The Race for Success in Home Monitoring: Only Those with the

The Race for Success in Home Monitoring

Only Those with the Broadest Vision will Prevail

by Luis Diaz-Santana

I’ve focused my professional life on ophthalmology for more than 20 years, and you know what? I can’t recall a more stimulating time to be pushing the boundaries in this challenging and fast-paced area of medicine. Ophthalmology is brimming with innovation in all its subspecialities — just as the world begins to rebuild from the pandemic with renewed purpose and urgency.

I sense the mood every day in my role as head of ophthalmology at Cambridge Consultants. We’re having plenty of discreet conversations with bold, ambitious start-ups and multinationals alike intent on bringing transformational product ideas to market sooner, rather than later. With a lengthy record of working with clients to help enable breakthrough innovation, it appears our advice is at a premium right now. I can live with that!

The trend was set before the sudden emergence of the novel coronavirus, of course. The relentless pressure on the global healthcare system from our increasingly aging population was already driving rapid advances in medical technologies. And the stakes are higher: Now, we are dealing with a worldwide health emergency. A significant consequence of this has of course been the swing toward longdistance patient and clinician contact. The telemedicine race — worth many billions of dollars — is well and truly on.

The implications for innovation in ophthalmology are clear. Preserving eyesight remains the key driver for innovation, but growing in importance is the need to improve the patient’s experience throughout their entire treatment and — increasingly these days — the virtual experience component of this journey. Elevating the journey is valuable for product differentiation and crucial to market adoption. New treatment options must respond to two main objectives. One, reduce the number of touchpoints between the patient and healthcare provider and two, increase the patient’s independence by allowing them to selfmanage their treatment.

These very welcome and powerful benefits necessitate the need to monitor the patient remotely, so that the healthcare provider is alerted to the need for intervention when necessary. This brings me to the central question of my article: What is the key to unlocking successful home monitoring in ophthalmology? I have a succinct answer to this multileveled and complex problem: Seek the broadest possible viewpoint and tap into a comprehensive blend of competencies.

As the graphic here shows, the new kind of home monitoring device relies on a system design that encompasses a great swathe of influences. The patient group and the visual need in question are just the beginning. Devices to be used at home need to deeply understand the behaviors and journeys of the patient and their support network. They must consider important usability factors, from age to mobility, serviceability and much more.

To glue everything together, of course, it is vital to have a firm grasp of the science and technology that will ensure the operation of any device is reliable, predictable and safe — as well as transformative for clinicians and patients. For home monitoring, that should include an understanding of the role of off-the-shelf devices such as smartphones. It is possible to use their functionality to monitor a number of body parameters, such as heart rate, activity, gait, eye movements and breathing patterns, to mention just a few. Often, this is possible with out-of-the-box sensors in the device, but sometimes an ergonomic holder is needed. In other instances, the smartphone might just be used to

process, log or transmit information.

Smartphones and tablets lend themselves to visual tests such as the classic Snellen eye chart, color vision tests, the Amsler grid test and so on. The team here at Cambridge Consultants has plenty of experience in this area, including the development of an innovative perimetry testing concept capable of offering simple, affordable and fast glaucoma screening. It’s a smart approach, by the way, to consider gamifying a test — which is a great way to improve patient engagement and adherence.

I’ve taken part in many “smartphone versus standalone” debates when it comes to home monitoring innovation. Take an application such as fundus photography, for example. It can be achieved with the camera of a smartphone along with a simple lens/ flash adaptor. This approach has a lower development cost and quickens time to market. But on the downside, it is difficult to use unassisted, gives a very small field of view (up to 10°) and does not give access to the raw data that’s needed for better analytics. Depending on the quality of the data required, it may be better to use a standalone device that is able to produce high quality data consistently. What might appear a slower, more expensive route would actually be more robust and easier to control in future generations. In both cases, the device must be easy to use and minimize the risk of user errors to ensure high quality data consistently. My advice would always be to consider market and user needs, and don’t leave out any of the other stakeholders involved in that patient’s journey so that the most appropriate medical device can be deployed accordingly.

Optical coherence tomography (OCT) imaging is an example where a smartphone is not suited to collecting data. Here, a home monitoring system would require the specialized technology of an independent, standalone device to collect and process the data. Technical, ergonomic and safety considerations dictate the form factor of the device. For example, head-worn versus tabletop devices are both possible options, but factors such as age group, dexterity, lifestyle and frequency of data collection would need to be carefully considered.

Certain parameters may need to be monitored very frequently, making a strong argument for smart implant devices that can monitor eye health continuously. Intraocular pressure (IOP) is a case in point, as it varies significantly across the day. In glaucoma patients, an implant to monitor IOP day and night will significantly improve their care and outcomes. But once again, specific product specifications will be dictated by a host of factors, all of which need to be understood before development begins.

As I said at the start, an exciting race for success is definitely on — but I’d urge entrants to pause long enough to view their potential opportunities from the broadest possible perspective.

