In Pursuit of Physician Innovation

Gary Wörtz, MD, continues the discussion of physician startups and pipeline projects by inviting John Berdahl, MD, and Damien Goldberg, MD, to share their insights. Dr. Berdahl shares advice on how to determine if your innovative idea is worth pursuing and Dr. Goldberg provides pearls for uncovering the potential unmet needs in ophthalmology.

Gary Wörtz, MD: Open, outspoken. It's Ophthalmology off the Grid—an honest look at controversial topics in the field. I'm Gary Wörtz.

It's that nagging thought, the one that occupies your mind, that creeps up in your patient encounters, that pulls at you in surgery, that keeps you awake at night and your wheels spinning all day. It's that idea, that idea for something new, something innovative, that could change patient care. For those who've experienced this, it's what puts you on the precipice. That point where you must decide whether to go back, to return to the way things were, or to dive head first into something unknown.

This episode, part two of our physicians’ startup and pipeline projects feature, is about that very precipice. Today, I'll talk to two people who have been there before and aren't timid about going back. First, we'll hear from Dr. John Berdahl, who describes a process of determining whether your beliefs are in fact truths, and thus, worth jumping for. Then we'll here from Dr. Damian Goldberg on the importance of partnerships and discovering and seizing new opportunities, and how to detect and fill an unmet need.

Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Gary: Today, on the podcast, we have John Berdahl, who I think is making his third appearance on our podcast. John, you need no introduction, so I won't even go there. I just want to say thanks for, once again, making some time to talk to us. We're talking today about physician startups, pipeline projects. I know this has been something that you've been living kind of simultaneously to the experience that I've been living through Omega Ophthalmics. I thought it would be kind of nice and interesting for us to maybe talk about both your company, what I've been doing, and maybe share a little bit about the process, maybe more so than even the product, but maybe giving some pearls of wisdom to other people out there who are perhaps at the planning phase or just having that idea, and giving people a little bit of encouragement or insight around what do you do once you have an idea. How do you take it to the next level? With all that being said, give us a little bit of background about the startup that you formed, and we'll just kind of go from there.

John Berdahl, MD: Yeah, Gary, thanks. Your podcast is great. I hear a lot of people tell me how much they enjoy it. I always enjoy listening to it and being on it. Thanks for having me.

Gary: Absolutely.

John: Yeah, I started a couple little companies. We did a little something with Astigmatism Fix, which is a free website for people, that we talked about before, to help fix astigmatism after cataract surgery. We also had an idea about sedation without needles for IVs for cataract surgery, and it worked around that.

The real one, the one that's kind of more like could turn into a real company is one called Equinox. The idea behind this is that glaucoma's really a two-pressure disease, not a one-pressure disease. It's a balance between eye pressure and CSF pressure. We've done some of the early research on that. We think that with a pair of goggles that adds negative pressure in front of the eyes, we've got a good chance of just being able to control eye pressure. I know that's perpendicular view to glaucoma from what we usually think of glaucoma as, but that's the device.

It kind of came to fruition as we're thinking about what can we do with this knowledge about eye pressure and CSF pressure and how decouple the two of them. As I was ping-ponging ideas back and forth with my partner, Vance, we kind of came up with this idea and though that it was a testable hypothesis, and started to go after it. It's burgeoning into a real company.

Gary: I think that is incredible when you have an insight and that insight is based not only just on observation, but also on some data, some studies that I know you did when you were a resident, maybe even in your fellowship, you continued some of that. I've been seeing this idea actually presented by other people. I think you know your idea is getting traction when other people are presenting it and not giving you credit for it. I've actually seen that a couple of times. This idea of maybe glaucoma and ocular hypertension or low-tension glaucoma, and even on the other side of the coin with pseudo tumor, or even getting into the effects of the optic nerve during a low-gravity situation, long-term space flight, I think this idea's really gaining traction. I want to congratulate you on that.

