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Helping Diabetics Keep Their Vision

August 12, 2020 Lloyd Hildebrand Season 1 Episode 90
Radio Cade
Helping Diabetics Keep Their Vision
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Radio Cade
Helping Diabetics Keep Their Vision
Aug 12, 2020 Season 1 Episode 90
Lloyd Hildebrand

Diabetes sometimes leads to loss of vision. What if there were a simple screening device to find out who is at risk? Dr. Lloyd Hildebrand, a Canadian ophthalmologist and founder of two start-up companies, invented a hand-held device that in minutes measures the eye’s electrical waves to detect patients who may be suffering from diabetic retinopathy. Hildebrand talks about the challenges in moving from academia to the start-up world. “It was hard to get somebody that understood what we were doing to fund the company and run it,” Hildebrand said, “so I drew the short straw.”

Show Notes Transcript

Diabetes sometimes leads to loss of vision. What if there were a simple screening device to find out who is at risk? Dr. Lloyd Hildebrand, a Canadian ophthalmologist and founder of two start-up companies, invented a hand-held device that in minutes measures the eye’s electrical waves to detect patients who may be suffering from diabetic retinopathy. Hildebrand talks about the challenges in moving from academia to the start-up world. “It was hard to get somebody that understood what we were doing to fund the company and run it,” Hildebrand said, “so I drew the short straw.”

Intro:

Inventors and their inventions. Welcome to Radio Cade the podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade , who invented Gatorade in 1965. My name is Richard Miles. We'll introduce you to inventors and the things that motivate them, we'll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

Richard Miles:

An EKG for the e ye is helping people with diabetes to keep their eyesight. Welcome to radio Cade, I'm your host, Richard Miles. And today I'm talking to Dr. Lloyd Hildebrand and ophthalmologist and founder of two startup companies. Welcome to Radio Cade, Lloyd.

Dr. Lloyd Hildebrand:

Thank you very much. It's good to be here.

Richard Miles:

So Lloyd, I got to say you're the second Canadian I've interviewed in the last three days. And our listeners may begin to think I've fled to Manitoba, Saskatchewan or somewhere, but I promise from the beginning, no hockey jokes, no references to Molson or any of that nonsense.

Dr. Lloyd Hildebrand:

Okay. At least it's not February and 40 below zero.

Richard Miles:

Exactly. But I did want to comment on that. Actually, you were born in Canada and you grew up in Brazil. You came back to Canada for medical school, you practice in Iowa for a few years as a physician, then some training in Oklahoma, you worked in Portland, Oregon for a while . And now you're either in New York or Las Vegas. I can't remember where you are at the moment.

Dr. Lloyd Hildebrand:

I'm in Las Vegas now.

Richard Miles:

So the obvious question is, are you on the run from the law or sort of what explains your trajectory, give us a snapshot of Lloyd Hildebrand and why it is you in so many different places?

Dr. Lloyd Hildebrand:

Sure. I was born in Canada and at age four, my family moved to Brazil, Southern Brazil. All my parents were missionaries there. And I lived there till I was age 16. I came back to Canada and finished high school and went to do my undergraduate work in my medical school in Winnipeg at the University of Manitoba. I then went into primary care and was a primary care physician for almost a decade one year in Canada, and then move to council Bluffs, Iowa, where I joined two of the Canadian physicians there in a primary care setting, doing family medicine there , obstetrics. I then went back to training in ophthalmology at the University of Oklahoma in Oklahoma city at the Dean McGee eye Institute, which is a large regional well known academic center and did a fellowship at a family plastic and reconstructive surgery in Portland, Oregon. That was a one year program. And I was recruited back to the University of Oklahoma at that time. And I spent 22 years there on faculty and went through the full academic career there. I retired in 2016 to go to New York and work on an artificial intelligence project. I worked a couple of companies that were working with IBM Watson at the time. And after that project is completed, now I've decided to come to Las Vegas, Nevada and I start work on Monday, two days from now.

