Why a Better Eye Test Still Needs Market Development

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0:00 In medtech, the difference between a good quarter and a great one isn't always the product. It's the friction standing in the way. Broken sales cycles, misaligned teams, deals that stall at the finish line. Every leader feels it, and the best ones know how to remove it. Welcome to Zero Friction, the podcast where we go inside the minds of MedTech's top commercial leaders to uncover the real barriers they face, the decisions they make, and the systems they build to keep the revenue moving. I'm your host Terry Coutsolioutsos. Let's remove some friction. Well, welcome Zero Friction Podcast Nation. Terry Coutsolioutsos here and I have a wonderful guest today, Kasia Hein-Peters, MD. She is the CEO of Evoq Technologies, which is a unique eye technology that does some incredible things from a a diagnostic perspective. Kasia's background though before we go there.

She's trained psychiatrist from communist Poland and she actually helped launch Prozac back in central East Europe. So with that I'm going to let Kasia give us a little background on her journey in the medical and medtec space and we'll get started on talking about Evoq as well. So welcome to the podcast. Thank you very much for the invitation. I'm really happy to be here and have the opportunity to talk with you. So, what do you think from my background would be the most interesting for your listeners?

Well, I think a couple things. I think your your personal background just the fact that you you grew up in in communist Poland number one and we don't get that very often on the podcast but tell us about like your journey from being a doctor and then what made you make that pivot into the ind the industry side of the business to go work for Lilly and then how did you go from like you know Prozac into the eye care business as well. So tell us a little bit about that. Okay. So, yes, I was a a a practicing young practicing uh psychiatrist in the early '9s in Poland and this was the time of enormous changes as we just uh got out of the communist dictatorship. But we needed to transform the entire country and the economy and everything to become a real country and have a viable economy as opposed to what we had before. So not every field was moving in the same with the same speed and since the healthcare

Was owned by the government at that time it actually was moving very slow and I was already noticing one thing about myself is that slow is not really the thing that excites me. So I decided at that time to join the pharmaceutical industry and it was not necessarily at that time a definitive decision. I didn't know how long I would stay with the pharma industry but I said well it's really it's really seems to be a little bit more a bit more innovation moving faster you know I tried to expand my horizons and I joined Eli Lilly because Eli was launching Prozac their famous anti-depressant medication back at that time and as a psychiatrist I was able to create the right messages the right marketing campaign even though I had to learn everything about business because obviously I knew nothing about how to do that. So there's a lot of learning involved in that as well. And sometimes people ask me why I stayed with the industry then and didn't come back to

3:18 Practicing medicine. And my answer to this is that I realized at some point that I actually have a much bigger impact on people's lives and the improvement of patient lives if I work for the industry than if I worked as an individual practicing physician because I can help millions of patients and as opposed to maybe thousands of patients and I was a practicing physician and this impact actually made me staying in the industry and then my path led to different therapy areas. It led through different companies. Then I worked for Merc, I worked for Novartis, Sonia and finally for Terumo which is the met company. But I like to say also that the eye lies very close to the brain and the retina which is at the other side of our eye is actually part of the brain. So I don't feel like being in the opthalmology area is so far away from the brain that I really liked initially and that's why I became a psychiatrist.

That's true. you know and and so the the I guess the eyes are the window to the brain correct and the eyes are the window to the brain and you know looking at retina and checking the retina function we not only can see ocular diseases we actually can see neurodeenerative diseases as well and that's will be probably for us at evoke it may be the next frontier that we'll try to conquer once we you know do what we are supposed to do right now so tell me a little bit about like evoke by itself and its company its technology ology and then what problems or solutions is it designed to either create or solve?

