Visions Magazine 03 - Bausch + Lomb | See Better. Live Better.

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Autumn 08/Issue 03
The Bausch
& Lomb story
- a history of
innovation
Life through my mother’s eyes
Crystalens® provides optimal visual quality
Too young for reading glasses?
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Dear Colleagues
The cover story for the Autumn edition of ‘Visions’
is ‘The Bausch & Lomb story – a history of
innovation’. In 1853 John Jacob Bausch and
Henry Lomb started a business with one purpose –
to improve the way people see. Now 155 years
later we are privileged to be able to continue in
the same spirit as our founders, as we strive to
perfect the vision and enhance the lives of the
people who use our products. With the treatment
of presbyopia very much a hot topic for both
Ophthalmologists and Optometrists at the
moment, this edition of ‘Visions’ devotes a whole
section of the magazine to covering presbyopia.
Earlier this year, Bausch & Lomb acquired eyeonics inc.,
the highly innovative company that has developed
what is still the only FDA approved accommodating
intraocular lens on the market - the Crystalens®. This
lens is not only used to restore vision in patients with
cataracts, but also to correct presbyopia. The lens is
designed to work with the natural functions of the eye
to achieve focus at all distances.
Crystalens® is the result of over 14 years of
research and development and has undergone
extensive clinical testing. To date, more than
100,000 lenses have been implanted and the
response from both eye care practioners and
patients has been extremely positive. In the
article Crystalens® provides optimal visual
quality’, hear how actor Henry Winkler, best
known as The Fonz in ‘Happy Days’, benefitted
from the Crystalens®.
The speciality contact lens market is also
growing rapidly. For example, the multifocal
market has increased substantially in the last
year, and the trend is set to continue. This is
driven by product innovation and the desire of
‘young’ 40-50 year olds to live life spectacle
free. After all, 50 is the new 40!
More and more people are asking for products that
are not only comfortable and healthy for their
eyes, but also provide a quality of vision that really
meets their personal needs. Multifocal contact
lenses provide an attractive opportunity to help
Optometrists create happy and loyal customers and
grow their business as a result. The article ‘Too
young for reading glasses?’ shares the experience
of two Optometrists who now routinely fit the
PureVision® Multi-Focal in their practice.
We really appreciate your support of this quarterly
magazine and I am proud to announce that the
new ‘Letters’ page will be a regular feature. This
section gives you the opportunity to ‘Have your
say...’ and to read the thoughts and comments of
your peers. As our valued partners in eye health,
we hope that you will take the opportunity to join
us in developing this tool further so that it provides
ongoing value to the Ophthalmic and Optometric
communities.
Best regards
Gareth Steer, General Manager
UK, Nordics, Netherlands
“Multifocal contact lenses
provide an attractive
opportunity to help
Optometrists create happy
loyal customers and grow
their business as a result.”
Inside this issue at a glance...
SCIENCE &
TECHNOLOGY
Aberration-Free
cataract surgery
HEALTH
PHARMACEUTICALS
PRESBYOPIA SPECIAL
B&L IN FOCUS
Life through my
mother’s eyes
Lotemax® a new solution
Too young for
reading glasses?
The Bausch & Lomb
story - a history of
innovation
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PRODUCT UPDATE
03
Product Update
Ne
w
ReNu® MPS™
OnTheGo pack
The Millennium Microsurgical System with the
Millennium Vitrectomy Enhancer (MVE) delivers
high-speed cutting now with 20, 23 and 25
gauge cutters designed for superior aspiration
performance and better control. The optimal
platform for posterior segment surgery, MVE
offers versatile performance and exceptional
patient outcomes.
Introducing ReNu® 'OnTheGo' pack an exciting new product is brought to you
by Bausch & Lomb to meet your
customers' busy lifestyle needs!
This special ReNu® MPS™ 'OnTheGo' pack is
made for going to the gym, participating in
sports, on a night out or those simply needing
to carry ReNu® in their handbag.
The MVE offers surgeons:
Around half of EU citizens exercise at least
once a month. Of these citizens, 11.9 million
are contact lens wearers who would greatly
benefit from using the 'OnTheGo' pack with
a handy 60ml bottle.