Richard Miles:

You're quite the traveler. I did note that you've actually hit both coasts and the dead center of the United States, Canada and Brazil. So you've got the hemisphere pretty well covered. Lloyd, let's talk about your core idea that you've been working on for a while, but I think is fascinating. I think that what we'd like to spend most of our time today talking about, and then later the company or the companies that you have founded to spread those ideas. So let's start talking about diabetes, which isn't obviously connected to eyesight for a lot of people, but tell us what is the connection to vision? And then what is the problem that you are trying to solve?

Dr. Lloyd Hildebrand:

Sure, well, diabetes is the largest growing problem and growing very rapidly at epidemic proportions, diabetes really does a lot of its damage in terms of damaging the end organs, The eye being one of them, the kidney, the heart, and the brain are also organs that can be damaged. It's usually damaged to the small blood vessel of the eye and that's called diabetic retinopathy and diabetic retinopathy is actually the leading cause of preventable blindness in working aged Americans. So it's a major cause of vision loss. The real challenge in diabetic retinopathy is that it's easily treated. They're very effective treatments and there's very, very good research, probably one of the best research diseases in our scientific literature. And yet at the same time, it's best treated when patients are asymptomatic. So therefore patients with diabetes, there's a guideline recommendations for them to have an annual examination or evaluation of their retina to see if they have treatable disease. And if you treat the disease, you can prevent the blindness . If they start having symptoms, you can prevent the progression, but it's very difficult to reverse the vision that they've already lost. So therefore the real challenge becomes how do you treat people in a timely way? And the way to do that is to evaluate them regularly and have a reliable test for doing that. The result of the healthcare system though is that only about 40 to 50% of people have that test done on a regular basis. And as a result, a lot of disease go detected until it becomes symptomatic. And they're behind the eight ball in terms of treatment at that point in time.

Richard Miles:

Can you give us a sense of the magnitude of the problem and do you know, what is the percentage say of people who are going to develop diabetic retinopathy? If they're not checked ? I mean, reminds me a little bit of skin cancer or certain forms of skin cancer, right? Where if you detected easy to treat, if you don't detect it, it's highly lethal. What are we talking about in terms of those folks who don't get checked? Are they in big, big trouble?

Dr. Lloyd Hildebrand:

80% of people will develop diabetic retinopathy at some point in their lifetime of the disease. And there are certain risk factors that are associated with it. How long you've had diabetes, how poorly controlled it is. So the hemoglobin a one C level or the level of blood sugar that you have also it's associated with a higher risk of patients with high blood pressure and high cholesterol and triglyceride levels. So high lipid levels. So all three of those states combined to increase the risk of the patient in doing this. So the relative risk of people developing vision from this , there were about 40,000 people a year that go blind from diabetic retinopathy. So it's significant and there's a much larger group of people that then have what we call moderate vision loss and moderate vision loss. Wouldn't be so moderate to you and I. It's the loss of the ability to read newsprint and loss of the ability to drive. So they're very, very significant impacts in terms of people's lifestyle and activities of daily living.

Richard Miles:

It sounds like if you have diabetes or if one has diabetes, you should at least be aware of the problem. But if I understand it correctly, from what I've read, the key is you may get this recommendation from your primary care physician and then you get a referral to a specialist and it's in that scene , right? That a lot of people just don't get around to doing it, or they don't want to do it or whatnot. And so a lot of people who are actually told are aware that this may be a problem, don't do the critical followup and there for, they go largely undiagnosed. Do I have that right ?

Dr. Lloyd Hildebrand:

That's correct. So the big challenge in the healthcare system is what I call people falling off the wagon. And you fall off the wagon from the primary care setting to the eye care environment where the eye exam needs to be done. Part of that is because it's asymptomatic people, don't perceive the importance of it. Part of it is it takes time. It costs money to do that. Part of it is that there's some resistance on the eyecare environment in terms of getting appointments in a timely way. So there's some inconvenience factor in that as well. And some of it is just that people aren't even referred for it because again, it's the asymptomatic disease.

Richard Miles:

So tell me then about the technology that you've developed to make this more efficient. I assume a primary care physician can do this in his or her office or pretty rapidly, so you no longer have to refer them to a specialist.