Evoq Technologies was set up by our founder Daniel Lingren and I want to mention his name because he is really behind all the technologies that we develop and he's been in this field for a long time having some other companies in the past but um what is very interesting about of themology and optometry nowadays is that it's a very highly sophisticated field from the technological perspective. There are lots of diagnostic tools and the major problem with those tools is that they most of them the vast majority look at the structure so of the eyes. So um you need to have some damage in your structure for these tests to actually say oh yeah there is a disease in there but the function of retina coming back just to retina the function of retina is impaired sometimes 3 years before any structural damage occurs. So a patient for example may come to an optometrist or opthalmologist with some very vague complaints like oh you know doc I don't

Think I see so well at night or I really don't like driving at night anymore and they do the tests that are currently available and part of standard of care and they say well I don't see anything just come in one year right so there is this wait and see approach to people who start having some problems with the retina and only when the structural damage occur then we can diagnose And then it's sometimes a little late for treatments that truly prevent vision loss. So we really uh are here to promote functional tests because they are the earliest alarm of the retina dysfunction for whatever reason. So the twilight dark adaptometer which is the device that we currently have on the market. It's a it's a device that diagnoses night vision loss. Actually, it does not diagnose any particular disease, but it does and it's the power of it because it says to a doctor that the patients symptoms are objective. It gives a doctor very precision, a very precise read of what the problem is and

6:45 Then it triggers additional tests to find out what is actually the cause of it. And there are multiple causes of retina dysfunction. The most common is the age related macular degeneration but it could be the beginnings of diabetic retinopathy. It could be some vitamin deficiencies, vitamin A, uh vitamin E, even zinc deficiency may cause some retina dysfunction. Could be drug toxicity. There are some drugs like hydroxy chloroquin that causes retina toxicity. So there are multiple reasons why um a retina may not function as well as it used to and we don't have to wait until the structural damage occurs to basically help the patient. Now if this is truly an early AMD there are some interventions that can be helpful like there are some dietary supplements that have been actually proven in clinical trials to work. There's an emerging science on the technology called photobiomodulation that potentially can help in these patients. So there are many things that can be done early on to prevent the disease progression or to

Slow down significantly the disease progression and they are currently not done because these functional tests are a very small very small percentage of uh practices actually have any dark adaptometry device and even if they do they don't always deploy them to these patients with very early symptomatology and so what's the impact when that doesn't happen? Well, if it doesn't happen then again a patient comes after a year the symptoms still continue and then at some point one year afterwards 2 three the structural damage starts occurring and then some of these interventions uh recommended but they are not sufficient so the disease progresses and finally a patient has an option of getting some eye injections with drugs that are being developed for AMD or geographic atrophy but this is an advanced state. Now a patient who um starts losing vision is becoming increasingly dependent on others and that's very very painful for people not to be independent and it's also very dangerous for them because when they

Don't see well they trip over things you know for example somebody doesn't you know has this night vision loss and they walk out of their house into the garden at night and they trip over something that they don't see you know or like you know we talked last time about my grandfather like my grandfather died because he had AMD and he walked in on the street in front of the car because he didn't see it. So and he was so adamant of not losing his independence that he was very very eager to still walk on his own despite his vision loss.

9:27 So you know he died as a result of that. You see the the vision loss can can kill people actually if they are not really careful and if they're not surrounded by others who can help them in every situation. So what does it is there current there are current technologies out there today serving this purpose? Are you coming into a market that exist? Are you creating a market? I think it's a little bit of both because the market does exist. There is there are dark adaptometry devices on the market and there are two types. One is the desktop device but it does require a dark room. So very few practices actually have it. And the second one, it's a kind of a Google based uh device that was launched several years ago, but it's actually it was launched at a very high price 50 uh device. So very few practices actually purchased them because obviously the the optometrist and opthalmologist know that the technology will continue to change.

They will have to renew it after a few years. Uh and sometimes uh they just don't see the return on investment with the device that costs so much. uh we think our assessment is that only 5% of kind of primary eye care practices currently have any dark adaptation device. So this is the established market but 95% don't. We are really in fact are building the market with this 95% uh primary eye care practices. Got it. And so your price your price point comes into the marketplace. I'm I'm guessing it's commercially viable, right? So it's a it's a is this a a profitable diagnostic tool?

