Innovation can be hard to notice sometimes, even when it’s staring you right in the face. “There is no reason anyone would want a computer in their home,” Ken Olsen, founder of Digital Equipment Corp., said in 1977, just as the PC revolution was beginning. Similar bad calls have been made whenever something new challenged the existing way of things—radio, TV, the Internet, you name it. In 1962 an executive at Decca Records rejected an audition tape from a new band called The Beatles. He even went so far as to say that they “have no future in show business.” Whoops.

In business circles, people talk about the “innovator’s dilemma,” referencing a book of the same name that describes how companies are prone to miss or dismiss the impact of ground-breaking new technology or ideas. The concept is that companies can be so focused on their current model of serving customers that they fail to see how people’s needs might change in response to innovation. In other words they suffer from, “If it ain’t broke, don’t fix it” disease. The company’s dilemma, then: abandon a successful business model in favor of a leap of faith into the unknown, or stick with what they know… and risk being overtaken by more nimble competitors.

Is there an innovator’s dilemma in health and science too? Less so than in other circles, as this is such a data-driven field, but it’s true that old ways of providing care are sometimes hard to give up. When ophthalmologist Charles Kelman invented phaco, it wasn’t welcomed as a safer alternative to intracapsular cataract extraction; rather, it was dismissed as “ridiculous” by the establishment and called malpractice. 

By the way, Dr. Kelman got the idea for phaco while having his teeth cleaned at the dentist—the ultrasound probe triggered a flash of insight—proving that innovative ideas can arise anywhere, any time.

You Say You Want a Revolution
This month we shine the spotlight on several frontiers of innovation in eye care. Some are applicable right now, like the many new technologies that are improving dry eye diagnosis and therapy (see page 54), while others are more about new ways of thinking, like glaucoma’s link to the central nervous system (page 32). The notion that glaucoma may be governed by the same processes as Alzheimer’s and Parkinson’s is indeed a radical idea that opens up new avenues to explore. Some are high-profile sci-fi concepts like Google’s “smart” contact lens (page 46) or the notion that an eye drop might be able to treat a posterior segment disease (page 40). Others are more workaday and unglamorous, but perhaps a bit more practical. Either way, you’ll find plenty of great ideas this month from people who are challenging the status quo.

It’s hard to question tried-and-true ways of treating your patients, and in fact standard of care tends to favor protocols with a long track record of success. But keep your ear to the ground for the “next big thing.” It could be here before you know it. Perhaps it already is.