Let's back up a little bit. You have an idea that is, I don't want to say 180 degrees, but you said it right. You're perpendicular to what most glaucoma docs would say is the canon of the disease process. Yet, you had the confidence to say, I'm going to try this, and, despite everybody else thinking this maybe off or wrong, I'm going to bet on this idea. Walk me through, in your mind, what gave you the gumption or what gave you the motivation to say, "I want to take this one step further than just an idea on the back of a napkin. I don't want to let this idea die in the corners of my mind, where maybe other ideas have died." What was that thing that you felt like, "Hey, I think this is real, and I'm actually going to do something about it."

John: Great question, Gary, and there's a multitude of answers. I'll give you a couple. I think that it's Peter Thiel that talks about exploiting an unfair advantage that you have when you're starting a business. I think that all doctors have a bit of an unfair advantage because we see the patients. We have direct access to observation, and we understand the disease process, which is better. That's one part of it, that there's that unfair advantage.

I also have a liking towards physics and kind of was a physics major and a numbers kind of guy. It's always hard for me to understand pharmacology and biology, but physics kind of made sense to me. This process of just hydrostatically changing pressures by relieving some pressure that the atmosphere puts on your eye was fairly natural, so maybe that's the second unfair advantage.

Then the third one is when you kind of can't shake an idea. Every idea seems amazing when you first have it. When you sleep on it the next day, maybe you lose a little enthusiasm. By a week, you're not sure if it's good anymore. By a month, you've forgotten it. In this case, it was kind of like an itch that just wouldn't go away until you scratched it. I'd wake up in the morning thinking about it. I'd see patients, and I'd say, "This is really what I believe is happening when I see your optic nerve."

I think it's a combination of having an unfair advantage, having it be an idea that you can't shake, and then feeling like you have a testable hypothesis at that very early stage. Is there a way you can figure out if your beliefs are actually truths? If you can test that, then it's worth going for.

Gary: That's really interesting, the idea of an unshakeable new idea, or an unshakeable hypothesis that you can't get off your mind until you figure it out. There are a number of books. I like talking to you because you give me ideas for great books you've read. I like to share some things as well. There's a great book called Making Ideas Happen. In that book, it basically talks about the euphoria of new ideas. It talks about creative people, how there's sort of this temporary high that you get, or you get this inspiration. You get this great feeling when you think about a new idea. Because when you visualize that new idea you can see it in your mind. You see how it is impacting people. You can go through thought experiments where you're sort of testing this new concept in your mind in various ways. You sort of fast-forward through all the hard work and you kind of see what it could be.

Then once you decide to actually do something about it, good ideas break down into a lot of hard work. It's a lot of times that people, when they sort of have an idea, I found this in myself even, you have an idea and you are really excited about it. Then once you start putting pen to paper, drawing up a project plan, thinking about all the steps involved and the overwhelming resources that you might need and the level of skill that you may lack, it just feels less fun. The problem becomes rather than taking those steps to pursue the idea, maybe another good idea comes in your mind. You sort of cycle on good ideas. That great feeling that you get with a new idea, that sort of almost undermines your ability to execute on one good idea.

I found in my own journey through startups, I've really had to temper new ideas. I see that almost as the siren song that's trying to crash my ship against the rocks, is getting off focus. Have you found that as well? You've had this idea for a while. You're pursuing it. You're going through the ups and the downs of a startup. Have you had to say no to some other ideas that have come along? Walk me through that if so.

John: Yeah, Gary, I haven't ever heard it said better than just how you said it. It's exactly right. The ideas are intoxicating. When you have a great idea, you're maybe 2% of the way there, and it's the fun 2%.

Gary: Yeah, exactly.

John: The rest of it is just plain old hard work. I didn't know what a quality system was. I just thought that meant you made something that was good. It turns out it's a big deal in design verification. All of these things that we, as docs, just don't have to deal with. Honestly, it's given me respect for what these companies need to go through to get a product to market. Sometimes you have your doctor hat on, and you never take that off. Then you have a CEO hat on. It's pretty easy to decide if a cataract should come out. It's pretty hard to make high-risk bets on the future of a company and a technology in an area that you're unfamiliar with.

I've gained a lot of respect for the hard work. I think that that's why the idea has to kind of percolate for a while and be unshakeable, because there are going to be times when you say, "Is this mountain really worth climbing?" It only really is if it's an idea that's so compelling that you can't get it out of your blood. When it comes to other ideas that present themselves, you're right. You get that new kind of intoxication from them, but most of the time, they're just shiny objects. You're at much higher risk of chasing all of these potentially good ideas but never accomplishing any of them, as opposed to focusing on the one idea that you have.