Is this break even? Do they get the bill extra for it? So what's the So we are our device which uh which which has a price below $10,000. So the the difference in price is huge. And this is because of the way how our device is built. It's a a a high quality device, but it's built in a way that eliminates uh a lot of cost and therefore it's still highly profitable for us, but it's way more affordable for uh the clinics and that was the goal because our goal is really to expand this diagnosis diagnostic abilities with the dark adaptation or Daniel build it from the beginning with the affordability in mind and so there is a device Then because the data go to the cloud and this is very important because the cloud allows longitudinal monitoring of the same patient. The analytics available will allow a a doctor to actually compare the patient results over time. And that's important when a patient uh was given some therapeutic interventions and we want to see if the

12:11 Disease progresses or not or if the therapies that were given actually improve the patient vision. This longitudinal analytics sit in the cloud. So we also charge some amount for the subscription for the cloud and then because the device also has an eye mask that's put inside to create the to create a dark room inside the goggles. So we also charge for these masks uh as we send them to to the practices for their use. So there are kind of the three components and the biggest of course is the device itself. The other two are relatively minor and the and the practice itself can deal for the procedure right. So they they so so the dark adoptometry is reimburseable in patients who have either risk factors or already are diagnosed with some diseases like diabetes for example or early AMD but there is a code for it 92 to 84 and several practices that adopted the device they already seeing uh that they actually created a new revenue stream for them because not only the rest

Itself in appropriate patients of course is reimburseable But it also triggers some additional um some additional tests that will help to diagnose the reasons for night vision loss because the dark adaptation test does not diagnose any particular disease. So it triggers additional tests as well and then it triggers therapeutic interventions. So all in all we believe and it has been confirmed with a few first clients that we have that the return on investment can be quite easily achieved within the first year after purchasing the device which we think is actually a great value proposition for the practice. So now that you have the device and it's very close to being in market we're pivoting towards a commercial launch anytime soon.

So we actually launched it on a we call it controlled release because it's a limited launch. We launched it at this point with keyopino leaders who also will participate in collecting some real world evidence. That's exciting. That's always good because we what we actually discuss you know this clinical path of patients who are diagnosed with night vision loss and uh the reimburseability of it and the clinical interventions. We would like to collect this information in kind of a real world evidence environment so that we can then show others you know how this actually works in practice so that they can see how their practice may benefit from it. So um we launched this program with with a number of Kopino leaders and we are getting ready for two things basically one is the fundraising we are approaching our seed round and the second one is a little bigger commercial launch.

14:48 Okay. And what does that look like? How do you think you launch the product? Do you have a sales team today? Do you have an infrastructure or you starting from scratch? You going to distributor networks or you know like what what where do you go? So our idea is to find a distributor first. Uh but again because the the device requires some market development. It must be someone who is actually able to do it. And sometimes distributors are more probably better in selling into established markets rather than developing new markets. That's at least my experience. But we are looking for some who have more vision for their own growth and the ability to uh to uh do a little bit more marketing and sales of a new device like that. Not just put it in the catalog and send the catalog to their clients, right? or not only put it on their website and wait until people ask for it. So I think the selection of the right distributor is a very

Important aspect for us. So I think that's the first step and from the marketing perspective I think there are basically two things that need to happen. One there must be medical education about night vision loss and dark adaptation because as we said 95% of clinics don't have a device. So even though every optometrist and every opthalmologist learned about night vision loss and dark adaptation during their studies and residency, if they don't practice this on the everyday basis, certain things may you know got lost over the years. So I think there must be some medical education and this we will do through some established channels in of opthalmology. So we are thinking about working with a few providers of uh continuous medical education to make sure that it is high quality delivered by opinion leaders who know this subject and then it will gives us access to uh multiple optometrist and opthalmologists who already attend some of these events both online and offline.