The pack includes:
• 2 ReNu® MPS™ solutions (60ml)
• 2 Lens cases
• 1 Care instructions booklet
Millennium®
Vitrectomy Enhancer
(MVE) with NEW
23 Gauge Solution
• 1 Special 'OnTheGo' pouch - this ultra
convenient zipped pouch is ideal for carrying
your solution with you anywhere!
Order online at www.bauschonline.co.uk
EasySept®
Peroxide Solution
Simple One Step System
Bausch & Lomb has just launched new packaging for the
EasySept® hydrogen peroxide contact lens solution and
upgraded the consumer friendly lens case. The new look is
designed to:
• Assist you in communicating the benefits of hydrogen
peroxide to your patients
• Clearly identify the steps which aid consumer compliance
• Create compelling shelf presence for an improved
Bausch & Lomb consumer experience
Order online at www.bauschonline.co.uk
Great new look!
Safety
• The MVE delivers cut rates up to 2500cpm in 20G,
23G and 25G. Higher cut rates reduce retinal
traction, lowering the risk for iatrogenic retinal
tears and increasing patient safety.
Efficiency
• Optimised duty cycles, together with an increased
port size area promote faster tissue removal and
higher aspiration flow in all gauge sizes.
• Higher cut rates also reduce turbulence, which
enhances fluidic stability and predictability. As a
result, surgeons can cut closer to the retina with
the cutter itself, reducing the need to use
scissors and forceps. With fewer instrument
exchanges surgeries can proceed more efficiently.
Versatility
• The MVE 25G cutter features a rigid probe shaft
that enables surgeons to reach the anterior
margin. Increased shaft rigidity also enables a
wider variety of techniques due to better globe
manipulation.
These benefits are delivered utilising a light
weight, ergonomic cutter that will be included in
Millennium vitreoretinal procedure packs thereby
offering cost savings and streamlining your
ordering process.
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SCIENCE & TECHNOLOGY
04
Beginning the era of
Aberration-Free cataract surgery
By Roberto Bellucci and Simonetta Morselli, Ophthalmic Unit, Hospital
and University of Verona, Italy
Among the many advancements observed after
the year 2000, two outweigh the others - the
control of spherical aberration obtained by
modifying the profile of intraocular lenses and
the advent of micro incision cataract
surgery (MICS™).
Hyperaspheric and aspheric intraocular lenses
The control of spherical aberration began with
lenses designed with the purpose of counter-acting
the positive spherical aberration of the corneal
surface.1,2 I have termed these kinds of lenses
hyperaspheric, which are also known as aspheric
aberrated IOLs. These lenses have a negative
spherical aberration, an optical modification, which
aims to compensate for this opposite optical defect
present on another refracting surface, the cornea.
While early results in implanted eyes were
encouraging,3,4 some issues with these
“hyperaspheric” lenses have arisen5,6 (a) the lens
offers good results only when centred without tilt;
(b) results are affected by the lack of centration of
the eye as an optical system; (c) results are poor in
eyes with low positive spherical aberration of the
cornea; (d) due to the flat anterior surface,
photopsias are more common especially with lowpower lenses; (e) the induction of coma is by no
means lower than with spherical lenses.
To overcome these issues, a new lens design was
developed with a perfectly aspheric optic, the
Figure 2: Pre-operative and Post-operative corneal topography after C-MICS™ with 1.8mm incision,
analysed at 6mm optical zone. Note: Pre-operative (left), Post-operative at 1 week (right)
Advanced Optics aberration-free lenses from Bausch
& Lomb. These lenses are truly aspheric: they are
corrected only for their own spherical aberration,
and not charged with an optical modification
(negative spherical aberration) to correct a defect
of another optical surface of the eye (the cornea).
Asphericity is lower than that of “hyperaspheric”
lenses, and divided between the anterior and the
posterior surface. As a result, their optical
behaviour is independent from centration or tilt,
and also from the optical properties of the cornea
or from any other refractive surface of the eye.
Photopsias are avoided because the anterior surface
is more curved than that of aberrated lenses.
Spherical Aberration Z4 (0) 4mm Optical Zone
0.08
Corneal
Ocular
Internal
0.06
Microns
0.04
0.02
0
-0.02
-0.04
-0.06
-0.08
-0.1
Tecnis
Figure 1:
Adv.Optics
SA60WF
In addition, the hydrophilic acrylic material of the
Akreos® series is the best material for the
avoidance of photopsias.7
Advanced Optics (AO) lenses can be implanted in
any eye, regardless of the optical conditions of the
cornea and the IOL position inside the eye, with no
impairment of the optical aberrations present on
the corneal surface (Figure 1). With these
aberration-free lenses, the optical aberrations and
quality in the implanted eyes can be anticipated
from corneal topography analysis. The question is:
Does cataract surgery impair the optical characters
of the cornea? And if so, what can be done to
improve this?