In truth, a good idea not executed is probably worse than having the idea in the first place. It's probably better to have a mediocre idea that it gets executed well to the point where it actually ultimately helps people.

Gary: Yeah, I totally agree. I think we're totally on the same page. One thing I've been doing lately, which is kind of new thing, is I've been just taking a design thinking and innovation course through MIT. They kind of have these online courses you can take. It's not really a big deal. It's a few hours a week. It's online. It's really helped me appreciate some of the things that go on on the other side of the coin. As a physician, as an inventor or an entrepreneur, we kind of just think about the idea. We don't really take an idea through an entire thought process of, all right, how is this going to be received in the market? How is it going to be received in the engineering world? How is this going to be eventually ... We see how it affects patients, but we don't always have the other skills that round out the things that you need to make an idea happen.

One framework that I've been studying in this course is something called the real-win-worth-it framework. It's opened my eyes to a really simple way to vet my own ideas and maybe even look at other ideas. I don't know about you, John, but I have other people who approach me from time to time. They say, "Hey, I've got a company or a startup. I'm looking for investors. Let me pitch you on this idea." It's kind of interesting, because I have been on both sides of that, to listen to other people's ideas.

The concept essentially is this. You have three boxes or three categories that a good idea has to go through. The first one is the real category. The idea is, does it solve a real problem? Is there really a market need or a demand that's out there for this product, whatever the product or service is. The first category is, is it real? Does it really solve a problem?

The second one is, can you win? Does your team have the necessary tools, skills, engineering prowess, funding, ability to build a better mousetrap or dominate a space? You have to make sure the idea is real. Can your team execute on that, make it into a product that is going to be better than anyone else's?

The last category is if you can do those first two, is there a business waiting for you at the end that would make it worth it for the investment of time and resources in that idea? I think that's a really interesting framework for people who are out there, maybe thinking about an idea, to say okay, I've got maybe a novel treatment for pterygium, or I've got a novel treatment for EBMD or something. Well you've got to run it through this scenario because it's really hard to get someone to invest if you haven't thought through these three categories.

This is one framework. There are lots of frameworks you can think about. For me, on my journey, this has been something that's really helped me to not only refine the way I present my idea, but also to think about other people's ideas. What are your thoughts on that?

John: Yes, so what I learned when I was talking to some of our early investors, which was a couple of professional investors and some doctors, was that the doctors were really interested in the idea. The business people really didn't care about the idea. They cared about the things that you couldn't change, the market size, is there a pathway for regulatory approval, and the team.

Number four was the idea for people that have been down this road before as investors. Number one for the doctors was the idea. We're a self-selected group of people that are inquisitive, scientifically inclined, and hopefully, altruism-inclined. We may not be able to see that big picture. Even if, at first, you're just doing it for curiosity. As your curiosity blooms into a business, unless you're going to be able to find folks to finance that appropriately, and they're only going to if they really think that you've got an ability to have a meaningful product in the space, you can climb the first tenth of the mountain and then stall out.

Gary: Right. Right. Yeah, I think that's interesting. You're exactly right. We look at the idea as the holy grail. Once you get sold on an idea and you think that this is something that's super important, we have a tendency, I think, as physicians, to minimize the challenges. We see the end product. We see the potential, so we kind of think, oh yeah, we can get through this or that. I think you're right. The business guys are maybe more pragmatic on the obstacles that are in the way.

One other thing I sort of think about, and I'd love to get your thoughts on this, is what is the biggest challenge or the biggest obstacle that you didn't see coming. For me, I kind of think about my journey as almost like ... This is not in scale representative. Christopher Columbus decided to go west. Everyone else was going east. He decided to go west. He could not forecast when he was going to arrive in India, because he never even got there. He got to the New World, and obviously, made great discoveries. It seems like when you're on this journey when you're trying to invent something that hasn't been invented before, or you're trying to do something no one's done before. It's really hard to know what's coming next, because you just don't know what you don't know. Have you found that yourself?