So that's one and this is a big effort and the second one is to complement the sales efforts with the digital marketing efforts right so your classical digital marketing uh you know we need to be visible in places online where of themologist and optometrist go have um an convincing uh message platform so all this is currently in the development excellent and you know building calculators business models all kind of things like that exactly or the return on investment calculator is already something that we have but it's I would say it's a bit uh it will sit on our website for example so yeah we any practice can go through the ROI calculator and see based on their reimbursement levels and their patient population they can actually see if this device is uh financially viable for them or not.

17:41 It's great and it never happened yet that it wasn't by the way. So it's it's h because again we build it for affordability. So it's it's very unlikely that it wouldn't be uh financially viable. It's excellent. And you got the price point where it's simple, right? It's Yeah. Easy to bring in. You know, you're going to pack it full with education andformational experience for your users, which is going to translate well for patients. Yep. Supporting a distributor channel. That's another And that's, you know, as you're, you know, it keeps it keeps some of the expenses on the light side, too. Like so you know there's advantages and disadvantages to that exactly distributor model.

You know with a small company like ours I think or starting at this point I think that going through the distribution channel is probably better than uh trying to hire our own sales team which I think eventually will happen down the road but not not immediately. Well, it makes good sense and you know, like I said, it keeps it light and you know, sometimes even there's new models too that have sales organizations for hire. They're like $10.99. So, you you you don't pay them salaries. You you hire a sales team that comes in and sells your product.

And if they don't sell, they don't get paid. And then kind of that could be an option too, you know, that could be an option. just some really interesting what I would call low friction options that you know don't require hiring, don't require taking on the the W2 component of the employee. You still want to make sure that you train and that you have to build the content and the materials for the sales enablement piece and the marketing piece, but you actually are contracting your sales team. And so, um, and it's pretty easy to build that cost into your sales structure because it's variable in nature. It's not a fixed cost. and you know so it reduces your risk of cash burn that is not creating cash as well.

So that's the nice thing that if the cash isn't getting created the the the expense for selling the product is not generated as well and so those are those are good things as well. So you know I'll be happy to to chat about that later. I've got a few friends in and that do that as particular space and and it works really well for Yes, I would like to understand a little better how this would work because yes, I know that these salespeople exist and I would really like to get a little bit more educated about the this opportunity because this sounds uh this it does it's interesting you know the eye business is so specialized too.

That's the other piece too. I think the eye business is a very sort of particular business and I' I've worked with plenty of people in the cardiovascular side that that were actually in the eye business and you know I know it's a very you know it's a it's a very tight industry as well. So it is a tight industry and there's highly specialized so we see we see very many service providers who work only for this industry. Got it. Well good. So commercially coming out next getting ready to go and what do you think the biggest friction points for you in launching the product are going to be? you sort of predicted or have you done any sort of battle planning to kind of see how things are going to work and what do you think is going to be you know the easy part of the launch or what's going to be the challenging part of the launch if you look at you know I actually think that the maybe

20:55 The challenging part although you know not something that I see will will stop us is actually the need to for education about night vision loss and dark adaptometry and not only because it's not so broadly used but we already started discovering some misconceptions. For example, people link dark adaptation test only with age related macular degeneration, which yes, it does cause night vision loss, but it's by no means the only disease that causes night vision loss. So, I think that this is probably the biggest friction point for a relatively small company like us. But I think also that the and I don't think there is anything that I would call an easy part because it's never easy to launch a new product in healthcare.

Right? So I don't think there is really something that I would call easy. I think what's really easy is we have we really have a very clear mission and we are also well aligned around this mission that there are no frictions inside the company and that sometimes that sometimes is also a a barrier right that there are companies that you know people work in silos and then these different teams fight with one another I've I've reached through a few of those in my the team has an aligned purpose and mission and they're all moving in the same direction is always a good thing right that's a good And I say I think that the only easy thing here is that we all move into the same direction and we are very well aligned. Doesn't mean that we always have the same point of view.