MICS™ surgery and corneal optical aberrations
From previous and recent studies we know that
the optical properties of the cornea are changed
by the 3.2mm incision performed for cataract
surgery.8,9 As for low-order aberration, there is
some change in astigmatism (induced cylinder)
that accounts for up to 1D in the meridian of the
incision, with variable coupling effect. This change
also affects coma (3rd order aberration), as the
corneal flattening is asymmetrical and more
pronounced near the incision site. Secondary
astigmatism and spherical aberration (4th order)
are changed as well, making it impossible to
predict the aberration outcome based on
pre-operative assessment, even with aberrationcorrecting IOLs.
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SCIENCE & TECHNOLOGY
05
Aberrations with Akreos® MI60 IOL MICS™
0.200
0.200
0.150
Note:
Optical zone = 6mm
Pupil diameter = 6.69mm
WF Analyser Centre = Pupil
WF Centre Shift = 0.470mm
-0.050
-0.100
-0.150
Z3
Z4
Z5
Z6
0.100
Microns RMS
0.050
-0.200
0.150
Optical Aberrations
of the entire eye (6mm)
0.100
Microns RMS
Optical Aberrations
of the corneal
surface (6mm)
0.050
-0.050
-0.100
-0.150
-0.200
Z3
Z4
Zernike Order
Z5
Z6
Zernike Order
Figure 3
Micro-incision cataract surgery made a clear
revolution in this area, because sub-2mm
incisions allow the surgeon to perform
phacoemulsification without changing the
optical properties of the cornea.10,11 With both
Biaxial and Coaxial MICS™ we are now able to
maintain the astigmatism, the coma and the
spherical aberration of the cornea in the postoperative, making it possible to predict the
aberration outcome if the optical properties of
the intraocular lens are known and maintained
after implantation. With MICS™, the aim of
cataract surgery towards the least anatomical
impairment comes to its endpoint, and we can
speak of “Aberration-Free
phacoemulsification”. In a short time, MICS™
surgery will be used routinely by most
ophthalmic surgeons, especially because of
the MICS™ Platform now provided by Bausch &
Lomb, encompassing the new Stellaris®
system, new MICS™ instruments, and a new
MICS™ intraocular lens – the Akreos® MI60 IOL.
Akreos® MI60 IOL and MICS™ for
Aberration-Free cataract surgery
By designing the Akreos® MI60 micro incision
IOL, Bausch & Lomb developed an intraocular
lens with Advanced Optics that can be
implanted through 1.8mm incisions. This lens
has aberration-free aspheric surfaces, a thin
optic and haptics designed to counter balance
both capsular bag contraction and vitreous
pressure. After the first year of use, this lens
showed stability and optical performance
equal to the Akreos® Adapt AO lens i.e. offers
the same results as lenses designed to fit
3.0mm incisions.
The combination of MICS™ phacoemulsification
with the implantation of the Akreos® MI60 IOL
results in a particular type of cataract surgery:
same surgical quality of standard surgery
using 3.0mm incisions, but no optical
impairment of the cornea by the incision, and
no induction of optical aberrations by the
intraocular lens. We have termed this
combination “Aberration-Free
cataract surgery”.
Because of the optical impairment of the eye
caused by the cataract before surgery, the
aberration-free technique can only be verified
in two ways. The first way is a comparison of
corneal topography between the pre-operative
and the post-operative, analysing the optical
aberration at different optical zones. Figure 2
is an example of this comparison, indicating
no change in the aberration level at 6mm
optical zone. The second way is a comparison
of the aberration of the cornea with those of
the entire eye in the post-operative. Figure 3
is an example of this computation, again
indicating the same aberration level for the
cornea and for the entire eye.
Conclusion
The era of aberration control in cataract
surgery is here. We can select the proper
intraocular lens for any specific eye, but this
choice will be of little value if we cannot
control the corneal aberrations, and we only
can do so by reducing the incision size to less
than 2mm. Then we can choose to implant the
Akreos® MI60 IOL, and the aberration profile
of the eye in pseudophakia will be the
aberration profile of the cornea in the preoperative. As the Akreos® MI60 IOL offers the
same results as the Akreos® Adapt AO lens,
this technique has no disadvantages.
