WEBVTT
00:02:53.770 --> 00:03:07.289
Welcome back to IC Podcast, and today we're exploring the world of atomic surgical innovation, particularly the technology and instruments that help retinal surgeons perform some of the most delicate procedures in medicine.
00:03:07.449 --> 00:03:13.370
I'm very pleased to welcome Beth Brower, Regional Sales Manager of Vortex Surgical, and of course Mr.
00:03:13.449 --> 00:03:16.969
Mike Fanning, the esteemed CEO of Vortex Surgical.
00:03:17.129 --> 00:03:19.689
Beth and Mike, welcome to IC Podcast.
00:03:19.769 --> 00:03:21.050
It's great to have you with us.
00:03:22.250 --> 00:03:23.210
So great to see you, Dr.
00:03:23.289 --> 00:03:23.610
Ross.
00:03:23.849 --> 00:03:24.009
Dr.
00:03:24.090 --> 00:03:24.650
Ross, how are you?
00:03:24.889 --> 00:03:25.370
Good morning.
00:03:25.849 --> 00:03:28.969
I'm wonderful and I'm excited to host you guys.
00:03:29.849 --> 00:03:33.930
We were just talking about how long I've been working with Beth.
00:03:34.729 --> 00:03:42.169
And we've been excited to work with uh just great innovators that are sharing and learning.
00:03:42.250 --> 00:03:44.810
And that's how I've known Beth in that capacity.
00:03:44.969 --> 00:03:47.209
We've always been tag teaming, and what do we know?
00:03:47.289 --> 00:03:48.009
What can we learn?
00:03:48.170 --> 00:03:50.250
How can we make a patient's case go better?
00:03:50.490 --> 00:04:00.409
So now we're taking it a little bigger because these are a little bit volatile times, and we're recognizing that there's few family-based companies or family-based practices.
00:04:00.730 --> 00:04:04.329
Solo practices going by the wayside because of private equity.
00:04:04.490 --> 00:04:12.409
So we wanted to engage uh someone who, when we had zero patients out here in Arizona, I've known Beth in two states now.
00:04:12.569 --> 00:04:24.970
Uh, you were guys were the first group that gave us a few starter kits before we got patients, and that really was a great help because we're burning through cash and we don't have any patients.
00:04:25.129 --> 00:04:27.289
So your support was really helpful.
00:04:27.370 --> 00:04:48.169
And now we're entering a new era where because of PE and we're seeing the lack of investment in capital and operating rooms, we're building our own in-office operating room, and we're seeing that trajectory go from hospital-based surgery to hospital outpatient-based surgery to ambulatory surgery centers, 80% of which are owned by PE now.
00:04:48.409 --> 00:05:02.970
And now the trend toward in-office operating rooms where we control when we can do cases, how we can do cases, and transitioning our office staff into the operating room to try to improve safety and quality.
00:05:03.129 --> 00:05:07.769
So I've come back because I noticed that one of your mission states was was never silent.
00:05:07.930 --> 00:05:12.569
And so we've been outspoken that we need to continue giving uh great care.
00:05:12.730 --> 00:05:18.889
So I wanted to start with uh how did you get founded and why was that a critical part of your mission statement?
00:05:19.210 --> 00:05:20.329
Yeah, so uh Dr.
00:05:20.409 --> 00:05:21.050
Ross, thank you.
00:05:21.129 --> 00:05:24.569
And Hazel, thanks for hosting uh Beth and I uh today.
00:05:24.730 --> 00:05:35.210
And we are thrilled to be here and a longtime supporter of you and your mission and and uh everything you're doing to help expand education, training uh throughout the world uh for ophthalmology.
00:05:35.289 --> 00:05:36.810
So thank you for your efforts as well.
00:05:37.050 --> 00:05:51.930
So um really uh Vortex Surgical, fairly humble uh story, truthfully, uh founded in 2016 uh by a collection of former employees uh at a company that was purchased by Boston Lawn.
00:05:52.490 --> 00:05:57.930
And we uh you know, we started with uh one employee in St.
00:05:58.090 --> 00:06:00.250
Charles, Chesterfield, Missouri.
00:06:00.889 --> 00:06:04.889
And uh as we sit here today, we're at almost 60 employees.
00:06:05.050 --> 00:06:14.889
Um but really um the origin of that group is that we had spent our careers fundamentally designing and developing specialized instrumentation for surgical retina.
00:06:15.050 --> 00:06:42.009
And we kept running into the same structural problem, and that is that retina is uh is a very small and, as you know, deeply specialized field uh that is served in most part by very, very large companies, large organizations, and for perfectly rational reasons, you know, that they design for the average case in the widest marketplace, and frankly, they shouldn't be ashamed for that because that's how you scale a business.
00:06:42.250 --> 00:06:55.610
Um, but a retina surgeon, in our opinion, isn't working on an average case, they're working on this detachment in this eye with this anatomy on this particular patient.
00:06:56.250 --> 00:07:08.089
And, you know, it's quite possible that the instrument in their hand at that particular point in time is a compromise somebody may have made in a boardroom or a conference room several years prior.
00:07:08.730 --> 00:07:16.410
And so our focus is surgeon and patient intimacy as much as we can.
00:07:16.649 --> 00:07:32.649
We work very, very closely with surgeons, uh much like yourself, who are innovators, leaders in forward thinking, and we look to partner with them to turn their concepts and thoughts and ideas uh into products.
00:07:32.730 --> 00:07:35.449
So our vision has never been to become a big company.
00:07:35.529 --> 00:07:49.370
Uh, it is to be a company that a retina surgeon could reach out to where the person who picks up the phone um can get a prototype made, and a good idea doesn't have to clear four committees uh before anyone tries it.
00:07:49.529 --> 00:08:03.689
And you know, everything else we've built, the engineering team, the clean room, the quality systems, the partnerships exist to make that possible at a level uh of and vigor, a vigor than an operating room and we feel the patients deserve.
00:08:03.850 --> 00:08:05.930
So I think that's a great question.
00:08:06.089 --> 00:08:07.529
I think that's a great answer.
00:08:07.689 --> 00:08:23.129
And as I look to the future, when we decided to build this in-office operating room, we went with IOR partners, also in your neck of the woods, and they said, Well, you have to have a lot of volume to make your purchase of building the IOR, et cetera.
00:08:23.290 --> 00:08:24.649
I said, that's not what we're about.
00:08:24.810 --> 00:08:31.529
We're about, I've had four patients with retinal detachments this year that had to wait five days to get into an operating room.
00:08:31.769 --> 00:08:36.970
And that is really heartbreaking for me as a great surgeon who knows I can fix it.
00:08:37.210 --> 00:08:50.410
So we ended up, you know, doing an in-office pneumatic retinopixie when they were an ideal candidate and having them, you know, literally stand on their head almost while we waited for an operating room.
00:08:50.569 --> 00:09:02.009
And that's when I decided that all my decisions in my career have been based on those patients and the trajectory, even though four patients isn't a lot and it seems like a big expense to endure.
00:09:02.170 --> 00:09:09.129
But I noticed that doctors coming from overseas said they were profoundly impacted by your tools.
00:09:09.450 --> 00:09:13.930
And as they practiced with them in the Sim Center, they said, where did these come from?
00:09:14.170 --> 00:09:21.690
And then I heard a talk on 2050, one of four four peoples demographically in the world will be in Africa.
00:09:21.850 --> 00:09:30.569
So it dawned on me that we're not really thinking about who's going to be the next group of surgeons dealing with thousands and millions of people.
00:09:30.730 --> 00:09:42.569
And I thought that your products, it really would stand the test of time because the concept is to tailor them to the pathology, the patient population, and I'm noticing a change.
00:09:42.809 --> 00:09:51.289
So um patients want to know individual things now, like what operating room, what kind of equipment, what are you using, who do you partner with?
00:09:51.450 --> 00:09:53.289
And I see them getting more granular.
00:09:53.370 --> 00:09:54.970
So I think it's pretty exciting.
00:09:55.289 --> 00:10:00.730
Uh Vortex's mission, and I just wanted to highlight how long you guys have been supporting.
00:10:00.889 --> 00:10:11.129
I think when you were under another company, you gave us the first surgical instruments to go to Brazil, and we took those to northern Brazil, and I think they're still using some of them.
00:10:11.289 --> 00:10:17.850
They took great care of them, but uh we hand carried them in and walked, walked them through uh customs.
00:10:17.930 --> 00:10:23.049
And I said, How am I gonna get a vitrector, uh a hundred IOLs and all this through?
00:10:23.129 --> 00:10:32.649
And someone said to me, Unfortunately, you're gonna have to look for the obnoxious person on the plane and get right behind them in customs and just put them in a dirty duffel and walk them through.
00:10:32.730 --> 00:10:43.129
And so all of them got through customs, but you guys were the ones that sent us all the non-disposable instruments that were cared for and used in northern Brazil.
00:10:43.370 --> 00:10:47.850
So as I see the times changing, I want to thank you for all the things you're doing.
00:10:48.089 --> 00:10:58.250
Um, I'm gonna talk about your um convenience kits and your in-office uh kits because I've seen a lot of endophthalmitis in the last two years.