Doesn't mean that we don't argue. But I think we are very well aligned in what needs to happen next and what needs to be done next. And I think from this point of view that's that's the easy part. Our internal mission and vision alignment, right? And then you you take it to market and then you think you you know what's going to happen and then you know then the reality of the world sets in and you learn new things. You have to adapt to new things and that's where the friction begins, right? Is when you get it to market and you start figuring out where it's easy, where it works well, where it doesn't work well.

Yeah. Do you have do you have your your launch kind of built out and mapped out in your brain in terms of where you go first, second, and third yet? And is that We do. So we actually started so I actually started when I became the CEO I started from developing a very classical go-to market strategy which was already there partially in the company but I think I am someone who is putting this on paper now. So we did look at different market segments. So we started from market segmentation very classical exercise decided on which targets which specific market segments should be our priority targets and that's how we landed on primary IAR because they have patients that are early enough in their disease development with these early symptotomatology that actually is very good they're very good candidates for dark adaptation test. There's another group of people who are basically retina researchers they also use dark adaptation but for a different reason.

23:50 So we can kind of have our primary and secondary target. We also have target some other basically everyone who's doing primary IARE is the great candidate for for the for this dark adaptation device. And then we started looking at drivers and barriers in these segments. We started looking at the needs that they have and what are kind of the product outcomes that we can offer to meet these needs. And as you know in the healthcare space there is always clinical need there's always economical need operational and experiential. So we kind of work around these four uh and build our value proposition around this and then started developing our messages and kind of we went as far as kind of building some key message pillars because now we know and a message pillar is basically a theme that we need to cover with these audiences. So we are currently have identified a series of these themes that are important for them and we have to build our medical education and our

Product promotion around these themes. So we went as far as understanding those. So uh so I think that we progressing very relatively fast with with developing uh of a proper marketing campaign. Well good. So important because then we need to train sales people how to talk about the product what to focus on right what is important for the audience from the point of view of this particular product you know and that's you know like one of those things where that used to be a really big challenge getting people trained consistently um you know back when I started my man it was all done in per person and you had to fly in and it cost a lot of money and you took people out of the field for one or two or three weeks depending on how long training I mean you did it with Prozac I'm You remember the days when it was all face to face, you know, flying flying around the world

Sometimes. Yeah. And so now, you know, you can build your scripts, you can have AI generate it, you can have AI avatars do the training, you know, from a an asynchronous perspective online. And yeah, you can monitor it, you can quiz it, you can score it, you can, you know, there's so many different wonderful things in today's age that at least that part of the heavy lifting of training has become much still means you have to build the training content and the material, but that's the hard part. Then you just fill it into the channel and then you can monitor it and go. So that must be something that you're very excited about. Yes. Because that'll make it go fast. That's that's one thing that you know you can measure it, monitor it, and those are always fun things. And when do you anticipate when do you anticipate like the green day of go? Like when's go day?

26:33 Do you think I know you're you're raising the funds, you need to get the money to fund the launch, but like when do you think that's all going to happen? You know, I actually think it's going to happen very soon because we are officially starting our seed round with me going to an investor meeting next week, okay, or the end of the next week. And I think that I am working with our marketing agency on some messaging and outreach which is should be done within the next two weeks. So I would like to say that over summer we should actually launch it the product properly.

