*APAC Heritage Month* Founder Focus

Oh, and we're live! Welcome to another episode of Founder Focus. I'm your host, Jade Wang. I run the startup program here at Cloudflare, and today our guest is Quinn Wang. We're not related, by the way. I would love to be. I think she's awesome. Well, welcome to the show. First of all, very briefly, tell us what your startup does. Cool. Well, thank you for having me, and as you mentioned, my name is Quinn. My startup, Quadrant Eye, is building an end -to-end remote eye exam solution that ultimately will be able to replace the in -person eye exam experience for a number of issues, just short of people needing surgery. Can you tell us a little bit about the scope of the problem? I'm nearsighted myself. What percentage of humankind has some kind of issue? Can you give us a little bit of scope here? Yeah, sure. Let's just limit it to the U.S. Even here, the scope is pretty large, so about three-quarters of the American population has some sort of uncorrected refractive error, and refractive error means you could benefit from glasses or contacts or some combination to see well, which is 20 -20. That's a ton of people, and that is only thinking about the glasses and contact lens aspect of it. When people think about their eyes, that's the most obvious part, but I'm an ophthalmologist, so the way I conceive of eye care is in two buckets. The first one is vision. What can you see on the eye chart, and do you need glasses or contacts? The second part is eye health. Are you at increased risk for things like glaucoma, diabetic retinopathy, age-related macular degeneration, etc.? Most people are touched by some sort of eye concern, if not glasses and contacts, then pink eye or a stye or allergic conjunctivitis. What came first, solving the remote eye exam problem or the pandemic? Which problem came first? Was it motivated by lockdowns? It was accelerated by lockdowns. Throughout training, I've always been interested and became increasingly interested in the idea of using pretty elegant and simple remote eye care solutions to reach people who either are too immobile to make it into clinic or just live five or six hours away from an eye clinic, such that it doesn't really make sense. There's a whole category of people who need eye care regularly, but not active eye care, so monitoring, and figuring out how to get these people care and the monitoring they need without having them come in or sending someone to their homes, which doesn't happen now, but just in theory. It's better for everyone. It decreases burnout from eye care providers and just makes quality of life way better for patients and extends access. Coming from that background, when the shelter-in-place orders came down, I live in San Francisco, so it's particularly harsh here. Eye exams were deemed to be nonessential. I was in private practice at the time doing cataract surgery, and my clinic shut down, and we stopped doing cataract surgery because it's an elective procedure. I was like, okay, crap. On that one, right? I know, because even though that was the case, my patients still needed eye care. I was like, well, it turns out I have time on my hands now. I was like, okay, I've always had this interest. Let me see what's out there. If people have made progress on being able to remotely monitor the state of a patient's eyeball and their vision, and none existed. I just was both surprised and not surprised because when it comes to innovation in health care, it's very like either you are in a specialty where there's a lot going on, like cardiology, or you kind of fall on the other side of the spectrum where things are slow to change. So did you start with your own patients who you were already seeing? Is that how you got started? Yeah. What I really wanted was a way to see if my patients were indeed seeing worse, and if they were in danger of going blind. I just wanted a tool to check that, and there was no option for it. So I built out a vision check tool and an eye health check tool on Typeform and started running it through my patients and was super stoked about the quality of data I got. My patients were like, wow, Dr. Wang, I'm actually getting an objective assessment. I feel very reassured versus my other doctors who listen and then kind of just say, it's okay. Let's just watch this. It's COVID. Let's be safe. From there, from a Typeform prototype for some sort of remote eye exam, I kind of scaled that up to a venture-backed company. We just finished YC and hired our first round. Do you want to tell us about that? Yeah. What happened was that I started raising shortly before YC demo day and closed the round in two and a half weeks, took 85 meetings, and oversubscribed our multimillion dollar seed round. It's pretty crazy given that my background is very traditional medicine. I graduated from ophthalmology residency in 2019 and I practiced for a year as an attending cataract surgeon and then COVID hit so that I was doing this thing and I went full-time. These people I was pitching to, these firms I was pitching to, I didn't know who they were. Our lead, who's tier one, I was like, when I was pitching to them, we had multiple meetings and the head guy came on. I was like, I don't know who you are and I know more about the eyes than you and so let's do it. My ignorance in that respect was helpful, I think, because it was way less intimidating for me. It's incredible to think about it and now we have some breathing room to be more thoughtful about long-term strategy but are aware