INNOVATION IN RETINA

Dr. Eugene de Juan, Jr.: A Lifelong Quest to Innovate

Jerry Helzner, Senior Editor
Edited By Emmettt. Cunningham, MD, PhD, MPH, and Pravin U. Dugel, MD

Eugene de Juan, Jr., MD, MA, has played a key role in the development of more than 100 ophthalmic innovations, ranging from basic handheld surgical instruments to biochemical therapeutics to the most complex miniature microcircuitry that is restoring some sight to individuals afflicted with retinitis pigmentosa (Figure 1).

Figure 1. A normal retina (A) and one with RP (B). The Argus II implant restores some functional vision to RP patients.

His prodigious body of work, which includes holding patents on more than 50 medical devices, has earned him a global reputation as one of the world's foremost ophthalmic innovators. He has participated in such companies as NeoVista, which is using small, targeted doses of radiation to help combat wet AMD, and Second Sight Medical Products, whose CE-marked Argus II retinal implant is bringing sight to RP patients. He holds a master's degree in biochemistry, giving him the expertise to innovate in both devices and pharmaceutical products. Yet, his initial motivation to invent sprang from a simple observation he made as a child.

“My father was an ophthalmologist and when he showed me the instruments he used in cataract surgery, it fascinated me that almost every instrument was named after the surgeon who had developed it,” recalls Dr. de Juan. “I thought it would be cool to have an instrument with my name on it that people all over the world would be using. Even at that age, I was interested in leaving a legacy of making surgery better.”

Many decades and hundreds of inventions later, Dr. de Juan can chuckle about his childhood concept of fame. Today, his only real priority in deciding to lend his energies to a potentially innovative concept can be expressed in a few words: “Will it make people better?”

UNIVERSITY-BASED INNOVATION

As a vitreoretinal specialist and an inventor, Dr. de Juan has pursued his quest of making people better through both patient care and in the laboratory. His varied career has led him from medical school at the University of South Alabama, through residency and fellowship to prestigious leadership positions at Duke University Eye Center, the Wilmer Institute at Johns Hopkins University, the Doheny Eye Institute at the University of Southern California and currently to the University of California at San Francisco.

At each stop, Dr. de Juan has combined a commitment to patient care with developing new ophthalmic concepts.

“As an ophthalmology resident at Wilmer, I designed a retractor and had it made by a machinist,” he recalls. “Dr. Robert Machemer ran a sort of incubator at Duke where you could bring your ideas to the lab. I designed a combination pick/forceps and also flexible iris retractors there. Johns Hopkins had what they called a MAD (Microsurgery Advanced Design) Lab that was responsible for about 100 inventions, including small-gauge transconjunctival vitrectomy.”

CREATING FORSIGHT LABS

Dr. de Juan enjoyed the give-and-take of university-based innovation, with experienced faculty mentors helping young ophthalmologists, scientists and engineers bring their ideas to fruition. However, in more recent years he refined his own idea of what constitutes the ideal setting for innovation and made it a reality in the form of ForSight Labs (www.forsightlabs.com), which he founded in cooperation with Bill Link, PhD, of Versant Ventures and Hanson Gifford of The Foundry, a California medical device incubator. In creating ForSight Labs, Dr. de Juan drew upon the models of both the Innovation Factory in Atlanta and The Foundry, both of which have achieved outstanding track records as incubators developing a wide range of medical devices.

All aspects of ForSight Labs have been designed to encourage intense and highly focused ophthalmic innovation. Even the location of the lab was chosen especially with that goal in mind.

“Bill Link told me to locate the lab in the Bay Area because the entrepreneurial environment here is so in-grained in the community,” says Dr. de Juan.

The ForSight concept encompasses a small, hand-picked team that selects and tackles one major project a year and, with the help of venture capital, develops it from concept toward the ultimate aim of commercializing a product. Ideas for projects can come from within the team, from colleagues or from other inventors. Projects are selected through what Dr. de Juan calls “brainstorming, searching, thinking and collaborating.”

“Thus far, we have been involved in starting five companies, with the fifth one just getting under way,” says Dr. de Juan. “The first was Transcend Medical, which has developed a glaucoma surgery that uses an entirely new mechanism and employs a stent placed in the supraciliary space (Figures 2 and 3). It's already CE marked in Europe and is in final clinical trials in the United States.”

Figure 2. The mechanism of the CyPass IOP-lowering device.

Figure 3. An implanted CyPass Micro-Stent device from Transcend Medical.

ForSight has also developed a punctal plug drug-delivery system that was bought by QLT, another sustained-release drug-delivery system for the back of the eye, and a treatment under the company name NexisVision that is intended to improve refractive surgery outcomes.

ADVICE FOR INNOVATORS

Asked what is the greatest lesson he has learned over his many years of participating in ophthalmic innovation, Dr. de Juan does not hesitate.

“Working with the right people is 99% of achieving success,” he asserts. “It really matters who you work with. That encompasses their experience, their commitment, their values, their judgment, their intellect and creativity. And that includes the investors as well.”

Dr. de Juan much prefers team players over “geniuses” who isolate themselves from the team.

“Every project goes through ‘near-death’ experiences, but if you don't have the right people, these events can easily become ‘death’ experiences,” he says. “Anyone can be responsible for disrupting a project.”

Dr. de Juan says he now has the perfect situation with ForSight.

“For me, this is the ideal. In over 30 years in ophthalmology I've never worked in an environment that's more productive,” he says.

Given what he calls the “stunning” advances in ophthalmic technology and the knowledge of eye diseases that have occurred in recent years, Dr. de Juan says ophthalmologists with innovative ideas should come forward. He advises that they first protect—and then promote—what they have to offer.

“It's not an easy road. It's not for the faint of heart,” he cautions. “Protect your idea through a patent process, which is not all that costly, and then talk about it with friends and colleagues,” he advises. “If other people are also enthusiastic, you probably have a good idea. Then go to business friends, go to ForSight, go to a venture capital firm. Get more feedback from people who are in a position to evaluate your idea. And continue to test and improve your concept.”

Dr de Juan says an innovator without a track record will probably not get a great financial deal on the first project, but once the innovator is established it will be easier to fund projects.

“Don't be so concerned with the financial deal you are getting,” he advises. “Remember, we are doing this to make people better.” RP