00:10:58.889 --> 00:11:12.089
And I always tell patients that we're using, you know, sterile kits that are disposable, but we're not trying to re-sterilize these during a time when there's a decrease in human resources.
00:11:12.250 --> 00:11:15.450
We're all having difficulty uh getting great staff.
00:11:15.690 --> 00:11:33.930
And so when you see a change where there's more volume needed to break even, and you see uh less people staying long term at individual practices, there's room for safety problems, meaning, uh, how do you know that the autoclave is being worked appropriately?
00:11:34.089 --> 00:11:41.690
So I think those convenience kits are very important because we know that we're not worrying about did someone sterilize them correctly.
00:11:42.009 --> 00:11:48.009
And so I want to highlight that that's a unique feature of Vortex and those kits are very reasonably priced.
00:11:48.170 --> 00:11:52.490
Um, but when doctors are thinking about margins, some of them are making shortcuts.
00:11:52.650 --> 00:11:57.210
I'm seeing more videos of intravitual injections with people not wearing gloves.
00:11:57.369 --> 00:12:01.049
I'm seeing more videos, and I'm thinking, are you really gonna post that?
00:12:01.289 --> 00:12:06.809
So I want to highlight that we've always partnered with people that are pro focused on safety and innovation.
00:12:07.049 --> 00:12:08.970
Same thing with your convenience kits.
00:12:09.130 --> 00:12:24.250
I don't know if you've been thinking about how doctors transitioning to in-office operating rooms are going to keep the number of purchases uh going forward to make it less less costly to the patients in their quote unquote facility.
00:12:24.650 --> 00:12:28.569
I wanted to just add a comment along the lines of the convenience kits.
00:12:28.730 --> 00:12:37.450
We're also noticing that the um surgical tech who has been with a retina surgeon, you know, for 20 years, we're not seeing that model any longer.
00:12:37.690 --> 00:12:43.369
There's been a lot of turnover in surgery centers and hospitals with the with the staff and the level of training.
00:12:43.529 --> 00:12:50.250
And so to be able to say to somebody who might be newer to retina surgery or vitrectomy surgery, you know, just go pull that kit over there.
00:12:50.410 --> 00:12:56.089
It doesn't, it, it doesn't matter what what uh the peel requires.
00:12:56.410 --> 00:12:57.690
Everything is in the kit.
00:12:57.849 --> 00:13:01.210
And so it's taking one level of decision making away.
00:13:01.369 --> 00:13:04.809
And it's also, I think, upping everybody's skill level.
00:13:04.890 --> 00:13:09.609
If everyone's on the same page for these three cases, we're gonna pull these kits.
00:13:09.769 --> 00:13:14.569
Um, if you wouldn't mind, I you touched on something else I wanted to add a comment about.
00:13:14.730 --> 00:13:20.809
You were talking about looking at office-based vitrectomy or doing more in the office for surgical procedures.
00:13:21.130 --> 00:13:33.930
The nice thing about vortex surgical, if um I could offer up our small humble brag, is that with experience, you get the opportunity to step in and see uh see a problem.
00:13:34.009 --> 00:13:37.049
And with our experience, we can offer more solutions.
00:13:37.289 --> 00:13:46.329
And so I can speak to Mike Fanning and I being involved with in um some early in-office vitrectomies dating back to 2014.
00:13:46.650 --> 00:13:58.890
And so that's experience that we can bring with any retina surgery surgery group that's interested in, let's say, changing the model for surgery, um, or maybe like adding something that's a little bit more flexible.
00:13:58.970 --> 00:14:07.529
Um and so vortex surgical are really we we have a number of goals per se, but we really want to meet the retina surgeon where they're at.
00:14:07.690 --> 00:14:12.569
So, whatever your patient surgical goals are, there are patient surgical goals.
00:14:12.730 --> 00:14:20.250
And so we hope that every retina surgeon that we work with, they can draw on our experiences and tell us like what the challenge is.
00:14:20.490 --> 00:14:26.650
And to Mike's point earlier, we we we're our our our bench is not that deep.
00:14:26.730 --> 00:14:33.529
So there's not there, I mean, today for the call, you have the CEO of Vortex Surgical and myself a regional sales manager.
00:14:33.690 --> 00:14:37.210
And so, and I know by the way, my boss is the CEO.
00:14:37.609 --> 00:14:40.170
That's that's a whole other level of pressure.
00:14:40.410 --> 00:14:47.049
But um so yeah, you touched on uh being flexible with the procedures and and then the convenience kits.
00:14:47.130 --> 00:14:52.490
So I think that's something that Vortex Surgical as a smaller company can address for retina surgeons.
00:14:53.210 --> 00:15:07.609
No, we plan to partner with you guys for the convenience kits because I'm seeing uh symbiosis in a way of decreasing uh the stress that the staff has as they transition from the clinic to the operating room.
00:15:07.769 --> 00:15:12.009
And I think they're gonna be more diligent because they know the patients.
00:15:12.170 --> 00:15:15.930
So there's decreased anesthesia risk and there's increased safety.
00:15:16.089 --> 00:15:21.210
But adding to it that we're just opening this kit and putting the pack in is gonna be wonderful.
00:15:21.289 --> 00:15:23.930
So that I'm I'm noticing the efficiency.
00:15:24.089 --> 00:15:29.369
Um, I myself have gone through six vitrior retinal techs that I've had to train in the last year.
00:15:29.769 --> 00:15:38.250
And as you know, having that same consistency increases efficiency, decreased OR time, and patients have better outcomes.
00:15:38.410 --> 00:15:41.289
So I think it's very exciting what you guys are doing.
00:15:41.450 --> 00:15:45.450
You guys are a concierge uh retina equipment team.
00:15:45.609 --> 00:15:47.210
That's how I'm thinking of you.
00:15:47.369 --> 00:15:49.289
And we're partnering with concierge.
00:15:49.450 --> 00:15:53.369
And I know Hazel had a question as to how go ahead, Hazel.
00:15:53.450 --> 00:15:54.569
I don't want to interrupt you.
00:15:55.130 --> 00:15:55.769
Oh, yes.
00:15:55.930 --> 00:15:59.049
Um, as we discussed earlier, and as Dr.
00:15:59.210 --> 00:16:06.410
Ross had mentioned, I think one of the things that stands out about Vortex is the focus on surgeon-driven innovations.
00:16:06.970 --> 00:16:13.210
How important is direct feedback from retinal surgeons when you're developing a new product?
00:16:13.609 --> 00:16:15.289
Um, happy to take that, uh, Beth.
00:16:15.369 --> 00:16:19.130
So this is truly one of the real advantages of a small company.
00:16:19.289 --> 00:16:22.410
And I don't want to be cute or curt about it.
00:16:22.490 --> 00:16:43.450
Uh large organizations, our experience, because we've worked for them in the past, uh, typically run voice of customer analysis, uh sometimes on a calendar basis, structured advisory boards, quarterly cycles, a roadmap for product development that can be sometimes as much as a year uh out in advance.
00:16:43.690 --> 00:16:51.849
As I mentioned earlier, we can take a call on Tuesday and have something in the surgeon's hands within a very, very short period of time.
00:16:52.089 --> 00:16:54.490
That's not a process improvement.
00:16:54.890 --> 00:16:57.289
That's a different category of relationship.
00:16:57.450 --> 00:16:58.730
And I think Dr.
00:16:58.890 --> 00:17:00.970
Ross, you kind of touched on that a little bit earlier.
00:17:01.210 --> 00:17:08.490
We just look at things and we've tried to from our very early days to just look at the intimacy that I referred to earlier.
00:17:08.650 --> 00:17:11.289
Uh, and we really do take that to heart.
00:17:11.529 --> 00:17:19.049
Um, the thing I would I would tell anybody doing this is that surgeons almost never hand you a specification, right?
00:17:19.450 --> 00:17:22.490
Um, what they hand you is a workaround.
00:17:22.970 --> 00:17:33.769
And what I mean by that is you'll ask them and they'll say, you know, the case went fine, and then you watch, uh, and maybe they just curved something or bet something in the surgical field.
00:17:34.009 --> 00:17:36.170
Or they've used an instrument for a job.
00:17:36.410 --> 00:17:37.609
I see you smiling, Dr.
00:17:37.769 --> 00:17:38.250
Ross.
00:17:39.289 --> 00:17:45.609
Um, or you see them using an instrument maybe for a job it wasn't initially designed for, or they've switched hands, right?
00:17:45.769 --> 00:17:46.490
Just nuances.
00:17:46.650 --> 00:17:49.450
Pay attention to see what's going on in the operating room.
00:17:49.690 --> 00:17:56.970
And really, what I find is that the the question that unlocks uh most things is not what do you need?
00:17:57.130 --> 00:17:57.369
Okay.
00:17:57.769 --> 00:17:59.849
It's what did you do instead?
00:18:00.490 --> 00:18:01.930
What was your workaround?
00:18:02.089 --> 00:18:04.329
And the workaround is the unmet need.
00:18:04.650 --> 00:18:08.170
And it's probably already solved poorly by the workaround.
