In So Many Words is a timely chat with an ophthalmic industry thought leader.

Seven years ago, Bilal Khan was asked to take the reins of his father-in-law’s company, New World Medical. A former actuary, Mr. Khan, now New World’s president, has grown into the position; he aims to continue the company’s history of innovation and humanitarian aid.

Ophthalmology Management: What is your background?

Bilal Khan: I worked as an actuary in the US and UK for nine years after college. Twelve years ago, I married the daughter of Mateen Ahmed, PhD, founder and CEO of New World Medical. After a few years, Dr. Ahmed asked me to take over the business, and I’ve been managing the organization for the past seven years.

OM: Did you hesitate to take over an ophthalmic business?

BK: Even though I was doing well as an actuary, [running New World Medical] is the most impactful role I could hope for and the best contribution I can make to society. What Dr. Ahmed has built is truly unique. One of the first things he told me was, “If you join, you have to commit to never selling the company.” That’s somewhat shocking for a person with a financial background like myself to hear. Various suitors approach us every year, but we are not building towards a liquidity event. What I did not realize initially is that this commitment provides our team with a competitive advantage.

It allows us to take a committed approach to all of our relationships. Our overarching goals drive our financial decisions rather than the other way around. We are building New World Medical for the long-term with an eye towards impacting as many lives as possible.

Our organization’s vision is to launch a pioneering ophthalmic surgical device every two years moving forward. This is obviously an audacious goal, but we are committed to building out a sustainable organization to achieve it.

OM: Why that amount of time?

BK: It speaks to building on our current product platforms, whether they be in glaucoma drainage devices or the new Kahook dual blade, and also to expanding into new product platforms.

We’re not a profit-maximizing company. While we do want to be a healthy business and reward our employees for their efforts, our primary intent is to optimize our impact by launching products that help democratize patient care globally.

In line with this, we are also developing programs intended to raise the standard of care in underserved parts of the world and ensure our products are consistently available in those regions. Take the Kahook blade for example; it is delivering value for US patients, providers and our health-care system in general. Elsewhere, we sell it for less than cost in markets where patients have limited means.

However, we must also focus on skills transfer to empower local surgeons to use our products effectively. To do this we need to partner with talented surgeons willing to educate colleagues abroad.

For example, when Oluwatosin Smith, MD, of Glaucoma Associates of Texas, was traveling to Nigeria to train surgeons, she reached out to us about supplying no-charge Ahmed glaucoma valves (AGV), but said that it was only worthwhile training surgeons if they had access to valves afterwards.

This is completely aligned with New World’s mission, and we have committed to supplying those surgeons with product in a manner that is hopefully sustainable and enhances their ability to care for their patients.

OM: How did the company become involved in humanitarian efforts?

BK: It started with my father-in-law, and it is a tradition our team plans to continue. Dr. Ahmed managed the farmers on his familial lands during his formative years in rural India, and I believe that being responsible for those communities instilled in him an empathy for others.

After finishing his PhD in biomedical engineering from the Indian Institute of Technology in Delhi, he eventually assumed a faculty position in Ilorin, Nigeria. There he encountered a number of patients with onchocerciasis, or river blindness. This disease was eventually eradicated by Merck, but the experience focused Dr. Ahmed on ocular diseases.

He realized that his expertise in valve design and implantation techniques could help glaucoma patients. He later moved to the United States and founded New World Medical to develop the Ahmed glaucoma valve, which he has made available to impoverished patients at no charge.

We recently expanded on this legacy by announcing the inaugural recipients of our Humanitarian Grant and Fellowship Award during the 2017 ASCRS meeting. Sight for Souls, based in Ethiopia, received the Humanitarian Grant to further their work to train surgeons throughout the second most populous country in Africa. Jeanie Ling, MD, who is about to begin a glaucoma fellowship at UT-Houston, was named as this year’s Humanitarian Fellowship Award recipient.

Fittingly, she was unable to be physically present when accepting the award as she was in Nepal treating patients.

OM: Tell us about your products at New World.

BK: Our flagship products are the AGV and KDB.

OM: What do physicians tell you that they would like to see improved in new versions of the Ahmed valve?

BK: There are many unmet needs in glaucoma therapy, even with the recent introduction of several devices to the market. Our aim is to standardize and simplify surgical techniques in a way that yields more consistent postoperative results and improves outcomes. We are hoping to begin an FDA IDE study for the next generation AGV during the first half of 2018.

OM: What did you discover about the first Ahmed valve in terms of patient selection?

BK: The AGV is intended for patients who have refractory glaucoma. Before the advent of glaucoma drainage devices, these patients had very few avenues to treat their disease. Given the decades-long experience, it is clear that many glaucoma patients have benefited from the immediate pressure control with flow regulation provided by the AGV.

OM: How did the Kahook blade come to be in your possession?

BK: Our Chief Scientific Officer, Suhail Abdullah, arranged a meeting with Malik [Kahook, MD, Slater Family Endowed Chair in Ophthalmology, University of Colorado School of Medicine] during a conference in San Francisco. At the time, Dr. Kahook was trying to harvest trabecular meshwork tissue for research purposes. During this process, he realized that to harvest it, he would need two parallel blades connected by a ramp. The ramp is the key feature of the device as it lifts the trabecular meshwork tissue and puts it on to stretch so when the tissue engages the dual blades, it is cleanly excised, minimizing trabecular meshwork leaflets left behind. Without significant leaflets, he theorized that Schlemm’s Canal would not close, thus potentially enhancing long-term outflow. If that tissue was truly obstructing the outflow of aqueous from the anterior chamber, removing it would allow aqueous to access the eye’s natural outflow channels. Suhail and Malik saw immediate synergy between our company’s vision and what this device could do for glaucoma patients around the globe.

We have launched and reported on multiple KDB studies that have substantiated the utility of the KDB device in lowering eye pressure and decreasing dependence on pressure-lowering topical therapies with over one year of follow-up. The 12 month results presented at ARVO demonstrated that KDB goniotomy, when combined with cataract surgery, reduces IOP and medications from 17.4 and 1.6 (N=71) preoperatively to 12.4 and 0.6 at one year (N=58) with the same high safety profile as other canal based procedures.

The device itself is designed for standalone use by way of goniotomy, and it is exciting to see that it can also be successfully combined with cataract surgery in a safe and effective manner. These are extremely encouraging results and we are only getting started. We intend for New World Medical to be around for a long time and the team is excited to help fill the many unmet needs for ophthalmic diseases worldwide. OM