Clint Betts
Tom, thank you so much for coming on the show. You are the CEO and president of Samsara Vision, an incredible company. I was talking to you before we came on air here. I've been spending a lot of time reading about you and your company this morning. Man, it's pretty incredible. How did you get to where you are now? How did you get to become the CEO of Samsara Vision?
Tom Ruggia
Thank you, Clint. Thank you for having me on. I really appreciate the opportunity to talk about what the company's doing and just a little bit about me. Yeah, I've spent my entire career in ophthalmology and optometry and eye business, so to speak, and much of my career with the big companies, 15 years with a company called Alcon, which is the biggest in the surgical realm. And then everybody knows Johnson and Johnson, where I spent five years.
During my time at J&J, I had the opportunity as a team member in business development to meet a company that had an up-and-coming product for age-related macular degeneration. I saw the company's profile and got to meet with the CEO and some of the investors in an M&A opportunity for J&J. But I really loved the mission statement. I loved what the product could do. When I got a call from a recruiter and from the board of directors asking me if I had an interest in joining the company as CEO, it was a no-brainer for me. This company can deliver improved lives for people in need, and that's a really important thing for me in my career to do. So I came to Samsara now four years ago, after spending quite a few years in bigger companies, but I have been leading this company ever since.
Clint Betts
I think it'd be good to go deep for those who don't know what Samsara Vision is. Like what you do, what you focus on, and the role you play in the vision world.
Tom Ruggia
Sure. It's a medical device technology company out of Israel. It's an implantable miniature telescope, so it's a true Galilean telescope. Miniaturized for implantation into the eye for patients with age-related macular degeneration. Now, these patients have made it through their lives and at the end of the disease cycle, where they've lost a significant amount of vision. They're considered legally blind. It's more of a central blindness. So they lose the ability to see someone's face that they're speaking with, read a book, watch television, or do any central visual tasking. So, all they have left is their peripheral vision. This Galilean telescope can be implanted so that the patient can regain that central vision. One eye will be the implanted eye, and that eye will do central tasking, while the fellow eye will still do peripheral tasking, and the brain learns how to meld both images together, giving the person a full field of view using two eyes for different tasks.
So that's what Samsara Vision does. We do it with a product called the SING IMT or a smaller-incision new-generation implantable miniature telescope. It's a 25-minute surgical procedure, and the patient walks out just like a cataract surgeon. A short recovery time, and then some time with occupational therapists. They learn how to use the vision. Then, patients can generally see three to four lines better on an eye chart. So, if you're watching, you can see the eye chart behind me. You might start at the top of the eye chart, and after implantation, you can see four lines deeper. We've proven to be two times more effective at reading acuity, meaning the person can read things on a page two times better and two times improved reading speed. So, functional vision improvements come along with this, too. It's really a remarkable device.
Clint Betts
What was this that you launched? Are you talking about this procedure you launched in China, the SING IMT that you did in July?
Tom Ruggia
Yep. The SING IMT is it.
Clint Betts
How'd that come around? How did that come about?
Tom Ruggia
Yeah, it's a device, that is ... Then I can show a little graphic for the watchers. And if you're listening, you can't quite see it, but here's a larger version of what this is. But it's four-foldable haptics, and this gets implanted during a cataract surgery. It came from three guys in Israel, one optic specialist and a couple of engineers, who thought that the vision would work with a Galilean telescope, and then just the process of miniaturizing it for implantation was the challenge. The first time around, the first-generation technology was optimized for vision but not for the day of surgery. So, the surgical procedure took quite a bit of time. It took an expert surgeon, and it required a long recovery period for the patients. But this smaller incision version can now be done by any cataract surgeon or surgeon that does cataract surgeries in the world. It is miniaturized so that the procedure can take only 25 minutes, and the patient can bounce back within one to three days.
Clint Betts
It's pretty remarkable, actually. That's wild. It's like magic. The best technology is magic, and what you just described to me feels like almost magic. When I saw you hold up that device, I thought about it. People may see this device, and they're like, "Oh, that's cool." I just thought about the number of hours and years and time and talent and various prototypes that you had to go through in order ... I don't think people realize a device ... You probably have even regulations and various things you've got to go through. What all went into it, and how long did it take to get the device that you just showed us?