Advantages
•optical improvement over spherical IOLs in
every implanted eye
•no need for patient selection
•no dependency on the incision location
•no negative effect of small IOL decentration
or tilt, and without the disadvantages of
hyperaspheric lenses
We believe that Aberration-Free cataract
surgery will soon become the standard of
lens surgery for a wide arena of
ophthalmic surgeons.
Dr Bellucci and Dr Morselli can be contacted:
[email protected] and
[email protected]
As the Akreos®
MI60 IOL offers
the same results
as the Akreos®
Adapt AO lens,
this technique has
no disadvantages.
References
1.Holladay JT, Piers PA, Koranyi G, van der Mooren M,
Norrby NE. A new intraocular lens design to reduce
spherical aberration of pseudophakic eyes. J Refract Surg
2002;18:683-691
2.Packer M, Fine IH, Hoffman RS, Piers PA. Prospective
randomized trial of an anterior surface modified prolate
intraocular lens. J Refract Surg 2002;18:692-696
3.Mester U, Dillinger P, Anterist N. Impact of a modified
optic design on visual function: clinical comparative
study. J Cataract Refract Surg. 2003; 29: 652-660
4.Bellucci R, Scialdone A, Buratto L, Morselli S, Chierego C,
Criscuoli A, Moretti G, Piers P. Visualacuity and contrast
sensitivity comparison between Tecnis and AcrySof
SA60AT intraocular lenses: A multi center randomized
study. J Cataract Refract Surg. 2005;31:712-717
5.Altmann GE, Nichamin LD, Lane SS, Pepose JS. Optical
performance of 3 intraocular lens designs in the
presence of decentration. J Cataract Refract Surg
2005;31:574-585
6.Bellucci R, Morselli S, Pucci V. Spherical aberration and
coma with an aspherical and a spherical intraocular lens
in normal age-matched eyes. J Cataract Refract Surg.
2007 Feb;33(2):203-209
7.Radford SW, Carlsson AM, Barrett GD. Comparison of
pseudophakic dysphotopsia with Akreos® Adapt and
SN60-AT intraocular lenses. J Cataract Refract Surg
2007;33:88-93
8.Pesudovs K, Dietze H, Stewart OG, Noble BA, Cox MJ.
Effect of cataract surgery incision location and intraocular
lens type on ocular aberrations. J Cataract Refract Surg
2005;31:725-734
9.Yao K, Tang X, Ye P. Corneal astigmatism, high order
aberrations, and optical quality after cataract surgery:
micro incision versus small incision. J Refract Surg.
2006;22:S1079-1082
10.Guirao A, Tejedor J, Artal P. Corneal aberrations before
and after small-incision cataract surgery. Invest
Ophthalmol Vis Sci 2004;45:4312-4319
11.Elkady B, Alió JL, Ortiz D, Montalbán R. Corneal
aberrations after micro incision cataract surgery. J
Cataract Refract Surg 2008;34:40-45
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HEALTH
06
Life through my mother’s eyes
Lowri Turner reveals why her mother’s AMD diagnosis has changed her outlook.
Lowri Turner doesn’t mince her words. The
London born and bred fashion journalist come
TV presenter, 42, is also as well known for her
controversial newspaper columns and says
that she is still coming to terms with her
mother’s diagnosis of Age-related Macular
Degeneration (AMD).
“I’d never heard of AMD before Mum’s
diagnosis,” says Lowri. “I was aware that failing
eye sight was something that often happened
to people as they grew older but never
expected to hear that AMD was not only very
common but that it also led to blindness.
good health to be able to perform both as a
Mum, and at work, which is why looking after
my sight is all the more important to me.” she
says. “I’ll certainly be ensuring my eyes are
regularly tested from now on. If my sight fails,
life would be much more difficult for all of us.”
That’s why Lowri now gets her eyes tested
regularly and takes Bausch & Lomb’s Ocuvite
Lutein®. “I began to look in to the benefits of
Lutein® after my mother was recommended it
by her doctor to help slow down her AMD
symptoms.” she says.