Editor’s Note:

Dr. Luis Diaz-Santana is the head of ophthalmology for Cambridge Consultants, United Kingdom. luis.diaz-santana@ cambridgeconsultants.com

The Eclectic Approach to Becoming a CEO part

by Nikki Hafezi, MAS IP ETHZ

In Part 1 of this two-part Women in Ophthalmology story, Nikki Hafezi shares how her journey in ophthalmology began.

Igraduated from UCLA with a Bachelor of Arts in English and a minor in Spanish with the aspirations of pursuing a master’s degree in either law or education. However, financial constraints meant that before I could do that, I had to find a way to support myself and save enough money to go back to school.

I took a paid position to develop and implement a nature-focused educational program for urban school children in Los Angeles. I started this job in 2001, and well, 9/11 happened not long after I had started. The charity’s annual income dropped significantly, as most of our donors were now directing their donations to 9/11 relief efforts in New York. My employer transitioned me from the department of education to fundraising to sustain the program. And this is where I found a hidden talent: storytelling. I discovered that the secret to successful fundraising is being able to tell a story that resonates on a personal level with the target audience. As Americans say, “you need to tug at the heartstrings to make the music play.”

Introduction to medical fundraising

One of the charity’s board members was also the

president of a large private hospital in Los Angeles. He took notice of what I could do, and he asked me to join his team at the hospital. This transition was my first step into medicine and medical research. I learned about medical fundraising,

in the context of grateful patients; raising money for capital funds; and directed research projects with industrial partners and clinical trials. I loved my position because the fundraising team was filled with spirited individuals who truly enjoyed what they did for a living, and I was able to meet and engage with the medical and scientific staff members. I earned enough to comfortably sustain my life as a single woman in Los Angeles, and I got to work with a wonderful team.

Although I really loved my position at the hospital, I knew that in order to climb the career ladder, I needed managerial experience, so I transitioned to a management role in development for a public policy organization. In this position, I led a small team that was focused on raising funds and building alliances with the private and public sectors. I engaged with governmental organizations to develop private-public partnership relationships to help support the programs that the organization provided. In other words, I coupled my experience in traditional and medical fundraising with the network relating to public policy and governance.

Understanding how people make decisions has always been fascinating to me, so it probably does not come as a surprise that I developed an instant fascination for politics. What I found is that fundraising and politics almost always go hand-in-hand, and telling a compelling story can influence people’s decisions about both.

Working within the academic sector

The public policy space was very interesting as well as challenging, but I did not lose focus on my educational

goal of pursuing higher education. At this point in my career, I had saved a little bit of money, but I thought I would try to combine my future education with an executive program. I wanted to continue to work and enroll in a master’s program. I thought that the best option would be to seek a position at a university, which might have provided a discount on the tuition and allow me to continue to work.

My dream was to work for my alma mater, UCLA, but unfortunately, they were not hiring at the time. So, I applied to UCLA’s crosstown rival, USC (University of Southern California). I have to admit that despite my experience in fundraising, the open position had a job description that I did not quite understand. It was for an “Industrial Liaison Officer’’ with mention of “being able to handle intellectual property, being able to bridge the gap between researchers and industry, and helping facilitate relationships with invested parties.” I was always up for a challenge, so I thought I could at least learn more about the position by applying.

The first part of the interview was with Dr. Howard Phillips, an engineer, and a very close colleague of Prof. Mark Humayun at USC. Dr. Phillips told me that he was looking for a candidate who had drive and spirit, and that the other aspects of the position can be learned. He liked me as a candidate probably because of my fighting spirit, and then he recommended that I meet Prof. Humayun. This part of the interview process took no more than three minutes because he said, “If Howard recommends you, I trust Howard.” What I learned quickly thereafter was that to be great, you must surround yourself with good people who you trust. It is exactly what Prof. Humayun did.

Due to his rockstar status, I never really saw Prof. Humayun because he was either traveling, in meetings, or in surgeries. However, he managed to do the impossible, because he had really, really good people. Another person was Prof. Gerald (“Jerry”) Chader, the former IOVS chair and one of the board members and past presidents of the Foundation for Fighting Blindness. Jerry showed me the ropes and was my lifeline to understand the ins and outs of the research lab because everything was new to me.

Speaking the industry’s lingo

But in any case, I had a plan for this position and a personal timeline. I wanted to streamline my responsibilities, goals and milestones, and be able to automate them in a way where I could pursue my education and maintain this position. I knew that my position needed me to secure money from our industrial partners. That was key. I already knew which partners I needed to go after: I just needed to understand what motivated them. I needed to know what story I needed to tell them for them to support us. To do this, I needed to be in the laboratories, talking to the researchers, understanding the technology, understanding the problems related to the technology, and so on.