That's so exciting. Good for you. That's congratulations. That's a big that's a big Just talking about AI, what I'm really excited about is what AI can also do for customers because we are also looking at creating a sophisticated AI chatbot to actually talk with physicians about this dark adaptometry and night vision loss. So an medical education delivered by a chatbot, they again ask yeah they can ask questions, they can get answers, right? Because we have compiled already so much information about these topics that just feeding properly a chatbot with this information creates creates a knowledge center and even feed it to chat GPT or even feed it to chat GPT or Gemini as well because you know the one thing that we're starting to learn is that consumers are using answer engine search optimization more than Google these So you still go to Google, but if you notice when you go into Google, Gemini pops in and yes, you know, AI is becoming a bigger part

Of that search. And I just went and purchased a computer the other day that I actually gave ChatGpt my specs. They gave me three models to go look for. So you know that whole concept of people you know used to have medical ailments and they would go to Google to get the information and now chat and chat GPT and cloud and Gemini and all these other AI tools are becoming prominent information providers on next steps for patients and that's another really interesting angle. So that's true that's true. So I think that eventually we also have some very early materials for patients that can be delivered through the uh primary I care clinics but I think that people will be looking for this information online as well and we we definitely will be doing something around that.

So this for those people in LinkedIn looking and if you're in a restaurant trying to read the menu in dark light this is this is a device that can actually help diagnose the problem right? Yes. If people feel that their their night vision somehow declined, I think they really need to do something about it because it may be a very maybe the earliest alarm of something happening with retina. How how often are you in a restaurant when you see somebody pull their phone out the menu with the light? So, I mean I I've done it, you know. I do it. So, I did obviously the test and my dark adaptation is good, but I still do it. I think it's I'm doing this because I'm becoming a bit of a short, you know, I I I need the reading glasses for example. So either I get reading glasses or I use my phone and take the menu, you know, away from me. But uh yes, I think that's that might be the problem. And

29:49 The biggest problem is really driving at night. You know, people who don't adapt well to darkness and you know the twilight comes in the evening and before they adapt to darkness, there's this 20 30 minutes when they actually don't see well. That's really the problem. Well, good. Well, I've certainly enjoyed our day today. I have one more question for you and it's a question that I like to ask all my guests and sometimes I'm successful, sometimes I'm not. But today I remember to ask it is that Sukasha, you know, current day Kasia goes back and meets 22-year-old Kasia back in communist Poland. Yes. What is the one piece of advice you would give your current day self to your 22-year-old self? You know, I would basically tell myself back then that I should prepare for the change because we did not expect any change happening politically or economically and yet it happened and then it appended our lives completely in a in a good way in my case. So I actually and we were not

Getting ready in any way for the change. The advice I would have given my younger self was that first and foremost you need to prepare for many many changes that will happen in your life. So don't think that any decision is final. There are no final decisions. That's one. And the second one I would say probably don't think following up on this there's no final decision. Don't think that what you've chosen right now is the end of the story. So don't don't fret too much around you know do you choose A or do you choose B you can choose A and then you can abandon it and still go to B right we had this feeling that every choice is final like like like I will not be able to go back and re revisit that's the advice I would give myself you can always go back and revisit you can always change you can always pivot well and you've done it throughout your entire life and your career has been

Nothing but success and pivot and change and pivot and change and pivot and you know, and you certainly have, you know, you've given yourself that advice and you've lived it as well. So, that's wonderful. So, so Kasia, great to meet you today. Thank you so much. We wish Evoq a very successful launch and I look forward to staying close to you and and figuring out if there's any ways that I can be of assistance and support as you take this novel new diagnostic tool to a market where now physicians can, you know, viably use it in their practice. And that's that's always a great way to transform the way care delivered. So, thank you.

Thank you very much for having me. Good luck on your trip, by the way. Go get them. Thanks. That's a wrap on Zero Friction, the show built around one simple idea. Remove the barriers and the revenue will follow. If today's conversation was valuable, please subscribe and share it with somebody who needs to hear it. That's how we will grow this community. I'm Terry Coutsolioutsos, revenue architect powered by AI. Come find me at my website, my revrx.com, and let's talk about what friction is costing you and your organization. Until next time, keep removing the barriers and keep the revenue flowing.