00:18:08.250 --> 00:18:12.250
And our job is to try to partner with that surgeon to hear their feedback.
00:18:12.329 --> 00:18:27.529
And again, Hazel, to your point, it's not always direct, it's sometimes indirect feedback that you take by being observant in the operating room, picking up on cues, and then asking the right questions because it's in there.
00:18:27.769 --> 00:18:36.170
The problem is in there, it may not be obvious, and we have to come uh to the same conclusion with uh with the surgeon.
00:18:36.490 --> 00:18:49.369
Um and and and I'll tell you that it it's really about discipline and truly about discipline is separating a surgeon's preference from something that may be generalizable.
00:18:49.769 --> 00:18:57.369
Great surgeons have strong hands, oftentimes strong opinions, and not every strong opinion may be a product.
00:18:58.089 --> 00:19:01.130
And and that sometimes is a hard reality.
00:19:01.210 --> 00:19:05.289
And it doesn't mean it's not a great idea, um, but we put things into trial.
00:19:05.450 --> 00:19:15.529
We try with the surgeon ideas, once we've collaborated and figure out what their workarounds are, we try to put the products into trial early for exactly that reason.
00:19:15.690 --> 00:19:31.769
I'd much rather, I think we would much rather be told uh during a wet lab or very, very early prototypes uh than to find out in a wet lab that this product is a good idea, but it's not serving an enormous opportunity.
00:19:31.930 --> 00:19:42.089
Then we can make the judgment, as we have done with a number of products that we've provided to the surgical market, because there was no feasible alternative to meet that clinical need.
00:19:42.569 --> 00:19:44.970
And that requires the powers of clinical observation.
00:19:45.049 --> 00:19:53.210
So when you guys are coming into the operating room, you're really looking and observing, um, which is not seen very much today.
00:19:53.370 --> 00:19:55.049
So I want to compliment you there.
00:19:55.210 --> 00:20:15.210
I'm gonna circle back to your team developed the first in-office vitrector back uh because I know that I met with Beth and we were going to implement it in our office in Grand Blanc, Michigan, because we noticed there was a difficulty, even though I could call and say I have a detached retina, and they'd say, come at five.
00:20:15.450 --> 00:20:17.289
Not everybody had that ability.
00:20:17.450 --> 00:20:21.370
And so and many of my patients started having hired deductibles.
00:20:21.690 --> 00:20:31.850
So going to a surgery center meant surgeon fee, anesthesia fee, and a um pretty high surgical hospital facility fee.
00:20:32.090 --> 00:20:35.529
So that was starting back in 2013.
00:20:35.690 --> 00:20:38.809
That's when I engaged Beth for in-office surgery.
00:20:38.970 --> 00:20:47.850
So it hasn't changed, just the deductibles have gone skyrocket high, and the access has gone down, and the expertise of the staff in the operating room has gone down.
00:20:48.090 --> 00:20:54.490
So uh you'll be the uh go-to for in-office surgery equipment moving forward.
00:20:54.730 --> 00:20:59.769
Um, do all your pieces of equipment uh tie into the major vitrectors right now?
00:21:00.009 --> 00:21:03.289
The light the lasers, et cetera.
00:21:03.610 --> 00:21:03.850
Go ahead.
00:21:04.090 --> 00:21:05.610
Yeah, thank you for that question.
00:21:05.850 --> 00:21:07.850
Because um I'll take it.
00:21:08.090 --> 00:21:13.289
So, yes, our laser probes are fully compatible with all of the vitrectomy machines.
00:21:13.450 --> 00:21:18.970
Um, our forceps are handheld instruments, so it really is irrelevant which platform that you're using.
00:21:19.130 --> 00:21:28.970
Um, a small thing that when Mike was um looking at the product platform goals early on, we were looking to his point where the doctors were doing workarounds.
00:21:29.049 --> 00:21:31.930
And the first product that we came out with were soft tips.
00:21:32.090 --> 00:21:41.210
And before the Vortex soft tip was launched, um, doctors were either trimming the tips to make them shorter because they were not passing through the valves easily.
00:21:41.450 --> 00:21:45.769
I've heard stories of where they have to turn the room lights on, they have to get the tech involved.
00:21:45.930 --> 00:21:51.210
If the scissors trimming the soft tips aren't sharp, they're gonna have a messy soft tip.
00:21:51.529 --> 00:22:01.130
And so Mike and our early engineers were like, let us come up with a soft tip that just without thinking and in a length of one millimeter length.
00:22:01.210 --> 00:22:06.490
So, you know, because a lot of times you have to drain subretinal fluid, so why should you have to compromise that length?
00:22:06.650 --> 00:22:12.170
So they made our soft tips with slightly stiffer silicone that pass very easily through the valves.
00:22:12.250 --> 00:22:14.570
And it's like a small thing within the engineering.
00:22:14.730 --> 00:22:17.769
So I know your question was do our equipment work with everything?
00:22:17.930 --> 00:22:18.250
Yes.
00:22:18.410 --> 00:22:22.009
Our equipment, laser probes work with all the machine platforms.
00:22:22.330 --> 00:22:30.970
Yes, we're fully compatible with all the machine platforms, and we are always trying to put a small improvement in the device.
00:22:31.130 --> 00:22:34.809
Um, our forceps, we came out with the tail and line of forceps.
00:22:34.890 --> 00:22:43.289
And so what we did is we improved the um visualization where you're working because a lot of surgeons now are working with heads up 3D systems.
00:22:43.450 --> 00:22:49.930
So they have a wider angle view, they have great illumination, they can really see the tips where they're working with those forceps.
00:22:50.090 --> 00:22:59.210
Oh, but a lot of forceps haven't been uh re-engineered or developed for 10 or 15 years and the soft and the tips are bulky.
00:22:59.370 --> 00:23:06.809
So where you're going to peel that one micron membrane, do you have metal, yeah, surgical stainless steel in the way?
00:23:06.970 --> 00:23:09.289
So we came out with the tail and line of forceps.
00:23:09.370 --> 00:23:25.529
So I I realize I kind of um expanded on your question, but um, yes, we work with all the platforms and we're always looking to make things, make the surgical experience more comfortable for the retina surgeon so they can more easily obtain their surgical goals.
00:23:25.850 --> 00:23:26.809
That's that's awesome.
00:23:26.970 --> 00:23:29.690
Thank you for uh elaborating there.
00:23:29.930 --> 00:23:40.890
Um in the next five years, as we move to gene therapy potentially and a new delivery of medication that could be submacular, are you innovating for that future?
00:23:41.210 --> 00:23:42.170
Uh we absolutely are.
00:23:42.410 --> 00:23:48.890
As we look to the short and midterm future, that those are subchroidal, subretinal, macular.
00:23:48.970 --> 00:23:59.690
I mean, the the the ability to deliver precise volumes to very specific areas without egress is a challenge I think a lot of companies are chasing right now.
00:23:59.930 --> 00:24:18.410
Um we have already designed and developed a number of products in collaboration with surgeons that have have helped us leapfrog a lot of what has been available in the market, and we continue to work on a very robust RD pipeline that continues to address those specific therapeutic challenges.
00:24:18.809 --> 00:24:24.410
Well, I noticed that you've also tackled ocular oncology and you've developed a light box.
00:24:24.650 --> 00:24:26.490
Can you tell us a little bit about that light box?
00:24:26.570 --> 00:24:37.049
Because we used to use the old greasehopper light box that was the became the chandelier system for uh more complex uh peripheral retinal pathology.
00:24:37.210 --> 00:24:41.049
Can that light box that's used for That's LED based.
00:24:41.289 --> 00:24:44.730
Can that be used for a chandelier system?
00:24:45.370 --> 00:24:46.890
I can take this question.
00:24:47.289 --> 00:24:51.450
The LED light, unfortunately, is not bright enough for a chandelier.
00:24:51.610 --> 00:24:54.730
However, you touched on ocular oncology.
00:24:54.890 --> 00:24:57.210
Again, that's an example of vortex surgical.
00:24:57.529 --> 00:25:08.490
A retina oncologist approached us and said that there was an unmet need because the Myra boxes that were 40 years old in every OR were no longer being able to be serviced.
00:25:08.650 --> 00:25:15.289
And so we came up with transglerol illumination and pupil illumination for marking tumors for brachytherapy.
00:25:15.370 --> 00:25:20.570
And then we also have the nanocannula that has a 41-gauge tip.
00:25:20.809 --> 00:25:28.250
And so you can insert it through a 27-gauge cannula to do an intraoperative posterior tumor biopsy.
00:25:28.410 --> 00:25:36.809
So we have a product for illuminating to mark tumors, and then a product for posterior tumor biopsies.
00:25:37.450 --> 00:25:47.610
But no, sadly, the light box, sorry, we do get that question a lot from international customers about chandelier illumination with the beacon, but the LED light is just not bright enough.
00:25:56.650 --> 00:25:59.529
Do you guys have a vision board in Vortex?
00:26:00.730 --> 00:26:01.610
Uh we don't.
00:26:01.769 --> 00:26:08.090
I think it resides in each one of our individually in each one of our heads, which is not a great leadership strategy, admittedly.