John: Yup. I'll answer that, but I'll say one other thing before that. I do think that that business guys add just an incredible ton of value, but there is something special about having a doctor included in the decision-making. We're the one that's there that took that oath. We're the ones that look patients in the eye. I do think that doctor founded startups, if we respect the business side of it too, can really have a strong true north on doing good things for people.

Then on to your question, which was what was I surprised by. Oh man, how many things have I been surprised by? You know, the first thing I was surprised by is just the magnitude of the work. It is incredible. The other thing that I was a little surprised by the endurance that's necessary and the crisis of confidence that can come sometimes, where even if you got good data, and you've got sound principles, you can ask yourself, especially when people invest money in you and your company, oh my gosh, I hope I'm right. It's kind of like the passage, "Lord, I believe. Help my disbelief."

Gary: Yes.

John: As the leader of this company, like a good coach, you need to believe and you need to know, but you also need to understand the dis-confirming evidence, and have people around you that when you do have these crisis of confidence, can say, "Whoa. Whoa. Whoa. You're just having a moment. You know? You got it. Remember. You got the principles. You got the data. We're all in this together." That surprised me a little bit, because it's easy allegiance to an idea. It's hard to have an allegiance to a process that's moving forward to get that idea into reality.

Gary: Yeah. Yeah. I totally agree. One thing I've found that was surprising. I've got an idea for a lens. We've got the IP and those sorts of things. It's amazing the number of steps you have to go through to prototype something and test it. Prototype, redesign, test it. It's incredible. Every step of the process, you can almost find a new way to fail every time you do something. It does, as you mentioned before, it kind of gives you a different respect for people who have done this. For me, a different respect for the industry.

I was one of these guys who would sit back at a lecture or a conference and say, "Well someone ought to do X, Y, or Z. Why hasn't so and so made this product?" Since I've gone through this experience, trying to develop my own product, it's really given me a whole new level of respect for the products that are already out there and the level of innovation that actually does make it through. Yeah, I agree. There is a lot that we don't know.

The crisis of confidence, you're exactly right. You got friends, potentially, who are supporting you or are investing. You got your own sort of reputation on the line as someone who has ... I think about myself as someone who is pretty level headed and logical and hopefully has good ideas. But you put yourself out there a little bit when it's your idea that's actually moving forward. That can be a little bit disconcerting sometimes.

John: Yup, agree.

Gary: John, any last words of wisdom before we wrap up?

John: I think my last word of wisdom is know you are and what you're meant to be and what you're doing, what your why and your purpose is. I know that I'm meant to take cataracts out of little old ladies and take care of the team here in our practice. That helps me put in perspective what I can do for this company while still being a good dad and a good husband. Knowing that we're going to get somebody that, if we meet our milestones, that is a professional CEO that can take the business where it needs to go. I know that where I'm really satisfied is helping people in their moments of vulnerability. Taking an idea and bringing it to fruition is super fun, but it's not my reason for existence. It is kind of the cherry on top of a life that's better than I ever imagined it could be.

Gary: Yeah, totally agree. You know, one of my favorite quotes is from Jim Watson. He said, "A river cuts through rock not because of its power, but because of its persistence." John and everyone else out there who's trying to wake up every day, make the world a better place, whether that's through cataract surgery or through business or through innovation, man, just stick with it. We will make this world a little bit better if we all commit to that." John, as always, I love talking to you. Best wishes on this project and everything else in your profession. Take care.

John: Thanks, Gary.

Gary: With John's experience and advising mind, I decided to touch base with another surgeon entrepreneur, Dr. Damien Goldberg, to collect some more insights on starting a new venture, surrounding yourself with the right people, and pursuing your own hypothesis to fill an unmet need.

This is Ophthalmology off the Grid. I have the pleasure tonight to interview a great friend, Damien Goldberg. Damien and I have really been friends for a number of years. We met through the Vanguard Ophthalmology Society, and actually maybe even before that at some meetings. Damien's someone I really look up to. Someone who is doing great work as an ophthalmologist but also as an entrepreneur and as a sort of a physician startup guy.

