Emergent Innovation Systems and the Delivery of Clinical Services: the Case of Intra-ocular Lenses

Health Trust for their very considerable assistance in the prosecution of this research. We are also grateful to Sharon Dalton and Deborah Woodman for their help in producing this draft. INTRODUCTION In this paper we report on the results of an investigation into the development of an extremely important medical innovation in the field of ophthalmology, the intra-ocular lens. Ophthalmology as a distinct field of medical practice has been the focus of major technological changes in the past four decades. Separate markets have been developed for the treatment of glaucoma, for the treatment of short and long sight through refractive surgery (radial keratotomy and the laser-based derivatives, PRK and LASIK) and for the treatment of cataracts. In each case new procedures have transformed service provision. Underpinning these treatments has been a long sequence of innovations in materials, techniques, equipment and drugs. It is on the treatment of cataracts and the intra-ocular lens that this study is focused, and we shall treat it as a particular example of knowledge based medical services typical of the state of modern ophthalmology. Moreover, it is the practical demonstration of lens implantation that laid the foundations for the subsequent development of refractive surgery culminating in corneal refractive surgery in the 1980s. The study of the intra-ocular lens provides an opportunity to follow the innovation process in a way that draws attention to the interdependence between artefact and service innovations in a field of rapidly changing medical knowledge. To summarise the main findings we simply state that the innovation of the intra-ocular lens has radically transformed the conception and delivery of a major medical service, namely the removal of cataracts combined with their replacement by a functioning lens. This has brought great benefit to countless patients and has greatly increased the efficiency and effectiveness with which the clinical procedure is carried out. It has been achieved by the creativity of individual clinicians combined with the development of a transnational medical-industrial complex that has changed radically the innovation system in this field of ophthalmic medicine. It has transformed the procedure from one requiring 'hero-surgeons' and craft technique carried out within capital-intensive hospital contexts to one that is a routinised procedure capable now of being effected in a local medical centre by clinician nursing staff. This is indeed a fundamental transformation of a service activity and its skill base. 2 By way of summary the main conclusions of …