Tom Ruggia
We're in year 24 for the optic for the center of the device. But if we were starting today with a new technology and medical device from idea to market, it would take 10 to 15 years. The SING IMT is a second generation of an original implantable miniature telescope, and that was not effective because the day of surgery was a little more challenging. So, 24 years is two times the time for us or innovation to market over two times. It's about 10 to 12 years, I think, and it is a proper life cycle. In medical devices, generally, Europe is a faster approval process. The regulatory process is different in Europe than it is in the United States.
So, you can get to market earlier in Europe, but the United States is a little more speedy in reimbursement. So, where you have to go from country to country in Europe, bringing your argument to each government and getting the clinical trials necessary to get reimbursement in each place takes a long time. So, getting paid for your technology in Europe takes a little longer than in the US. For medical tech that addresses the aging population, Medicare is usually the biggest hurdle. Once you've cleared that, private insurance is a little bit easier.
Clint Betts
Yeah. That actually is really fascinating. I wouldn't have thought that Europe would be easier to go to market.
Tom Ruggia
In pharmaceutical, it's not. So in drug development, it's the opposite. But in medical device, it's a little easier. It's faster. Not easier, but faster.
Clint Betts
Interesting. So what does it take to ... So if it takes 10 to 12 years for those listening, how do you survive those 10 to 12 years? I assume you're taking a good amount of VC and capitalizing it from that perspective. But tell us, if somebody wanted to ... Listening is like, "Hey, I want to start a medical device company," what are you going to do in order to get through those 10 to 12 years?
Tom Ruggia
Yeah, particularly if you're a founder. I think founders, you have to realize what you do well and what talent you need to go out and outsource. So if you're a founder and you're an engineer and you've got a great idea, I think you need to know that the faster you surround yourself with good business people that know regulatory, particularly regulatory, and can get your product to market as fast as possible, that's key. So I joined four years ago, as I'm saying. But I'm an expert in commercial and regulatory reimbursement. So, I'm not a founder of the company. We still had one of the founders on when I joined, but his expertise was in the tech, and my expertise was how to get it to market. Now, the secret sauce would be to get early capitalization, but go out and hire somebody who knows the roadmap to get the thing to market as quickly as you can.
You might say, "Well, that's a big expense." And time, this is big. And I think this will recur as we talk more and more about this. Everybody looks at startups as money. How much money can you raise? This is very important, but everybody forgets that time is probably a bigger part of the equation than money. So sometimes, you spend a little bit early. If you get the right people on board and speed things up by a year, you reduce the total investment necessary by one full year of burn. So any time you're spending a little to save a little long run is usually a good ... If you've got it right if you got the formula right, it's usually a good idea to get the right people on board early.
Clint Betts
What does a typical day look like for you as the CEO?
Tom Ruggia
Me, I'm a unique person. Because in addition to being a CEO, I'm an Ironman triathlete. So, my day starts at 4:17 A.M. every day, usually without an alarm. So, usually, I beat that by a couple of minutes. I'm up and at them, and my first hour and a half goes global business, and our manufacturing facility is in Israel. As you mentioned, we've got new business in China, and we've got Europe. That really is the heart and soul of what we're doing today. So, in my first hour and a half, I'm engaging Europe, Israel, and China, as the US is still way far behind the clock. And it's two hours of training, usually every day, for me to get my oxygenation right. I like to enter work at full stride, so to speak. So I get through the training part of my day, and then I get in the office about eight o'clock, 8:30, and it's early calls and getting the pressing issues of the day done before lunchtime.
Then, I spend most of the afternoon on a perfect day; I could spend the afternoon with strategy, recruiting, and other things like that. I'm usually done with calls and things by 5:30, six o'clock, and then some family time. I wind down really early. I hit the rack at eight o'clock, 9:30. I'm out, and then the next day starts. There's not much difference between a Monday and a Friday, and a Saturday to me. I would like to replay it over and over on the same day.
Clint Betts
That makes a lot of sense. I imagine you have to, given what you do. That's incredible. How long have you been doing that, the Ironman stuff?