00:26:08.250 --> 00:26:13.769
Um but the but the but but the truth of the matter is we we're based in in St.
00:26:13.930 --> 00:26:15.289
Charles, as we mentioned.
00:26:15.370 --> 00:26:18.330
We've got a handful of people outside of the office.
00:26:18.570 --> 00:26:25.769
We are pretty aligned on what our annual and global strategies and um uh goals are.
00:26:25.930 --> 00:26:29.370
Um, but no, to uh to having a visual board.
00:26:29.529 --> 00:26:33.450
Uh no, but I will say that from an organizational perspective.
00:26:33.769 --> 00:26:51.289
As a lot of manufacturing companies have, um, we do have um data boards built through our manufacturing processes where we can track things, but that's more on a task related as opposed to where we see ourselves in 10 days, 20 days, a year from now.
00:26:51.690 --> 00:26:57.450
And my last question for you, uh, you partnered with CORSA, is that correct, in 2022?
00:26:57.850 --> 00:27:06.410
Can you tell me a little bit about that alignment and how it's benefited uh ophthalmologists that might be practicing in other countries outside the United States?
00:27:07.130 --> 00:27:08.809
Uh, so a great question.
00:27:08.970 --> 00:27:16.330
Uh, as you point out, we've had a uh commercial relationship with uh CORSA ophthalmology for since 2022.
00:27:16.490 --> 00:27:21.049
Um, quite simply, we are a relatively small organization, right?
00:27:21.210 --> 00:27:22.570
From a distribution perspective.
00:27:22.730 --> 00:27:30.330
This is really about helping Vortex deliver our products from a commercial perspective to global operating rooms.
00:27:30.490 --> 00:27:38.250
And Corsa has a vast, vast, in the United States alone, they have a very robust distribution organization.
00:27:38.650 --> 00:27:48.090
Uh in the US, as an example, uh, they will be on purchasing agreements that Vortex, because of our pure size being small, may not have access to.
00:27:48.170 --> 00:27:56.970
But because Corza has agreements with some of these large uh GPOs and purchasing groups, they can accelerate adoption of our products.
00:27:57.210 --> 00:27:59.049
Same thing internationally.
00:27:59.210 --> 00:28:11.610
They have Katina brands, uh, they have uh Aseco brands, they've got SharpPoint, they've got a number of different brands that they represent throughout the world.
00:28:11.850 --> 00:28:15.850
Last told, I think it's 142 different countries they sell product into.
00:28:16.170 --> 00:28:23.769
And we are the beneficiaries of the relationships and the distribution channels they have established in many, many, many of those markets.
00:28:24.090 --> 00:28:33.610
So Corsa is is violently, and I use that word not to sound uh super aggressive, but they are violently committed to education.
00:28:34.009 --> 00:28:39.610
And they have a very, very uh large uh educational team.
00:28:39.690 --> 00:28:49.930
Uh they do wet labs globally, they do, and so they are the perfect partner for Vortex to permit us to get uh into Tanzania and other markets.
00:28:50.090 --> 00:28:58.330
I mean, markets where we want other North Africa, uh all over the world, where we simply don't have the reach or the bandwidth at the current time to be able to do so.
00:28:58.490 --> 00:29:04.570
So we're grateful for Corza for what's been a wonderful relationship, and we look forward to continuing that for a number of years.
00:29:04.970 --> 00:29:05.690
Well, thank you.
00:29:05.930 --> 00:29:12.250
Hazel's gonna finish with some rapid fire questions, and they're just brief answers, and we appreciate whoever can answer first.
00:29:12.330 --> 00:29:12.890
We'll take that.
00:29:13.130 --> 00:29:14.009
Go ahead, Casey.
00:29:14.250 --> 00:29:14.330
Yes.
00:29:14.570 --> 00:29:14.890
All right.
00:29:14.970 --> 00:29:17.930
So I think I only have um four or five questions.
00:29:18.170 --> 00:29:20.890
Are you ready um for the questions, sir, Mike?
00:29:21.210 --> 00:29:22.170
Let's go.
00:29:22.809 --> 00:29:26.490
What has been the most rewarding part of your career?
00:29:27.450 --> 00:29:37.049
Um waking up every day and realizing that I am surrounded by the industry's top people, professionals.
00:29:37.289 --> 00:29:39.610
I love going to work every day.
00:29:40.170 --> 00:29:45.130
Um the team we've assembled at Vortex is special to me.
00:29:45.210 --> 00:29:53.289
Um, not because we've worked for together for a combined almost 180 years, if we combine all of us.
00:29:53.690 --> 00:30:00.890
Um, but I really look around and as I look at the team that we've assembled, there's they're pros, pros.
00:30:01.289 --> 00:30:06.490
I I couldn't be any more delighted and thrilled, including uh, you know, a family member.
00:30:06.650 --> 00:30:09.769
Uh so I I'm just I'm absolutely, I'm absolutely thrilled.
00:30:09.850 --> 00:30:12.009
Beth and I have spent 20 plus years working together.
00:30:12.170 --> 00:30:14.650
I don't see her, I mean, I see her as a as a colleague.
00:30:14.809 --> 00:30:23.049
And it really generally uh genuinely helps uh all of us become consistently aligned with what it is we're trying to execute on.
00:30:23.450 --> 00:30:24.330
Next question, sir.
00:30:24.410 --> 00:30:26.009
That was a really great answer.
00:30:26.250 --> 00:30:32.090
But next question, what continues to excite you about ophthalmology and medical technology?
00:30:32.410 --> 00:30:36.009
Um innovation is a word I think that's largely overused.
00:30:36.330 --> 00:30:36.650
Okay.
00:30:36.809 --> 00:30:47.370
And innovation from where I sit right now outside the operating operating room suite, I'm really curious to see how AI is going.
00:30:47.450 --> 00:30:49.690
And it's a there's another term that we hear a lot of.
00:30:49.769 --> 00:31:00.009
I I know there's a lot of work being done on the diagnostic side and even workflows and surgery and uh on the surgical side, but we're at a really interesting point, I think.
00:31:00.170 --> 00:31:13.529
You know, we've got digital operating rooms, we've got, you know, operating room equipment that's functioning largely like computers looking to integrate all this sort of stuff to help complete the treatment uh circle.
00:31:13.769 --> 00:31:21.930
Um I'm really fascinated to see, and I may not be around long enough uh to see exactly how AI leans into this.
00:31:22.090 --> 00:31:23.529
No, no, but don't worry.
00:31:23.690 --> 00:31:29.930
Uh uh, but I may not be around long enough to see how AI genuinely impacts the surgical side of this.
00:31:30.090 --> 00:31:35.850
I know it's already having an impact in every other part of your functional departments uh in in the practices.
00:31:36.009 --> 00:31:38.730
So that's what I think I'm most interested and excited to see.
00:31:39.049 --> 00:31:40.009
Another one, sir.
00:31:40.170 --> 00:31:44.410
What is one professional lesson that has stayed with you throughout your career?
00:31:44.890 --> 00:31:51.210
Um always treat people with i uh so I hope you weren't looking for some exotic answer.
00:31:51.370 --> 00:31:55.529
Okay, and this really comes from my background and my upbringing, okay.
00:31:55.930 --> 00:32:05.769
Um is is people always m may not remember what you said, but they'll always remember how you made them feel.
00:32:06.009 --> 00:32:13.529
And I think um that's an important mantra and a uh a a little fight song that I kind of carry around in my mind.
00:32:14.330 --> 00:32:16.410
I think I'm gonna carry that too, sir.
00:32:16.809 --> 00:32:18.809
And finally, last question.
00:32:18.970 --> 00:32:24.970
If you could see one major breakthrough in ophthalmology during your lifetime, what would you hope it would be?
00:32:25.049 --> 00:32:29.450
Aaron Powell Big picture, uh elimination of blindness, restoration of sight.
00:32:29.850 --> 00:32:34.650
That no one would have to wait to be repaired if they have a sight-threatening condition.
00:32:34.890 --> 00:32:36.650
And so many people do wait.
00:32:37.289 --> 00:32:47.690
And if I may add, I think one of the most important takeaway from our discussion is that innovation doesn't always have to mean completely reinventing the way we do things.
00:32:47.930 --> 00:32:56.330
Sometimes it's about identifying a challenge that surgeons face every day and then finding a more precise, practical, and effective way to solve it.
00:32:56.570 --> 00:33:00.730
Um, Beth and Mike, thank you so much for joining us on IC Podcast.
00:33:00.890 --> 00:33:02.970
It has been a great pleasure having you here.
00:33:03.450 --> 00:33:04.410
Thanks for hosting us.
00:33:04.570 --> 00:33:05.289
Thank you so very much.
00:33:05.850 --> 00:33:10.970
And to everyone who is listening or watching, thank you for joining us today.
00:33:11.130 --> 00:33:19.850
Be sure to subscribe to IC Podcast for more conversations with the physicians, innovators, and leaders of shaping the future of ophthalmology.
00:33:20.090 --> 00:33:22.170
Until next time, keep an eye on the future.
