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Steven Vold, MD, sees huge advances in MIGs treatment, drug delivery and new neuroprotective compounds that could help treat glaucoma and perfect vision.
Steven Vold, MD
Steven D. Vold, MD, certified by the American Board of Ophthalmology, specializes in the diagnosis and management of glaucoma and cataracts. He is an award-winning cataract surgeon and is a graduate of the University of Minnesota Medical School in Minneapolis.
Tom Salemi: Hi, everybody, welcome back to the OIS Podcast. This is your host, Tom Salemi. Thank you for joining us on today’s Podcast. We’re going to talk glaucoma in just a few minutes with Dr. Steven Vold of Vold Vision. He’s been a regular at OIS and involved in Glaucoma 360 earlier this year. And we’re going over some of the advances that are happening on glaucoma, including some interesting things that Steven’s particularly excited about. Talked a little bit about robotics, a little bit about drug delivery and a little bit about baseball, which is a favorite of mine. But first I just wanted to ask you to go to OIS.net, look for our newest event, OIS@ASRS. We’re beginning to put some information up there. We have a preliminary agenda. It’s a half-day event on August 8, dedicated exclusively to the retina, and I’m sure you will find it enjoyable. It’s in San Francisco right before the ASRS annual meeting. So go to OIS.net for the latest information on that event. And now take a few minutes to listen to this great interview with Dr. Steven Vold of Vold Vision.
TS: Dr. Steven Vold, welcome to the Podcast.
Steven Vold: Thank you so much for having me.
TS: It’s great to have you here. We’ve had the opportunity to talk a lot about glaucoma lately with the acquisition of Transcend a few weeks ago, Glaucoma 360. There’s just so much going on in this specialty. Is this – when you got into glaucoma, clearly it wasn’t this exciting. But is this sort of something you had anticipated moving to this sector? Did you see a lot of room for growth and for new technologies?
SV You know, it’s kind of funny that you ask that question because when I first started my residency back in the mid-90s, I remember thinking to myself, Well, there’s one fellowship I’ll never do; that would be glaucoma. Because at the time, really I thought the surgery was fairly primitive and the medications weren’t that great. Then during my training when we came out with a lot of the newer medications – at that time latanoprost and brinzolamide and dorzolamide, as well as came onto the market, and I was thinking to myself, you know, we really have an opportunity to potentially transform how glaucoma care is being practiced. And so that was actually one of the drawing cards for me is I thought, if we’re going to have a chance to really impact the field – and obviously, I couldn’t foresee exactly what all was going to happen and how exciting it has become, but I have to tell you I’m extremely grateful that I made the decision to go into glaucoma. And really, I anticipate that we’re really at the tip of the iceberg in this regard.
TS: Yeah. What do you see out ten years? We’ll obviously hopefully see some adoption of the various MIGs devices that we hope will be approved over the next couple of years, which will compliment Glaukos’ offering. But ten years from now, are you anticipating the introduction of technologies that will continue to amaze us then?
SV You know, I really do. I think there’s a very good chance that some of these new micro-invasive glaucoma surgeries will really continue to evolve, we will be intervening earlier and earlier in the disease as far as the surgical side. But I also think drug delivery is another area that is very exciting, and I think we’re going to actually be able to give people, whether it’s an implant or something that’s placed on the surface of the eye, a way to maintain good glaucoma control, using more sustained drug delivery system. And then of course there’s going to be new drugs that come along the way. And one class of drugs that I really hope hits the way is – we’ve seen it work some of the animal models. Wouldn’t it be nice if we could actually come up with a truly neuroprotective compound that was outside of the scope of lowering intraocular pressure?
TS: The microinvasive surgery is fascinating. And this is – we’ve seen in other specialties the use of robotics, and there’s been talk of robotics sort of entering ophthalmology. One company was supposedly interested; now I’m told they’re not. But do you see a future for robotics in ophthalmology?