that we need to continue moving really fast. Awesome. By the way, most of our viewers are working in the tech industry, usually in a developer position or DevOps or something like that. If you want to say that you have a hiring announcement, it's a great time to make a plug. Well, we definitely want to talk to anybody who is interested in creating a brand new category in eye care. This notion, what we're calling it is at-home eye care and a complete solution doesn't exist. A lot of people think that it's very weird and unachievable because if you've been to the eye doctor, you see that there's so much heavy duty in it. It's expensive and you are always interacting with some sort of that equipment and so making the cognitive leap from being confined in a room, uncomfortable room, having uncomfortable things done to your eye to being able to interact with a digital exam plus some hardware components at home is foreign to people and a little bit crazy inducing but it can be done. We just have a lot of obviously a lot of work to do, a lot of development to do and a lot of education to do. And we all know it is a sensical time to do this since there's been a huge shift toward telemedicine and remote care but this has been really a long time coming and it's really super exciting and when we succeed, it's gonna be transformative because you can take care of your eyeballs from home and have a hand in helping people have more productive lives and like see the details in their visual environments that they might be missing but not even aware that they're missing because they haven't worn glasses before or they have this underlying treatable eye condition. So let's talk roadmap a little bit, right? So like are there sort of subtypes or like profiles of patients for whom this is a really good fit right now and then and maybe some that it's not a good fit right now but depending on features released in the future, they will become a good fit in the future. Great. So right now our current product, we are calling it an online eye exam just as a placeholder and it has people who walk through, check their vision, check their eye health and we're aiming it at people who wear glasses and contact lenses because it is like very intuitive and it's the first thing people think of and yeah three quarters of the American population has some sort of refractive error and half of Americans wear glasses and contact lenses and they all have the problem of dealing with expired prescriptions every year and even if you're happy with your vision, your prescription hasn't changed in 10 years, you still have to go in to see the eye doctor and it's very inconvenient like this annual cadence of exams is not in fact based on any body of clinical data. It all revolves around the fact that it is illegal for any sort of entity to sell you glasses or contacts if you have an expired prescription. So prescription renewals for people who wear glasses and contact lenses using an online interface. That's what we're doing now and our users, there's a pretty wide range. I'd say it's mostly folks between age 20 and 45 and it tends to skew female and like that's how things have shaken out and in the future we want to create, hmm how much can I say, we want to create like an increasingly sophisticated online portion of the exam that can do more in the prescription realm and also start checking elements of eye health that historically have only been done in clinic and then introduce hardware to gather the data like all the points of data that an eye doctor will need to make some sort of assessment as to whether or not you're okay and that will be applicable to people who are generally healthy but have some sort of condition whether it be they need glasses or very mild diabetic eye disease and then we can start applying it to people with serious eye conditions too. So becoming more and more like widening the scope essentially. So here's a, so the pandemic has put a great deal of urgency on the problem right of you know remote eye care but you know there will come a time eventually when the pandemic is over where most people are vaccinated. So like what happens at that time like what's the in the short medium and long term like what happens to the demand for remote eye care then and like what are your predictions? That's a great question. Pandemic aside there is an increasing shortage of eye doctors and when I say eye doctors I mean both optometrists folks who have ODs and went to optometry school and ophthalmologists folks who have MDs and went through residency some fellowships and can do surgery on people's eyes. There is yeah as the population ages there are more and more people who need eye care and fewer and fewer people who can give it and that is like a matter of limited training spots and also geographic restrictions and so what. So you're making it scale. Yeah we're making it scale we're kind of like making it possible for every eye doctor to be able to more efficiently see patients at volume and then take that capability and start automating some of the really easy parts of it and it's super exciting and like prior to the pandemic it was predicted that by 2025 there would be a shortage of 6,000 ophthalmologists and with the pandemic it forced a lot of ophthalmologists into early retirement so it's like coming sooner than 2025 and no one is really doing anything about it because there is inertia and in medicine and ophthalmology in particular the focus innovation wise has been on refining the giant pieces