00:02:53.770 --> 00:03:07.289
Welcome back to IC Podcast, and today we're exploring the world of atomic surgical innovation, particularly the technology and instruments that help retinal surgeons perform some of the most delicate procedures in medicine.
00:03:07.449 --> 00:03:13.370
I'm very pleased to welcome Beth Brower, Regional Sales Manager of Vortex Surgical, and of course Mr.
00:03:13.449 --> 00:03:16.969
Mike Fanning, the esteemed CEO of Vortex Surgical.
00:03:17.129 --> 00:03:19.689
Beth and Mike, welcome to IC Podcast.
00:03:19.769 --> 00:03:21.050
It's great to have you with us.
00:03:22.250 --> 00:03:23.210
So great to see you, Dr.
00:03:23.289 --> 00:03:23.610
Ross.
00:03:23.849 --> 00:03:24.009
Dr.
00:03:24.090 --> 00:03:24.650
Ross, how are you?
00:03:24.889 --> 00:03:25.370
Good morning.
00:03:25.849 --> 00:03:28.969
I'm wonderful and I'm excited to host you guys.
00:03:29.849 --> 00:03:33.930
We were just talking about how long I've been working with Beth.
00:03:34.729 --> 00:03:42.169
And we've been excited to work with uh just great innovators that are sharing and learning.
00:03:42.250 --> 00:03:44.810
And that's how I've known Beth in that capacity.
00:03:44.969 --> 00:03:47.209
We've always been tag teaming, and what do we know?
00:03:47.289 --> 00:03:48.009
What can we learn?
00:03:48.170 --> 00:03:50.250
How can we make a patient's case go better?
00:03:50.490 --> 00:04:00.409
So now we're taking it a little bigger because these are a little bit volatile times, and we're recognizing that there's few family-based companies or family-based practices.
00:04:00.730 --> 00:04:04.329
Solo practices going by the wayside because of private equity.
00:04:04.490 --> 00:04:12.409
So we wanted to engage uh someone who, when we had zero patients out here in Arizona, I've known Beth in two states now.
00:04:12.569 --> 00:04:24.970
Uh, you were guys were the first group that gave us a few starter kits before we got patients, and that really was a great help because we're burning through cash and we don't have any patients.
00:04:25.129 --> 00:04:27.289
So your support was really helpful.
00:04:27.370 --> 00:04:48.169
And now we're entering a new era where because of PE and we're seeing the lack of investment in capital and operating rooms, we're building our own in-office operating room, and we're seeing that trajectory go from hospital-based surgery to hospital outpatient-based surgery to ambulatory surgery centers, 80% of which are owned by PE now.
00:04:48.409 --> 00:05:02.970
And now the trend toward in-office operating rooms where we control when we can do cases, how we can do cases, and transitioning our office staff into the operating room to try to improve safety and quality.
00:05:03.129 --> 00:05:07.769
So I've come back because I noticed that one of your mission states was was never silent.
00:05:07.930 --> 00:05:12.569
And so we've been outspoken that we need to continue giving uh great care.
00:05:12.730 --> 00:05:18.889
So I wanted to start with uh how did you get founded and why was that a critical part of your mission statement?
00:05:19.210 --> 00:05:20.329
Yeah, so uh Dr.
00:05:20.409 --> 00:05:21.050
Ross, thank you.
00:05:21.129 --> 00:05:24.569
And Hazel, thanks for hosting uh Beth and I uh today.
00:05:24.730 --> 00:05:35.210
And we are thrilled to be here and a longtime supporter of you and your mission and and uh everything you're doing to help expand education, training uh throughout the world uh for ophthalmology.
00:05:35.289 --> 00:05:36.810
So thank you for your efforts as well.
00:05:37.050 --> 00:05:51.930
So um really uh Vortex Surgical, fairly humble uh story, truthfully, uh founded in 2016 uh by a collection of former employees uh at a company that was purchased by Boston Lawn.
00:05:52.490 --> 00:05:57.930
And we uh you know, we started with uh one employee in St.
00:05:58.090 --> 00:06:00.250
Charles, Chesterfield, Missouri.
00:06:00.889 --> 00:06:04.889
And uh as we sit here today, we're at almost 60 employees.
00:06:05.050 --> 00:06:14.889
Um but really um the origin of that group is that we had spent our careers fundamentally designing and developing specialized instrumentation for surgical retina.
00:06:15.050 --> 00:06:42.009
And we kept running into the same structural problem, and that is that retina is uh is a very small and, as you know, deeply specialized field uh that is served in most part by very, very large companies, large organizations, and for perfectly rational reasons, you know, that they design for the average case in the widest marketplace, and frankly, they shouldn't be ashamed for that because that's how you scale a business.
00:06:42.250 --> 00:06:55.610
Um, but a retina surgeon, in our opinion, isn't working on an average case, they're working on this detachment in this eye with this anatomy on this particular patient.
00:06:56.250 --> 00:07:08.089
And, you know, it's quite possible that the instrument in their hand at that particular point in time is a compromise somebody may have made in a boardroom or a conference room several years prior.
00:07:08.730 --> 00:07:16.410
And so our focus is surgeon and patient intimacy as much as we can.
00:07:16.649 --> 00:07:32.649
We work very, very closely with surgeons, uh much like yourself, who are innovators, leaders in forward thinking, and we look to partner with them to turn their concepts and thoughts and ideas uh into products.
00:07:32.730 --> 00:07:35.449
So our vision has never been to become a big company.
00:07:35.529 --> 00:07:49.370
Uh, it is to be a company that a retina surgeon could reach out to where the person who picks up the phone um can get a prototype made, and a good idea doesn't have to clear four committees uh before anyone tries it.
00:07:49.529 --> 00:08:03.689
And you know, everything else we've built, the engineering team, the clean room, the quality systems, the partnerships exist to make that possible at a level uh of and vigor, a vigor than an operating room and we feel the patients deserve.
00:08:03.850 --> 00:08:05.930
So I think that's a great question.
00:08:06.089 --> 00:08:07.529
I think that's a great answer.
00:08:07.689 --> 00:08:23.129
And as I look to the future, when we decided to build this in-office operating room, we went with IOR partners, also in your neck of the woods, and they said, Well, you have to have a lot of volume to make your purchase of building the IOR, et cetera.
00:08:23.290 --> 00:08:24.649
I said, that's not what we're about.
00:08:24.810 --> 00:08:31.529
We're about, I've had four patients with retinal detachments this year that had to wait five days to get into an operating room.
00:08:31.769 --> 00:08:36.970
And that is really heartbreaking for me as a great surgeon who knows I can fix it.
00:08:37.210 --> 00:08:50.410
So we ended up, you know, doing an in-office pneumatic retinopixie when they were an ideal candidate and having them, you know, literally stand on their head almost while we waited for an operating room.
00:08:50.569 --> 00:09:02.009
And that's when I decided that all my decisions in my career have been based on those patients and the trajectory, even though four patients isn't a lot and it seems like a big expense to endure.
00:09:02.170 --> 00:09:09.129
But I noticed that doctors coming from overseas said they were profoundly impacted by your tools.
00:09:09.450 --> 00:09:13.930
And as they practiced with them in the Sim Center, they said, where did these come from?
00:09:14.170 --> 00:09:21.690
And then I heard a talk on 2050, one of four four peoples demographically in the world will be in Africa.
00:09:21.850 --> 00:09:30.569
So it dawned on me that we're not really thinking about who's going to be the next group of surgeons dealing with thousands and millions of people.
00:09:30.730 --> 00:09:42.569
And I thought that your products, it really would stand the test of time because the concept is to tailor them to the pathology, the patient population, and I'm noticing a change.
00:09:42.809 --> 00:09:51.289
So um patients want to know individual things now, like what operating room, what kind of equipment, what are you using, who do you partner with?
00:09:51.450 --> 00:09:53.289
And I see them getting more granular.
00:09:53.370 --> 00:09:54.970
So I think it's pretty exciting.
00:09:55.289 --> 00:10:00.730
Uh Vortex's mission, and I just wanted to highlight how long you guys have been supporting.
00:10:00.889 --> 00:10:11.129
I think when you were under another company, you gave us the first surgical instruments to go to Brazil, and we took those to northern Brazil, and I think they're still using some of them.
00:10:11.289 --> 00:10:17.850
They took great care of them, but uh we hand carried them in and walked, walked them through uh customs.
00:10:17.930 --> 00:10:23.049
And I said, How am I gonna get a vitrector, uh a hundred IOLs and all this through?
00:10:23.129 --> 00:10:32.649
And someone said to me, Unfortunately, you're gonna have to look for the obnoxious person on the plane and get right behind them in customs and just put them in a dirty duffel and walk them through.
00:10:32.730 --> 00:10:43.129
And so all of them got through customs, but you guys were the ones that sent us all the non-disposable instruments that were cared for and used in northern Brazil.
00:10:43.370 --> 00:10:47.850
So as I see the times changing, I want to thank you for all the things you're doing.
00:10:48.089 --> 00:10:58.250
Um, I'm gonna talk about your um convenience kits and your in-office uh kits because I've seen a lot of endophthalmitis in the last two years.
