Douglas Anderson, founder of Optos, tells the story of his innovation which went on to have a global impact.
Over the last two decades, huge strides have been made in the medical imaging of our eyes. In the early 90s, the use of standard techniques meant it was only possible to view less than 5% of the retina in a single image during routine examinations. This has since dramatically improved, with modern technology now capable of imaging approximately 82% of the retina, making the identification of threats to eyesight much easier. I have been lucky enough to have played a key role in bringing this technology, made possible through innovative engineering, into widespread use across the healthcare industry.
In 1991, my five-year-old son, Leif, suffered a detached retina that caused him to lose the sight in his left eye. Learning that if the detachment had been spotted earlier, his eyesight could have been saved was devastating. The inability of then current tests to identify early-stage eye problems, coupled with professionals’ lack of experience in assessing often uncooperative children, were major factors in the missed diagnosis. As an industrial design engineer by trade, this motivated me to kick-start the development of a new machine that would tackle those issues. Creations under the optos brand would later go on to catch a similar defect in my son’s right eye, subsequently saving his sight.
There were major problems with retina-scanning technology when I set out to find a solution. The first was its field of vision. Its width was very limited compared to what is available now, making it extremely difficult to effectively analyse the entire retina and catch the signs of illness. I discovered this after many studies of Leif’s eye by a clinician of international standard who said that it was only possible to get “a glimpse” of his retina. The second was its usability. The technology, a binocular indirect opthalmascope, was a tricky tool to use, uncommon outside of a hospital and requiring specialist expertise. In order to be effective, this tool also required patients to stay still with dilated pupils for substantial periods of time, making it very hard to get accurate recordings for patients like my son. After all, it is tough to get a five year old to sit still for an extended period of time! This combination of low capability and poor usability meant referrals to specialists only happened once symptoms were well developed. Any new design would have to overcome these issues, delivering an image of the entire retina in an easy and fast way.
I had no background in ophthalmology and so was reliant on knowing the product requirements, as well as my training in design planning processes. I found and directed a team of more than 20 engineers with different expertise to develop the technology. It took us two and a half years to develop an ellipsoidal mirror that directed the scanning point of a laser onto the pupil in such a way that the laser was then refracted onto the majority of the retina, allowing it to be mapped. Yet this idea – called a scanning laser opthalmoscope – was initially discarded, as it appeared too difficult to manufacture. We looked instead at how to improve existing technology, but found that any solution was a compromise to either its usability or functionality. These were also thrown out as the time as the effort required for them was not worth the small incremental benefits they would deliver. So we returned to the ellipsoidal mirror design, which was the only one that promised a step-change in capability.
It took a further eight and a half years of engineering to bring the design – the Panoramic200, or P200 - to market. To do this took painstaking management. We broke down every single task into numerous sub-tasks that took no longer than a week to complete, ensuring a continuous stream of updates were seen by stakeholders and a sense of progress was felt regularly. We also focused whole-heartedly on the risk areas of the project, ensuring that these were overcome first and time and effort not spent on work that would not come to fruition. Development may not have been fast, but it was assured and was not at risk of collapsing.
Once the product was ready for market, we had to convince a cost-averse audience to take on a product worth £100,000, when typical equipment was worth between £1,000 and £10,000. This market also did not grasp the value of the product. It was necessary to consider unusual strategies to get a product into the market as, once in use, its benefits would ensure continued uptake. The capital investment was the major hurdle, so we removed it entirely. The P200 was offered free, with money made instead from a $20 charge for each use. This was usually passed on to the customer, delivering a new revenue stream for the practice. Yet part of this agreement – but not a contractual one – was to use the device for all examinations. While an expensive strategy not without risk (it required a major change in work flows for practices), it worked. Imaging was done by a technician before the consulting room was even reached, meaning the actual consultation was a thorough analysis of the retina.
This strategy has been a huge success as the P200 has been used in over 60 million exams across 11,000 practices. 400 clinical trials have been completed or are in progress using the equipment. What’s more, the technology won the prestigious Royal Academy of Engineering MacRobert Award in 2006, known for spotting the ‘next big thing’ in engineering and recognising outstanding innovation combined with commercial success and tangible social benefit. As described by the award judges, Optos “developed a revolutionary diagnostic instrument by dint of eight years’ determination, creativity and perseverance”, ensuring “many people owe their sight to the timely use of this outstanding example of clinical engineering.” Such recognition culminated in the purchase of Optos by Nikon in 2015 for £259 million, the biggest ever spend on medical imaging by the company. Most importantly, however, 16 years later it helped save the sight in my son’s right eye as the same condition re-surfaced, catching it early enough to be treated.
While I would not want to relive the personal trauma of my son’s early sight loss, it is gratifying that it inspired a solution that has since helped millions of people and prevented other similar incidents. It also goes to show that the most successful and impactful ideas often stem from personal experience. It gave me a focus and uncompromising drive for success, fuelled by the understanding of the true impact that a better solution could deliver, even though I had no background in ophthalmology. After all, engineering is, at its heart, about finding solutions to real world problems; I am very pleased to see that this solution solved a problem not just for my son, but for millions of others around the world.