Dr. Lloyd Hildebrand:

Yes . So again, drawing back from my experience as a primary care physician, diabetes has exploded since I last practiced as a primary care physician, but nonetheless, it was an important part of our treatment as well. And so one of the things that primary care physicians do very well is tests people find out when they hit a threshold of disease that needs a specialist and then send them onto a specialist. So our idea is if we could provide a test for a primary care physician to do that was reliable and accurate and convenient for them to do. And generally you have to consider also the economic aspects of it so that they can actually make some revenue from doing this. B ut that would be something that could help us address this issue because it would avoid patients having to move from the primary care setting to the e ye c are setting until they had what we call threshold disease or disease severe enough to need t reatment. So the initial application that we did is we u se the photographic technique to do this. There was a photographic technique developed by the national institutes o f health that was used for all clinical trials that were done for the FDA, for the new treatments, for new therapies and for epidemiologic studies. And that technique was developed on film, very similar to the view master film reels of cartoons that we used to watch a s kids, little view masters. And it used that ability to create stereo by creating these two different views, our initial solution for doing that in t he first company, I started took photographs and converted that process from a film based process to a digital process, created a reading center. So the photographs could be done in the primary care setting sent to the reading center and a report sent back to the primary care physician with a red and green label on it, a lot more detail if they wanted to, but they knew that if it was ramped, they needed to send the patient onto the op hthalmologist f or treatments. So what we're using now instead of imaging technology is we're using a different form of imaging electrophysiologic imaging, where we actually me asure t he electrical activity of the eye to determine whether or not there is disease present there. And so that's where the EKG of the eye analogy comes from. So it's simpler to do doesn't require the challenges of imaging, particularly in patients with cataract, because it doesn't require us to image through the eye to get the data and it can be done much quicker and the reimbursement model is better. So there are several different advantages to the te chniques o f doing that currently. So part of that then was developing the service in such a way so that it could be delivered in the primary care setting. The workflow would not interfere with how the primary care physician does his or her work, and then setting up a reading center to be able to interpret the data and then report it back and doing this all through a cloud based architecture for doing it, and then important to the primary care physicians that we be able to integrate this into their existing healthcare infrastructure, their EMR sy stems, and that is n't s uch a trivial thing to do either. So once we got all of t hat established, we were actually rolling out our pilot site and then our pilot site was very successful. And once we were successful with that, we were really working on commercial deployment and that's when COVID hit. So we ha ve t o shut down for aw hile. And now we're reopening at this point and ti me.

Richard Miles:

So that makes it sound like this idea should spread like wildfire, right? Because it sounds like a quite superior way of handling it. And probably it's going to save if not lives, at least people's vision. Let's talk now about the companies that you founded, not just the origin story, sort of like the day, but also a little bit about the experience of doing so, because you're not the first one that we've had on the show. They come from primarily an academic background. They hit upon a great idea through their research, or they are collaborators on somebody else's original insight. And most of them find it a very challenging transition to go from the academic world in which you do research and you publish and you then move on to the next research and you don't have to worry about who's paying for the little lights over your head or air conditioning or any of that. When they go into this world, in which your idea doesn't sell itself, it has to be developed it has to be tested. It has to be marketed, it has to be distributed. How did you get, first of all, the idea that you wanted to do this to be involved yourself, right? Cause there's another path and simply you could license the technology. And a lot of people do that and you move on to whatever else you want to do in life, but you decided to take the hard road and actually get involved in not one but two companies. So tell us what was the impetus for doing that? And describe for us maybe your first, I dunno , six months, what was it like and what did you learn in those early days?

