Partnerships With Industry Facilitate Progress in Ophthalmology

More than 15 years ago, as I was finishing my training, I marveled at the progress made in cataract and refractive surgery during the preceding 30 years. Even more, I wondered how far the fields could progress in another 30 years. Surely, incredible advances would be made in the treatment of presbyopia, the final frontier of refractive surgery. The idea fascinated me so much that I made it my career goal to conquer presbyopia. It remains an ambitious and, admittedly, audacious goal but one that is becoming increasingly plausible through meaningful partnerships with industry.

THE IMPACT OF INDUSTRY

Almost everything in the practice of ophthalmology has been influenced by industry. Whether a diagnostic device, a pharmaceutical treatment, or a surgical procedure, most of what we use has been conceived, developed, manufactured, sold, and distributed by industry. The Accreditation Council on Continuing Medical Education defines a commercial interest as “any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients,” and the organization requires financial disclosures by contributors to educational content and leadership activities.¹ Although those are the types of industry relationships that must be disclosed, other for-profit entities have an impact on the delivery of health care as well. There are companies that develop electronic health records. Some companies provide ancillary and support services like billing and consulting. Other companies, such as Bryn Mawr Communications, publisher of CRST, conduct educational programs and create print and online media. Clearly, corporations and industry have a huge impact on the practice of medicine.

In my mind, that’s a good thing. Free enterprise and healthy competition can drive innovation and progress. Although conflicts of interest can result from physician partnerships with industry, I firmly believe that the intrinsic moral and ethical grounding of my colleagues is the primary determinant of the trustworthiness of their comments and actions. Furthermore, because most practicing physicians derive a majority of their income from patient care, even those who eschew industry relationships profit significantly from the care they provide to patients.

THE BENEFITS OF PARTNERSHIP

Relationship building. Physicians can partner as consultants and/or speakers, allowing them to build relationships with industry leaders. Physicians can also work as clinical investigators, allowing access to products months and even years earlier than would otherwise be available. Some physicians have even left clinical practice for full-time positions within industry. There are also those who have started and sold their own companies—becoming a part of industry themselves.

These partnerships benefit industry as well. Physicians have a unique perspective on patient needs and the impact of pharmaceuticals and devices on clinical practice. We see the benefits and the shortfalls, and we can offer insight from the frontlines not otherwise available to industry. We understand clinical care, and we are the best educators of our colleagues.

Education. Consulting has given me opportunities to meet and work with the scientists and researchers who develop the products I use in my daily practice. This kind of collaboration allows me to learn more about the science and technology behind such products. For example, my work with Johnson & Johnson Vision has expanded my understanding of optics and IOLs. My work with Carl Zeiss Meditec has educated me further about keratometry and biometry.

My father always told me that teachers learn more than their students, so I view any speaking engagement as an opportunity to learn. For example, it was while preparing a presentation on the Signature Pro (Johnson & Johnson Vision) that I finally came to understand the science of venturi fluidics and its advantages over peristaltic fluidics—more than a year after I had access to the former. Working with pioneers in the field teaches me about the technologies that matter to my patients. The foundational science provides a context in which to interpret clinical results and regulatory claims.

Networking. My work with industry has also connected me to many amazing people, both in industry and in leadership positions in ophthalmology. I remember the dinner after one of my first presentations at an industry-sponsored symposium at a major meeting. I shared a table with David F. Chang, MD; Douglas D. Koch, MD; and Steven C. Schallhorn, MD—not as a fellowship applicant but as a peer and fellow faculty member. Well-respected leaders such as Eric D. Donnenfeld, MD, and Kevin L. Waltz, MD, have contributed to my career development after initially meeting me through our mutual partnerships with industry.

Influence. Not only can we help to bring new products to market, but we can also help to shape the way physicians think about and treat disease. For example, Allergan is developing the first eye drop for the correction of presbyopia (AGN-190584). In preparation for the product’s introduction, the company has done extensive work on patient and physician attitudes and perspectives regarding the development of presbyopia. Additional work such as staging presbyopia severity and categorizing treatment options will provide physicians with a framework to understand, evaluate, and treat the condition in a more logical and directed fashion.

SOME WORDS OF WISDOM

In the early years of my practice, I reached out to one of my fellowship mentors, Richard L. Lindstrom, MD, for advice on working with industry. His first comment to me was that he supported the idea. I was a little surprised that he felt this sentiment had to be explicitly stated, but I can heartily say, after more than a decade of my own partnerships with industry, that I wholeheartedly agree.

Around that time, I first visited the headquarters of Advanced Medical Optics (now Johnson & Johnson Vision), and then-CEO Jim Mazzo gave me some advice that guides my decision-making about partnerships with industry to this day. He advised me to partner only with companies making products I believed in, even if those companies weren’t the ones offering me the most money. By following this advice, I can support a company in good conscience, and I can speak with conviction. Not only does this protect my reputation, but it may also help motivate companies to produce best-in-class products.

I will close with two sagacious pieces of advice regarding partnerships with industry shared with me by John A. Vukich, MD, who credited them to Stephen G. Slade, MD, FACS:

No. 1: Never speak on a topic that you wouldn’t be excited to travel to Podunk, Texas, with a week’s notice to talk about.

No. 2: Don’t whistle while you pack and don’t be too tired to help with the kids when you get home.

