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40 | EYEWORLD DAILY NEWS | MAY 5, 2023 ASCRS ANNUAL MEETING DAILY NEWS wait for FDA approval, which came 2 years later, was difficult as well. "I remember going to meetings, seeing people that I knew, and them putting their hand on my shoulder and say- ing 'How are you doing?' … Those were a long 2 years." David Haffner, senior vice pres- ident of new technologies, Glaukos, brought up that COVID, when elective procedures were stopped for several months, was a challenge, even for the company, which at this point was well established. "We had to put some pretty austere things in place to get through that point." Mr. Mazzo brought Thomas Samuelson, MD, Minnesota Eye Consultants, up and asked what his "ah-ha" moment was with iStent as one of the top surgeons. Dr. Samuel- son said it took a while for surgeons to gain confidence with the device because it was a completely different way of getting them to think about efficacy. Though a surgical proce- dure, Dr. Samuelson said it wasn't going to get the efficacy of tradition- al glaucoma surgery, but over time the community began to understand that safety matters. "You can have a procedure that doesn't work as well, but you're not putting your eye at risk, [and that's] really valuable, it launched the MIGS market." This session also looked at Glau- kos' acquisition of Avedro and its planning that expanded its pipeline to include products in other areas of anterior segment surgery, drug deliv- ery, and small molecule innovation for the posterior segment. Editors' note: The speakers have financial interests with the companies they represent. T he Eyecelerator Company Case Study is a new series at the meeting that features an in-depth look at companies that survived challenges, ultimately finding commercial success. In the first of this series, moderator James Mazzo, executive chairman of Neu- rotech, and a panel took a look at Glaukos. Mr. Mazzo started the session with discussion among Thom- as Burns, president and CEO of Glaukos, and William Link, PhD, managing partner of Versant Ven- tures. Mr. Burns said Glaukos had a very altruistic beginning. The idea began when an 18-year-old with pigmentary glaucoma and vision loss was being recommended to have bilateral trabeculectomies. The patient's father challenged the oph- thalmologist, Rick Hill, MD, saying there had to be a better way. Dr. Hill, Dr. Burns described, told this father there was a better way but no one would listen to him. Dr. Burns shared his idea for a device that would bypass the obstructed trabecular meshwork. The patient's father was a venture capitalist and began con- versations that led to initial device design, patents, seed capital, and the founding of the company. Dr. Link was early in his venture capital career when approached to invest, and he initially wasn't interested but eventually came to understand how this idea could be transformative. Versant Ventures led the first round of small investments to get the project started, and Dr. Link described how he brought Mr. Burns on board to provide leadership and build the team in 2002. Mr. Mazzo asked Gil Kliman, MD, managing partner of InterWest Partners, why he decided to invest. Dr. Kliman said he came in a little later in the game with investment in 2007 when he thought the device would be approved within 2–3 years. Mr. Mazzo then turned to Chris Calcaterra, chief operating officer of Glaukos, and asked why he risked leaving AMO to go to Glaukos, a smaller company that didn't yet have an FDA-approved product, in 2008. Mr. Calcaterra said he was familiar with the work done by Transcend Medical and, after a conversation with Mr. Burns, he became intrigued with his vision. He said he was excited about the idea of creating a new category and creating his own commercial team. During the discussion, Mr. Mazzo challenged the panel to talk about the salient, difficult moments the company faced over the years. Dr. Link said some of the early challeng- es were getting the right size and shape for the device and finessing its actual surgical insertion. iStent was initially being researched as a stand- alone device, Dr. Link said, but there was concern over whether surgeons or the FDA would be on board with that. He described how the team was presenting to a group of surgeons on the concept when Richard Lindstrom, MD, said the procedure should be done during cataract surgery when the eye was already open. "That moment changed our path very ma- terially," Dr. Link said. Mr. Burns said one of the most "searing near death experiences" the company had was the PMA pan- el, which he said had a colossally disastrous morning. In the afternoon, a couple of surgeons advocated and convinced the panel, which Mr. Burns said was largely cornea specialists, and the meeting ended with a near unanimous advocation. Mr. Calcaterra said that while that meeting was excruciating, the Eyecelerator Company Case Study: Glaukos

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