Dr. Lloyd Hildebrand:

A little bit of this is the story of necessity is the mother of invention. So a lot of this was stimulated by a need. I had to do something to do that, to keep the idea alive. We developed the technology in our labs and we had actually continued to grow and develop the idea. We're validating the idea through research grants and doing it through the traditional academic settings . We had a very large national trial that was going to be done, which is going to be the largest clinical trial ever done through the VA system. It was funded. We got the highest scores ever granted the program. And then for some unknown reason, it was rescinded. Again, I'm still not clear on why that happened. It was an almost $10 million grant, which at the time was the largest grant ever granted the University of Oklahoma health sciences center. So when that happened, the university said, look, either you have to abandon the idea or what you need to do is commercialize this idea and license it out. So we said, fine, we'll do that. And we had obtained a patent for it at the time. So we thought we had some very tangible intellectual property license it out , but again, those things are a little bit challenging to do. And it was hard to get somebody that understood what we were doing to fund the company and then to run the company as well. There were two other co-inventors with me and they asked one of us to step out. And so I actually took the short straw and stepped out of the academic environment on a leave of absence from the university, just as I was about to hit tenure, my tenure promotion. It was a bit of a challenge and it was something that I hadn't done before. And I remember the driving force behind my initial business plan was the Ernst & Young book, How to Write a Business Plan. And I literally followed that line by line chapter by chapter and develop a business plan for doing that. And I started marketing the business plan locally in Oklahoma, at the time it was hard to do that because a lot of people didn't really understand what we were doing and the.com was booming at the time. So I packed everything up and I went to California and I started cold calling people on Sandhill Road.

Richard Miles:

Did you have any mentors at all that you turned to, or that offered you advice or was it just the Ernst & Young book and trial and error? You know, their whole bunch of small steps when you start a company that you don't even think about filing for registration and finding an office and getting office furniture, all those sort of things that in other circumstances just appear out of nowhere as you do your work, did you have a roadmap or did you just day by day figure out, well, I guess I've got to do this and I guess I got to do that.

Dr. Lloyd Hildebrand:

So it's not that there weren't mentors, but at that point in time, especially in our academic environment, we were fairly immature at this concept of commercializing technology. So I was a little bit of a pioneer in all of that. And I think I suffered a lot of the arrows that pioneers have in their backs as a result of that as well, but still I did have good mentorship from some business people in the community, some people inside the university and then some of foundations that supported research at the university and these people were early investors in the idea, if nothing else, they provided me with encouragement. But much of what I had to do is really learn on the job OJT for sure, on the job training for the largest part of it. And the most frustrating part about it was that we really had an investor community in the Southwest in Oklahoma and in the region that really didn't understand the digital world and the digital technology. And that changed dramatically when I went to California, didn't move there. But when I went there to visit with investors there.

Richard Miles:

Primary care physicians are your principle market. I take it right. I mean, they're the ones who you really expect this, or at least their hospitals will buy it for them. Once you had the product up and going or something to offer, was it a struggle at all? Or was it difficult to sell them on this idea? I mean, having been one yourself, you knew the language, at least that wasn't a hurdle, but were there cost considerations or ease of use consideration ? Did they said like, yeah. Okay. It looks great, but you know, we're just going to stick with what we do and that's fine with us. What did you encounter that at all? Or was it an easy sell?

Dr. Lloyd Hildebrand:

It was not an easy sell, as you can imagine. Medical systems are very resistant to change. First of all. So innovation is difficult to get implemented in medical systems. And there's plenty of doors in terms of how long that takes somewhere between 7 to 14 years to really get that kind of adopted change. That was one of the points of resistance. So one of the main concerns that they had is the reimbursement issues and the reimbursement issues were complex because of the regulatory events around reimbursement. So Medicare and CMS had certain regulations that we had to follow. There were anti kickback rules that had to be followed as well because of self referral issues. And there were some telemedicine laws that were also pretty antiquated at that point of time, particularly anything that was done out of state. And when that happened , then we also have to follow other new rules in terms of licensure to be able to do this in other States. So there were significant complications to doing that. And then there was the natural resistance of the medical system to changing anything that they're doing. There was some resistance from organized ophthalmology as well, which seemed to think that this was a threat because the ophthalmologist perspective of the problem is I see every diabetic that comes in and I examine them. What they don't realize is that 60% of them aren't making it in. Right? And so that was also one of the burdens that we had to overcome in order to do this.