Discovering that AMD is often hereditary was an
added blow for Lowri. “Like any single parent
I’m very aware that I need to keep myself in
Now keener than ever to protect her health and
support her Mum, Lowri’s latest big project has
been a nutritional therapy course which she has
been doing for the last two years. She says: “In
my twenties and thirties my weight went up and
down by as much as three stone at a time and it
wasn’t until I was working on ‘Celebrity Fit Club’
and started interviewing doctors and nutritionists
that I realised the importance of maintaining
your blood sugar level by eating sensibly.
“I never expected to hear
that AMD was not only
very common but that it
also led to blindness.”
I began to apply some of what I’d seen and
heard about on the show to my own diet and
really noticed a difference. That spurred me on
to sign up for the course on nutritional therapy.
I’m hoping to be able to practice after a further
year of study.”
I was also shocked to find out it was incurable.
Most conditions can be treated these days so I
assumed it would simply be a matter of getting
the right help.”
Case study
Mr John Acres, who is 61
from Whyteleafe in Surrey,
was diagnosed with Wet AMD
in November 2007.
He first noticed a problem when sitting at home
one evening, and as the light began to fade he
happened to close one eye and noticed that his
vision was cloudy in the open eye. This came as
a complete surprise to him, as when both eyes
are open, a ‘good’ eye often compensates for
the poorer sight in the second, making vision
loss in one eye particularly difficult to detect.
He promptly called his optician to book an
appointment and, upon examination, he was
informed that the condition was in fact Wet AMD.
Mr Acres was understandably concerned about
the situation and, having never heard of the
condition previously, feared it would simply be a
downward spiral towards blindness. After seeking
the advice of his optician and conducting his own
research via the internet, he discovered that the
best option was to receive a course of (3)
Lucentis Anti-VEGF injections in his bad eye.
Whilst this was only available to him if he went
for private healthcare and at a price of £2,000 per
treatment, he was delighted to find something to
treat his condition.
Following his injection, the hospital recommended
he take PreserVision® to help prevent further
deterioration of the macula. He is thrilled that the
injection was a success and is confident that, since
taking PreserVision®, he has not seen any further
deterioration in the quality of his vision.
Following his experience, Mr Acres now offers
the following advice to others: “I would urge
For now the focus is firmly on her mother who
is helping to preserve her sight by taking
PreserVision® Lutein® Soft Gels. “It’s very much
a case of ‘wait and see’,” she says, “My
greatest fear is that there might be a time
when Mum will no longer be able to see her
grandchildren which would be a great shame.
But my family has always coped with whatever
life has thrown at it and come out the other
side. When the going gets tough, the Turners
get fighting!”
people who have any concerns about their
vision to get in touch with an eye specialist or
optician, and don’t delay in the hope that the
situation will just rectify itself.”
SUPPORT AND GUIDANCE
To give your patients access to continued
support and guidance outside your clinic,
you may refer patients diagnosed with
macular disease to the Macular Disease
Society. To join, patients can register online
www.maculardisease.org or contact the
Macular Disease Society as follows:
The Macular Disease Society
PO Box 1870, Andover, Hants, SP10 9AD
Registered Charity No. 1001198
Tel: 01264 350551
Fax: 01264 350558
email: [email protected]
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HEALTH
07
11th Jeantex Transalp
marathon 8 day race
In the first of a two-part story Mark Wevill, Consultant Ophthalmologist, serialises his
exhilarating ordeal as he cycles over 650km in 8 days (19-26 July 2008) for charity.
“We rode through the hail
passing other cyclists huddled
under the trees.”
“I completed the 2008 Jeantex Transalp
mountain bike race, which crossed the Alps
from Fussen (south of Munich in Germany) to
Riva del Garda (south of the Dolomites in
Italy), with my team mate Hein. The race
passed through Austria and Switzerland and,
at times, ascended over 21,000m. We rode in
support of "Sightsavers" and received
generous donations for this charity.”
the bike, was exhausting. Once over the top, we
flew down 10km dropping 1000m on fast roads
before the final stretch of fast, flat 10km of dirt
paths into Imst, a beautiful Alpine village.
Day 2
Day 1
Stage 1 - 1200 racers crossed the start line and
rode out through the small castle village of Fussen
to the thumping beat of AC/DC's "Highway to
Hell". The pack seemed endless and splintered into
groups of 30-40 riders. The profile was misleading
due to multiple steep climbs and a mix of fast
open road and narrow gravel bike trails. At 50km
we started the ascent of Marienbergloch. The pack,
now miles long, could be seen snaking its way up
the climb which kept pitching up steeper and
steeper. The sun shone and the views were
beautiful; it was hard to remember that we were
supposed to be racing.