Tom Ruggia
My first Ironman was in 2014. That was my first full Ironman. I think I started Triathlon 2011 with an Olympic distance, which I had a road bike. I see some pictures of that, and I want to laugh at myself. It was the worst performance ever, but I think I got the bug. I was a college football player, a bodybuilder, a powerlifter, and a marathoner. And then you just naturally ... I haven't climbed Everest yet, but I bumped into Ironman Triathlon in 2014, my first one. And I've done six full-distance Ironmans, 11 half Ironmans, and I've qualified for [inaudible 00:11:53] Kona a couple of years ago, 2022, and just qualified again for world championships this year after I spent three months ... I had a spine infection this year, so I had to recover from the spine infection, get back out there and was able to qualify again this year.
Clint Betts
That's incredible. Congratulations.
Tom Ruggia
Thank you. Yeah.
Clint Betts
Beautiful. I wanted to ask you how what's happening in Gaza and Israel affected your business, given that this is an Israel-based company.
Tom Ruggia
Yeah, it's sad. We had a couple of people deployed, which has been a challenge, so we are checking in with them as much as we can. One thing that's remarkable is my deployed folks; I'm able to stay in communication, which, the first time I experienced something like that, I didn't realize. We have an employee who comes back and forth between military service and the office, and I'm able to stay in touch during both times. It's great how communication has improved that. But I'm worried for my people. They live in and around the Tel Aviv area, and there are sirens every day. And I've got a friend that I've made. She doesn't work for us, but I've made it through business, and she's competing in a marathon, forgetting where it is. I think it's in Florence. But she's, I think, the second or third-fastest marathon distance woman in Israel today, and she's training for this marathon.
She's got young kids at home and a husband as well. She's doing runs just one mile back and forth in front of her house. So, just in case the sirens happen, you have to be ready to get your family prepared. I think what it's done for me as a leader is to increase the amount of empathy that I have not only for my team but also for the people that are living there. Them, their families. I'm constantly worried about waking up every morning to see the news. If there's news, I'm texting and trying to find out, "Is everybody okay? How are you doing emotionally?" I lead off every meeting with a little bit of a chat about mental health, and it's just something that I think leaders need to be aware of.
But I think what's gotten me is this is such a part of their life that it's obvious. But even as a leader, you don't know what's going on in everybody's life every day. I think we need to learn maybe to be a little bit more empathetic. We're on such a mission and driving so hard to get the business that sometimes, we can lead off with our priorities. But I think this experience has taught us all that we're all part of one big world.
Clint Betts
Yeah. And I think during COVID we learned in particular, man, a lot of people are struggling with mental health, particularly as went full remote and now we're remote, hybrid, whatever it is. And how do you think about that as the leader? You just mentioned like, "Hey, this is something we do." But what are some of the things that you've put in place to help your employees with their mental health?
Tom Ruggia
I don't think I've formally put anything in place. I think I like to lead by example in terms of exercise. I think everybody wants to talk about SSRIs and every new medicine that could come out to help mental health, and those are all very important tools. But the value of getting up early in the morning, exercising, getting your sleep right, and getting the right vitamin and mineral supplementation, all of those things are critical for mental health, too. So, I try to lead by example. We had a couple of meetings last year in Europe where instead of doing late nights in the bar, I encouraged to have a running group that meets every morning and goes out in Berlin, and I think I got three volunteers. That's okay. It's a start. But I try to live and encourage people to do those to eat and exercise because I think those are the building blocks for a strong biopsychosocial approach to your life.
And so I think that would be one thing I've done. I think I also do a lot of one-on-ones where I do the big meetings, of course. But I'm often texting and talking to people one-on-one, asking them how they're doing and following up. So, nothing's worse than a boss that asks you about your situation. You tell them your situation, and they forget it. That's the worst in the world. But I try to genuinely follow up on people's personal items that they share with me, and I think that way of connecting allows me to tell them how much I care about them.
Clint Betts
Yeah, that's super interesting. It does seem like it has to be something led by example. It doesn't seem like there's any sort of silver bullet in that particular area that works over.
Tom Ruggia
If people try to put programs on it, it's like a training class. A million years ago in business, they talked about technical adaptations and adaptations that are more smooth in nature. I just think some of that, some leadership is you can't put a program in place. You need to just live the life a certain way and things take care of themselves.
Clint Betts
Yeah, for sure. How are you thinking about AI, and how is that going to affect Samsara Vision?
