Seeing the future

June 20, 2019

Real-world experience can bring fresh insight

A young ophthalmologist and I strolled into the convention center at an event in another country. We found ourselves among booths exhibiting the wares from a wide range of ophthalmic device and pharmaceutical companies. It was the first such international meeting for this junior colleague.

“What is particularly fun about these exhibits is seeing what they have for sale in other countries, including medicines and devices that might not be approved for marketing in the United States until years from now,” I told this young person as we walked along the exhibit floor. “It is like seeing into the future.”

Meeting memories

This recent experience reminded me of something that I had learned many years ago while attending a meeting. I was a young assistant professor with much to learn, and the meeting was in the tropical paradise of Hawaii.

The Aloha State became the 50th state in 1959, and while it may not be an international venue, this particular meeting had attracted speakers from countries around the world.

The daily routine during the meeting was a few hours of lectures followed by relaxation, including floating in the swimming pool, body surfing at the beach, or trying to hit a little white ball into a succession of 18 holes. On this particular day, I had listened to one of my fellow American speakers describe the results of a clinical trial with a new multifocal IOL.

Impressive initially

The data were impressive and the speaker, a consultant to the manufacturer, was enthusiastic that this device would be a big success in the United States. Distance and near uncorrected visual acuities were quite good, and contrast sensitivity testing showed very little loss of contrast compared with standard monofocal lenses.

A few hours later, I found myself in the pool with a senior ophthalmology department chairman from Europe.

We found that we could beat the afternoon heat and humidity by standing in the pool near the edge, with our mai tais within easy reach to maintain proper hydration. I brought up the subject of the multifocal IOL.

“When I get back to Los Angeles, I am going to have to get ready to start implanting a lot of those IOLs,” I told my friend.
“Why?” he asked.

“You heard the talk this morning,” I said.

“The data he showed seemed quite impressive to me.” “Don’t waste your time,” he responded. “That lens is no good.”

“No good?” I asked. “But the data he presented seemed wonderful. Why do you say the lens is no good?”

RELATED: Measles in focusMy senior colleague explained that it had been available in his country for two years, and everyone was quick to try it when it first entered the market.

“We quickly learned that a very high percentage of patients complained bitterly of problems with night driving, and we were soon dealing with angry patients and explanting the lenses,” he explained. “No one uses them anymore. You definitely don’t want to be putting those lenses in your patients.”

Learning the truth

I recall being stunned by his statements. The “hot-off-the-press” information from the clinical trial that seemed so exciting was rendered moot by two years of practical real-world experience of excellent clinicians.

Time then proved my colleague to be absolutely correct. Within a period of about two years, the limitations of the device became evident to all and the lens never was marketed in the United States.

“Wow,” I thought. “You can learn an awful lot about what will happen in the future in the United States by hanging around in the pool with intelligent ophthalmologists from other countries.”

Instead of continuing to plan my use of this new multifocal IOL, I took another sip on my mai tai and focused on perfecting my floatation technique.

RELATED: A ‘mental’ picture

Disclosures:

Peter J. McDonnell, MD
P: 443/287-1511 E: pmcdonn1@jhmi.edu
Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.