Interview with Joan Prat: 'We can always decide between what we know and what we don’t. We chose the unknown'

Andrea Pelayo interviews Joan Prat, Head of Ophthalmology at Hospital Sant Joan de Déu

Joan Prat is an ophthalmologist and, since 2002, has headed up the Ophthalmology Unit at Hospital Sant Joan de Déu, where he works and began his career as an innovator. Strabismus, the most common condition among children visiting this public center in Barcelona, gave him the idea to create a new device that he has patented in Western Europe, parts of Asia and North America.

After having had a business idea in his head years, thanks to a grant from the Government of Catalonia, Head of Ophthalmology at Hospital Sant Joan de Déu Joan Prat decided it was time to take the leap and hired a great industrial and electronic engineer to help him move forward with his idea to improve his professional practice. This is how he created, not without having to overcome hurdles and surprises, Gazelab: a new system to more accurately measure strabismus and which has led to its own spin-off, BCN Innova. He explained all of this at the event entitled Innovating in medtech. Experiences and collaborations from EU and USA organized by Biocat this week.

What is your experience with medtech innovation?

A few years ago, I created a device to measure strabismus: Gazelab. It’s a set of glasses like the ones used to test a patient’s vision that record eye movement with two infrared video cameras that sit like “wings” on either side. We can then use the images to measure misalignment of the eyes.

How has your system improved on the previous one?

The previous measurement system was a manual prism bar, used for over a century and, in fact, still used today by ophthalmologists that don’t have Gazelab. After that, a more sophisticated mechanical device was patented, the synoptophore, but it wasn’t any better than the prism bar so it fell out of use. The difference between the prism bar and Gazelab is threefold: objectivity, precision and quantity of data. From a subjective system like the prism bar, we’ve moved towards an objective system; and from a system that has a moderate level of precision to one that is highly precise. Plus, we can explore in any position all at once. It’s also a question of time: it takes an orthoptist 40 minutes to do a proper exam with the prisms and with Gazelab it can be done better in just two minutes.

So, during your practice as a doctor, you came across this need. When did you start working on the idea?

I started working on this project, which we called Digmo, in 2005. But I couldn’t fund it then. There was no framework at that time for innovation coming out of a hospital. Then, two years later, the Government of Catalonia launched a program through which we got funding for the first part of the development. Without that, it would have just stayed a good idea.

How did the hospital help you push forward with this idea?

The grant we received was through the hospital. They’re the ones that banked on our project and submitted it to the call for proposals.

But there are opportunities to innovate from inside a hospital, aren’t there?

In fact, the possibilities are endless. If I, and others here, were given the chance to devote our time to innovating in medicine, we would never stop seeing things that can be improved on because that’s the way our heads work. A hospital is an ideal place for innovation, but with our workload and profile its difficult for us to set aside the brainpower this requires.

What are some of the main difficulties you’ve run into for marketing Gazelab?

This type of company was extremely uncommon in Catalonia in 2009. No ophthalmologic medical device company had ever been created in Spain, so we were up against everything that comes with doing something a bit out of the ordinary. We weren’t used to seeing people here taking the initiative. If you went about this in a country that funds innovation –like the United States through tax initiatives– people would be seeking you out to help you move forward. It’s just the opposite here because we don’t have a culture of risk and innovation. Even though we’ve been hearing about it for years now. In Catalonia we’ve tried to promote it from a philosophical point of view, at least. In economic terms, however, it’s another story.

Why, if it’s so complicated, did you decide to create the spin-off?

When the money from the first part of the prototype ran out, I asked my brother to help me put together a business plan, some numbers, and we saw that there was clearly a market for the device and we decided it was a risk worth taking. We can always decide between what we know and what we don’t. We chose the unknown.

What is the market you discovered?

Approximately 4% of the population has an ocular misalignment, some form of strabismus.

Where have you patented the device?

In Spain, France, England, Germany, Italy, Japan, China, Canada and the United States. And it’s a slow process for one reason: it’s one thing to introduce something similar to the old way of doing things but it’s totally different when you’re dealing with something completely new. We have to teach people.

Who has been hardest to convince? The moneymen or the doctors?

It’s been really difficult to convince the doctors. Right now the device is used more often in private centers, like the Institute of Ocular Microsurgery (IMO), but only because the public system has cut off all spending. If not, it would be used equally because the price isn't exorbitant and any group could purchase one.

So it hasn’t been an easy process.

No, it hasn’t been easy because it also takes a huge investment in marketing when we’re talking about an international product. It’s a global product that you have to advertise in every country and that has its limits. Right now, we’ve sold between 35 and 40. We’re not complaining but we didn’t think the process would be so slow. The main reasons are budgetary but we also had to make the product pleasing to the consumer. If you have to re-adapt it, that’s a few more years of work. We didn’t really know how users wanted it to be or how much they were willing to pay. The thing is, no one knows the price of medical technology: customers pay according to the benefit to society.

What have you learned along the way?

That it’s not enough for me to like what I’ve created. We’ve found that the real market demand led us to develop a less powerful device. The current version of Gazelab does a lot fewer things than the first device we made. Customers prefer something simpler and easier to use. This is one of the main things I’ve learned. Logic told me they would want power but really they prefer ease of use.

Despite the setbacks, would you recommend entrepreneuring in a hospital setting?

Without a doubt, I would encourage anyone to become an entrepreneur. It’s part of an existential issue: creating something isn't the same as not creating anything. It’s better to leave behind something that is of use to others.