00:10:58.889 --> 00:11:12.089
And I always tell patients that we're using, you know, sterile kits that are disposable, but we're not trying to re-sterilize these during a time when there's a decrease in human resources.
00:11:12.250 --> 00:11:15.450
We're all having difficulty uh getting great staff.
00:11:15.690 --> 00:11:33.930
And so when you see a change where there's more volume needed to break even, and you see uh less people staying long term at individual practices, there's room for safety problems, meaning, uh, how do you know that the autoclave is being worked appropriately?
00:11:34.089 --> 00:11:41.690
So I think those convenience kits are very important because we know that we're not worrying about did someone sterilize them correctly.
00:11:42.009 --> 00:11:48.009
And so I want to highlight that that's a unique feature of Vortex and those kits are very reasonably priced.
00:11:48.170 --> 00:11:52.490
Um, but when doctors are thinking about margins, some of them are making shortcuts.
00:11:52.650 --> 00:11:57.210
I'm seeing more videos of intravitual injections with people not wearing gloves.
00:11:57.369 --> 00:12:01.049
I'm seeing more videos, and I'm thinking, are you really gonna post that?
00:12:01.289 --> 00:12:06.809
So I want to highlight that we've always partnered with people that are pro focused on safety and innovation.
00:12:07.049 --> 00:12:08.970
Same thing with your convenience kits.
00:12:09.130 --> 00:12:24.250
I don't know if you've been thinking about how doctors transitioning to in-office operating rooms are going to keep the number of purchases uh going forward to make it less less costly to the patients in their quote unquote facility.
00:12:24.650 --> 00:12:28.569
I wanted to just add a comment along the lines of the convenience kits.
00:12:28.730 --> 00:12:37.450
We're also noticing that the um surgical tech who has been with a retina surgeon, you know, for 20 years, we're not seeing that model any longer.
00:12:37.690 --> 00:12:43.369
There's been a lot of turnover in surgery centers and hospitals with the with the staff and the level of training.
00:12:43.529 --> 00:12:50.250
And so to be able to say to somebody who might be newer to retina surgery or vitrectomy surgery, you know, just go pull that kit over there.
00:12:50.410 --> 00:12:56.089
It doesn't, it, it doesn't matter what what uh the peel requires.
00:12:56.410 --> 00:12:57.690
Everything is in the kit.
00:12:57.849 --> 00:13:01.210
And so it's taking one level of decision making away.
00:13:01.369 --> 00:13:04.809
And it's also, I think, upping everybody's skill level.
00:13:04.890 --> 00:13:09.609
If everyone's on the same page for these three cases, we're gonna pull these kits.
00:13:09.769 --> 00:13:14.569
Um, if you wouldn't mind, I you touched on something else I wanted to add a comment about.
00:13:14.730 --> 00:13:20.809
You were talking about looking at office-based vitrectomy or doing more in the office for surgical procedures.
00:13:21.130 --> 00:13:33.930
The nice thing about vortex surgical, if um I could offer up our small humble brag, is that with experience, you get the opportunity to step in and see uh see a problem.
00:13:34.009 --> 00:13:37.049
And with our experience, we can offer more solutions.
00:13:37.289 --> 00:13:46.329
And so I can speak to Mike Fanning and I being involved with in um some early in-office vitrectomies dating back to 2014.
00:13:46.650 --> 00:13:58.890
And so that's experience that we can bring with any retina surgery surgery group that's interested in, let's say, changing the model for surgery, um, or maybe like adding something that's a little bit more flexible.
00:13:58.970 --> 00:14:07.529
Um and so vortex surgical are really we we have a number of goals per se, but we really want to meet the retina surgeon where they're at.
00:14:07.690 --> 00:14:12.569
So, whatever your patient surgical goals are, there are patient surgical goals.
00:14:12.730 --> 00:14:20.250
And so we hope that every retina surgeon that we work with, they can draw on our experiences and tell us like what the challenge is.
00:14:20.490 --> 00:14:26.650
And to Mike's point earlier, we we we're our our our bench is not that deep.
00:14:26.730 --> 00:14:33.529
So there's not there, I mean, today for the call, you have the CEO of Vortex Surgical and myself a regional sales manager.
00:14:33.690 --> 00:14:37.210
And so, and I know by the way, my boss is the CEO.
00:14:37.609 --> 00:14:40.170
That's that's a whole other level of pressure.
00:14:40.410 --> 00:14:47.049
But um so yeah, you touched on uh being flexible with the procedures and and then the convenience kits.
00:14:47.130 --> 00:14:52.490
So I think that's something that Vortex Surgical as a smaller company can address for retina surgeons.
00:14:53.210 --> 00:15:07.609
No, we plan to partner with you guys for the convenience kits because I'm seeing uh symbiosis in a way of decreasing uh the stress that the staff has as they transition from the clinic to the operating room.
00:15:07.769 --> 00:15:12.009
And I think they're gonna be more diligent because they know the patients.
00:15:12.170 --> 00:15:15.930
So there's decreased anesthesia risk and there's increased safety.
00:15:16.089 --> 00:15:21.210
But adding to it that we're just opening this kit and putting the pack in is gonna be wonderful.
00:15:21.289 --> 00:15:23.930
So that I'm I'm noticing the efficiency.
00:15:24.089 --> 00:15:29.369
Um, I myself have gone through six vitrior retinal techs that I've had to train in the last year.
00:15:29.769 --> 00:15:38.250
And as you know, having that same consistency increases efficiency, decreased OR time, and patients have better outcomes.
00:15:38.410 --> 00:15:41.289
So I think it's very exciting what you guys are doing.
00:15:41.450 --> 00:15:45.450
You guys are a concierge uh retina equipment team.
00:15:45.609 --> 00:15:47.210
That's how I'm thinking of you.
00:15:47.369 --> 00:15:49.289
And we're partnering with concierge.
00:15:49.450 --> 00:15:53.369
And I know Hazel had a question as to how go ahead, Hazel.
00:15:53.450 --> 00:15:54.569
I don't want to interrupt you.
00:15:55.130 --> 00:15:55.769
Oh, yes.
00:15:55.930 --> 00:15:59.049
Um, as we discussed earlier, and as Dr.
00:15:59.210 --> 00:16:06.410
Ross had mentioned, I think one of the things that stands out about Vortex is the focus on surgeon-driven innovations.
00:16:06.970 --> 00:16:13.210
How important is direct feedback from retinal surgeons when you're developing a new product?
00:16:13.609 --> 00:16:15.289
Um, happy to take that, uh, Beth.
00:16:15.369 --> 00:16:19.130
So this is truly one of the real advantages of a small company.
00:16:19.289 --> 00:16:22.410
And I don't want to be cute or curt about it.
00:16:22.490 --> 00:16:43.450
Uh large organizations, our experience, because we've worked for them in the past, uh, typically run voice of customer analysis, uh sometimes on a calendar basis, structured advisory boards, quarterly cycles, a roadmap for product development that can be sometimes as much as a year uh out in advance.
00:16:43.690 --> 00:16:51.849
As I mentioned earlier, we can take a call on Tuesday and have something in the surgeon's hands within a very, very short period of time.
00:16:52.089 --> 00:16:54.490
That's not a process improvement.
00:16:54.890 --> 00:16:57.289
That's a different category of relationship.
00:16:57.450 --> 00:16:58.730
And I think Dr.
00:16:58.890 --> 00:17:00.970
Ross, you kind of touched on that a little bit earlier.
00:17:01.210 --> 00:17:08.490
We just look at things and we've tried to from our very early days to just look at the intimacy that I referred to earlier.
00:17:08.650 --> 00:17:11.289
Uh, and we really do take that to heart.
00:17:11.529 --> 00:17:19.049
Um, the thing I would I would tell anybody doing this is that surgeons almost never hand you a specification, right?
00:17:19.450 --> 00:17:22.490
Um, what they hand you is a workaround.
00:17:22.970 --> 00:17:33.769
And what I mean by that is you'll ask them and they'll say, you know, the case went fine, and then you watch, uh, and maybe they just curved something or bet something in the surgical field.
00:17:34.009 --> 00:17:36.170
Or they've used an instrument for a job.
00:17:36.410 --> 00:17:37.609
I see you smiling, Dr.
00:17:37.769 --> 00:17:38.250
Ross.
00:17:39.289 --> 00:17:45.609
Um, or you see them using an instrument maybe for a job it wasn't initially designed for, or they've switched hands, right?
00:17:45.769 --> 00:17:46.490
Just nuances.
00:17:46.650 --> 00:17:49.450
Pay attention to see what's going on in the operating room.
00:17:49.690 --> 00:17:56.970
And really, what I find is that the the question that unlocks uh most things is not what do you need?
00:17:57.130 --> 00:17:57.369
Okay.
00:17:57.769 --> 00:17:59.849
It's what did you do instead?
00:18:00.490 --> 00:18:01.930
What was your workaround?
00:18:02.089 --> 00:18:04.329
And the workaround is the unmet need.
00:18:04.650 --> 00:18:08.170
And it's probably already solved poorly by the workaround.