of hardware that we have in clinic and so like doing software first is a little bit unusual because again when people think about eyes they're like we have these things that are large and expensive and like well there's no way there's no way we can provide remote eye care so like just having this like trend of a deficit of care and also facing the inertia for innovation because of the hardware component that's that's kind of like been a problem regardless of COVID and yeah it's like people are a little more open to doing like a full-on remote eye exam but there's a lot of elements of the exam that ophthalmologists and optometrists are like you can't do that you can't do that at home and my answer is you can and we will. Is there sort of a frequency that you would recommend at present where you know like maybe every other time they renew their prescription is with you versus or maybe every two to three times like what how did how does a how does a patient think about something like that? Okay I love this question so if you right now the the state of things is that you need to get your prescription renewed every year and there's the powers that be if you don't go in in person every year then you're putting your eye health at risk. The American Academy of Ophthalmology like so the folks who have trained in the medical part of eye health say that for people who have healthy eyes no risk factors and have like you know just baby little prescription pretty straightforward there's like no indication at all from an eye health standpoint to have any routine exams. So if you're under 40 you should and then like you've had a baseline exam your prescription's stable theoretically you can do your renewals online like all the time. I think there will be people who are uncomfortable with that so like doing a mix of online renewals and in person is a good way to go about it and probably more prudent but like speaking from like a clinical standpoint it doesn't make sense to do these annual visits and then like at age 40 you should definitely have a baseline comprehensive exam which means a dilated eye exam. I know people hate that but you know like that's that's a pretty low bar just like when you're 40 if you've never had an exam to do a dilated exam and then again as opposed to doing that every year yeah yeah and then if you're like healthy again no history of eye problems no systemic risk factors no family history then after 40 every two to three years and after 55 then you think about doing that annual cadence and of course if you have like a serious eye problem glaucoma you should be seeing a doctor in person if your family history of retinal degeneration like none of this stuff applies to people with serious eye problems but yeah I think for a lot of people who are watching these like healthy developers who like probably a lot of you wear glasses and contacts um we should just be doing this stuff online and plus it's easier I don't have to talk to anyone that's great oh my god okay no you don't have to drive anywhere and like every time I talk to somebody about this they're like I hate the air puff test that the eye doctor gives me it's like yeah okay I hate it for two reasons number one it's accurate right yes it is wildly inaccurate it's not the gold standard and um number two it's like again needlessly psychologically traumatizing and makes people reluctant to go into the eye doctor when you know maybe some of them should be going in regularly but the part that gets me is yes no one likes it and it's not even accurate it's not gold standard it's not even helpful no it's really not helpful it's like the opposite of helpful it associates the eye visit with bad stuff even more bad stuff you know you're getting dilated and then there's like it's an air puff test so yeah so so switching gears a little bit um you're among like a very small like Venn diagram of people who have a foothold in medicine and also a foothold in tech um and so like I so I I'm really curious about the sort of intersection and the and the sort of cultural difference between the two groups and um like can you talk to me about for instance like medicine's negative bias against social media and how physicians express themselves and the cultural difference between tech and medicine that way? This is a very timely question because I've been chatting about this with my team right because I'm the I'm the one who came from who comes from a surgical background and went through like those brutal 80 hour work weeks like 36 cycle 36 hour cycle calls and just like intense pimping by attendings like all sorts of abuse and then like my team my co-founder Christine and um our first engineer uh Alex Akagi um they come from a tech background and culture where there's a lot more openness and um just kindness and respect for as a human being which I love like that is my natural tendency uh but I also have like expectations and habits that have carried over from medicine being like for example if something needs to get done in surgery you say it once and it's done. In tech there's like a number of complicating factors like you know when code code breaks blah blah blah you it's like there's there's all these variables that you don't really think about it coming from something might be blocked on something else that needs fixing yeah and like I can't see it I can't see it so I'm like what is happening what is happening um and like just the communication style is a little bit different and so that has been um that has been