1. Sullivan T. Continuing medical education: ACCME offers new guidance on the role of commercial interest employees in CME. Policy and Medicine. Updated May 5, 2018. Accessed May 11, 2021. www.policymed.com/2015/05/continuing-medical-education-accme-offers-guidance-on-the-role-of-commercial-interest-employees-in-c.html

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Partnering With Industry Is an Opportunity to Make an Impact

The term industry can be polarizing. Over the past decade—and for a variety of reasons—greater limitations have been placed on industry access at trainings and events. It’s likely that these increasingly stringent policies cause those in training to wonder if the stringency should be extended to physician relationships with industry overall. However, ophthalmology is a dynamic field that demands advancement, and a relationship between physicians and industry is essential to progress.

WHY WORK WITH INDUSTRY?

Many physicians in training think that working with industry simply means supporting a product, but there are many other aspects to it, including education, clinical research, the pathway to the podium, and advisory and consulting roles. Motivations certainly evolve, but physicians’ relationships with industry are often borne of a desire and passion for excellence. For those who have this innate desire to be the best they can be, I believe that a relationship with industry is inevitable.

Knowing that my work will benefit patients on a scale far greater than what I can achieve in routine practice is what I love most about working with industry. It brings me such joy to know that something I gave a presentation on, taught, or participated in allowed someone halfway across the world to provide better care to their patients. The potential for my work to positively affect an exponential number of patients is incredible.

HOW TO GET INVOLVED

Find your why. First, make sure your motivation is rooted in more than a desire to get to the podium or gain credibility.

Specialize. Identify an area of practice that you are passionate about and learn every detail of it. If your chosen area of focus is clinical, apply your learning in practice and analyze your outcomes. Work with the different technologies and identify what works, what you can change, what you can do better, and what you might be able to help others with.

Get the word out. Let your mentors and other colleagues know that you are interested in working with them and with industry. If you have a mentor who is an expert, ask that person to guide you. This may open doors to you.

Say yes. When opportunities arise, say yes! You can’t be choosy at first. Say yes to the book chapters, say yes to the small articles, and say yes to the small talks. Whatever it may be, say yes and do a great job. In time, industry will recognize that you are great to work with and that you produce high-quality work on deadline. Your name will begin to come up for partnership opportunities, which will build your brand and broaden your opportunities.

CONCLUSION

As you develop relationships and gain a good sense of the needs of our field, your work with industry can become more refined. Your experiences will equip you with the skills needed to see the bigger picture and serve as a consultant or in an advisory role. Consultants know what they use in their own practices, what others use (and why), what is in the company portfolios, and what is in the pipeline, and they use this knowledge to identify future needs and potential ways to meet them—beyond a nuanced change to the current molecule, technology, or piece of equipment.

Bias and loyalties occur among individuals working with industry. I firmly believe, however, that when patients are at the forefront of a physician’s decision to work with industry, doing so will only ever be a net positive.

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Collaboration With Industry Creates Opportunities to Innovate, Teach, and Lead

Ophthalmologists who are interested in furthering the ophthalmology specialty while developing their careers may sometimes overlook the pathway to excellence offered by collaboration with industry. In my experience, working with ophthalmic companies creates opportunities for surgeons to identify potential areas of innovation, develop inventions and bring them to market, and hone their professional, surgical, and leadership skills.

Fostering strong industry relationships ultimately helps our patients. It can help bring innovations to market and advance the quality of care our patients receive with the goal of optimizing the patient experience and surgical outcomes.

GETTING STARTED

An important way to engage with industry is to enroll your practice in industry-sponsored clinical trials to gain experience with new technologies and a better understanding of how they meet patient needs. As the surgeon-industry relationship develops, industry representatives gain a sense of your particular strengths and interests. When your strengths align with a project’s requirements, they will be eager to work with you.

Surgeons are uniquely situated to understand the unmet needs that arise in the clinic and the OR. Surgical device and pharmaceutical companies have a broad idea of the challenges surgeons face, but we are often the first to encounter the issues. Surgeons who point out opportunities to improve the patient and surgeon experience are often invited to participate in the evaluation and promotion of a new device.

THE NEXT LEVEL

Surgeons with creativity and a passion for engineering often find themselves with new product ideas or improvements for existing products, some of which may even be patentable. Bringing an idea to market in a meaningful way can be challenging for surgeons, particularly those with high-volume, premium practices. Working with industry to expand production and distribution of a product can allow your invention to ultimately help more patients.

In addition to managing a busy practice, I own more than 45 patents. I understand the value of working with companies to help realize an invention. For inventors, finding a company that serves the patient population of your innovation and shares your ideals and goals is key to getting that innovation into the market. I work with many companies, and I choose partnerships based on the scope of their product lines and their potential for bringing products to market. It’s important to find a company that is a good fit for both you and the product you hope to bring to market.

BUILDING YOUR PROFESSIONAL, SURGICAL, AND LEADERSHIP SKILLS

Learning how to teach and educate your peers on new technology is an important part of professional development. For clinical investigators, helping to identify a need that can be addressed by industry or collaborating with industry on an invention of your own can lead to invitations to speak on behalf of an innovation as the product comes to market. Surgeons with a knack for teaching may be invited to speak at major meetings or smaller surgical conferences, and they could even be asked to lead discussions at global events.

Others may find themselves leading innovation from the clinic or surgical suite. Surgeons with a taste and talent for transferring their knowledge and skills are often asked to train their colleagues on the use of a new device or technique. Inventors may be particularly well suited for this type of collaboration with industry.

Clinicians who are passionate about industry collaboration are often asked to serve on medical advisory boards or even as a chief medical officer for established and startup companies alike. Surgeons in these positions can help to shape the direction of our field.

ALWAYS REMEMBER THE GOAL

In everything you do, including the work you may do with various companies, it is important to remain focused on patient care. Remembering that your patients come first will keep you grounded during your journey. They are, after all, the reason you entered medicine and collaborate with industry.