saving potential for patients who have congenital retinal diseases. These therapies may be able to prevent or reverse some forms of inherited retinal diseases such as Leber congenital amaurosis, retinitis pigmentosa, and forms of Stargardt disease, and we are aiming to be at the forefront of that work. Within the next 2 to 3 years, Spark Therapeutics will have an intravitreal injection of a gene-manipulating virus to stop the progression of blinding diseases. This is the type of innovation that stimulates research dollars; it’s the type of innovation that can absolutely be described as disruptive.

Mr. Daniells: Stem cell therapy is also a potentially game-changing field. Bio-Tissue has identified the active components of amniotic tissue, and we have patented the process for maintaining the key elements of the tissue responsible for regenerative healing. The entire cellular matrix which contains these healing properties essentially creates an environment where stem cells are able to proliferate, and our products can be used to promote wound healing. My vision of the future is that we continue to disrupt the market through the use of regenerative medicine and stem cell therapy, in combination with the complex that we discovered. Use of our cellular-component for intravitreal injections and in topical ointments to promote ocular surface healing are directions we are exploring. The future for us is going to be taking this tissue and making it into gels, into ointments, into coating agents, and into additives to various products—this will certainly be disruptive to the market.

AOC: There is clearly a path for collaborative care between optometrists and ophthalmologists that is ripe with opportunity. Where do you see this collaboration headed over the next 5 to 10 years?

Mr. Gibson: With the supply of ophthalmologists flat or declining, collaborative care among eye care providers will be essential. Along those lines, it’s important to ensure that health care providers outside of the eye care realm refer to optometrists as first-line care providers.

Mr. Taylor: It’s all about patient care. I see the ophthalmologist-optometrist turf war that has been around for so many years as diminishing. We gathered a group of ophthalmologists for a discussion, and when this topic came up all the ophthalmologists said either they had optometrists working with them in their practice whom they treat as equals, or they had no problem with the issues that have traditionally pitted these eye care professionals against each other. I really think that the challenges that have stood in the way of collaborative care are on the wane, and that it’s going to be better for ophthalmologists, optometrists, and patients in the future.

Mr. Dempsey: This is a topic that we have to keep discussing because we’re still not where we should be. There’s an “old guard” on both sides of the aisle that perpetuates the turf war mentality, and we need to get beyond that. We are committed to even allocation—50% for optometry and 50% for ophthalmology—of resources including education, KOLs, advisory boards, and everything we do. We want everyone to be happy, but we also have to put actions behind our words. For the 20-plus years that I’ve been in this field, we’ve been hearing that “we’re making gains,” and I think we are all very ready to see a gain from the therapeutic standpoint.

Mr. Daniells: At the political level, collaborative care still has a long way to go. There are small overtures and handshakes and reaching across the aisle at society meetings, but change is coming slowly, if at all. However, on the practical level, collaborative care works well, and that is really what’s going to drive it moving forward. For the most part, ophthalmologists are interested in performing surgery, and optometrists are educated in and interested in providing eye care treatments and management of patient care. At the end of the day, optometrists and ophthalmologists were meant to be together; it works so well. Based on this model, optometrists are perfectly positioned for the future. n