Damien, I thought you'd be a great person to talk to about really this concept of physicians with an idea, making that idea happen. Give us a little bit of a background on your work, just in ophthalmology. Then walk us through a little bit of the unmet need you saw and maybe some first steps on how you decided to solve that problem.

Damien Goldberg, MD: Absolutely. Gary, thank you so much for having me on your podcast today. I think it's been amazing to listen to. It's really fresh and right on. Much like yourself, with your own startup, I think it's all about finding the need, or seeing the vacuum and finding that there's a potential need that needs to be met. One thing that I always also remember a few years back when I got started, I was at a function. You were there. Some other people were there. Somebody asked me, who wasn't as involved in some of the projects that we do.

He said, "Why do you do all this? You've got a busy practice. It's a successful practice. You have a family. Why do you get so involved in these meetings and do all this stuff?" I thought it was an interesting question, but I realize, right in that moment what it was. I said, "Well you know what? Be honest. If you look around at all the people in the room, the people in industry, the KOLs that want to get involved, these are the people that I honestly think are going to have an impact. The way ophthalmology will be led in the future."

At the time, I was doing a lot of work with BMC, which I enjoyed working with them and some of the projects like MillennialEYE, and some of the other research projects I had been doing with some of the ophthalmology companies that I respect and hold dear to my heart. A lot of those people are great. Like yourself, I just felt like I had more to do. Maybe it was also one of these AECOS meetings I went. I think Robert Maloney was on the stage. Somebody was on stage. They called out. He said, "You guys have the ideas. It's in your brains. You just got to be creative and come up with a way to do it." That's kind of what I think got me motivated.

Gary: I share that same sense. Sometimes we look around at the stage of a career. We both have been blessed to have great careers. That is enough. It's not to say that being an ophthalmologist is not enough. I find tremendous satisfaction with what I do. I sort have this longing or this urge, like I think I can have a greater impact, maybe in a different way. There's just this restlessness to move the ball forward, the restlessness to lead in a new direction, and to see if I can leave this profession, maybe in one small way, a little better than I found it. I think that's what I'm hearing from you as well.

Damian: Yeah. One other point you mentioned too that just reminded me. I remember hearing Ed McMahon once say. He did all these things where the million-dollar draw that he did, and all the other projects he did. He said he never forgot what made him was being Johnny Carson's sidekick. I am never going to forget. The only reason I got to where I got is the guy, Dr. Barry Wolstan, the guy I joined, had an amazing practice, healthy practice. It's helped me get started a lot earlier so that I could kind of leapfrog and do these other things.

Like yourself too, I think you got to have the practice. You got to have the drive. You got to be a good surgeon. You got to be a pretty good doctor and make it all work. Then you get the opportunity to possibly do these other things, which I feel blessed to do.

Gary: I don't think you could've said it any better. My Johnny Carson is my partner, Lance Ferguson. If I was only the rest of my life referred to as the guy who works with Lance Ferguson, I think that would be enough for me.

Damian: Right.

Gary: I think I could die a happy man. I respect him that much. I feel so honored and blessed to be a part of that practice. I hear what you're saying there. Let's take this conversation to the next level of all right, we're ophthalmologists. We're sort of in our early careers. We've been really fortunate to take care of the main things in our careers, in our lives. All of a sudden, you see an unmet need. There are tons of unmet needs if you just keep your eyes open. To the fact that sometimes, I look around and see so many unmet needs, it almost is overwhelming when you start tuning your radar in that direction.

At some point, Damien, you saw an unmet and decided to do something about it. Walk me through sort of what the unmet need that you defined was. What kind of led you to say, "I'm going to be the guy that actually do something about this"?

Damien: Well, let me start from a little bit of a different angle. There's lot of unmet needs. There's a lot of great ideas. Any great idea can only be developed and delivered without the right people on the right team. I felt that we needed to first, with limited ... a startup challenge is working more with less. You have limited power, limited funding. There's high risk, but there's high reward. As you know too, the founding fathers and their families definitely deal with the stress. When we put our team together, we sort of had a corporate culture of no egos. Leave your ego at the door. We literally have a no douchebag rule. You cannot have any. As soon as we start to smell one of the members of the team is a douchebag, we gently ask that perhaps this isn't the right thing for them.