SV You know, it’s interesting you mention that. The thing about the robotics, at least in general surgery and some of these others is it really kind of replaces the hands. There’s no question we’re going to have more automated devices. But when you think about robotics, at least I think of a little bit devices. And so I think some of this is going to be on more the micro level. And so it’s really more of a nanotechnology that I think will be more automated. So I do think we’re going to have things like that. In fact, I’ve been working with devices that potentially could replace sutures in ophthalmology just by having kind of an almost auto-suture or a little micro clip that we can place instead of a suture. So I definitely think those sort of technologies are going to be available. And also, I think there’s going to be alternative types of ways to remove the cataracts and certainly the lenses are getting better. So I think it’s going to be very fun to watch how really we’re going to be able to enhance people’s vision in ways that we never, ever thought possible. It used to be we thought that 20/20 was good vision. I actually think with some of the newer devices I’ve been working with, including the light adjustable lens, we’re going to be able to get people better than 20/20 vision. We’re going to get better intraocular pressure control with a lot of these newer glaucoma devices. And so my hope is we can intervene earlier and give people long standing glaucoma control.
TS: Maybe major league baseball better ban these things now rather than later if you can give everyone Ted Williams’ eyesight.
SV Well, you know, it’s actually true. It’s really been kind of funny because as you know, in sports, especially in baseball, a lot of these major leaguers, they really do see better than 20/20. And I think as we go along, even the refractive procedures that our young people really want, or Millennials want to have, all of a sudden, they’re going to be wanting things that certainly exceed what they would be able to see in contact lenses or glasses.
TS: And I see, just looking at your website, that you’re actually a sponsor of the Razorbacks, the official, I think, eye care provider of the Razorbacks, and a local baseball team, it looks like, down there. How did that relationship come together, and how does that work?
SV We enjoy being part of the community. That’s a big deal to us. And in our area, especially in the state of Arkansas, we don’t have a professional sports franchise. And so being part of the Razorbacks is really a tremendous privilege. And we’ve really enjoyed being part of supporting the university, and that’s been a big deal. And then we’re fortunate also to have the Northwest Arkansas Naturals here, and they’re the AA baseball team for the World Series winning Kansas City Royals. And so we got a chance to be a participant with that as well. And for us it’s just a lot of fun, an opportunity to meet and help people, and also a way to support our local teams.
TS: I’ll take AA baseball all day long. It’s a great take. Speaking to your comment before about younger people moving toward eye care, is there a greater awareness of eye care maintenance amongst young athletes, either in college or young professionals?
SV Well, we’re still working hard to make that happen. Believe it or not, there’s a lot of ophthalmic training techniques that are available now, and clearly I think for especially in some sports, baseball you mentioned, but I also think a lot of football and basketball, hand-eye coordination is a big deal now. Unfortunately, I can’t make you hit a curve ball better, but what we can do is optimize the quality of vision you have, and certainly for athletes that wear contact lenses or glasses, it potentially can be a big deal for them to be able to see better, but also get out of their contacts or glasses.
TS: Going to take this quick break from this conversation with Steve Vold to remind you to go to OIS.net in addition to checking out information about OIS@ASRS. You’ll want to sign up for the Eye On Innovation Newsletter so you will get our original reporting, our Podcast, and our video reports sent directly to your inbox. So go to OIS.net to sign up for the Eye On Innovation Newsletter. Now back to this conversation.
TS: And I know in addition to performing surgery and treating patients, you seem to enjoy writing. You’re the Chief Medical Editor of Glaucoma, and I know that comes with many different duties. But on your website I see a lot of papers you’ve written about MIGS, which we can get into in a second, but also about practice management. That seems to be something you give a lot of attention to. And you had written one piece about the Aravind Eye Care System and sort of the lessons we could learn from that. What was your take away from studying Aravind?
SV You know, it’s interesting. I think as you know, the cost of healthcare is a very big deal. And so practice efficiency is very important. And when you look at the Indian healthcare system, especially Aravind, it’s a great story about basically a retired ophthalmologist who started what is now the largest ophthalmic eye hospital in the world. And they produce not only good surgery and very efficient surgery, but they produce intraocular lenses that are very comparable to things that are on the market here in the United States, but at a fraction of the cost that we’re able to get them here in the United States. And so to me, we can learn a lot. We know in the United States we’re really working to lower healthcare costs because it’s become such a large part of our GDP. And so one of the things that I really feel like in somebody who’s started his own practice here in 2011, I want to make my practice as much cash pay as I possibly can and be independent of some of the challenges facing us with insurances. But also I really want us to be more efficient and effective so that hopefully we could give more cost effective care to our patients as well.
