The Eyesight Sessions

Welcome to the Eyesight Sessions, a new series focused on the people in the Ophthalmology and Eyecare markets. These interviews are designed to focus on leaders in the space; their journey, their influences, what they are currently working on and their passions outside of eyecare.

In the third edition, I spoke to Patrick Smale, CEO and Co-Founder of Clearsight Therapeutics. We discussed the importance of networking in ophthalmology, his expertise across glaucoma and wider eyecare space and his love of football (soccer).

Firstly, for those in my network who may not be familiar, can you give us a brief introduction to yourself and your background in ophthalmology?

I’m Patrick Smale and I’m coming up to 20 years in the ophthalmology field, it goes very fast. The majority of that time was with Alcon and I actually started there towards the end of 2005 in market research for glaucoma pharmaceuticals. This was launching Travatan Z back in the days of the prostaglandin wars between Alcon, Allergan and Pfizer.

I was working across pharma and surgical when Novartis acquired them and through this I really got to know the contact lens space too as the Ciba Vision team came into Alcon and managed a market research team across all 3 verticals. The thing that I really like about market research was that it allowed me to get very close to the customer, one of the things that Alcon has done very well and has been one of their sustainable competitive advantages is getting to know the customer and working really closely with the surgeons and the doctors. As a leader building out the commercial team for market research, it allowed me to really get to know the surgeons and the markets well.

I had a short stint with Smith+Nephew to build out a very similar format in medical device, pharma and consumer before being part of the original team for the launch of the CyPass micro stent which was a very important part of the MIGS evolution, unfortunately it was a temporary step as that product was eventually taken off the market but that really gave me the chance to get into two exciting things.

One was the MIGS space, which was truly a breakthrough in glaucoma care but then also the start-up world as gave me the opportunity to build a company from the ground up, Alcon didn’t have a surgical glaucoma team so we had to build everything commercially. That led to myself and a few other former Alcon leaders going to Sight Sciences to launch the OMNI Surgical System which really gave me hands on start-up experience as we took that it minimally viable product in 2017 to IPO in 2021 which was a crazy fast intense 5 year journey.

This love for start-up environments shaped my next role with eosera? , working with 2 other former Alcon colleagues that I’d kept in touch with who had built an OTC company for Ear care. I helped build their sales and marketing team and through that role connected with another former Alcon colleague that caused me to want to apply the technologies she was working on with a new company.

So it really is the six degrees of Kevin Bacon, the six degrees of Alcon – building relationships, having very similar expertise and trust in the people you are working with that brings you together. This led to me establishing ClearSight Therapeutics and working with Iantrek .

Starting with ClearSight Therapeutics, can you tell us more about the company and the immunotherapies that you are developing for common eye conditions?

So, ClearSight was spawned from the reconnection of myself and a former Alcon colleague in R&D, Dr. Suchismita Acharya, PhD . We met whilst I was at Eosera and she had founded a company called AyuVis, we were at an Ernst and Young Entrepreneur of the Year event where she was being recognised. We got a chance to connect and talk about what she was working on, a very promising small molecule therapeutic that was targeting the respiratory space but as soon as I got the understanding, my brain could only think about the applications it could have in the eye – both anterior and posterior segments.

After that meeting I probably spent the next week or so just thinking through different applications and potentially how this could really benefit a number of eye conditions. We met again and she agreed that this would be a great application but couldn’t do both respiratory and eyecare on her own so the combination with my passion, energy and capacity helped to found ClearSight.

We are now splitting this into two companies as we have found that that what we are working on can be applied through both OTC and Rx pathways. So what started as one company has now become two focusing on acute infectious conjunctivitis, corneal and conjunctival fibrosis, pain and inflammation in the eye and Dry Eye Disease.

And then Iantrek, another start-up that you have been involved in as consultant, using your expertise in the surgical glaucoma space to support their commercial expansion. What should we expect from that organisation over the next year?

The opportunity to work with Iantrek was again through the ex-Alcon network, a number of colleagues from the CyPass team are working with the company, which is founded by Sean Ianchulev MD MPH , who is a real luminary in the space. He was actually one of the founding members of CyPass with the Transcend team so that is how I got to know him. We connected because of my knowledge and passion for the MIGS space and I’m helping to lay out their commercial plans.

I can’t talk too much about the portfolio, products and development but it is a very exciting innovative new company. I can say that one of their lead products is in that uveal scleral space where CyPass was so they are realising the promise of that space. What has attracted me to Iantrek is that they are focused on truly meaningful innovation in the space, not just iteration. Dr Nathan Radcliffe has described the MIGS space as one with riches in technology, this has gone from 10 years ago when there was very few products to now where you have so many options but a few are getting to that iterative state.

Iantrek is truly looking to move the category forward and I believe the products they are working on have the potential to do this and represent the next revolution for the surgical glaucoma space. Going back into the uveal scleral space, it’s very important to have a disciplined and diligent approach. It is great to work with Sean again because he is truly one of the great minds and innovators in ophthalmology.

You have an impressive background in the ophthalmic space, but as you mentioned, have left the space a couple of times to work across wound management and ENT. What is it about ophthalmology that keeps pulling you back?

I think its both the relationships built on the industry and the professional side; I’ve kept very close relationships with many of the former colleagues I’ve worked with as well as the doctors. One thing I think is great about ophthalmology is that there truly is a partnership, that you don’t find in every medical speciality, around innovation and a desire to work with the industry for meaningful innovation. I certainly did not see it as much in ENT and Wound Care.

