[creativ_pullleft colour=”light-gray” colour_custom=”” text=”Episode 093″]
Over two decades ago, Mark Humayun – who will co-chair our upcoming OIS@ASRS – helped launch a “moonshot” that would eventually restore vision for retinitis pigmentosa patients. In this podcast we discuss what drives him and what’s next for ophthalmology.
Mark Humayun, MD, PhD
Mark S. Humayun, MD, PhD, is the Cornelius J. Pings Chair in Biomedical Sciences, Professor of Ophthalmology, Biomedical Engineering and Cell and Neurobiology, Director of the USC Institute for Biomedical Therapeutics, and Co-Director of the USC Eye Institute.
Tom Salemi: Well, Dr. Mark Humayun, welcome to the Podcast.
Mark Humayun: Oh, thank you. it’s a pleasure to be here.
TS: I’m glad to have you. We had Bob from Second Sight, Bob Greenberg from Second Sight on last year, I think. It’s been a while. And he had conveyed the origins of Second Sight, and it’s just such a great ophthalmology story, such a great medtech story, that initial procedure that you and Gene Dowan were involved in. Can you take us back a little bit to that? I’ve been wanting to talk to you about it. What was that experience like to essentially give the first glimpses of vision to someone who hadn’t had it in so long? Maybe you can tell us a bit about how that all came together.
MH: Yeah. Well, I mean the Second Sight project was really a moon shot when we first thought of it, about now almost 30 years ago. The idea of using electronics to put into the eye to restore sight was really science fiction. And so to make it science fact there were lots of hurdles that we had to overcome, including initial funding, because there was really no proof of science, leave alone proof of concept. So the key turning point was when we took these tiny electrodes and put them into – momentarily in the operating room for about 45 minutes or thereabouts, into a blind person’s eye. Now these patients were blind from retinitis pigmentosa, and by blind, I mean no light perception. So those tests showed us that when we could actually stimulate in the local area, the patient could see a spot of light. And they could track the frequency of stimulation and the location of the probe in the eye, which was very, very exciting, meaning that we could actually input through this blind retina and have the patient have visual perception of seeing a spot of light. So that really changed the whole project. It wasn’t so much now that it couldn’t be done; it was more could we actually engineer a device and put it into the eye to make this possible.
TS: And when that happened, when you had those moments of success, what were your feelings at that time, at that one moment?
MH: Well, I mean that moment, as I’ve said before, is really one of – in fact it is the most exciting moment in my professional career. It’s the defining point for my career. This is a project that I’ve dedicated my entire professional life to. So having that perception that, even if it was a small spot of light, and even if it was dim and flickering, I remember that just like yesterday. It was an amazing moment, and the defining moment for my professional career.
TS: And did you envision the path that it took to finally get the Argus device or the Argus II device on the market? Did you anticipate it being that long a road? I know Argus I came out about 12 years ago or so. But what did you think was lying ahead when you had that moment of success? And how did that match reality?
MH: Well, that moment of success in that operating room with hand-held electrodes was very, as I mentioned, was extremely joyful. It’s something that I still remember clearly. But then as the emotions of joy came back to reality, the reality was we knew we had a very long road ahead. There was just no such device that had ever been – sorry. There had never been such a device that everyone had thought about for the eye, and to make this device, how do you interface with the retina? The eye moves, it’s extremely delicate; what about the lens, the cornea, the sclera? There were lots of challenges. And we knew it was a long road ahead, but you know, did we know it was going to take from 2000 – when we did these tests were literally 1992. Did we really know that it was going to take that much longer? I would say no, but we knew it was a long road.
TS: And it really was a perfect fit for your background, being both in medicine and engineering. It’s a great combination of both. Did you seek both the medical and the engineering backgrounds sort of knowing that these possibilities were ahead, that we could have these sort of implants? Or is this just a good bit of timing, that your skill and your training and technology, the advances of technology sort of came together in that one important moment?