Roughly, what we've done is we put 15 positions together from all walks of life in ophthalmology, both younger and older, a nice mix of academia and private practice. That's what we put together for our medical adviser. I may have some great ideas in one aspect, but I'm still kind of new to the world of ophthalmology. Other people have more experience in different ways. We wanted this to be a dynamic group.

We sort of identified there still were some problems in postop management. We wanted to develop products there. We think there are still some unmet needs in dry eye. We're excited to be developing some unique products in the biologic and pharmaceutical space.

The postop management drops, we've already released. We have other dry eye products that should come to market in 2017 that we think will be clinically superior. Pharmacologic therapies have a lot of challenges with them, because of much of the restriction and FDA guidelines. We believe through compounding medication space, this is an area of growth. This is an area that further development can happen. We're excited to pursue that.

Gary: Well, I think you've hit on some really, really key concepts. First of all, the unmet need clearly was postop cataract drops. I'm assuming it's cataract. Maybe, are you also doing this for LASIK patients as well?

Damien: We are. We focused primarily in cataract, but exactly, we're going into Lasik as well.

Gary: Okay. This is something I've been really passionate about in the past. I really see that we can do this in a smarter way with a combination therapy. Patients, they can only be compliant to the level that they can understand your instructions, access the drops, get the drops you're trying to prescribe them, and then not run out of those drops. At every stage in that process, there is a lot of potential for either confusion, miscommunication, subversion, either intentionally or unintentionally by the pharmacies. Then just quantities. You don't really control that. Especially with samples, if you give someone a sample, it may not be enough to last them throughout the entirety of their post op course.

In my clinical practice, this as not a minor problem. This was almost one of the largest unmet needs, the largest headaches was surrounding those cataract patients, trying to, first of all, explain a tapering schedule. That's not easy.

Damian: It's amazing how much energy and time. I'm with you. I only want to explain it twice. If the patient still has questions, I have my nurse sort of explain it, but the amount of energy that goes into it has been remarkable, still, to this day.

What I would say is big pharma has been on our side. They've been trying to come up with solutions. They've been able to reduce the frequency, but the FDA still limits them to be able to combine them into one package, one easy to understand method to offer it. That's why we believe ... we're pursuing it kind of a little different than some of the other players in the market. We want to go with a preservative free combination solution. We think we sort of have a next generation combination drop that we believe will be able to meet this unmet need.

Gary: Well, and this is not an indictment on the FDA. I think the FDA has great intentions. They definitely want to keep American citizens safe. They want to make sure that safe products are developed. They're in a quandary. It's almost a catch 22, where they're trying to protect us and keep us safe as physicians and patients. At the same time, there's almost a lack of common sense or a lack of understanding of the common practices, for example, or standard of care issues even.

These compounding rules really allow innovation. They allow for great products to be developed. In many ways, products that are superior, at least in the minds of most ophthalmologists, and I think if you pulled patients, they would say the same thing, superior to the products that are available for less cost. That's what value is.

Damien: But then that's the other issue, right? Sometimes you need just a very simple disruptive technology to sort of identify the elephant in the room. Really, I think for a lot of people, you touch on the fact that this can be done simpler. It's unfortunate that it continues to be spread in headlines, in every paper, and on the news almost every week, another story of pricing in the pharma world getting what seems more and more higher. For a new innovative product, it makes sense. I don't know. It can be justified.

When you see generics just going up in price, that doesn't ... medication's not gasoline. People's lives and health depend on it. When you see the prices changing and going higher and higher, there just needs to be a discounted price solution, but it's important that even though it's a discounted price, it doesn't mean the quality is discounted. We just think that this can offer a way to still be very effective and control cost.

Gary: I want to talk a little bit about the products themselves. Your startup is actually light years ahead of some of the other physician startups that own product and some other folks I know. I want to give you a chance to talk a little bit, not in a commercial sense, but more or less just explain the products that you've offered, and maybe a little bit about the why did you decide to go in that direction.

Your company is ocular science. You can be found online at ocularscience.com. Walk me through a little bit about the products that you offer, and maybe the direction that you decided to go, the why behind those products.

