Dr. Brian DeBroff, Yale Ophthalmology Professor publishes Double Optic Capture case report
This report published in the American Journal of Ophthalmology Case Reports https://doi.org/10.1016/j.ajoc.2025.102341.
This case represents the longest reported follow-up a surgical case who achieved 20/20 vision in the affected eye in a often devastating eye condition that frequently results in legal blindness despite numerous medical and surgical interventions.
Dr. DeBroff is currently the lead investigator at Yale University of a multiple site national and international clinical trial investigating the potential benefits of Double Optic Capture in surgically treating patients with cataracts and pseudoexfoliation syndrome.
Brian DeBroff, MD, FACS
Yale University
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He was released from hospital, undiagnosed, the following morning but ended up in hospital again a week or so later after returning to the United States, where an appendectomy seemed to correct his problems. He was released less than 24 hours after the surgery. A week later, he was back in hospital in Florida, suffering from a complex array of confusing symptoms. Were they related to the appendectomy or were they caused by something else entirely? No one knew. After this, Professor Snyder, who maintains a demanding schedule, was in and out of a number of hospitals in several states and European countries, but a diagnosis and an effective treatment remained elusive. Meanwhile, Professor Snyder became progressively, inexplicably, sicker. A few months later, he was gravely ill. Despite having health insurance, access to healthcare and a lot of support from family and friends, Professor Snyder almost died. Certainly, most Americans without healthcare in this situation would have died. I know I would have. Cover art for Our Malady: Lessons in Liberty and Solidarity by Timothy Snyder (2020, The Bodley ... More Head, London) The Bodley Head, London Throughout the entire ordeal, Professor Snyder kept a hospital diary where he recorded his symptoms, the test results and treatments provided, events and conversations, his dreams and he even drew pictures. This diary, which Professor Snyder refers to several times as 'a rant', was the basis of his book, Our Malady: Lessons in Liberty from a Hospital Diary (2020; Penguin Press / The Bodley Head). Despite its small size (168 pages, including 20 pages of notes in the back), Our Malady is a timely and gripping examination of the state of the healthcare system in the USA as compared to healthcare systems in several European countries. As you might guess: the USA does not measure up very well. 'Americans helped to establish health care as a human right around the world,' Professor Snyder laments (p. 41). 'Why then is health care not seen as such in the United States? Why are Americans not protected by the agreements that our government signed? Should we accept that citizens of other democracies enjoy a right that we are denied, and live longer and healthier lives than we do? Many of us seem to find that acceptable. Why?' The answer lies in the chokehold that the health insurance industry wields over Americans' access to healthcare and over the authority of medical doctors to provide adequate and necessary care to their patients. Without any relevant medical training or apparently, even any empathy, insurance agents often make medical decisions based on what's best for their insurance company's bottom line, rather than what's best for the patients; effectively prioritizing profits over people. 'When money becomes the only goal, values disappear, and people imitate the oligarchs,' Professor Snyder warns (p. 139). 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Forbes
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Champions help articulate your value, often leveraging their professional credibility to advocate for it. Finding and 'winning' them is essential to scaling. - Graham Gardner, Kyruus Health 2. Navigating Integration Requirements Across Hospital Systems One of the biggest hurdles is navigating the complexities of integration requirements across different hospital systems. Healthcare startups frequently underestimate the time and resources needed for integrations. Success requires building flexible APIs from day one and having dedicated integration specialists who understand healthcare IT infrastructure, not just general software development. - Ted Kail, Cority Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify? 3. Gaining Traction In A Risk-Averse Environment Most healthcare organizations are risk-averse and don't want to be early adopters. They look for proven, well-established companies and products, making it difficult for healthcare startups to get traction, even when they have clearly better solutions. Partnering and delivering real value to that first set of clients is critical in scaling early on. - John Bou, Modio Health 4. Integrating With Insurance Systems Health insurance companies amplify the interoperability challenge by adding another layer of complex, often siloed, data and systems that healthcare tech startups must integrate with. This makes the negotiation and implementation of business associate and HIPAA agreements more complicated, given the data types, security requirements and shared liabilities that arise from integrating with both providers and payers. - Ajai Paul, Affirm Inc. 5. Understanding The Complex Stakeholder Ecosystem Healthcare startups often make the mistake of viewing the U.S. healthcare system with a 'singular' point of view. It is an integrated ecosystem where each stakeholder is affected by the others, which means multiple interests must be aligned when adopting new technologies. - Raghav Ramabadran, Intelligine Technologies 6. Building Custom Integrations For Each Customer Healthcare startups' challenges include integrating with electronic health record systems, which is not a 'plug and play' process. Each hospital or system has its own highly customized version of an EHR, with unique workflows, data fields and security protocols. This lack of standardization means startups must build a new integration for nearly every customer. - Chris Ciabarra, Athena Security Inc. 7. Developing Strong Governance From The Outset