MH: Well, this project is very personal motivation. There’s a very personal motivation behind this project. My grandmother went blind when I was in medical school, and it made me focus on developing something for patients who are going blind or are blind, and then really I had no background in engineering. But it’s really the project that drove me to go back in medical school pretty late, and also residency to get a PhD in engineering, and then really bring those 2 together to see this project to fruition. So it was a personal motivation from my grandmother going blind that took me into this path, and going back and getting an engineering degree to make this project possible.
TS: And what were your experiences in working with Al Mann in getting Second Sight done? He obviously passed away recently. He had accomplished so much. What was it like to work with him on this?
MH: Well, Al Mann, you know, was a very unique figure. We all in the medical device community are really saddened by his death. I mean he had a very full life, and he passed away when he was 90. But without him, it’s difficult to develop these long term projects. He was one that was once he believed in the science and the approach, he was a big cheerleader, and always supported the project through ups and downs. And projects like these and the other ones that he worked on, whether it was a pace maker or the cochlear implant, or his latest, which is the drug delivery system, inhaled drug delivery system, these have taken decades. And he was always supportive, both from a financial and emotional standpoint, which is so critical and so missed without him being here.
TS: Absolutely. And going back to your innovative drive, you’ve obviously worked with a lot of innovative people, people who have created new ideas. Do you find that there’s a common thread between people who are looking for absolutely new ways of doing things? Is there a personal motivation in a lot of people? Is it more just a scientific curiosity? Perhaps it’s a mix of both? What’s your experience been like in working with other innovators? What drives them?
MH: You know, I was fortunate enough to get the National Medal Of Technology and Innovation this year, presented by Doctor –
MH: Yeah, thank you. And that, you know, I’ve interacted with innovators and technologists, and at that meeting, I met a number of them that were also getting the award. And basically, the reason I mentioned that is that this interaction just recently further confirmed the kind of experiences that I’ve been having with innovators is that usually they go into it either because of a personal interest or personal motivation, or they just like what they’re doing. There’s no – it’s just a lot of fun for them. So there isn’t really any timelines per se, or any idea that they’ll make a product and make a lot of revenue or return on investment. They’re just truly driven by the pure experience and the love of innovating. So and of course there’s a blend where people are motivated personally because somebody in their family either went blind or had a heart problem or a stroke or whatever. But they also very much enjoy innovating and going through the ups and downs, and really paving a new path.
TS: That’s for sure. And obviously, lot of different stories we see at OIS. On the clinical side in the practice of medicine, how has that changed for you? And what do you enjoy about treating patients? Obviously, restoring vision in someone has to be an enormous accomplishment. But beyond those great moments, just the day to day in ophthalmology, what drives you? What do you enjoy about the specialty?
MH: Well, I love ophthalmology because – and love interacting with the patients because you get to practice a well-known art. So basically, when you’re in the clinic, whether it’s through your diagnosis or your surgical skill, you’re able to see results immediately, or in short order, because you’re practicing something that’s well established. And it gives you an appreciation for those procedures because then you go back to what you’re innovating in the first in human trials, and you learn that even the simple steps, if they haven’t been refined or worked through, can be challenging. So it gives you a great appreciation for what you practice in the clinic, especially if you’re innovating new technologies. But more than that, it’s the human aspect of it. You see patients. You love to improve their vision, but also you’re driven by those who you can’t help, that that’s a real motivation to continue to invent.
TS: That’s terrific. And you’re obviously involved in leadership. You’re the incoming President of ASRS, and you’re going to take office in August at the annual meeting, where we’ll be with our OIS@ASRS for the first time. What do you envision happening in retina in the coming year, both from your position in leadership, but also in the specialty itself? How has the retina specialty changed in recent years, and how do you see it developing in the upcoming years?
