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Tech Culture | Jan/Feb '17

Design Thinking and Innovation in Ophthalmology

Linking inspiration and passion to execution and delivery.

Design thinking was an unfamiliar concept to me until about a year ago, when I registered for an online course at MIT called Mastering Innovation and Design-Thinking. In pursuing this study, my goal was to address two questions: (1) what is design thinking? and (2) how can it be applied to innovation in ophthalmology?

Five years ago, I founded a company called Omega Ophthalmics and set out on a path to develop a novel IOL. Although we have taken this product all the way through the first human trial, the beginning of my journey started with just an initial idea, conceived at a small ophthalmic meeting. Since then, I have learned a lot about myself and about innovation. This article details some of the key discoveries I have made along the way, peppered with insights from my recent coursework.


Playwright George Bernard Shaw said, “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.” If you want to go out on a limb to change the world and move things forward, some people will think you are unreasonable. But all change comes from the unreasonable man.

If necessity is the mother of invention, then frustration is the father of innovation. My former professor Woody Van Meter, MD, used to say, “Frustration is the difference between expectations and reality.” This concept can be applied to practice, to marriage, and even to raising children. If you are frustrated with your kids, you either lower your standards and accept their behavior or you figure out a way to change the reality. Sometimes we have to do a little of both. When you are frustrated, you develop a solution to change the status quo or you accept your failures and lower your standards.

A brief aside. After finishing residency, I flew to San Francisco for my oral boards. I was there for an entire week, doing nothing but studying like a responsible ophthalmology post-grad. After taking my boards, I had a 12-hour window of time before my flight home to Kentucky. Being my first time in California, I was determined to squeeze everything I possibly could out of San Francisco … and do so in style. I called my hotel’s concierge and asked for their best car, which was a brand-new Mercedes-Benz S-Class. A couple friends and I ventured out, driving around on cloud nine. However, unbeknownst to me at the time, the roads in California are narrower than in Kentucky. I came upon this realization the hard way, when I not so delicately parked the Mercedes atop a yellow curb.

Hit with one of life’s many curveballs, I felt frustrated by this self-inflicted wound. My friends and I stood there, looking at each other and back at the car. Thinking quickly, we said, “We’re smart. We’re guys. We can fix this.” Unfortunately, it was Sunday and there were no auto shops around. The only place open was a Safeway grocery store. What miracle-workers did we find inside? Toothpaste and a meat hammer. To most, this may not seem like an adequate auto repair kit, but in the hands of determined young ophthalmologists, you’d be surprised. We hypothesized that the meat hammer had enough tensile strength to pop out the dent and the toothpaste could work to buff out the scratches. Thirty minutes later, the bumper looked good enough that we were able to drop off the keys without another word.

So, get frustrated, innovate, develop a solution, test your hypothesis … and fix a Mercedes. Every frustration is a seed for a future innovation.


Despite the bad rap they get for being tech-obsessed and not present enough, millennials truly understand that change is possible. That is why there are so many startups and why many millennials do not follow a traditional career path—they are ready to change the world right now. If you are going to build a great company or practice, it should be full of unreasonable people and frustrated souls, creative minds, and dirty hands. Those are keys to any successful venture. You have to have passion, but you have to be willing to get your hands dirty.

It seems that in all types of industries, many innovations fall into the categories of hype, incremental change, and disappointment. Sometimes it feels like an innovation is being sold just because a company can sell it and not to truly solve an unmet need. This can be disappointing because, as consumers, we feel like the company and its products are not getting to the root of our frustration. For companies, disruptive innovation is risky and difficult to develop correctly, even when done thoughtfully and carefully. It is much easier to put a new shiny bell or whistle on an existing product and say, “Look at what we’ve innovated,” than it is to completely change the paradigm with a new product.

Looking at innovation from a top-down approach, the question becomes: Can we systematize disruptive innovation? Can we have a system where we are making disruptive innovation the goal and we are making that outcome possible? How do we stay one step ahead? Peter Drucker and others have said that the best way to predict the future is to create it. We often assume that innovation happens by these random occurrences where the muse of creativity strikes and out pops a concept or a product. In reality, that is not how innovation occurs.

