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Glaucoma Experts | Mar/Apr '14

Inside the Innovator’s Mind

An Interview With Malik Y. Kahook, MD

In my mind, the pinnacle of ophthalmic innovation is the act of taking an idea generated from unmet needs encountered during one’s clinical experiences and translating it into a therapy that can be delivered to patients all over the world. I recently had a chance to pick the brain of a young clinician-scientist who has done just that, several times. My friend and mentor, Malik Y. Kahook, MD, Professor of Ophthalmology, Vice Chairman, and the Slater Family Endowed Chair in Ophthalmology at the University of Colorado School of Medicine, has filed for 21 patents, several of which have been licensed by companies for development and commercialization, earning him the title New Inventor of the Year for the University of Colorado in 2009 and Inventor of the Year for 2010. Below are a few questions I had for Dr. Kahook.

What was your first ophthalmic invention?


My first experience with inventing a device started during my last year of residency at the University of Colorado. I was reading literature on how cataract extraction reduces IOP and started thinking of ways to replicate this effect with a noninvasive approach. I played around with a lot of different devices and settled on a mechanical method that resulted in cyclical stretching of the trabecular meshwork from an external approach. This ultimately resulted in a device that entered human trials in 2009, and the next-generation device is now in a second clinical trial under the direction of a company called OcuTherix. OcuTherix licensed my patent from the University of Colorado, and I have the opportunity to work with them to further the development of the device. Early results are promising, with significant IOP lowering in the majority of patients. Time will tell if this device will make it to market. I have also had the great fortune to help start other companies such as ShapeTech, ShapeOphthalmics, ClarVista Medical, and Mile High Ophthalmics. Each experience has had unique challenges, and all have been fun. 

How did you get started down this path?


I’m honestly not sure what the first inflection point was that led me down the road that I’ve taken. I guess it was a very gradual process that started when I learned more about surgery as a resident and realized that the physician could play a central role in enhancing devices and improving outcomes. I remember my first trabeculectomy, during which the thought “There has to be a better way to do this” kept running through my head. I am still playing with different devices that I hope will improve invasive glaucoma surgery. I now spend a significant amount of time developing new technologies in addition to maintaining a full clinical and surgical practice at the University of Colorado.

How does an ophthalmologist in academics or private practice take the first step in creating a novel ophthalmic device?


I would first start by saying that ophthalmologists in general are best suited for inventing new devices and new surgical techniques, regardless of whether they are in academia or not. We understand ocular anatomy, pathophysiology, and surgical technique better than anybody, and every one of us can contribute on some level to the discovery process.

The first step to creating a novel device starts with being honest to the process. We all think of many ideas while in the clinic or the operating room. The tipping point to turn things from an idea to an actual device begins when we can look past the initial excitement of our idea and start to pick away at it with questions such as:

•Is this really novel?
•Does this really improve upon what we are doing today?
•Will this make clinical or surgical care better or safer?
•Can I realistically follow through with what is needed to get this past the idea stage?

If the answer to these questions is yes, then the next steps usually involve performing a patent and literature search to explore competing ideas, working through the research plan to reach proof of concept, and then, of course, figuring out how to pay for all that is needed. It always helps to call a colleague who has been through the process and ask him or her for advice. Seeking advice from others has been of great value to me over the years and has saved me from a few sand traps along the way. 

How do you know when it is time to let go of an invention and ask someone else to “take it from here”?


Speaking from lessons that I have learned the hard way, the best possible thing is to hold on to your inventions and allow them to mature as much as possible before passing them on for others to control. The inventor typically understands his or her technology the best and is (usually) ideally positioned to help nurture the project through the early phases.

I will also stress that it is very important to build a team around the invention process. Physicians have a particular skillset, and most of us lack some of the basic skills required for early development of devices (such as engineering, patent writing, and understanding the regulatory process). Bringing together a team will allow the inventor to properly position an invention for success in the future and can also help keep the invention “in house” as long as possible. I can’t stress enough how important the team-building process is to the success of an invention.

It is essential to create a team that emphasizes collaboration, cooperation, and hard work. Everybody has to carry their weight and be ready to take on tasks that might be out of their comfort zone. I’ve also found it extremely valuable to work with the same team on subsequent projects. When you find the right chemistry with a group, it makes everything easier. Bringing in others to help lead the technology to the next stage typically happens as dictated by funding needs or when a larger strategic investor joins the process and can bring in manpower and resources beyond the capabilities of a typical startup company. Equally important to holding on to a technology is knowing when to hand it off so that the invention can mature and reach the intended patients. 

What is the biggest challenge in the invention process?


Funding is by far the most difficult and least enjoyable part of the invention process. I am lucky to be supported by a strong department at the University of Colorado and have backing from campus leadership to keep things running. However, fundraising is part of every project that I am involved in, and backing from strategic investors and venture capital firms is usually the difference between getting a great idea from the bench to the bedside or not. I’ve had devices that were given a lifeline by investors and are now in clinical trials. I’ve also had a greater number of devices that I believed were promising fall to the wayside due to lack of funding. 

What novel technological innovation not created by you do you find most exciting in 2014?


I am most excited about the potential of femtosecond laser technology. We all know about the current femtosecond lasers that are used for cataract surgery and cornea-based refractive procedures. However, the future of these devices is what has me really excited. We will soon see devices that can do much more than just cataract or cornea surgery. Next-generation devices will be able to perform glaucoma procedures and potentially provide assistance for retina-based procedures. I am also excited about the potential for nonlinear microscopy with femtosecond lasers that will allow us to obtain both structure and function information of ocular tissues. All of these things are now possible in the lab, and it is just a matter of time before we have these capabilities in the operating room and the clinic. 

Malik Y. Kahook, MD, is a Professor of Ophthalmology, Vice Chairman, and the Slater Family Endowed Chair in Ophthalmology at the University of Colorado School of Medicine in Aurora. He may be reached at malik.kahook@gmail.com.

Nathan M. Radcliffe, MD

Nathan M. Radcliffe, MD, is an Assistant Professor of Ophthalmology at Weill Cornell Medical College, New York-Presbyterian Hospital, New York. Dr.Radcliffe may be reached at (646)962-2020;drradcliffe@gmail.com.