Richard Miles:

I think you pointed out an under-appreciated problem or problems in the medical device or healthcare industry, and that this is classic third payer problem, right? Where even if the physicians themselves love the product or love the technology very often, they're not the ones paying for it, nor do they have to deal with the regulatory hurdles necessarily in getting to use it. So did you find yourself having to spend a lot of time at Medicare offices in Washington or with regulators and insurance companies convincing them, this was a good thing for the field? Or how did you negotiate those hurdles?

Dr. Lloyd Hildebrand:

So we actually had to develop a strategy who we call coverage and reimbursement. So first of all, we had to change the policies and make this acceptable in order to do that, we went to the accreditation body. First of all, MCQA that this would meet the quality regulations that were part of the heat it's report card, which is the report card, measuring the quality of a health plan performance on all of this . So that's the first thing we had to do. Then we had to go to individual payers in each marketplace in order to get them to provide coverage and the reimbursement for this. So part of that is that we did a technical assessment. There are these organizations that the Hayes group does technical assessments of new technologies that come out, get that done. They review the literature and then provide a judgment on whether or not this is a qualified test to be done. We then went into individual marketplaces and we, first of all, tried to get Medicare coverage for that region. And we did that by visiting with people at CMS central office in Baltimore first, and then with the local carriers and the local carriers each made their own decisions . There's an interesting story about our initial visit to CMS. It was actually on 9/11 and it was at nine o'clock on 9/11. So you can imagine what that was like. As I was walking into the building, the building was streaming out and we were meeting with the director of CMS at the time Dr. Sean Tunis. And he asked us and said, do you want to stay for the meeting or not? And we said, well, if you're willing to meet, we'll still meet, but we understand if you don't want to do that. And we met and then lights were all grounded by them. And so we rented the last car at the airport and drove 24 hours, back to Oklahoma city. So it's a very memorable day when we got that, but it was also a very good meeting with Dr. Tunis.

Richard Miles:

Wow. You probably carried out one of the only previously scheduled meetings and actually finished it on 9/11. I was in Washington at the state department and it was quite chaotic and , um, yeah.

Dr. Lloyd Hildebrand:

It was very, very tense and we had just driven from DC to Baltimore. So during that time, it was a very interesting time and very chaotic time.

Richard Miles:

Let's go back a bit now about the company. So you have two companies, right? The current one is Trinoveon did I pronounce that correctly or how you did, but then the first one was called Inoveon, right? Correct. Okay. What's the meaning behind those words? And what's the difference between the two companies?

Dr. Lloyd Hildebrand:

Well, Inoveon was the initial company that we did and really the name was an aggregation of the word innovation and eon, the age of innovation. And so that was really the concept behind it. And our mission really was the prevention of diabetic blindness, because that was our whole mission in doing that. And so we set that up and we developed the technology. We developed all of the protocols with the protocols, the workflow, the business model, the regulatory model, and then the competency reimbursement and coverage decisions with all the health plans . We went through some ups and downs. We had several investors cycles and all of that. And ultimately, we sold that company to a German company that was a health IT company based in Germany, focused in, on the ophthalmology space and the largest provider of EMR systems for ophthalmology in the world. That company was then acquired in the sharks and minnows game by Topcon, which is a large Japanese ophthalmic company. And they were very interested because they were developing the devices that we were using to do the imaging. And so this was a natural fit for what they wanted to do. However, they also had an internal team that was working on their own solution for this. And so when they acquired the company, they basically mothballed the company. But the residual of all of that was that we had one of the largest datasets for annotated data that had very high quality data and evaluations in it that were commensurate with the research quality data that the NIH trials had done. So we had about 3 million images in that dataset . So as a result that became valuable to some of the artificial intelligence groups that were out there, the Googles of the world, and some of the large pharmaceutical companies that were developing and some of them are device companies. And so that data set has become the core of some of the big data analytics that has gone into some of the automated image reading systems that are out there. The challenge with imaging system and reading is that there are some significant operational challenges doing that. Diabetics have a large incidence of cataract. So when you have a cataract, it's difficult to get a good image. And when you don't get a good image, you can't get a good test result . There are other workflow issues and the cost of the equipment and the operation of the equipment is also complex. So we thought that might be a better way to do this. So after that company was sold and spun out and was doing all of those things, we continued to work on other new innovative technologies to solve the same problem. And that's the origin of trying to Trinoveon.