interesting and challenging but also very good because I like this much more like being open having a flat organizational structure rather than a formal hierarchy and when it comes to things like social media in medicine folks are very conservative in that they feel a pressure and need to maintain this like white coat demeanor where you're just like very very um professional and you are on a slightly different level from your patients and like more professorial ivory tower and so like the idea of going on social media and presenting yourself as anything other than that is very like not cool and so you it's it is changing now but like when I went through training you you go on social media to like share papers or like share your opinion about a new treatment or you're just not on it at all uh and the what we were told was that you know our careers and our chances of getting into a like a high quality med school or residency program would be jeopardized if we tweeted something vaguely political or posted an instagram photo of like being at a party near alcohol and like there was like there was like a controversy recently right or like sometime where I I forget the specifics right like that they were trawling like some researchers were looking at the social media photos of their colleagues so what happened yeah there was um there were some troll people went out and like looked at the social media profiles of a bunch of residents most of them female and uh there were they surfaced photos of these women in bikinis some of them were at parties holding a beer and then they like shamed them they published a paper and said like it's really inappropriate like these these women I think it was a urology residency program in particular that they were focused on and there was like a huge backlash obviously because physicians are people and recognizing that and giving them the freedom to show that they're people is like it frees you up to be more empathetic toward your patients and also patients see that you're a person and so that like opens up dialogue um more freely between patient and physicians and all that and it's just bullshit it's just bullshit and like going into tech I've been able to shed some some of that and increasingly become disconnected from this part of medicine and so like on twitter linkedin you know and like I tweet things that I would have never ever even dared to think about tweeting as a med student resident and really they're just stupid stuff like I'm gonna wear my sunglasses indoors at the airport because it makes me feel famous like in as a as a resident that probably would have been pulled and put in my file and like I would have been penalized for that I don't know like it's just a stupid nothing tweet harmless yeah I know I know but it makes me look unprofessional and now I'm like you can't touch freedom it's ridiculous yeah so in the last uh three minutes uh that we have left um and do I want to skip this one or well let's talk about like a pop culture art recommendation that you have for our audience a book that you've read recently or perhaps a movie or a game I will say that there's a website I really love it's called thisiscolossal.com and it's um a curation of visually interesting art so installations videos uh murals and things like that and every time I log on they update it pretty frequently I'm just blown away by the quality and quirkiness and just imagination of this collection um of yeah sculptures and any sort of artistic medium you can think of uh like my favorite so far has been this four minute video of dancers on like a black sand beach in Iceland like choreographed to um a piano piece that this young 20 year old woman is playing on the beach gosh it sounds I don't do it any justice it sounds lame but it's really cool I promise so I mean are they like fan submitted or are they um it's curated by the editors um and so they're all like all over the world yes yes they're from all over the world and that that part might be my favorite like you know Iceland uh South America of course places in the U.S. it's it's wide ranging and very satisfying for a number of reasons I feel like once uh we're able to travel freely without having to sort of think about the uh the epidemiology of it um that that might generate some uh a nice travel list of things to look up oh oh totally totally I actually hadn't even thought about that I've just like um I go on there and I'm like ah I wish I were an artist like so I was an English major and I have like all of these tendencies in that direction and I think maybe in another life that would have been the direction I've gone in so this is just like my way of indulging that part of myself but that's true they there are a lot of great travel destinations in there a lot of uh a lot of artwork to to see in person yes yes sculptures to interact with and all that and you know all the future patients will also be able to see them better oh nice nice trying it back thank you I appreciate it thank you so much for being on our show this has been a really great episode and uh and I wish you all the the best of luck in everything thank you so much for having me and again if anyone wants to work with me work on this like very cool project you can find me on like whatever I think the social media stuff will be shared on this but yeah moronic tweets also very active on LinkedIn and my dms are open and I think my email is like pretty easy to find so all right and that's a 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