Basic researchers and industry people talk to each other, but they often speak different languages. They usually have the same goal: to create a superior technology, but it’s difficult to get them to understand one another during the developmental process. Industry’s concern is the bottom line, and to make it to the market before the competitors, while the researchers don’t want to feel pressured to do suboptimal work just because of financial demands. A balance has to be kept. I acted as a liaison between them to get everyone on the same track, find common ground, keep everyone motivated, and push the process forward. It wasn’t easy, but my role and function were essential to the life of the projects because if the industry partners kept finding value in collaborations, the research funding remained.

Going back to school...

In 2006, I thought it was now time to go back to school because my work became second nature. All the industrial partners knew and could count on me. My position at USC was secure for about six more years assuming that I continued to do good work. While I was deciding on which master’s program to pursue, Prof. Humayun asked me to prepare for and attend ARVO (for the first time) to meet with our industrial partners. Traveling was an exciting aspect of the position, which I hoped that I would be able to do. I enthusiastically jumped at the opportunity.

Little did I know how impactful ARVO 2006 would be. I met my (future) husband, Farhad. It was like a whirlwind because I had to decide whether to stay in Los Angeles or leave the country so Farhad could continue with his career track as an aspiring professor in ophthalmology. Since I was younger (and I thought my skill sets and education had an easier time transferring to Europe than he would have moving to the U.S.), I agreed to move to Zurich. When I told Prof. Humayun I was leaving, he told me that one of the companies that I was involved in was going to be a successful spin-off company, and he would like me to lead the charge. At the young age of 26 years, I declined the offer because I ultimately had to choose love over my career. This company was later sold, but I think it is important to never look back on lost opportunities.

...and ending up in Switzerland!

After the dust settled from my whirlwind decision to move to Europe, I wanted to find a job.

I naïvely thought that fundraising was a global profession, and all research

Geneva University Hospital. So, I had to decide again if I were to follow him to Geneva or stay in Zurich and keep growing my company.

At this time, I was pregnant with our second child, and I knew that becoming chair was a once-in-alifetime opportunity for him. So, I agreed to downscale the company to move to Geneva to support him.

While I held onto the key clients, I reduced the employees to just me. This allowed me to support Farhad in his new position as well as manage a new life with two babies and learn a completely new language.

Biomimentic Microelectronic Systems Engineering Research Center (BMES ERC) Team from USC (2006).

groups need to continually raise money to sustain. So, after ringing a few doorbells of academic institutions, I realized that the concept of funding diversification outside of traditional grant writing was non-existent.

In fact, the concept of direct research projects and working with industry wasn’t really a thing here: it was (almost) viewed as biased research. So, as a pragmatic person, I relied on another skill that I needed to fine-tune if I was ever going to make it in Switzerland. This skill was in relation to intellectual property, with a particular focus on patents.

Of intellectual properties (IPs) and patents

Spin-off companies in the MedTech sector are typically based on patent(s). And, I saw firsthand at USC the power and influence that a patent can have in the industry. While I knew that I did not want to become a patent attorney, I did know that I needed to be well versed with the European Patent Office if I wanted to offer these services to future clients or be hired for a company. The Swiss Federal Institute of Technology (ETH) in Zurich had a master’s program dedicated to intellectual property, and it was a full intensive year program. Although my initial application caused some questions because I was not the typical applicant, after perseverance, I was accepted.

The course was a challenge for me because the lectures were in a mixture of German and English. My language skills in German were limited at the time, but I managed with extensive after-hours of studying to keep up with my bilingual classmates. I was also pregnant with my first child during the course, which made concentration and late-night hours difficult.

During this intensive year, I was also asked to develop and write a large European Commission grant for nine academic institutions in Europe. The focus of the grant was to reduce national fragmentation among retinal research academic groups. The final grant was over 100 pages. Little did I know at the time that this grant program, called the “FP-7 Program” was one of the most competitive research programs in Europe. I learned in 2007 that the grant was funded.

The birth of Light for Sight Foundation

During this period, Farhad and I founded the basis of the Light for Sight Foundation. In 2014, our family decided to move back to Zurich for personal reasons. We decided that we would start a spinoff company based on the research that was conducted in Farhad’s laboratory Editor’s Note: at the University of Geneva, which This story will be produced two continued. For more on Nikki Hafezi’s story, stay tuned for Part 2 in PIE Issue 18. patents. We acquired both patents privately and founded a company, Holding a double which is known today as EMAGine…

diploma (master’s degree + motherhood)!

So, after graduating with my master’s degree, I was able to kick-start my own consulting company called GroupAdvance Consulting. My first client was the management of some of the projects included in the grant. This consulting firm grew to about five people and continued to sign new clients until 2010. Farhad became the new chair of ophthalmology at the University of Geneva and eye clinic director at the

Contributor

Nikki Hafezi is partner of GroupAdvance (Management) Consulting GmbH, Zug, Switzerland; chief executive officer and board member of EMAGine AG, Zug, Switzerland; head of Strategy, Business

Development and Licensing, The ELZA Institute, Zurich, Switzerland; and co-founder and managing partner of the Light for Sight Foundation, Zurich, Switzerland.