Damien: Sure. Right now, what we have out is a Pred-Moxi-Ketorolac preservative-free solution for cataract surgery. We also have a Pred-Ketorolac solution for cataract surgery. We have a Pred-Moxi solution for LASIK. All of them are preservative-free. The purpose of the first two are some physicians found they wanted to have an antibiotic the first week and then just the nonsteroidal and steroid the second to third week. Some physicians are fine using the triple combo for the full month.

The nice thing is these medications can be packaged together in bottles together, so that it's very easy for a patient to follow. You use the first bottle the first week, the second bottle week two through four. It makes it very simple. I've been okay with using one bottle, the triple mix. I just reduce the frequency to twice a day after the first week.

We are currently about 85% finished with a perspective study that we've done looking at this, comparing this head to head in multi center observer, mass perspective study of 80 patients. Basically showing that there's no inferiority, comparing it to a branded moxifloxacin, prednisolone, and the nonsteroidal we used was Allegro. I can be very excited to, Gary, when we have the results, to present it. They look promising, but I don't want to pop the cork until I can tell you the statistical significance in the study.

Gary: Sure. Sure. I'm actually using a similar product, myself, a Pred-Moxi-Ketorolac combination, and doing it for the entire time, and have, just from my perspective, have had fantastic results. I think that there is a lot of befit to what you're doing. I think there's a ton of value that you're providing to both physicians and patients. Man, I'm really rooting for you.

Damien: Thanks, buddy.

Gary: Not just for this. When physicians go through a process like this, of building a team, of leading a team, of going through the science, but also going through the softer sciences of marketing and distribution, and all the things that are required for a medical startup. That next idea that comes across your mind, the next unmet need, you're going to be even better at executing on that.

I just think it's really important that we, as physicians, when we have ideas, when we have startups, that we support each other. Man, I'm looking forward to supporting you in this venture, but also for years to come. Man, I'm rooting for you.

Damian: Thanks, Gary. The other thing I want to hit home and I think is really important is, again, I am a fan of all the people that have done work before me. In no way do I, for any of the listeners, to think that I want to think my product is superior than anything that big pharma's done. No way I can say that, but I think that there is a need. We're not better, but we think there is a potential for our product to fit in the market also.

There's no way I can say this product is going to be superior than Durezol at reducing inflammation. I have grafts that are surviving months now that would've rejected if it wasn't for innovation like that. Same thing with medications like Prolensa. I think that we need discounted solutions that are still effective. I think this will be a great area.

We're also excited. We haven't shown all our cards. We're also excited later in the year to present another solution for dry eye that we think will be innovative. We look forward to being able to share that with you when the time is right.

Gary: Well we look forward to hearing more of the story as you can peel back the onion, so to speak. We look forward to hearing more about it. Any parting thoughts before we wrap this up?

Damian: Again, thank you. It's been fun, Gary. I think I want to turn the mic over and ask you a little bit about your startup.

Gary: You're turning the tables on me. Well sure, I'll give you a little brief update. We are really ramping up for our first human trial. That's going to be offshore. We are looking forward to positive results there. Again, like you said, not going to pop the cork until we have the results. We continue to make some progress in the intellectual property field. We're closing a B round of funding, which is then oversubscribed. That's always a good thing. We continue to get interest from people that we're presenting the idea to. Yeah, we look forward to, at the end of the day, making a difference, and making ophthalmology just a little bit better. Stay tuned. Hopefully, in the next 12 months or so, we'll have some more data to share.

Damien: Wonderful. I wish you best with it. This exciting podcast, it's been great. It's exciting. Thank you so much, Gary, for having me today.

Gary: Awesome. Thanks, Damien. This has been Ophthalmology off the Grid.

Having a pestering idea and knowing what to do about it can be daunting. Fortunately, there are many case examples in ophthalmology of physicians with ideas who tested, trusted, and committed to a hypothesis. It can be done. Even if you don't land exactly where you want it to, sometimes, just building the confidence in yourself to take that plunge makes it all worth it. This has been Ophthalmology off the Grid. Thanks for listening. Be sure to rate, review, and subscribe. Until next time…

Speaker 1: Ophthalmology off the Grid is an independent podcast, supported with advertising by Alcon.