In 2005, three young men—none over age 30—started a video-sharing website in a small office over a pizzeria. They called the site YouTube. Less than two years later, they sold it to Google for $1.6 billion, at an age when most people are still paying off student loans. YouTube’s founders had noticed three interesting trends: internet connection speeds were increasing, computer storage costs were dropping and a new phenomenon called social networking was on the rise. At the nexus of those they found a billion-dollar idea.

Even though medical research lacks the dazzle (and frivolity) of YouTube, the site’s story is akin to the ingenuity and impact we look for when choosing topics for our annual Innovations in Eye Care issue. Is there a product, concept or scientific breakthrough that stands a chance of radically changing and improving the day-to-day lives of doctors and their patients? Did it come about in an unusual, and possibly unanticipated, way? Is it close enough to launch to reliably expect it to come to fruition?

This month we highlight four we think qualify: an eye drop that might help regrow corneal endothelial cells, an implant that could radically reduce the number of eye injections performed, a wholly different way of thinking about glaucoma therapy and a technology-driven solution to the diabetes epidemic. 

Maybe one of them will be the next YouTube, or maybe not. But they’re all interesting stories about the sweet spot where science, business and inspiration converge.

Health care has the same mix of big ideas and deep pockets as Silicon Valley, often with success stories to match. One product in this month’s series, the Port Delivery System (PDS) for sustained-release anti-VEGF therapy, comes from a start-up ‘factory’ of sorts called ForSight Labs. Founded by retina specialist Eugene de Juan, MD, the company has already sold off three products that landed at behemoths: the PDS at Roche, the CyPass shunt at Alcon and a glaucoma drug sustained-release implant at Allergan.

Of course, not every promising idea makes it. ReVision Optics, manufacturer of the Raindrop corneal inlay for presbyopia, abruptly announced in late January that the company was going out of business. So far, there’s been no announcement about what might become of the Raindrop. Maybe another company will acquire it at fire-sale prices and try again. Or maybe it’s just gone. ReVision had a tough row to hoe—only a single product to sell, and in a very crowded market. Presbyopia correction already runs the gamut from dollar-store reading glasses to pricey premium IOLs, with options to suit every budget and personality.

Consider the Raindrop a cautionary tale as you read about what we (or anyone) speculates might be the Next Big Thing. Everyone wants to believe in and root for a new product at first. But after the honeymoon phase is over, it needs to offer more than just incremental improvement over other options, especially when going up against established players and entrenched habits.