Eyeworld Daily News

continued from page 1 Dr. Kurtz (center) receives the award for the Charles D. Kelman Innovator's Lecture from Ann Kelman and Edward Holland, MD. Invention, Dr. Kurtz said, is a new product or novel process, but innovation is the application of that invention to address a need and create value. "We start innovation with an invention," Dr. Kurtz said, but that invention undergoes further development with extensive input from various teams and people. There is the internal innovation team and partners in innova- tion who aid in development. Then there's the marketplace for innovation that improves upon and brings an invention through the cumulative adoption process (early adoption, early majority, late majority, and late adopters). Collaborative innovation can also happen between technologies where a particular technology can reach a certain level of adoption, but then additional technologies further it. This was seen, Dr. Kurtz said, with phacoemulsifi- cation and the development of viscoelastics and folding IOLs to accompany it, for example. When Dr. Kurtz entered clinical ophthalmology in the 1990s, he said the same process was going on with refractive corneal surgery. Pico (and femto) second laser intrastromal ablation were found to produce a precise sub-surface effect when focused, while the excimer laser provides a precise surface ablation. Gerard Mourou, PhD, developed the first high-power femtosecond lasers with chirped pulse amplification, which Dr. Kurtz explained were intense light pulses that didn't damage the internal workings of the laser. Dr. Mourou later found- ed a research center at the Univer- sity of Michigan where Dr. Kurtz was a resident. There, Dr. Kurtz encountered a graduate student who had an accidental laser eye in- jury. This got him interested in the technology—after he emphasized laser eye safety to the team. Dr. Kurtz started collaborat- ing with Tibor Juhasz, PhD. Even- tually, they decided to commer- cialize the technology. It held both technical and clinical challenges that had to be overcome, including size, patient interface, cost, laser parameter setting optimization, flap lifting techniques, patient flow, and more. "Together we made advances that were necessary to introduce this technology into the market- place in 2002," Dr. Kurtz said. Since then, it has undergone a number of marketplace inno- vations including increased laser repetition rate to improve resec- tion quality and day 1 vision and improved reliability to maintain surgeon confidence. "Over the course of a number of years, a number of companies joined in this technology, and currently, according to Market- Scope, about 70% of U.S. LASIK procedures are performed with a femtosecond laser," he said. Dr. Kurtz then described moving femtosecond laser tech- nology into the realm of refractive cataract surgery. Refractive cata- ract surgery, he said, really began in the 1960s, driven by the large pool of patients who, thanks to Medicare, would not have access to these innovations. Innovations included the first implantable IOLs, followed by phaco, visco- elastic, keratometry, biometry, and IOL power calculation formulas. There was a resurgence in refrac- tive cataract surgery innovation— presbyopia correcting and toric IOLs, diagnostics, and surgical techniques—spurred on by the 2005–06 CMS Dual Aspect Rule, Dr. Kurtz said. Femtosecond laser-assisted cataract surgery was introduced to the market in 2012, and in the time since, Dr. Kurtz said it has undergone this same process of marketplace-drive innovation with improvement in capsulotomy quality, fragmenta- tion patterns, and integration of surgical planning and diagnostic tools. Four years ago, Dr. Kurtz said he took a hiatus from the femtosecond laser and focused his efforts on the Light Adjustable Lens (RxSight). "I was intrigued by the ability to have an office-based system that could optimize patient vision after the cataract had been re- moved," he said. Dr. Kurtz said this innovation, which is already FDA approved, uses a specific pattern of UV light to change the shape of the implanted IOL according to the prescription for the patient. The Light Adjustable Lens, Dr. Kurtz continued, is meant to overcome the limitations of the preop and intraoperative prediction process. It is beginning a new journey in 2019, entering the era of market- place innovation for this technolo- gy, he said. Editors' note: Dr. Kurtz has financial interests related to his comments. MAY 7, 2019 | EYEWORLD DAILY NEWS | 3

• Cover