Translational funding leads to surgical breakthroughs

The femtosecond laser revolutionized eye surgery. All-laser LASIK, also known as Intra-LASIK, uses the femtosecond laser instead of a mechanical blade to make very precise cuts in the cornea, reducing complications and improving outcomes of the surgery. Additionally, it is safer to use for doctors than previous mechanical technology.

Dr. Roger Steinert, chair of the Department of Ophthalmology at The Gavin Herbert Eye Institute at UC Irvine, developed an application to use the femtosecond laser for corneal transplants. Using the laser, a surgeon can make extremely precise cuts to match the donor cornea with the patient cornea, promoting faster healing and better refractive outcomes than with manual cutting. It has been a breakthrough in corneal-transplant surgery.

Had it not been for translational-stage research funding, however, these sight-saving improvements may never have happened.

Dr. Tibor Juhasz, a professor of biomedical engineering at UC Irvine, invented the very first femtosecond laser for use in eye surgery in the late 1990s. According to Juhasz, once the basic – or discovery-stage – research was complete, it was very difficult to get funding for the translational phase. It took several years – and a significant investment – to develop the technology and ready it for clinical trails on humans.

Government agencies, such as the National Institutes of Health, tend to fund basic research, while corporations and private investors often won't come in until the clinical phase, when they are more confident of a return on their investment.

"There are many obstacles for funding translational research," Juhasz says. "The problem is you have this stage where you need to develop a device that can be taken to the clinic, I usually need a team of 20-30 engineers and tens of millions of dollars. It takes a great deal of money to bridge this gap, but it's often outside the range of what is funded by agencies or universities.

"Additionally, for really complex technology, private funding is hard to find coming out of the basic stage. Investing companies want commercialization plans, which might not yet be evident at this stage. To get to the private money, you have to have some technology, some plans, some approval. So it takes some money to get to the private-funding level. Organizations such as DEF help with this very important middle step, which is often the hardest part to fund."

Thankfully, the project did get the necessary funding, and the femtosecond laser is now also being used in corneal cross-linking (CXL) to treat keratoconus (KC). The laser has the potential to be used to induce cross-linking, allowing a surgeon to do the procedure in the middle or back of the cornea. "Normal" CXL uses UV light, which can only work from the surface of the cornea.

"DEF's mission is to provide essential ?bridge' funding for innovative research projects," DEF Medical Director Dr. Anthony Nesburn says. "This type of funding research leads to breakthroughs such as the femtosecond laser – and we are still continuing to discover new applications for this technology. If not for translational-stage funding, none of this would be happening."

Posted April 2012