00:18:08.250 --> 00:18:12.250
And our job is to try to partner with that surgeon to hear their feedback.
00:18:12.329 --> 00:18:27.529
And again, Hazel, to your point, it's not always direct, it's sometimes indirect feedback that you take by being observant in the operating room, picking up on cues, and then asking the right questions because it's in there.
00:18:27.769 --> 00:18:36.170
The problem is in there, it may not be obvious, and we have to come uh to the same conclusion with uh with the surgeon.
00:18:36.490 --> 00:18:49.369
Um and and and I'll tell you that it it's really about discipline and truly about discipline is separating a surgeon's preference from something that may be generalizable.
00:18:49.769 --> 00:18:57.369
Great surgeons have strong hands, oftentimes strong opinions, and not every strong opinion may be a product.
00:18:58.089 --> 00:19:01.130
And and that sometimes is a hard reality.
00:19:01.210 --> 00:19:05.289
And it doesn't mean it's not a great idea, um, but we put things into trial.
00:19:05.450 --> 00:19:15.529
We try with the surgeon ideas, once we've collaborated and figure out what their workarounds are, we try to put the products into trial early for exactly that reason.
00:19:15.690 --> 00:19:31.769
I'd much rather, I think we would much rather be told uh during a wet lab or very, very early prototypes uh than to find out in a wet lab that this product is a good idea, but it's not serving an enormous opportunity.
00:19:31.930 --> 00:19:42.089
Then we can make the judgment, as we have done with a number of products that we've provided to the surgical market, because there was no feasible alternative to meet that clinical need.
00:19:42.569 --> 00:19:44.970
And that requires the powers of clinical observation.
00:19:45.049 --> 00:19:53.210
So when you guys are coming into the operating room, you're really looking and observing, um, which is not seen very much today.
00:19:53.370 --> 00:19:55.049
So I want to compliment you there.
00:19:55.210 --> 00:20:15.210
I'm gonna circle back to your team developed the first in-office vitrector back uh because I know that I met with Beth and we were going to implement it in our office in Grand Blanc, Michigan, because we noticed there was a difficulty, even though I could call and say I have a detached retina, and they'd say, come at five.
00:20:15.450 --> 00:20:17.289
Not everybody had that ability.
00:20:17.450 --> 00:20:21.370
And so and many of my patients started having hired deductibles.
00:20:21.690 --> 00:20:31.850
So going to a surgery center meant surgeon fee, anesthesia fee, and a um pretty high surgical hospital facility fee.
00:20:32.090 --> 00:20:35.529
So that was starting back in 2013.
00:20:35.690 --> 00:20:38.809
That's when I engaged Beth for in-office surgery.
00:20:38.970 --> 00:20:47.850
So it hasn't changed, just the deductibles have gone skyrocket high, and the access has gone down, and the expertise of the staff in the operating room has gone down.
00:20:48.090 --> 00:20:54.490
So uh you'll be the uh go-to for in-office surgery equipment moving forward.
00:20:54.730 --> 00:20:59.769
Um, do all your pieces of equipment uh tie into the major vitrectors right now?
00:21:00.009 --> 00:21:03.289
The light the lasers, et cetera.
00:21:03.610 --> 00:21:03.850
Go ahead.
00:21:04.090 --> 00:21:05.610
Yeah, thank you for that question.
00:21:05.850 --> 00:21:07.850
Because um I'll take it.
00:21:08.090 --> 00:21:13.289
So, yes, our laser probes are fully compatible with all of the vitrectomy machines.
00:21:13.450 --> 00:21:18.970
Um, our forceps are handheld instruments, so it really is irrelevant which platform that you're using.
00:21:19.130 --> 00:21:28.970
Um, a small thing that when Mike was um looking at the product platform goals early on, we were looking to his point where the doctors were doing workarounds.
00:21:29.049 --> 00:21:31.930
And the first product that we came out with were soft tips.
00:21:32.090 --> 00:21:41.210
And before the Vortex soft tip was launched, um, doctors were either trimming the tips to make them shorter because they were not passing through the valves easily.
00:21:41.450 --> 00:21:45.769
I've heard stories of where they have to turn the room lights on, they have to get the tech involved.
00:21:45.930 --> 00:21:51.210
If the scissors trimming the soft tips aren't sharp, they're gonna have a messy soft tip.
00:21:51.529 --> 00:22:01.130
And so Mike and our early engineers were like, let us come up with a soft tip that just without thinking and in a length of one millimeter length.
00:22:01.210 --> 00:22:06.490
So, you know, because a lot of times you have to drain subretinal fluid, so why should you have to compromise that length?
00:22:06.650 --> 00:22:12.170
So they made our soft tips with slightly stiffer silicone that pass very easily through the valves.
00:22:12.250 --> 00:22:14.570
And it's like a small thing within the engineering.
00:22:14.730 --> 00:22:17.769
So I know your question was do our equipment work with everything?
00:22:17.930 --> 00:22:18.250
Yes.
00:22:18.410 --> 00:22:22.009
Our equipment, laser probes work with all the machine platforms.
00:22:22.330 --> 00:22:30.970
Yes, we're fully compatible with all the machine platforms, and we are always trying to put a small improvement in the device.
00:22:31.130 --> 00:22:34.809
Um, our forceps, we came out with the tail and line of forceps.
00:22:34.890 --> 00:22:43.289
And so what we did is we improved the um visualization where you're working because a lot of surgeons now are working with heads up 3D systems.
00:22:43.450 --> 00:22:49.930
So they have a wider angle view, they have great illumination, they can really see the tips where they're working with those forceps.
00:22:50.090 --> 00:22:59.210
Oh, but a lot of forceps haven't been uh re-engineered or developed for 10 or 15 years and the soft and the tips are bulky.
00:22:59.370 --> 00:23:06.809
So where you're going to peel that one micron membrane, do you have metal, yeah, surgical stainless steel in the way?
00:23:06.970 --> 00:23:09.289
So we came out with the tail and line of forceps.
00:23:09.370 --> 00:23:25.529
So I I realize I kind of um expanded on your question, but um, yes, we work with all the platforms and we're always looking to make things, make the surgical experience more comfortable for the retina surgeon so they can more easily obtain their surgical goals.
00:23:25.850 --> 00:23:26.809
That's that's awesome.
00:23:26.970 --> 00:23:29.690
Thank you for uh elaborating there.
00:23:29.930 --> 00:23:40.890
Um in the next five years, as we move to gene therapy potentially and a new delivery of medication that could be submacular, are you innovating for that future?
00:23:41.210 --> 00:23:42.170
Uh we absolutely are.
00:23:42.410 --> 00:23:48.890
As we look to the short and midterm future, that those are subchroidal, subretinal, macular.
00:23:48.970 --> 00:23:59.690
I mean, the the the ability to deliver precise volumes to very specific areas without egress is a challenge I think a lot of companies are chasing right now.
00:23:59.930 --> 00:24:18.410
Um we have already designed and developed a number of products in collaboration with surgeons that have have helped us leapfrog a lot of what has been available in the market, and we continue to work on a very robust RD pipeline that continues to address those specific therapeutic challenges.
00:24:18.809 --> 00:24:24.410
Well, I noticed that you've also tackled ocular oncology and you've developed a light box.
00:24:24.650 --> 00:24:26.490
Can you tell us a little bit about that light box?
00:24:26.570 --> 00:24:37.049
Because we used to use the old greasehopper light box that was the became the chandelier system for uh more complex uh peripheral retinal pathology.
00:24:37.210 --> 00:24:41.049
Can that light box that's used for That's LED based.
00:24:41.289 --> 00:24:44.730
Can that be used for a chandelier system?
00:24:45.370 --> 00:24:46.890
I can take this question.
00:24:47.289 --> 00:24:51.450
The LED light, unfortunately, is not bright enough for a chandelier.
00:24:51.610 --> 00:24:54.730
However, you touched on ocular oncology.
00:24:54.890 --> 00:24:57.210
Again, that's an example of vortex surgical.
00:24:57.529 --> 00:25:08.490
A retina oncologist approached us and said that there was an unmet need because the Myra boxes that were 40 years old in every OR were no longer being able to be serviced.
00:25:08.650 --> 00:25:15.289
And so we came up with transglerol illumination and pupil illumination for marking tumors for brachytherapy.
00:25:15.370 --> 00:25:20.570
And then we also have the nanocannula that has a 41-gauge tip.
00:25:20.809 --> 00:25:28.250
And so you can insert it through a 27-gauge cannula to do an intraoperative posterior tumor biopsy.
00:25:28.410 --> 00:25:36.809
So we have a product for illuminating to mark tumors, and then a product for posterior tumor biopsies.
00:25:37.450 --> 00:25:47.610
But no, sadly, the light box, sorry, we do get that question a lot from international customers about chandelier illumination with the beacon, but the LED light is just not bright enough.
00:25:56.650 --> 00:25:59.529
Do you guys have a vision board in Vortex?
00:26:00.730 --> 00:26:01.610
Uh we don't.
00:26:01.769 --> 00:26:08.090
I think it resides in each one of our individually in each one of our heads, which is not a great leadership strategy, admittedly.