TS: Does the arrival of technologies like MIGS pull you back into the payer world?
SV You know, it’s a good question. There’s no question that – I would say to some degree that that’s true.
TS: And is that a concern or is that – obviously you’re able to treat more patients, and that’s a great thing. But is that something that you weigh in your mind, this or that?
SV Well, you know, for me it’s all about giving patients the best optimal care. And so the one thing I do – the problem with efficiency sometimes is you lose the ability to connect with patients as much as I like. I’m a relationship kind of guy. And so I really enjoy getting to know my patients. The one thing I like about glaucoma is they do come back after they treat them. So a lot of times I get to know them over time. But there’s no question when things are – efficiency is such a big part of how we need to practice today, I think we lose a little bit of that. And I think it’s – we see that sometimes with the litigious nature of healthcare, unfortunately, these days. But for me, I learned if I treat people like a friend and treat them how I want to be treated, generally things work out pretty well for me in the end.
TS: Staying on the MIGS theme, I saw, I think it was a couple of years ago, you might have spoken at Glaucoma 360 just about the companies that were sort of leading the way in MIGS. And you identified four of them. You had Glaukos obviously, AqueSys, Transcend, and InnFocus, what was the fourth one. We’ve seen three of them either go public or be acquired. Do you see – is there room for – is there a home out there, do you think, for InnFocus as a clinician? Do you see a provider out there who would be looking for a property, not that company in particular, but for MIGS properties? And do you see this consolidation as a positive for the glaucoma sector?
SV Well, I think having the financing of these bigger companies all certainly makes it a probably a positive for the glaucoma patient. I really think someone like Alcon or Novartis, when they acquire a company like Transcend, they’re going to make this really, truly part of the fabric of how we take care of our glaucoma patients. And I really think Glaukos has done a remarkably good job of really creating a market in this regard, and helping patients and really doctors understand how important it is to treat glaucoma early, and that we have some really good options now that we haven’t had in the past. So I’m very bullish on what we’re doing in this field. How it all will translate long term, I’m not sure. Finances and how this is going to be paid for I think are things that are yet to evolve. But to me, this is something that for glaucoma patients, we are definitely providing a significant step up in care from my perspective.
TS: And final question: in 2011, you had created a venture called Ocunetics, that was acquired fairly quickly. But sounds like that there’s been some progress in that area of late. Can you bring us up to date on what Ocunetics was, what the technology did, and what might be happening in the near future?
SV Yeah. As you know, it’s really kind of focused on wound closure. And so what we’ve kind of developed is really a little micro-staple or a little clip that we can use to close the cornea, the conjunctiva, also the sclera as well. And this is something that really can be very helpful in helping surgeons close tissue in a very effective and actually more efficient fashion. It’s also reproducible, so people – surgeons, especially with newer surgeons who are not trained to do a lot of suturing that was done previously with cataract surgery, this is something that’s going to make it much more efficient, and I think also in under developed countries, it’s something that could also be really helpful for people that are non-surgeons to be able to help close tissue, whether it’s from an injury or what we’re doing right now is actually using it in the setting of a trabeculectomy in animals. And so we’re really excited about the possibility of bringing this to humans very, very quickly and in a 510K protocol. So it’s exciting times ahead.
TS: Fascinating. Well, Dr. Vold, thanks for joining us on the Podcast.
SV My privilege. Thanks so much for having me.
TS: Thanks, Steven Vold, for joining us on the OIS Podcast. It was a real pleasure to have you here. Great glaucoma talk, great baseball talk. And as I said, I’ll take AA baseball all day long. So thanks to our listeners for joining us. Very happy to have you here as well, and we certainly hope to see you at our upcoming OIS@ASRS. It’s happening on August 8 in San Francisco. Go to OIS.net. We’ll be updating that agenda as we confirm speakers. And we’ll be going over some of the speakers and the content in upcoming OIS Podcasts. So stay tuned. Go to OIS.net to register, and we will see you in San Francisco.