Stage 2 - Throughout the night rain drummed
down on the gymnasium roof - not a good omen
for the tougher day ahead. The rain stopped and
we set off for the ascent of Venetaim - 3170m and
a distance of 76km. The top was cold and covered
in mist. The fast descent on forest roads was
followed by another steep ascent to Pillerhoehe.
This descent was technical (slippery roots and
loose rocks) and down the historical Via Claudia, a
2000 year old roman-built road, which for
centuries was the main commercial route across
the Alps transporting wine, olive oil and oysters
from the Mediterranean. It is now a perfect biking
route with stunning views and historical sites.
Nearing the top of the ski lift, the trail turned left
and pitched up to 25% heading to a notch in the
peaks above the ski runs. The leaders road this
section but the rest of us were off our bikes and
walking! The thinner air at 2000m, and pushing
The final 20km trail and dirt roads up the valley to
Ischgl seemed endless. We had enjoyed sun and
light cloud during the day but 6 riding hours and
tired legs later, dark storm clouds came upon us,
closely followed by hail. Being wet through, cold
1800 m
1700 m
1600 m
1500 m
1400 m
1300 m
1200 m
1100 m
1000 m
900 m
800 m
700 m
600 m
500 m
400 m
300 m
200 m
100 m
0m
Mark Wevill
and hungry and eager to get to Ischgl, we rode
through the hail passing other cyclists huddled
under the trees.
Read the whole detailed story with stage route
maps at www.bausch.co.uk/charity
Marienbergloch
Marienberglalm
Lermoos
Reutte
Fussen
Nassereith
Ehrwald
Heiterwang
Strad
Imst
Hohenschwangau
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80.1 km
Day 1 (Stage 1) Fussen to Imst
Sightsavers International is a registered UK charity (Registered charity numbers 207544 and SC038110) that
works in more than 30 developing countries to prevent blindness, restore sight and advocate for social inclusion
and equal rights for people who are blind and visually impaired. Since 1950, Sightsavers has restored sight to
more than 5.65 million people and treated over 100 million more. Donations to support Sightsavers' work can be
made using the 24-hour donation line 0800 089 2020 or via their website www.sightsavers.org
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Page 08
HEALTH
08
Proven performances in
soft lens care
Fresh lens comfort and eye health with silicone hydrogel
contact lenses.
It is essential that eye care
professionals are able to recommend
an effective lens care system for
silicon hydrogel lenses that delivers
comfort and maintains health. In this
study, we consider the patients’
rating of lens care systems for
comfort and eye health.
End-of-day
cleanliness
End-of-day
comfort
6.7
Fresh Lens Comfort
When recommending care regimens for
silicone hydrogel lenses, it is necessary to
consider performance in real world situations,
such as when patients switch from one care
system to another.
End-of-day
cleanliness
6.7
End-of-day
comfort
6.7
In this multi-site study, 45 independent
clinicians enrolled OPTI-FREE Express and OPTIFREE RepleniSH subjects who were wearing
silicone hydrogel lenses (Bausch & Lomb
PureVision® contact lesnses, CIBA Night & Day,
CIBA AirOPTIX, ACUVUE Advance, and ACUVUE
Oasys). Using a 10-point Likert scale, subjects
(201 OPTI-FREE Express and 187 OPTI-FREE
RepleniSH) rated their habitual lens care
solution on a variety of performance
attributes.
After two weeks of using ReNu® MultiPlus®
solution with a rub regimen, subjects rated
ReNu® MultiPlus® solution on the same
attributes and participated in a forced choice
preference questionnaire. Figure 1 presents the
average rating results for performance
attributes associated with the ‘end-of-day’ time
point. The results indicated that Opti-Free
Express and Opti-Free RepleniSH users rated
ReNu® MultiPlus® significantly higher for ‘endof-day’ cleanliness (lenses feel fresh and clean
at the end of day) and ‘end-of-day’ comfort
(lenses feel comfortable at the end of the day),
in both the subjective ratings (Figure 1) and in
the forced choice preference (Figure 2).