According to Tim Brown, the father of design thinking, “Innovation is powered by a thorough understanding, through direct observation, of what people want and need in their lives and what they like or dislike about the way particular products are made, packaged, marketed, sold, and supported.” Basically, in order to develop better products for customers in any field, we need to observe how consumers use a product and figure out what they like or dislike about the way it is being sold, packaged, used, and so on.


Innovations that succeed exist in the intersection of the so-called Real-Win-Worth it (RWW) paradigm. If you are thinking about an innovation, you want to ensure that it passes three tests, as detailed below.

Does it solve a real problem? The first question to ask of your innovation is, does it solve a real problem? The key to innovation is finding an unmet need that is difficult for users to articulate. We need to create solutions that people want, not just the ones they ask for. Steve Jobs famously said, “You can’t just ask customers what they want and then try to give it to them. By the time you get it built, they’ll want something new.” If we ask people what they want, they will give a list of primary and secondary needs; the true unmet needs are discovered through observation and by figuring out how people use products differently.

Just because you can do something doesn’t mean that you should. You don’t want to develop a solution and then try to find a use for it. This is where key opinion leaders (KOLs) come in. KOLs fall into one of two groups: lead users and extreme users. A lead user is someone who uses a product in high volume. An extreme user is someone who performs niche procedures. Lead users utilize products more frequently, so they are able to figure out the problems with those products or ways they can be improved. Extreme users utilize products differently than intended, so they can uncover a variety of unmet needs that a product may not be targeting initially but can be adapted to address.

Ophthalmologists who are lead and/or extreme users are the most likely to have a lot of light bulb moments if they keep their eyes open to new possibilities. This happens so often in ophthalmology that the industry even has a nickname for us: DWIs, or Doctors With Ideas. The great DWIs are the ones who experience and define the unmet need they are seeking to address. Additionally, they explore the potential solutions. If a solution already exists, do not waste your time trying to reinvent the wheel. Go through a brainstorming session and try to identify additional ways to improve that idea. DWIs fall into a group called user-innovators, which are key for the development of disruptive technologies, as these individuals are deeply connected to the unmet needs of their industry.

Can you win at this? The second question in the RWW analysis is, can you create a real solution? If you have identified a real problem and feel you have a real solution, the second question becomes, can you and your team win at this? This involves a SWOT analysis, looking at strengths, weaknesses, opportunities, and threats. If you feel the strengths of the idea and the opportunities it presents outweigh the weaknesses and threats, move forward; however, if the idea’s weaknesses or threats to the market outweigh its opportunities and strengths, take caution.

Beyond that, you must ask whether it is technologically feasible to create this solution. Does the technology already exist in various pieces that just need assembly, or can your team develop this technology faster, better, or cheaper? It is important to think about this, as you do not want to develop a solution and then suddenly get sunk by someone with a better version.

Is it worth it? The last decision gate is, is it worth it? Is there a financial model and/or a market large enough to enable a return on investment? You don’t want your brilliant solution to only apply to a small niche of enthusiasts. It may be the best new thing, but if the market isn’t there, don’t pursue it.

Opthalmology Off The Grid

Listen Up! On Ophthalmology off the Grid, Gary goes inside the minds of innovators Malik Kahook, MD; John Berdahl, MD; Damien Goldberg, MD; and Sean Ianchulev, MD, MPH

Master of Innovation

In Pursuit of Physician Innovation

Problem Solving in Ophthalmology


There have been many great examples of disruptive innovation in the ophthalmology market, including IOLs, LASIK, phacoemulsification, laser cataract surgery, extended depth of focus lenses, multifocal IOLs, biometry, and more. We are likely at the precipice of a whole new generation of disruptive innovation.

Real, disruptive innovation lives at the center of the RWW analysis. If you have an idea, use this framework to screen your idea and see if it is worth pursuing. Further, take advantage of the brilliant minds around you. In our field, there are so many innovative people who are willing to help if you just reach out.

Author’s Note: I would like to thank MIT professor Steven Eppinger, PhD, for many of the concepts covered in this article that were gained through the program Innovation of Products and Services: MIT’s Approach to Design Thinking.

Gary Wörtz, MD | Section Editor
Gary Wörtz, MD | Section Editor
  • Cataract and refractive surgeon, Commonwealth Eye Surgery, Lexington, Kentucky
  • Founder and Chief Medical Officer, Omega Ophthalmics
  • drwortz@omegalens.com; Twitter @GaryWortz