IN SO MANY WORDS

TearScience’s Joe Boorady

In So Many Words is a succinct, timely talk with a need-to-heed KOL.

Few would argue that since Joe Boorady’s arrival at TearScience as president and CEO in winter 2015, he has upended the firm, whose sole mission is to diagnose and treat meibomian gland dysfunction. An optometrist who prefers to practice business, Dr. Boorady came to TearScience, a company young enough to still list its investors, via Zeiss Meditec, where he had risen from VP of Clinical Education and Strategic Accounts to senior vice president, Sales, Service and Marketing. He left, he says, because he liked the balance sheet of TearScience. “The one correction that was needed was to the business model.”

OM: You didn’t wait long to make that correction. You eliminated the requirement to purchase together the LipiView diagnostic and LipiFlow treatment and eliminated the click fee; In October, you halved the price of the disposable activators.

Joe Boorady

Joe Boorady: We actually did more. We introduced DMI, or Dynamic Meibomian Imaging. These images make structural changes to meibomian gland disease apparent. Patients will say yes to a treatment when they see their glands dying off; it’s like showing glaucoma patients their optic nerve dying off. Introducing DMI doubled treatments from January to June 2015.

OM: Tell us about your clinical trials.

JB: The nine studies listed in Clinicaltrials.gov are all completed.

These validate safety, efficacy and duration. Three will be published this year. One is a large, multi-center study on duration of effect. I can tell you the treatment clearly lasts a year. Eighty-six percent of the patients showed the same efficacy at 12 months as at one month. It showed a three-times increase in lipid production, and a 50% reduction in symptoms.

The cataract study shows significant benefit in ocular comfort to patients who show signs of MGD, even if they are only minimally symptomatic prior to surgery.

The contact lens study shows considerable increase in comfortable wear time. There is a correlation between contact lens wear and dry eye and contact lens dropout. We saw a significant increase in wear time over the course of the four-month study.

There have been 31 studies on technology alone.

OM: We would presume you are trying to get a Medicare code?

JB: We followed the Academy’s guidance to establish a category 3 code, and we got that. Having reimbursement would be to our advantage, but obtaining it requires time, money and effort. We received a mixed response from industry on getting a reimbursement code. A lot of practices, more than half, like self-pay. I would simply say we have begun the process.

Coding, it’s a complicated environment out there. Considering how pervasive dry eye is, it’s one of the most common diagnostic codes used today, it’s a tricky subject, especially with new technology. Our position is that we are doing everything we need to do. We are on [CMS’s] radar. As a small start-up, to get reimbursement, life would be good. It will happen on its own time.

OM: Did you ever practice as an optometrist?

JB: Yes, I practiced at least part time from 1993 to 2006, and in that time I started or purchased many private practices in New York and New Jersey. I also practiced with both optometrists and ophthalmologists.

OM: Why did you decide to go to business school?

JB: Since the majority of my professional time has been in executive management, I decided that the formal business training would be invaluable, and it has proven to be the case. Business training helped me to build a knowledge base and to think more prescriptively on how I approach business challenges — but more importantly I developed a network of friends and business colleagues that I tap into frequently for support.

JB: There were many factors. The dry eye space is largely underserved, so it is a huge growth area in eye care. The IP around the TearScience technology with over 90 patents filed was very attractive, as well as the clear clinical evidence around efficacy, with over 31 papers. And TearScience has the only electronic FDA cleared device for MGD.

OM: You went from a large company to a small one. Tell us about the pros and cons of that.

JB: Both models have advantages and disadvantages. In large organizations, you have the advantage of scale, stability and structure, but there can also be bureaucracy and politics that can slow you down. In a smaller organization, you have speed and agility, but you can be slowed down by lack of resources and lack of scale. Naturally, there are times in a company’s lifecycle where you want one or the other. I enjoy both environments.

OM: Can you give us any overall data on the number of: TearScience adopters; patients who have used the product; patients who used the product before surgery; post-surgical outcomes; adverse events?

JB: Around 450 practices in North America to date have adopted LipiFlow and LipiView with more than 100,000 procedures performed to date.

As a result of our original price point, LipiFlow had been reserved for highly symptomatic patients as an end-stage treatment. Since MGD is progressive, it is best treated as early in the disease process as possible and that may mean patients with very mild symptoms. The PHACO study shows 63% of cataract patients present with tear film instability, which is then exacerbated with surgery. The new business model allows MGD to be seen and treated early, before excessive atrophy and before symptoms are obvious. OM