Healthcare startups often wait to build full product depth until after landing their first client, but healthcare's high-risk, structured environment demands strong governance from day one. Change control, release management and a deep understanding of current operations, especially when replacing legacy systems, are essential before customizing. Building depth late risks delays and failure! - Trisha Swift, Mula Integrative Health & Wellness 8. Maintaining HIPAA Compliance With Digital Content One challenge healthcare startups face when scaling tech is managing digital content while staying HIPAA-compliant. Hospitals need more than stock photos and shared drives—they expect secure, role-based access to branded visuals that convey authenticity and protect patient privacy. Without a digital asset management strategy, startups risk falling short on compliance, credibility and growth. - Andrew Fingerman, PhotoShelter 9. Ensuring Consistent Performance And Compliance Across Disparate Systems Healthcare startups often struggle to scale because hospital environments vary widely in terms of infrastructure, workflows and data systems. Without a unified data architecture, real-time metrics, and built-in security and governance, it's hard to ensure consistent performance—or meet privacy requirements like HIPAA and business associate agreements governing protected health information. - Dave Albano, Diliko 10. Working Within Complex Pricing And Claims Rules One of the challenges is the integration of new tech into strict hospital billing and compliance processes. Hospitals have complex pricing and claims rules, and startups must work within these rules. They can't disrupt revenue or patient data safety. Doing this right builds trust and helps a solution scale faster. - Abhishek Sinha, Accenture 11. Processing Both Structured And Unstructured Health Data Integrating structured data (EHRs; lab results) and unstructured data (clinical notes; imaging; video) can be a major challenge. Healthcare startups must ensure their tech can process both, all while adapting to varying data and privacy standards across systems, which further complicates scaling and interoperability. Fortunately, generative AI is making this easier to do. - David Talby, John Snow Labs 12. Balancing Accuracy And Transparency With Scalability The healthcare and life sciences sector faces rigorous accuracy and transparency requirements that cannot be sacrificed and must be built into products from the start. Balancing this with scalability—which is really code for 'solving problems you don't have yet'—is a constant challenge—especially for startups, which often place a key focus on agility and speed. - Martin Snyder, Certara 13. Maintaining A Consistent, Accurate Record Of Core Assets One key challenge healthcare startups face when scaling tech solutions across systems is the inability to maintain a consistent and accurate record of core assets—such as patients, providers and devices—due to the absence of a robust master data management strategy. This causes data fragmentation, which in turn hinders decision-making, innovation and seamless integration across platforms. - Somnath Banerjee 14. Keeping Up With A Range Of Regional Norms And Laws Key challenges include a wide range of compliance requirements, regulations, cultural norms, and data privacy and region-specific laws—making a one-size-fits-all solution impractical, even within a single organization. Startups often rely on business rules engines that lack user friendliness. Agentic AI offers a more adaptable and intuitive alternative. - Koushik Sundar, Citibank 15. Working Within Legacy Hospital Systems One major challenge healthcare startups face when scaling tech solutions is integration with legacy hospital systems. Many hospitals rely on outdated EHRs or siloed IT infrastructure, making interoperability difficult. Startups must ensure compliance, data security and seamless integration to gain trust and adoption at scale. - Srikanth Bellamkonda 16. Clearly Demonstrating ROI And Pathways To Reimbursement Healthcare startups often struggle to clearly demonstrate a return on investment and secure reimbursement pathways. Without established billing codes or tangible cost-savings data, hospitals hesitate to allocate budget. Startups must invest heavily in economic validation, health economics and outcomes research, ensuring payers and finance teams see sustainable revenue models before adoption. - Manav Kapoor, Amazon 17. Creating An Internal COE Establishing an internal center of excellence with deep industry experience in scaling healthcare systems is vital, but costly. A key challenge lies in selecting vendors that align with the company's DNA. Bridging the gap between emerging tech and the unique demands of healthcare requires thoughtful planning and a nuanced understanding of both innovation and patient-centric outcomes. - Hari Sonnenahalli, NTT Data Business Solutions 18. Overcoming Resistance To New Tech I've regularly observed the challenges clinical sites face when adopting new technologies. There is often reluctance or resistance to change; staffing shortages further exacerbate these issues. A more effective approach may be to 'mirror' site-level data. This would allow AI-driven platforms to build a harmonized system that enables forward progress without disrupting existing workflows. - Rachel Tam, Bristol Myers Squibb 19. Accounting For Integration Issues When Building Solutions The biggest hurdle to overcome when scaling tech solutions across hospitals or healthcare systems is not technical; rather, it is integration—into provider workflows, clinical practice guidelines, financial models and revenue cycle management programs. Unless the issues around integration are considered and covered when building the solution, scaling will not occur. The landscape is littered with misaligned HealthTech startups. - Mark Francis, Electronic Caregiver 20. Completing Vendor Risk Documentation Post-ransomware, hospitals demand extensive vendor risk audits with hundreds of security controls, SOC 2/HITRUST docs, and custom BAAs. Completing these lengthy questionnaires stretches sales cycles to 18 to 24 months, burning cash and pulling engineers from product work to compliance, blocking scale. - Mohit Menghnani, Twilio