Tom Ruggia
Yeah, I think it's going to affect the way we do business. We do. I don't think it'll affect our technology as much, but we'll be able to get to patients more easily. I think we're interviewing companies that are doing great things in terms of outreach. Our patient base today is one that's been what's called Loss to Follow. It's a patient base that has gone to the doctor. The doctors told them that there's not a lot that they can do to improve their vision. There have been other products that have come out that have not improved their vision. So our patients are sitting at home, and they're blind, and they've been told there's nothing for them. So, how do you get out to a loss-to-follow population? And we've seen that with pharmaceutical companies. They've done television commercials. But for us, that's not a good approach.
It's not a wise spend. Reaching our audience is difficult through television. So AI has given programs that enable surgeons and doctors to read their electronic medical records and find the right candidates, to look through social media platforms, to find people who have been interested or clicked on links for age-related macular degeneration or vision enhancement in AMD, and find those people where they are and let them know there's a new technology out there. I think that's the way. Connecting with people will be the way AI changes our business. That's the opposite. Everybody's talking about how AI is minimizing getting to the people and the human touch. I think we'll be able to communicate with more people because of AI, which I think is a positive. But for our technology, not much. I think we've got Occam's razor-style technology. It's the simplest solution. So, I don't think AI will enhance the device itself. Everything around the device will be enhanced with AI.
Clint Betts
Yeah, it's really interesting. That really is the reverse for most. It actually helps you get more connected with your customers, which is incredible. What do you read?
Tom Ruggia
Yes. Our customer is disconnected, which is sad. They've disconnected because of their handicap. Yeah.
Clint Betts
Yeah. What do you read? What reading or recommendations would you have for us?
Tom Ruggia
I like classics. I'm a big podcast guy now. I think the election was made ... Everyone's listening to podcasts now. I've always been a podcast person. I think Rich Roll has always been one of my favorites. Rogan, of course, depends on the guest. But I love Rogan as well. Dateline: I think I've listened to every Dateline. It's sort of a mental candy for me while I'm traveling or something. But East of Eden was one of my favorite books. And 1984, I just read it for the third time. I listen to books, so audiobooks. So yeah, I think I don't read much on business subject matter, believe it or not. I like to do big thinking through books. And for me, it's fiction that ... The Girl With the Dragon Tattoo, that series was one of my favorites, too. I've listened to that twice. So that's me. More of a fiction guy.
Clint Betts
Perfect timing on Orwell in 1984.
Tom Ruggia
Oh my gosh. Three times now, I've listened to it, and each time, more and more of it has different parts. It's unbelievable, but the vision that that guy had is unbelievable. I think it was 1949 or '45 or somewhere in that timeframe when he wrote the book. And he was off by 40 years, but man, pretty damn close. Pretty remarkable.
Clint Betts
It is pretty incredible. What do you think about recruiting? How do you think about getting top talent for your company, and what does it take to do that?
Tom Ruggia
Yeah, for me, this company in particular, I think you need to have ... Of course, depends on the role, but I like to use a benchmark of finding people that have a connection to the patient. So if my people all have a passion for the patients that we're working on behalf of, then I'm comfortable that we've got the right team. Without the patients, there's no mission, and our patients are uniquely visually impaired. And that kind of patient, it takes a lot of patience for the people that are working in the company. And if you don't have that, if your North Star is not improving the lives of the people that we serve, then this is not the company for you. Then, you should look for a company that has your value set. But for me, if you're not waking up in the morning kicking and screaming to try to make someone's life better, and by the end of the day, if we haven't made at least one person's life better, this is not a day well spent. So, if you have that mindset, then I'm willing to listen and see why you should join. I like to pick people first and then find roles. And I do a lot of interviews for roles that aren't open. If I find talent, passion, and enthusiasm for the business, I've plugged people in where we've not had open roles in the past because talent is everything in our business.
Clint Betts
You mentioned the election, and we're not going to go into the politics of that, but now we do have some certainty into the way things are going to look in 2025. You see the way the market is reacting. They just want certainty. They don't want not understand things. So as you go into 2025, how do you think we're looking from a financial standpoint?