Richard Miles:

So the difference in, let me see if I have this straight part of what the challenge was. You've got all this data, but the ability to interpret the data and is that where the AI comes in, it just makes it more efficient and more accurate. Is that correct ?

Dr. Lloyd Hildebrand:

That's part of it. We still haven't validated that it's more accurate. We had human readers doing it. We had a very, very high quality system doing it. In fact, in daily routine operations, we actually matched or out performed research, trial quality data in our reading centers. So that was still difficult to do. The second part of it is that what's happened in the retinal imaging. It's become more of a screening technology rather than a diagnostic technology. And so what they've done is dummy down some of the questions that they have, and trying to just basically find people that have some disease and just get those people over. And so they can eliminate about 50% of the population that way.

Richard Miles:

I see. I hadn't thought about that key difference between screening and diagnostic. One is just kind of bare minimum to do with a triage sort. Right. And then the other one is to really try to understand the disease Lloyd, tell me, how do you spend your days now in terms of the life cycle of the company? Are you still primarily on the research and development end or strategic management or..

Dr. Lloyd Hildebrand:

So the answer is yes, to all of those as you do at small companies, there is a difference with Trinoveon, so first of all, the technology is different instead of technology we're using electrophysiologic imaging.

Richard Miles:

So it's the electrical activity, not actual photos that makes this so much simpler or relatively less complicated than the systems that are in place now.

Dr. Lloyd Hildebrand:

Yeah. So the technology of the device is actually quite complex, but what we're trying to do is we're trying to simplify all of the workflow for the primary care physician . So it can be done simply by a medical technician and can be done in less than five minutes. That was really the goal of what we were trying to do. So we've systematically operationalized all of those aspects with a device that used to be a desktop device that you put your head into now its a handheld device, much like an ice cream scooper has a little cup on it like that, that you put over the eye and the electrode that goes onto the lower eyelid and attaches to the device. And then a series of flashing lights that trigger the electrical activity in the eye and auto correct any errors in it, getting a valid test. And once a valid test is done, it notifies the user of that. And they put it into a little holster and that holster sends it over the internet to our reading center. And then we send the report back to them.

Richard Miles:

Is something that if you went to your doctor, it would only be done if you were diabetic or is this potentially something you would do as a normal battery things that physician's assistant will do before you see your primary care physician or is that over kill?

Dr. Lloyd Hildebrand:

So one of the critical elements of everything that we do is we try and make sure that there's a very solid, scientific and clinical foundation behind it. So what we've done is we've only validated this approach for diabetic retinopathy at this point, electrophysiology of the eye is done for other conditions, such as glaucoma. Hypertension can also make some changes in the eye, but we haven't validated that clinically, but those are some future applications that we had anticipated will happen.

Richard Miles:

Wow that sounds exciting. So usually what I'd like to do is give everyone on the show, a chance to dispense the many nuggets of wisdom that they've accumulated in their scientific and entrepreneurial journeys. And so I'm guessing that from time to time, you were asked for advice maybe from other startups or even other physicians who might be thinking of something similar, have you accumulated a short list of things that you wouldn't do again, knowing what you know now or pitfalls you definitely stay away from if you were say, asked to serve as a consultant to somebody else's business.

Dr. Lloyd Hildebrand:

Yeah. I think one of the real lessons that I've learned is that perseverance is probably as important as brilliance or intelligence in this game. Is that really persevering with the idea believing in it? And then when the naysayers come, it's much easier to say no to something than to say, Oh yes, that's wonderful. That was work. So I think you have to have perseverance and you have to be a little bit immune to some of the critique and criticism that are out there. Even from environments like the academic environment. Some of the harshest critique we took was actually from our research and development group at the university that was supposed to be supporting us for doing this . We had to work through constitutional amendment to the state constitution, which prohibited faculty from participating in equity positions in company . And so we have to work through a lot of these different issues in order to be able to even achieve it. Now, fortunately, we paved the path for other people to do it, and it's a leisure to doing it, but they're facing other challenges as a result . But I think perseverance is one of the key things. And I think the other one is really having a solid foundation for what you're doing. That's based in scientific merit, particularly in medical applications that has the validation to it always gives you the high road. And so when you face those challenges, knowing that you have that behind you, I think it's a very, very powerful tool. Ultimately, sometimes it's harder to sell people on that because they don't believe you can do it, but once you can prove that you can do it, then I think it becomes a real selling point.