These results are particularly significant, since
patients generally have the most complaints
towards the end of the day.
Patient Ratings
7.3
6.8
7.3
7.3
7.3
4.0
5.0
6.0
7.0
Ratings (over all visits) 0 = totally disagree 10 = totally agree
ReNu Multiplus®
Opti-Free Express
8.0
Opti-Free RepleniSH
Figure 1
Patient Preference
End-of-day
cleanliness
61.5%
38.5%
End-of-day
comfort
62.2%
37.8%
End-of-day
cleanliness
61.5%
38.5%
End-of-day
comfort
61.3%
38.7%
30%
40%
®
ReNu Multiplus
Figure 2
50%
Opti-Free Express
60%
70%
Opti-Free RepleniSH
B+L Newsletter 3rd edition:Layout 1
30/10/08
07:30
Page 09
HEALTH
09
Proportion of eyes by grade of slit lamp findings
Events
Opti-Free Express at Initial Visit ReNu Multiplus® after 2 Weeks
Grade
Events
0
1
2
3
4
0
1
2
3
4
Grade
Epithelial Edma
92.7
6.8
0.5
-
-
96.3
3.7
-
-
-
Epithelial Microcysts
96.8
3.3
-
-
-
99.0
1.0
-
-
Corneal Staining
76.8 19.8
3.5
-
-
80.1 14.7
4.2
Limbal Injection
69.5 25.3
5.3
-
-
71.4 25.6
Bulbar Injection
69.0 23.5
7.5
-
-
Tarsal Conj. Abnormalities 69.1 24.9
6.0
-
Neovascularization
77.4 18.6
4.0
Corneal Infiltrates
98.2
-
Grade
1 = Trace
0 = None
1.8
Opti-Free Express at Initial Visit ReNu Multiplus® after 2 Weeks
0
1
2
3
4
0
1
2
3
4
Epithelial Edma
92.5
7.0
0.5
-
-
96.3
3.7
-
-
-
-
Epithelial Microcysts
96.5
3.2
0.3
-
-
99.5
0.5
-
-
-
1.0
-
Corneal Staining
76.1 18.0
5.9
-
-
78.9 16.0
5.1
-
-
3.0
-
-
Limbal Injection
63.9 30.5
5.6
-
-
69.3 27.8
2.9
-
-
70.6 23.6
5.7
-
-
Bulbar Injection
63.4 27.5
9.1
-
-
66.3 27.5
5.9
0.3
-
-
68.8 27.3
3.0
1.0
-
Tarsal Conj. Abnormalities 60.2 33.7
5.6
0.5
-
65.0 32.1
2.9
-
-
-
-
83.5 13.5
3.0
-
-
Neovascularization
82.4 16.6
1.1
-
-
86.4 12.6
1.1
-
-
-
-
99.8
-
-
-
Corneal Infiltrates
99.2
-
-
-
100
-
-
-
2 = Mild
3 = Moderate
Figure 3
Professionals who prescribe
silicone hydrogel lenses for
their patients can
confidently recommend
Bausch & Lomb ReNu®
MultiPlus® solution.
Slit lamp evaluations were conducted at the
initial visit and at two weeks (study completion).
Health
Figure 3 and 4 summarise the proportion of
eyes by grade of slit lamp findings. Overall,
the proportion of eyes with grade 2 or greater
findings was equivalent between the OptiFree
solutions and ReNu® MultiPlus®.
These findings indicate that Bausch & Lomb
ReNu® MultiPlus® solution, which offers fresh
and clean feeling lenses and end of day
comfort, also helps maintain eye health.
Conclusion
It is essential that eye care professionals are
able to recommend an effective care system
that delivers comfort and health with silicone
hydrogel lenses. Bausch & Lomb ReNu®
MultiPlus® solution is an excellent choice.
Based on the data, eye care professionals who
prescribe silicone hydrogel lenses for their
patients can confidently recommend Bausch &
Lomb ReNu® MultiPlus® solution.
0.3
0.8
-
4 = Severe
Figure 4
®
®
ReNu MultiPlus
ReNu® MultiPlus®
multi-purpose solution
Fresh Lens comfort.
It is the only multi-purpose solution
that contains HYDRANATE®, a clinically
proven ingredient that removes protein
deposits while you clean your lenses.
Giving you exceptional cleaning,
ReNu® MultiPlus® offers superior
disinfection against a broad range
of micro-organisms to help ensure
your patients are compliant
with lens care.