This is something unique to ophthalmology, having a group of individuals that are looking to constantly evolve and understand which technologies can help them deliver better care to the patients. There are also a lot of companies who are truly engaged in wanting to work with those doctors. That is the difference for me that makes it really exciting and engaging. There truly is a partnership between doctors and industry.

With the ophthalmic industry being very much about the people, who has had the biggest influences on your career journey so far?

There are a great number of individuals I’ve had the pleasure of working with over the years, but I’ll focus on 3 for the sake of brevity.?

My first mentor in the space was Julie Speed who is now SVP Strategy and Marketing at Orasis Pharmaceuticals and bringing really important pharmaceutical technology to the presbyopia market along with Paul Smith , another former Alcon colleague of mine. Julie was great at understanding how to break a problem and a challenge down, very good strategic thinker and really helped from a strategic marketing standpoint on how to launch and evolve a technology. I think her, and Paul, are applying that really well at Orasis and I do expect big things from them moving forward.

I would also say Robert W. . Robert has been a friend, colleague, mentor for years and I did spend quite a bit of time working under Robert’s leadership at Alcon. What he taught me was really trying to break problems down to get to the root cause of how and what needs to be done. He also was great at building relationships across the different business units and understanding how the surgical side and pharma sides of the business are different – something that Novartis struggled with a little bit when they acquired Alcon. What I learned working from Robert is that each one has their own unique methods and mechanisms that you need to dive into to fully understand to be able to successfully navigate the hurdles in each.

And then Shawn O'Neil , who was the CCO of Sight Sciences. He surprised all of us at Alcon when he said he was leaving to go to this ‘little’ Menlo Park based company that was on my radar from evaluating other technologies to add to Alcon’s surgical glaucoma portfolio. He had a vision and a mission and one thing he did really well that I tried to take is the importance of being able to articulate this clearly. I think that was very much directly related to the success we had launching the OMNI surgical system and where Sight Sciences is today which is the leading non stent intervention going off recent Market Scope data. Articulating that mission and the importance of aligning a company behind it was what I learned from him.

So yes, that is 3 but there are 10,15 others that I could talk about too. I still keep up with everyone who has had an impact on my career at all the meetings and whenever I can.

Learning from these people, what advice would you pass on to people just getting started in the space?

A piece of advise that I would offer up is to raise your hand, get involved in as much as you can. The leaders and doctors I have worked with tend to be more collaborative so jump in, more often than not they will work with you and help you but you have to take that first step. So look for that opportunity, early in your career to volunteer for projects, do that extra work. If you have the opportunity to be invited into an OR then go do it.

These things will come back in spades and a lot of the success I’ve had in my career came from putting myself out there, working on projects that were a little outside of my scope and core objectives but got me a chance to work with someone which provided opportunities in the future. This truly is an environment where that pays off.

The other thing I would say is that relationships are so key, try not to burn any bridges because it is such a small world and you just never know. “People won’t remember what you said, people won’t remember what you did, but they will remember how you made them feel” – this is definitely that environment. Positive interactions last and turn into opportunities down the road.

Looking at the wider ophthalmology space, which areas of research or treatments excite you the most? Where do you see the most innovation?

I think there has been a lot of discussion in gene therapy and I do think there is an element of this working it’s way into clinical applications in ophthalmology whereby it’s still largely theoretical in terms of treatment modalities and conditions targeted but I do think in the next 5-10 years that will start to move into the clinic. I’d be very excited to see the breakthrough therapies coming through this route, a lot of time and money will be spent to solve this puzzle but when the pieces link up, we will see huge changes in disease treatment to truly address underlying causes.

It maybe AI fuelled, it may not. It’s easy to answer this with AI as it is everywhere. Aside from AI, I'm really excited about gene therapy in eyecare.

So, if you had never gone into working in ophthalmology and healthcare what career would you have liked to have? Where can we find you when you aren't working?

So my passion growing up was to be a professional football player, true football with your feet and I still play quite a bit if I’m not working or spending time with family, so you’ll find me on a pitch somewhere. One of my daughters is now getting into ‘soccer’ too. I love sports, I love athletics and have stayed engaged with it all my life.

I love the competition and it’s a great outlet because I can be high energy. It’s funny, I’ve done a lot of executive coaching and one piece of advise I get is that I should look into meditation and I think it’s because I have a lot of energy, passion and drive which I actually has benefitted me in my career. I take a lot of that into competitive environments too. If I wasn’t working in healthcare then I’d be doing something related to soccer, I just love it.

As well as soccer, I’m a big pickle ball fan too. A group of the dad’s have started playing together and it’s funny because we are the youngest out there by about 20-30 years, but I love competition and that type of environment.

At this point, myself and Patrick took some time to discuss England's woes at the Euros and as a Spurs fan, he had some interesting points about Harry Kane - should Watkins have played more minutes?

Careers like yours can often mean you have to travel a lot internationally, so where are your favourite destinations that the job has taken you to?

Barcelona by far, I’m a huge fan of the city and the football team. Whenever travelling to Europe I would always try to fit in a weekend there and at one point Alcon had an office right on the water.

I asked Patrick for some recommendations with ESCRS and EURETINA taking place there in the next few weeks:

Camp Nou, the mecca for football. I just love the little coffee shops right along the water. You don’t need to walk far. The food, the environment is amazing.

I’ve also went to a very interesting meeting in Helsinki during the summer when it is always light. Out to dinner with doctors and it’s 11pm but looks like the afternoon, that was a little bit of an adjustment which made for some long days but great conversations. I can’t imagine being there in the winter, but it was really cool to be there in the summer.

Huge thanks to Patrick Smale for his time and sharing his experiences and insights in the world of ophthalmology. Be sure to connect with him and ClearSight Therapeutics if you haven't already.