Jay Wei

Jay Wei, holder of 30 patents, described as a legend in some retinal physician circles, is an approachable intellect. The founder and CEO of Optovue, Mr. Wei (“I never got my PhD,” he says when addressed as Dr. Wei) is the kind of interviewee, who, once he gets comfortable, enjoys telling his stories. And if his listener is smart, enjoys the telling.

Ophthalmology Management: When did you arrive here from Taiwan?

Mr. Wei: I came in 1982. My interest was in optics so I went to Albuquerque.

OM: Why?

Mr. Wei: The University of New Mexico has a very good program in applied optics. This is 1982; it is the Reagan Administration, so there is a lot of money for the defense industry, and optics is a major basic science for this industry. I finished my master’s degree there in applied optics, and then moved to UC San Diego to continue my PhD studies. But San Diego’s program is not the same as Albuquerque’s. So after one year, I accepted an offer from a company in Colorado with an optical storage company. In 1985, optical storage was a very hot industry. It was so hot that Steve Jobs visited my laboratory.

OM: What can you tell us?

Mr. Wei: Not too much; due to proprietary reasons. He [Steve Jobs] was just looking for ‘how do you do it’, ‘what’s the capacity’, just basic things. I showed him what I do. He was nice.

OM: Was he wearing jeans and a black shirt?

Mr. Wei: Of course.

OM: And then?

Mr. Wei: So then I moved to California, working again in optics in the defense industry.

I learned a lot about optical design. But I didn’t have a good, warm feeling about that industry.

OM: How did you end up in medical?

Mr. Wei: A colleague worked at Humphrey Instruments, which was owned by Zeiss. He was a VP of R&D and he asked me to come over and help. A lot of my family is in medical, actually, and I have always enjoyed working in the medical industry, particularly in the human eye. So, I started working for Humphrey Instruments in 1992.

Soon after, I began working to try and figure out what this OCT is all about. By the end of 1992, Zeiss signed an OCT license agreement with MIT at which point we began working together to build prototype. The OCT system was only just invented, and it was very clumsy. It was basically invented for research, and my job was to develop this technology into a clinically usable instrument.

So, in 1994, I’m working with Eric Swanson, from MIT. He’s working on the OCT engine and I’m working on the optics part, and together we developed software that created the first clinically, usable OCT system. We called it OCT One and it was launched in 1996.

OM: And its reception?

Mr. Wei: People really didn’t know this technology. They would say, ‘we already have a camera, we already have fluorescein angiography.’ So, we needed to look for the clinical applications. But from 1996 to 2003, there continued to be technology improvements from academia, MIT, the University of Indiana and many others. So in the early 2000s, I told Zeiss that I can improve the speed four times and reduce the price by half. This resulted in Zeiss’ Stratus OCT.

In 2002, two factors make OCT a standard of care. One is the technology improvement, and the second is the release of the first anti-VEGF treatment. OCT becomes the standard diagnostic imaging system for macular degeneration treatment. The whole industry took off. But, a new technology emerges called Fourier domain OCT. Today, some people call it SD-OCT or FD-OCT.

I left Zeiss in 2003, which is when I started developing Fourier domain, the second generation of OCT.

OM: What differentiates the first and second generations?

Mr. Wei: The first operates by mechanical reading so it’s slow. Fourier domain uses a camera. The speed improved 64 times. So now your speed is limited by electronics. Also, resolution doubled again. In the meantime, in 2006 Lucentis obtained FDA approval, and the international market started adapting. Soon after, I launched the first Fourier domain OCT.

The international market was growing fast because it didn’t have many OCT devices. Now they have better drugs, better anti-VEGF and better technology to use. As a result, TD-OCT basically started dying and Fourier domain took over.

OM: Tell us about your Academy.

Mr. Wei: A few years ago we launched the third-generation of OCT called OCTA. And, last year we launched our Optovue Academy, which is an educational concept. We have 50 assistants to help our key opinion leaders. The mission is to ask the KOLs to learn clinical applications for OCTA, and then have them integrate the clinical applications into educational courses within the Academy, like curricula. It validates the technology.

OM: Will the KOLs train others?

Mr. Wei: Yes; they become the educators. We want to bring their results into the Academy to train other people who do not have access to OCT angiography.

OM: Which is your favorite patent?

Mr. Wei: Well, your first one is always your favorite. You remember that the most. It’s the one that gave you the most excitement; it makes you feel like you are at a different level in intelligence and creativity. That patent was for the optical design of the first OCT.

OM: Will Optovue ever move beyond OCT technology?

Mr. Wei: There are so many other things in the OCT field, such as OCT angiography. OCT is our core competence, and I don’t feel we have pushed it to the limits yet. Our mission is to always move OCT technology forward towards new clinical applications.

OM: If not the technology, what about beyond the eye?

Mr. Wei: Beyond the eye, the most interesting field for us is neurology. Using OCT, we can image the eye to monitor the progression of neurodegenerative diseases. For example, multiple sclerosis, Parkinson’s, and even traumatic brain injury. The technology to detect such conditions already exists. In the last few years many studies have correlated with the current standard of care, like PET imaging. Other neurological diagnoses are related to the nerve fiber layer, for example.

OM: Tell us please about the trials in which Optovue is involved.

Mr. Wei: I will answer you in general terms. We have at least nine active clinical trials together with pharmaceutical companies. Our technology is mostly used to study AMD and diabetic macular edema, usually on anti-VEGF. Currently, the way they’re looking at tissue, is to observe subretinal fluid, but that’s a secondary effect of the neovascularization. Now, they want to use OCTA to look at its treatment effectiveness directly because we are treating choroidal neovascularization. They want to follow the course of the treatment to see what is happening with neovascularization.

Some studies want to use OCTA to examine both the tissue and the vasculature because one thing they see with fluorescein angiography are the retinal capillaries. OCTA can see these capillaries and it also can quantify their density, which FA cannot.

Capillary density tells you about the amount of blood flow, and a low flow can indicate tissue damage in the eye. People are still debating which comes first – does lost blood supply lead to structural changes in the eye, or is it vice versa? Debate from this question might develop a better understanding of the disease and the pathogenesis, and that might lead to customized treatments for patients.

Also, by using OCTA, different specialties come together. Typically, ophthalmologists deal with just the eye, and they can forget that it’s connected to the optic nerve.

OM: Where do you see technology in 10 years?

Mr. Wei: Technology will continue to improve in terms of speed and other things. There’s no question about it. But, more fascinating to me, is the incorporation of technology from other fields, such as artificial intelligence.

Google has developed an algorithm for artificial intelligence. A couple months ago they had a big announcement that they’re working with Moorfield Eye Hospital, in London. Moorfield will make one million patients’ OCT images available to Google. Google wants to use this algorithm to develop an imaging classification for diabetes patients. Other companies, like IBM, have also started doing this kind of thing.

Any diagnostic machine in the industry will be used for data collection. Those data will be sent to a database in the Cloud, which can be mined with an algorithm to help with diagnoses. And those data will be passed through the Internet to physicians, and to patients. In effect the whole diagnosis is enabled by the Cloud, not by just a stand-alone machine anymore. OM