Tom Ruggia
Yeah, it's interesting in medical devices. I was reading an article the other day about investment in med tech. So there's a fixed amount of investment dollars that come into the market. I think it looks as if next year is going to be a good year for M&A private equity and venture investments. So, for those of us who are in businesses that are in growth mode or startup mode, I think there's going to be money out there for companies that are innovating, which is good. Where is that money going to go? I think this is the question that investors, especially healthcare investors, are thinking about right now. I was reading an article about uncertainties in the pharmaceutical industry based on some of the promises that this incoming administration has made to change the FDA and the way in which pharmaceuticals are advertised, and maybe there is some pressure on pharma. But we hear that every four years.
It seems like we hear that same kind of pressure coming to pharma businesses. And I don't find that ... Maybe that hasn't always come out, but I think medical devices, not being in that pharma sphere, may be a great year if you have medical technology, medical devices, particularly in applications or software that benefits patients. Those are going to be investment opportunities. So, I do think that we'll see an influx of capital. Where that capital goes is going to be interesting in the next four years. But I think that's all up in the air. Always in the case in our industry, if you're helping people and people are benefiting from the technology that you bring, you've got a good story, and you can tell your story. Somebody's going to fund it if it's going to make a difference in the lives of people. So whether that's pharmaceutical, med tech, or software related to health tech, I think good ideas get funded.
Clint Betts
Yeah. How do you think about leadership? What leadership lessons have you learned over the years?
Tom Ruggia
Yeah, we were talking about it earlier. Empathy is one thing. I never would ask the generals. This did come up in the election a little bit. I don't think ... It was one of those off-color comments that were misinterpreted. But as a general, are you willing to stand out there and on the front lines? For me, as a leader, the people I always respected were people who had experience but were in the fight and that kind of thing. And I am that kind of leader. And control-oriented, no. That's how you can interpret it. Micromanager, I don't mind. I'll wear that T-shirt all day long. But for me, I want to be in the OR where the surgery's happening. I want to meet the surgeons. I want to be in every country we've ever had surgery.
I think we've treated 400 patients or somewhere near that. I think I've probably been in about 25% of the surgical cases. Because on my calendar, if I have a few meetings, but there's surgery going on, and I can't get there, I'd rather be in the operating room with the surgeon. And so I think leadership and empathy are like we talked about. So knowing that everybody's carrying something with them every day and connecting with people on that heart level is super important. But then also, I think being willing to be on the front lines and in the business with the folks is my definition of leadership. It's always what I wanted to see from people leading me, whether that was a coach, a boss, or a teacher. I wanted to know that they felt emotionally for me, that they would give me feedback, that they would give their children or a good friend. And then also that they were in a fight with me. They felt like they were elbow to elbow-with me.
Clint Betts
Finally, we end every interview with the same question, and that is at CEO.com, we believe the chances one gives is just as important as the chances one takes. When you hear that, who gave you a chance to get you to where you are today?
Tom Ruggia
Oh, so many people. Geez, well, I'll give you a good story. And this is from very, very early in my career. It was a guy I talked to today. So he is one of my early friends, and I've known him for 25 years. I talked to him today. He's a CEO of Dermavant. They just sold their business, but it was a nice exit for the team, and he did a great job. But Todd Zavodnick was a sales rep at a company called Alcon. I was his personal trainer. I was actually getting ready to go to physical therapy school, and he took a chance on me, telling me to join this company, Alcon, and actually backfill him as a sales rep. I did that and jumped into the healthcare business in the year 2000 as a sales rep with Alcon. And that initial opportunity should have been all that Todd ever needed to give me. But weekly, monthly, staying in touch constantly.
Now, it's 25 years later, and we still talk on a daily, monthly, and weekly basis, whether it be just a joke on a text message or a call. And today was just a subject that I just asked him, a simple question. He called me. We talked for 10 minutes. So, I would say he's the one that got me into this industry. If not for him, I'd probably be treating patients somewhere right now as a PT. But it's been a great road since then. But there are so many others along the way that I'm fortunate that I've had some great leaders and mentors. I've learned what not to do from a lot of people, too. But maybe that's for another podcast. I've definitely had great role models.
Clint Betts
Tom, thank you so much for coming on. Congratulations on everything you're doing. Congratulations on the product, the SING IMT. That is incredible. Well done. What an accomplishment. And I'm sure we'll have you back on as you go down your journey, so really appreciate it.
Tom Ruggia
Thank you, Clint. Appreciate it. Take care.
Clint Betts
Thanks, Tom. See you.
Edited for readability.