MH: Yeah. It’s really great to have OIS at ASRS for the first time this year. We all are looking forward to that and looking forward to continued long relationship. OIS brings certain aspects, certain corporate and early stage company aspects that are not typically discussed or discussed to a great length in a meeting like ASRS. So we’re really looking forward to having OIS at ASRS. In terms of retina, I think it’s a wonderful, exciting time. Pharmaceuticals are really coming into play and have been in play in a very big way, and they will continue to make a difference for the retina. I think biologic approaches, whether cell based approaches or gene therapy approaches are also extremely interesting, and something that we’re all looking forward to and really bringing to fruition in retina. And I think from a device side, both in terms of diagnostics and therapeutics, we’re getting into being able to really see the retina both structurally down to micron levels, but also some very interesting work starting to look at the retina from a metabolic function standpoint. So I think in terms of the retina, there’s a lot of great things happening on the research and development side. We do have to also work in the advocacy area to make sure that reimbursements and other things are appropriately kept, so people continue to want to go into retina, and we can continue to treat our patients as best as we can.
TS: Do you think is that a challenge having physicians choose retina as a specialty? It’s my understanding it’s a very popular space. But is there some – I mean we’re seeing a lot of advances in glaucoma; that seems to be a specialty that’s growing as well. But how high is the level of interest in retina for new ophthalmologists?
MH: Well, if you look at – one metric is to look at ASRS credentialing, and so how many fellows are coming in and signing up both in fellows in training, and then as regular members. And this has continued to grow, and do so very well. So we don’t see any diminution in it, so I think people continue to be very interested in retina and to go into retina as a subspecialty of ophthalmology.
TS: And you mentioned the Second Sight initial procedure almost 24 years ago being sort of a moon shot. With all the advances in technology and all the interest in retina, are we on our way to Mars? Are we going to see some even more exciting advances in the coming years?
MH: I think this field of bioelectronics, as I call it, for ophthalmology, is very interesting. I think that how these devices work, whether it’s for a future version of the retinal prosthesis like the Second Sight prosthesis, whether it’s for an implantable drug pump. And whether it’s for even intraocular pressure measurement or some other aspects, even an electronic contact lens. You know, Google has talked about that. So I think this area of bioelectronics for ophthalmology, I believe we’re just seeing the tip of the iceberg, and I think we’re going to see a lot more technology being developed in this space that will provide both personalized and precision medicine.
TS: I was going to ask you about Google and about the other tech companies showing an interest. What is your take on that? On one hand, they’re obviously a fantastic company and you’d love to have their expertise here. But the eye is particularly challenging, I think, and I think Google is learning that with their contact lens that was going to measure glucose levels. Is this a positive for ophthalmology, having the Apples and the Googles in the world sort of looking at ophthalmology and looking at the eye?
MH: I think it is real positive for ophthalmology and eye care in general to have the big tech companies sort of look at this space and to develop these tech solutions, high tech solutions. Samsung is very interested, Google is very interested, and I think we’ll see others get involved. And I think that that will bring a lot of this microelectronics and nanoelectronics sensors to this space. Now of course, they have to realize that this is not an autonomously driving car type of situation. They really have to understand the biology in the space. So as long as they partner with the right people to make sure that they don’t waste their resources or get frustrated and get out of the space, I think that as long as there’s a good marriage, that I really welcome this and I look forward to more of these companies getting involved in this space.
TS: Excellent. Well, again, we’re excited to have you head up our new OIS family member at OIS@ASRS. It’s going to be August eighth. Are you getting a lot of interest or feedback from folks at ASRS? Is there an excitement about the event that’s coming?
MH: Yes, actually I’ve gotten a lot of interest in OIS@ASRS. Certainly the executive committee of the ASRS is very excited as well as a number of the board members. So we really do look forward to it. It’s the first meeting, so we’ll see how things go. But it’s – no, we’ve gotten a lot of excitement and look forward to working with OIS not only this year, but many years to come.
TS: Great. I know you’ll be co-moderating a panel, I think, with Emmitt Cunningham on combination therapies and AMD and DME. So that’s looking to be an exciting part of the agenda.
MH: I think that’s a very exciting area. As we deal with frequent injections, can we actually have these combination therapies, and what role will they have, and extending that interval between injections into the eye for retinal diseases. So that’s going to be a great session. And it’s just going to be a great meeting.
TS: Excellent. Well, we appreciate you taking a few minutes to talk about retina and for sharing the Second Sight story, and of course for talking a bit about OIS@ASRS.
MH: Absolutely. Happy to do it. Thanks, Tom.
TS: Thanks, Mark.