Richard Miles:

Right, because there's nothing like confidence in your product. If you know it works, then it's that much easier to go out and tell other people, I guess in many cases it's a chicken and egg thing, right. You know that a certain trial probably will confirm or make confirm , but you need money to do that trial. And so how do you split the difference? Like, you know, I'm very, very confident, but I'm not certain and get somebody to fund that.

Dr. Lloyd Hildebrand:

The other lesson that you learn is that leadership in a company like this is lonely, it's lonely at the top because ultimately somebody has to make the call. What's your priority and spending, are you doing it on marketing? Are you doing it on research? Research people are pulling for more data, the marketing people just want more money, so they can go out and tell the message, right? And so you have to make all of these decisions, how much to invest in technology. And so when you're making that final decision, I think you really have to think about what are the basic principles that you're going for. What are the metrics that you're using to assure that your decision is a good decision, then how do you implement that decision and not lose your organization.

Richard Miles:

The other comment I was going to make Lloyd is when you said that you didn't get the support, maybe you're expecting from the academic community. I was gonna say, I'm shocked, shocked to hear that that would take place pettiness in academia. And it reminds me of that famous. I think it's a Henry Kitchener quote in which he said the fights in academia are so vicious because the stakes are so small.

Dr. Lloyd Hildebrand:

Well, that's right in academics. And in a lot of ways is a very individual sport too, right? It's a lot about how do I develop my own career and how do I prosper in that career? And so each individual achievement has to be allocated to somebody. And so that is one of the challenges. The second one is that entrepreneurship wasn't typically viewed as part of the academic journey. And now I think a lot of those things have changed in some of the academic settings and entrepreneurship actually does count for some of that. So I think those are good changes.

Richard Miles:

Yes . And you've made a very impressive and rare transition, most academics. In fact, most academic adventures at some point say, you know, this is just not worth it. And I'm going to either get bought or let this go to somebody else. Although I guess you had the best of both worlds you got bought and you kept going, so that's even better, but I commend you for sticking with it Because it is a tough road, lots of very bright, energetic, committed people who don't ultimately succeed through a combination of circumstances. So congratulate you on doing it. Not once, but twice.

Dr. Lloyd Hildebrand:

I tell my children find something you do in life that makes it easy to get up in the morning. And usually that means that you find something significant. And when you experience a blind person and particularly somebody that's blinded from something that was avoidable preventable or treatable, then you really realize the pain and suffering that you can prevent by doing something significant is really relevant to the world. And it's meaningful. And I think that's the main thing that drives me. I work in other blindness prevention programs internationally as well, cataract blindness that's for example, and all of these activities I think are centered on this focus that I've tried to put into my career, which is how do we leverage information technology to give us better clinical tool . We have a lot of administrative tools in medicine that really encumber us more than they help us. So I'm really focused much more on the clinical side. It's how do we get good tool to help us do this? And that was part of the work in AI that I'm very interested in continuing to foster as well.

Richard Miles:

Lloyd, thank you very much. These have been very inspiring, encouraging words. My takeaway from this is I need to start booking more Canadians clearly.

Dr. Lloyd Hildebrand:

That's probably a good thing to do,

Richard Miles:

Right, thanks very much for being on Radio Cade and hope to have you back at some point.

Dr. Lloyd Hildebrand:

Absolutely. Thank you very much for the opportunity. It was a pleasure.

Outro:

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida. Richard Miles is the podcast host and Ellie Thom coordinates inventor interviews, podcasts are recorded at Heartwood Soundstage and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinists , Jacob Lawson.