Your career spans clinical practice to serial entrepreneurship – what drew you from practicing ophthalmology into building companies?
I had been involved in entrepreneurial things before I went to medical school, so I’ve always done both. In fact, I was partly drawn into medicine because it allowed me to do entrepreneurial things that applied more directly to people.
Although I loved clinical medicine and taking care of patients, from the beginning my career has always been a little of both. It’s only in the past ten years or so that I haven’t had direct patient care as part of my activities – and I miss it. There’s nothing more gratifying.
In many ways the two worlds are quite similar. There’s nothing more gratifying than having an impact on a patient. The highs and the lows are real. But there is also a similar gratification when you bring a product to market.
It’s not as immediate, but the feedback loop is the same – doing something that is valued by somebody else, whether it’s a patient or a doctor. The scale and the interactions are different, but that positive feedback loop is what keeps you going.
What were the toughest hurdles in bringing RxSight’s technology to market?
I’ve been involved in several projects over the years, and at least in medical devices they tend to follow a similar pattern. Pharma projects are a little different, but device projects have a few key hurdles.
The first is the technology itself. You must develop a technology that does something useful, and that’s often an iterative process. That’s one of the things I like about medical devices. With drugs, almost all the work happens on the front end, and once you begin the regulatory process you have much less flexibility.
With devices, the regulatory system assumes the device will continue to evolve over time – parts change, components need replacing – so there must be a mechanism that allows for that evolution. With drugs, you’re generally trying to maintain everything the same as when you first received approval.
So, the first hurdle is getting the technology to work the way you want it to – or the way the doctor wants it to. The second hurdle is regulatory approval.
For the Light Adjustable Lens, both were complicated. The technology involves an implant and an optical device delivering ultraviolet light into the eye with extremely high precision. It was a novel device, so navigating the regulatory process was challenging.
Then you move into commercialization – getting people to want to use the product and discovering how best to use it. That’s probably the most difficult phase, and we’re still in it.
We’ve been commercializing the product for about five years, but if you look at ophthalmic history, it often takes a long time for the field to adopt a new technology. Typically, it’s ten years or more before people look back and say, “Of course that was going to be important.”
The Light Adjustable Lens allows postoperative refractive customization. How did you first react to the concept, and what convinced you it could transform cataract surgery?
People often think about the Light Adjustable Lens primarily in terms of refractive correction. But I think it’s better understood as refractive customization. Correction is part of customization – it’s necessary – but it’s not sufficient.
The technology itself had been in development for more than ten years before I became involved. Much of the hard development work had already been done and the initial clinical studies were completed. When I joined, we were in a Phase 3 clinical trial, so my focus was helping get the technology through the trial and preparing for commercialization.
As I became more involved, I spoke with many doctors who had worked with the technology earlier – many of them in Europe, where the company had already obtained a CE mark before FDA approval.
What came through very clearly was that in cataract surgery people always talk about whether they “hit the target.” But the real question is: what is the target?
It isn’t always emmetropia. We have two eyes, and if you want efficient, optically pure vision across a range of distances, binocularity is very important. This technology allows individuals to optimize that to their own preferences – and to see the result before deciding.
That ability to customize vision and fine-tune binocular vision is powerful. My original interest in medicine was neuroscience, and such a large part of the brain is devoted to vision. Vision isn’t just an ocular phenomenon – it’s how the brain perceives the world.
As refractive expectations in cataract surgery continue to rise, how do you see the surgeon–patient relationship changing?
There was a time when the doctor simply told the patient, “This is what we’re going to do.”
Now every patient carries in their pocket a device that gives them access to an enormous amount of information. Patients arrive having already looked things up and formed expectations.
That means the relationship must be much more collaborative.
Technology like the Light Adjustable Lens supports that. Patients still need a skilled doctor – for both the technical aspects of surgery and the judgment that comes with experience. But many patients want a sense of control over what happens in their own bodies.
In traditional cataract surgery, the surgeon says, “I’m going to put this lens in your eye and I think this is the best power for you. We’ll see how it turns out.”
With an adjustable lens, the conversation becomes different. You can say: “We’re going to implant an adjustable lens, and after surgery you and I will customize it to your needs.”
For patients, that can be very reassuring. It gives them confidence that the outcome isn’t locked in beforehand.
What excites you most about the current direction of ophthalmic innovation – and where might the next breakthrough come from?
One of the biggest developments right now is the rise of machine learning. I’m not particularly fond of calling it artificial intelligence, but it’s a powerful tool that we’re only beginning to tap into.
Learning how to use those tools effectively will change a lot of what we do. It’s already changing how we operate at RxSight in our daily work.
We need to embrace the technology rather than fear it, although there will be hurdles because the regulatory framework in medicine isn’t set up for it.
In other parts of society – social media, advertising – AI tools can move forward very quickly. In medicine there is an important check in the form of regulation. That means adoption won’t be as fast, but on the development side it’s already having a significant impact.
In many ways this feels like a major technology moment. The skills that were important before will still matter, but the people who succeed will be those who figure out how to combine those skills with these new tools.
Having helped shape femtosecond laser cataract surgery and now adjustable IOL technology, what continues to motivate you to innovate?
I don’t think anyone can really claim true innovation. There are very few people who are genuinely innovative.
Most of us build on what others have done. We learn from each other and add pieces along the way. That process itself is what excites me.
These days I’m not as involved in the day-to-day work as I once was. A lot of my role is encouraging others and helping create the environment where new ideas can develop.
Often, it’s younger people who drive those advances. You probably reach your maximum intellectual capacity somewhere around your mid-twenties.
Of course you can still do a lot after that, but as you get older you rely more on experience and efficiency.
One of the things I enjoy most is being around younger colleagues. I’m probably among the older people in our company now, and at a time when many of my peers are retiring, it’s energizing to work with people who are at earlier stages of their careers.
How do you personally define success at this stage of your career?
I’m not particularly self-reflective, but I’ve learned a lot from my wife, who is also an ophthalmologist. She’s a pediatric ophthalmologist, and she often tells our children something very simple: “Just be useful. If you’re useful, a lot of good things will happen.”
That’s a philosophy I like.
With the Light Adjustable Lens, for example, we’re excited about bringing the technology back to Europe. What we think doctors will find is that it’s genuinely useful in their practices.
It helps surgeons meet the expanding expectations of patients while also supporting the financial sustainability of their practices by offering services that some patients value highly. Many people value their vision above almost anything else.
There are also unique situations where adjustability becomes an especially powerful tool. We’ve already seen creative surgeons use the technology to deliver excellent visual outcomes in patients with ocular conditions or less-than-perfect optical systems.
In many ways we’re still just scratching the surface of what adjustability can do.
If I look back at cataract surgery for an analogy, I think about foldable intraocular lenses and small-incision cataract surgery, which were emerging when I first entered ophthalmology. Today it’s very rare for someone to implant a non-foldable lens.
I believe adjustability may follow a similar path. For patients seeking optimal visual outcomes, the ability to fine-tune vision after surgery represents a capability that will become increasingly valued over time.