00:26:08.250 --> 00:26:13.769
Um but the but the but but the truth of the matter is we we're based in in St.
00:26:13.930 --> 00:26:15.289
Charles, as we mentioned.
00:26:15.370 --> 00:26:18.330
We've got a handful of people outside of the office.
00:26:18.570 --> 00:26:25.769
We are pretty aligned on what our annual and global strategies and um uh goals are.
00:26:25.930 --> 00:26:29.370
Um, but no, to uh to having a visual board.
00:26:29.529 --> 00:26:33.450
Uh no, but I will say that from an organizational perspective.
00:26:33.769 --> 00:26:51.289
As a lot of manufacturing companies have, um, we do have um data boards built through our manufacturing processes where we can track things, but that's more on a task related as opposed to where we see ourselves in 10 days, 20 days, a year from now.
00:26:51.690 --> 00:26:57.450
And my last question for you, uh, you partnered with CORSA, is that correct, in 2022?
00:26:57.850 --> 00:27:06.410
Can you tell me a little bit about that alignment and how it's benefited uh ophthalmologists that might be practicing in other countries outside the United States?
00:27:07.130 --> 00:27:08.809
Uh, so a great question.
00:27:08.970 --> 00:27:16.330
Uh, as you point out, we've had a uh commercial relationship with uh CORSA ophthalmology for since 2022.
00:27:16.490 --> 00:27:21.049
Um, quite simply, we are a relatively small organization, right?
00:27:21.210 --> 00:27:22.570
From a distribution perspective.
00:27:22.730 --> 00:27:30.330
This is really about helping Vortex deliver our products from a commercial perspective to global operating rooms.
00:27:30.490 --> 00:27:38.250
And Corsa has a vast, vast, in the United States alone, they have a very robust distribution organization.
00:27:38.650 --> 00:27:48.090
Uh in the US, as an example, uh, they will be on purchasing agreements that Vortex, because of our pure size being small, may not have access to.
00:27:48.170 --> 00:27:56.970
But because Corza has agreements with some of these large uh GPOs and purchasing groups, they can accelerate adoption of our products.
00:27:57.210 --> 00:27:59.049
Same thing internationally.
00:27:59.210 --> 00:28:11.610
They have Katina brands, uh, they have uh Aseco brands, they've got SharpPoint, they've got a number of different brands that they represent throughout the world.
00:28:11.850 --> 00:28:15.850
Last told, I think it's 142 different countries they sell product into.
00:28:16.170 --> 00:28:23.769
And we are the beneficiaries of the relationships and the distribution channels they have established in many, many, many of those markets.
00:28:24.090 --> 00:28:33.610
So Corsa is is violently, and I use that word not to sound uh super aggressive, but they are violently committed to education.
00:28:34.009 --> 00:28:39.610
And they have a very, very uh large uh educational team.
00:28:39.690 --> 00:28:49.930
Uh they do wet labs globally, they do, and so they are the perfect partner for Vortex to permit us to get uh into Tanzania and other markets.
00:28:50.090 --> 00:28:58.330
I mean, markets where we want other North Africa, uh all over the world, where we simply don't have the reach or the bandwidth at the current time to be able to do so.
00:28:58.490 --> 00:29:04.570
So we're grateful for Corza for what's been a wonderful relationship, and we look forward to continuing that for a number of years.
00:29:04.970 --> 00:29:05.690
Well, thank you.
00:29:05.930 --> 00:29:12.250
Hazel's gonna finish with some rapid fire questions, and they're just brief answers, and we appreciate whoever can answer first.
00:29:12.330 --> 00:29:12.890
We'll take that.
00:29:13.130 --> 00:29:14.009
Go ahead, Casey.
00:29:14.250 --> 00:29:14.330
Yes.
00:29:14.570 --> 00:29:14.890
All right.
00:29:14.970 --> 00:29:17.930
So I think I only have um four or five questions.
00:29:18.170 --> 00:29:20.890
Are you ready um for the questions, sir, Mike?
00:29:21.210 --> 00:29:22.170
Let's go.
00:29:22.809 --> 00:29:26.490
What has been the most rewarding part of your career?
00:29:27.450 --> 00:29:37.049
Um waking up every day and realizing that I am surrounded by the industry's top people, professionals.
00:29:37.289 --> 00:29:39.610
I love going to work every day.
00:29:40.170 --> 00:29:45.130
Um the team we've assembled at Vortex is special to me.
00:29:45.210 --> 00:29:53.289
Um, not because we've worked for together for a combined almost 180 years, if we combine all of us.
00:29:53.690 --> 00:30:00.890
Um, but I really look around and as I look at the team that we've assembled, there's they're pros, pros.
00:30:01.289 --> 00:30:06.490
I I couldn't be any more delighted and thrilled, including uh, you know, a family member.
00:30:06.650 --> 00:30:09.769
Uh so I I'm just I'm absolutely, I'm absolutely thrilled.
00:30:09.850 --> 00:30:12.009
Beth and I have spent 20 plus years working together.
00:30:12.170 --> 00:30:14.650
I don't see her, I mean, I see her as a as a colleague.
00:30:14.809 --> 00:30:23.049
And it really generally uh genuinely helps uh all of us become consistently aligned with what it is we're trying to execute on.
00:30:23.450 --> 00:30:24.330
Next question, sir.
00:30:24.410 --> 00:30:26.009
That was a really great answer.
00:30:26.250 --> 00:30:32.090
But next question, what continues to excite you about ophthalmology and medical technology?
00:30:32.410 --> 00:30:36.009
Um innovation is a word I think that's largely overused.
00:30:36.330 --> 00:30:36.650
Okay.
00:30:36.809 --> 00:30:47.370
And innovation from where I sit right now outside the operating operating room suite, I'm really curious to see how AI is going.
00:30:47.450 --> 00:30:49.690
And it's a there's another term that we hear a lot of.
00:30:49.769 --> 00:31:00.009
I I know there's a lot of work being done on the diagnostic side and even workflows and surgery and uh on the surgical side, but we're at a really interesting point, I think.
00:31:00.170 --> 00:31:13.529
You know, we've got digital operating rooms, we've got, you know, operating room equipment that's functioning largely like computers looking to integrate all this sort of stuff to help complete the treatment uh circle.
00:31:13.769 --> 00:31:21.930
Um I'm really fascinated to see, and I may not be around long enough uh to see exactly how AI leans into this.
00:31:22.090 --> 00:31:23.529
No, no, but don't worry.
00:31:23.690 --> 00:31:29.930
Uh uh, but I may not be around long enough to see how AI genuinely impacts the surgical side of this.
00:31:30.090 --> 00:31:35.850
I know it's already having an impact in every other part of your functional departments uh in in the practices.
00:31:36.009 --> 00:31:38.730
So that's what I think I'm most interested and excited to see.
00:31:39.049 --> 00:31:40.009
Another one, sir.
00:31:40.170 --> 00:31:44.410
What is one professional lesson that has stayed with you throughout your career?
00:31:44.890 --> 00:31:51.210
Um always treat people with i uh so I hope you weren't looking for some exotic answer.
00:31:51.370 --> 00:31:55.529
Okay, and this really comes from my background and my upbringing, okay.
00:31:55.930 --> 00:32:05.769
Um is is people always m may not remember what you said, but they'll always remember how you made them feel.
00:32:06.009 --> 00:32:13.529
And I think um that's an important mantra and a uh a a little fight song that I kind of carry around in my mind.
00:32:14.330 --> 00:32:16.410
I think I'm gonna carry that too, sir.
00:32:16.809 --> 00:32:18.809
And finally, last question.
00:32:18.970 --> 00:32:24.970
If you could see one major breakthrough in ophthalmology during your lifetime, what would you hope it would be?
00:32:25.049 --> 00:32:29.450
Aaron Powell Big picture, uh elimination of blindness, restoration of sight.
00:32:29.850 --> 00:32:34.650
That no one would have to wait to be repaired if they have a sight-threatening condition.
00:32:34.890 --> 00:32:36.650
And so many people do wait.
00:32:37.289 --> 00:32:47.690
And if I may add, I think one of the most important takeaway from our discussion is that innovation doesn't always have to mean completely reinventing the way we do things.
00:32:47.930 --> 00:32:56.330
Sometimes it's about identifying a challenge that surgeons face every day and then finding a more precise, practical, and effective way to solve it.
00:32:56.570 --> 00:33:00.730
Um, Beth and Mike, thank you so much for joining us on IC Podcast.
00:33:00.890 --> 00:33:02.970
It has been a great pleasure having you here.
00:33:03.450 --> 00:33:04.410
Thanks for hosting us.
00:33:04.570 --> 00:33:05.289
Thank you so very much.
00:33:05.850 --> 00:33:10.970
And to everyone who is listening or watching, thank you for joining us today.
00:33:11.130 --> 00:33:19.850
Be sure to subscribe to IC Podcast for more conversations with the physicians, innovators, and leaders of shaping the future of ophthalmology.
00:33:20.090 --> 00:33:22.170
Until next time, keep an eye on the future.
