The Philosophy of Innovation

One key to successful innovation is to have what Buddhists might call a ‘deluded personality,’ says Reay H Brown MD, noted cataract and glaucoma surgeon and innovator.

“Being deluded is a secret weapon for innovation,” he stated.

He traced the origin of this idea to a surprising moment during a university visit with his daughter, Annie. He recounted a conversation with one of Annie’s professors, a renowned neuroscientist and expert in Buddhism. The professor turned to Annie and said, “Your dad is so deluded.”

“The comment was startling at first, but the professor quickly clarified: in Buddhist psychology, there are only three basic personality types—aversive, greedy, and deluded. Given the options, ‘deluded’ did not sound so bad,” Dr Brown reflected.

He has since embraced the label—not as a flaw, but as a mindset essential for innovation.

“For me, being deluded means having irrational optimism, divergent thinking, believing things others don’t,” Dr Brown explained. “[It’s] thinking you can make a difference and not giving up.”

He proposed that innovation often requires two deluded steps: identifying an unmet need others have missed and believing you are the one who can fix it.

A basic, uncomplicated ‘why’ question can outline the unmet need. As an example, Dr Brown described his development of a triple post lid speculum.

“As a new surgeon, I wondered why lid speculums exposed the circular-shaped eye with a rectangular opening,” he said. “Featuring a central post, the speculum I designed and patented created a better, more rounded exposure.”

Nevertheless, having a good idea to solve a problem does not always lead to successful innovation. Timing is also important, Dr Brown said, and he quoted futurist and inventor Ray Kurzweil: “Most inventions fail not because they don’t work, but because the timing is wrong—not all the enabling factors are in place. Invention is like surfing: you have to catch the wave at the right time.”

Illustrating this factor, Dr Brown described his work to develop internal sclerectomy as an easier and safer alternative to trabeculectomy. This 15-year project led to the introduction of trabecuphine, which had very limited commercial success because viscoelastic, mitomycin-C, and other necessary tools were lacking at the time, and no companies sought to invest.

“So, imagine my surprise when at the 2019 ESCRS Congress, I saw my movie,” he said. “Sanoculis had brought back my idea as MIMS (minimally invasive microsclerostomy). Now, 35 years after initial conception, the trabecuphine is back because it is still a great idea.”

A big market is another fundamental element for successful innovation, Dr Brown said. Collaborative work with his wife, Mary Lynch MD, for example, led to the EyePass, a T-tube joining Schlemm’s canal to the anterior chamber. However, the FDA required testing in a costly blind eye study, and the sponsoring company went bankrupt during the phase 3 pivotal trial.

“Our goal was to help patients at risk of blindness, but they represented too small of a market,” he noted. “With the iStent, Glaukos created the engine of success for MIGS because it targeted mild to moderate glaucoma that accounts for 95% of the market.”

The long journey from idea to market

Beyond market size, success of independent innovation faces more challenges, as illustrated by the history of the Light Adjustable Lens. First conceived in 1995 by Dan Schwartz MD, a retina specialist at the University of California, San Francisco, the implant did not receive FDA approval until 2017. The years-long journey was possible because Dr Schwartz’s great idea was enabled through his collaboration with scientists at the California Institute of Technology (Caltech) University and company funding, Dr Brown said.

He also outlined a variety of reasons to explain his belief that future disruptive innovations will not come from large companies or from inventive surgeons who consult for many companies. Yet Dr Brown remained optimistic, observing there are still many independent innovators, who he described as deluded people with courage who want to solve big problems.

“For me, it was creating a better glaucoma operation to prevent blindness. Each project felt like an adventure,” he observed. “Innovators need to see things differently. It is like a belief about seeing the future before it is visible. Some things have to be seen to be believed but others have to be believed to be seen. Most innovations don’t begin with evidence—there is none. They begin with belief.

“Innovators have to be different because if you innovate you may fail, be discouraged, ignored, want to give up, see others more successful with your ideas, and see your contributions disregarded. But I hope you do it anyway,” he concluded.

Dr Brown spoke at an innovation session during the 2025 ASCRS annual meeting in Los Angeles.

Reay H Brown MD is in private practice in Atlanta, Georgia, US, where he specializes in cataract and glaucoma surgery. reaymary@comcast.net