Cataract surgery embodies power of innovation cycle
The innovation cycle is critical to product development and also to enhancing care delivery. In the innovation cycle, an unmet need is recognized, human and financial capital are applied to provide a solution to the unmet need, failure is always encountered but learning occurs, and for successful innovations through many iterations, failure is overcome and success achieved.
The pathway to successful commercialization of a new product or care delivery model is filled with many dead ends, road blocks and minefields. The innovation must really resolve an unmet need. It must then traverse a lengthy and expensive regulatory approval process. Even with regulatory approval, an innovation can fail due to a poorly executed commercial launch or lack of a reasonable reimbursement pathway.
Innovation can be disruptive, meaning to me that it topples market leaders or creates totally new markets, or incremental, meaning to me that it provides a small but measurable improvement in the performance of a product or care delivery system. The advances in the products used for cataract surgery and the care delivery model during my 40-year career in ophthalmology serve as perfect examples of both disruptive and incremental innovations.
I was trained in my residency at the University of Minnesota to do intracapsular cataract extraction and then correct the patient’s aphakia with spectacles or, in select cases, a contact lens. The cataract surgery was done in a hospital, and in our teaching institutions, which included a university hospital, a VA hospital and two large county hospitals, a full day of cataract surgery was four cases. In the mid-1970s, the total volume of cataract surgery done in the U.S. was less than 600,000 procedures per year, the patient was hospitalized for 3 to 7 days, and the total cost per case was more than $5,000 per eye.
Disruptive innovation included the development of phacoemulsification, posterior chamber lens implants, viscoelastic devices, sutureless incisions and topical anesthesia. Those of us familiar with the process can recite many failures followed by learning and continued incremental innovation that is still in evidence today. Innovation also occurred in our delivery model, with the majority of surgery today being performed in an ASC with discharge 30 minutes after surgery rather than after several days in a hospital. Outcomes are far superior and costs far less per procedure. Just imagine trying to perform 3.6 million cataract surgeries today in a hospital operating room with a 3- to 7-day inpatient stay and then fitting all these patients with aphakic spectacles or contact lenses at an inflation-adjusted cost of $15,000 per eye.
The benefits of innovation are abundantly clear in the field of cataract surgery, and those benefits are a wonderful example of achieving the goals of the so-called “triple aim” of improved patient care, highly satisfied patients and reduced cost. Innovation is the only way we will heal our dysfunctional health care delivery system, and the evolution of cataract surgery over the past 40 years is a perfect example of the amazing power of the innovation cycle.