Rightly or wrongly, one of the common complaints about the government-led effort to reform our health-care system, from both providers and patients, is the perception of a top-down approach, something forced upon us. An interesting contribution in the March 20 JAMA proposes an alternative: clinician-led innovation.¹

The authors note that the phenomenon of user-led innovation has gained acceptance in industries from  kite-surfing to mountain bikes and in large companies such as 3M. They relate successful technology development programs in which a “small but significant percentage of users” make innovative additions to products and services to better suit their needs. “Strategies from industry, such as innovation challenges and ‘crowd sourcing,’ further enhance development of new ideas,” they write.

It’s generally agreed that cataract surgery has not seen such a potentially transformative technology as femtosecond-assisted cataract surgery since the introduction of phacoemulsification, one of the technologies femto cataract is designed to supplant. But while phaco also had its doubters, femto cataract faces a far more difficult climb to mainstream acceptance. The reality is that the two major hurdles—the $500,000 price of admission and the demonstration of true clinical benefit—will only be answered with time and data.

But, as it has throughout its history, ophthalmology is showing itself to be well-versed in the concept of user-led innovation.

It’s still pretty tough to get much of a “crowd” of users together at this point, but we’ve done our best this month with our cover story on femto cataract (p. 22).

Predictably, the sources include the usual trailblazers and early adopters. Their experiences and  perspectives are invaluable, but for most surgeons there will always remain some reluctance to dive into the deep end. I hope that we’ve balanced that out with some other users who, like most of the profession, went into this with their skepticism on full alert.

On the whole, I’d say their results—and our article—came out better than I expected. It won’t change your mind, but that wasn’t its intent.

It’s meant to report the latest example of something that ophthalmology has always been good at: breaking a new technology down, identifying what works, improving what can be changed and replacing what can’t. User-led innovation is an old-fashioned concept in these parts.