Emergent innovation systems and the delivery of clinical services: The case of intra-ocular lenses

This paper is an exploration of the dynamics of technical change in medicine. We argue that innovation in medicine is a process that is distributed across time, space and epistemic and institutional domains; that it entails the entrepreneurial effort of creative individuals as well as the emergence of correlated understanding among heterogeneous agents whose rules of interaction are contingently instituted in socio-economic systems along unfolding scientific and technological trajectories. We illustrate our arguments through an in-depth analysis of a major ophthalmologic innovation - the intra-ocular lens - that has literally transformed the treatment of cataract in the developed world and has the potential to do so in many developing countries. We investigate the advancement of clinical knowledge about the disease, the development of effective technological capabilities and the co-evolution of the supply capacity and demand of a micro-innovation system emerged along a specific sequence of interrelated problems, and associated solutions, which engaged scientists, technicians, practitioners, regulators and patients alike over a period of around three decades.