“How long is a piece of string?” comes to mind almost immediately after the question in the title of this article is raised. The question has several possible answers that depend on a number of variables. With respect to new technology and ophthalmology, one variable is timing. Just as our patients—consumers of our refractive and cataract surgery services—can be divided into innovators, early adopters, and laggards, so can we as ophthalmologists.
From diagnostics to therapeutics, ophthalmology is a technologically driven specialty. Think of phacoemulsification versus extracapsular cataract extraction, of excimer ablation versus radial keratotomy, and of optical coherence tomography versus ophthalmoscopy. Notice a trend? Standards of care are continually advancing. The majority of us agree that new technology can advance our speciality and, ultimately, improve the services we provide our patients. But that does not mean that we have to be first in line to incorporate each and every new technology.
The key is to first determine where you see yourself and your practice. Ophthamic technologies do not come cheaply, so there are financial risks, as well as risks from the technology itself. Getting on board early with a technology may pay off in terms of marketing opportunity, but it may also backfire if a new device does not live up to expectations. The first item on the agenda, therefore, is to determine where you are comfortable in the consumer cycle based on factors including the quality of the scientific evidence (anecdotal and empirical), discussions with respected colleagues, personal experience as a surgeon, and assessment of the scientific concepts involved in the new technology. In my experience, I do not become involved just because the technology is novel.
VERY EARLY STAGES
If you are focused on new technology and enjoy discovering the potential of new devices, very early incorporation may outweigh the potential risks of a technology failing to meet expectations. If, on the other hand, you are happy to wait until your peers and trusted colleagues recommend a technology, you reduce the risk of incorporating a failing technology. However, you will also be late to offer the apparently better, newer technology to your patient base, and they may have sought treatment elsewhere in the meantime.
From the company’s point of view. Companies like to work with early adopters and innovators who can provide accurate feedback on new devices. These relationships often lead to technology developing more quickly and bugs being ironed out earlier, but it requires good observational skills from the ophthalmologist and a good relationship with the members of the team of nurses, technicians, research assistants, and optometrists who use the device. The more comprehensive the feedback, the more valuable it is to the company, to their wider user group, and, ultimately, to our patients.
From the user’s point of view. Experimenting with and adding a new technology to your current armamentarium requires extra work and discipline in collecting data. It can cause frustration in many instances, and this is part and parcel of the experience. If you are inclined to try a new technology, however, this additional dimension to your clinical life can be enjoyable. In the end, if you are looking for a perfect, finished product, it is best not to get involved at this early juncture in a product’s development.
In the early stages of development, the initial invesgitators have built a body of clinical evidence, but the data have not been validated by prospective, multicenter clinical trials. At this stage, the risk of incorporating the technology is slightly lower than during the very early stages, but the cost is rising.
From the company’s point of view. This is the beginning of the commercial phase of the product’s life cycle, and the company must start to recoup its research and development costs.
From the user’s point of view. In the early stages of a product’s development, there are strong marketing opportunities for your practice, as not many other surgeons in your area will be offering the same service. On the other hand, the performance of the technology and your real-world experience may differ from what early investigators found (Table 1).
As adoption of a new technology grows, the cost of integrating it will be lower due to increased production, but there will also be more competition in the surrounding market. Generally, at this stage, the technology is enjoying popularity; surgeons who do not have firsthand experience want to hear about it, and those who do want to share their experiences and knowledge. Publication opportunities are plentiful, most of the bugs have been ironed out, and frustrations are low. Additionally, there is typically a good network in place to provide service support for the product (Table 1).
In this table, the late category refers to the time when the product has confirmed its functionality and secured its place in the ophthalmologist’s armamentarium. At this point, the costs and associated risks (in terms of making a poor purchase) appear to be at their lowest, but now there is a chance that the late adopter is purchasing a product that is about to be replaced by something better. This, too, represents a risk.
As ophthalmologists in private or group practices, we all make significant investments in technology throughout our professional lives. These investments do not come cheap, with most products costing at least “1 ophthalmic nickel,” as William I. Bond, MD, would say. (I’ve done the math: That nickel equates to approximately €50,000.) In many cases, new products cost as much as several ophthalmic nickels, and, if these investments turn out to be bad, they can affect the practice or clinic’s financial well-being quite significantly.
Unfortunately, there is no magic answer to the question of when to invest in new technology. It all comes down to risk management in terms of finances, frustration, clinical impact, medical risk and reward, and your personal attitude toward these issues. I wish you well in making good decisions that suit your practice and personal goals.
Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin), is a Consultant Ophthalmologist at the Wellington Eye Clinic and UPMC Beacon Hospital in Dublin, Ireland, and Associate Chief Medical Editor of CRST Europe. Dr. Cummings states that he has no financial interest in the ideas presented in this article. He may be reached at e-mail: firstname.lastname@example.org.