B+L Newsletter 3rd edition:Layout 1
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07:30
Page 10
PHARMACEUTICALS
10
®
Lotemax - a new solution
Loteprednol etabonate in the treatment of post-operative ocular inflammation.
Carlos Pavesio gives an outline of the
treatment of ocular inflammatory conditions
with Loteprednol etabonate (LE) and provides
evidence from clinical studies on the efficacy
and safety of LE in the treatment of postoperative ocular inflammation.
Introduction
Ocular inflammatory diseases affect a significant
proportion of the population. The incidence
in developed nations has been estimated at
15-20%2, although other studies have suggested
that the actual number might be double this
figure. Such a high incidence imposes a
significant medical and economic burden on
society. In the USA, prescription costs alone for
ocular medication are over $200 million.3 In the
UK, the RNIB estimates that the costs associated
with sight loss are in the region of £4.9 billion
a year4, whilst more comprehensive studies
from Australia indicate that vision disorders cost
an estimated 0.6% of GDP.5
When treating ocular inflammatory conditions,
ophthalmologists rely on corticosteroids for their
overall effectiveness in reducing intraocular
inflammation in the anterior segment, as well
as to relieve symptoms.6 However, despite their
clinical advantages, corticosteroids can cause
undesirable side effects.7 When administered
topically to the eye, these side effects include
increases in intraocular pressure (IOP), induction
or exacerbation of glaucoma, cataract formation,
decreased resistance to infection and decreased
wound healing.7
The objective of all drug development is to have
an improved therapeutic index, i.e to maximise
the therapeutic response whilst minimising
adverse effects. The ester corticosteroid
loteprednol etabonate (Lotemax®) has been
specifically designed for ocular use.8 Although
In the UK, the RNIB
estimates that the
costs associated with
sight loss are in the
region of £4.9 billion
a year.
structurally similar to prednisolone, Lotemax®
has a substitution of an ester for the ketone at
carbon-20. Lotemax® is highly lipophilic to allow
excellent penetration into the cornea and has a
4.3 fold greater affinity for steroid receptor
binding than dexamethasone in vitro.8 Since LE is
rapidly converted to an inactive metabolite, the
risk of systemic and local adverse effects is
minimised.8 Furthermore, Lotemax® may be
potentially less cataracterogenic than other
steroids, since it is the ketone group (absent with
Lotemax®) which has been implicated in the
formation of cataracts.1
The efficacy and safety of Lotemax® has been
evaluated in common ocular inflammatory
conditions including Keratoconjunctivitis sicca
(Dry eye syndrome), Anterior Uveitis, Seasonal
allergic conjunctivitis (SAC) and Giant Papillary
Conjunctivitis (GPC).6,9-11 The use of Lotemax® in
post-operative ocular inflammation has also
been demonstrated with great success.12,13
The treatment of post-operative
ocular inflammation with Lotemax®
Advances in surgical techniques in recent years
have significantly reduced the amount of physical
trauma associated with ocular surgery and
hence the degree of inflammatory response.14
Nevertheless, post-operative inflammation still
occurs as a result of prostaglandin release,
recruitment of neutrophils and macrophages,
and production of inflammatory mediators.15
Post-operative inflammation is most common
after cataract surgery16 and usually consists of
mild iritis and flare in the anterior chamber.13
Post-operative inflammation is commonly
treated with topical corticosteroids and NSAIDs.
Whilst corticosteroids offer the widest range of
anti-inflammatory effect, their use still causes
concern regarding the potential for raised IOP.13
The safety and efficacy of Lotemax® 0.5%
was evaluated in two identical studies in the
treatment of post-operative ocular inflammation
following cataract surgery.12,13 Patients were
randomised to receive LE or placebo four times
daily (approximately every 4 hours for 14 days)
and anterior chamber cells and flare were
measured. Results showed that anterior chamber
inflammation was resolved in significantly more
subjects receiving Lotemax®, compared with
Of a total of 901
patients who
received Lotemax®
for 28 days or longer,
only 15 patients
experienced
a significant rise
in IOP
placebo (p<0.001). Furthermore, the incidence of
clinically significant elevations in IOP (defined as
>_10 mm Hg) was similar in patients receiving
Lotemax® compared with placebo.
Incidence of intraocular pressure
elevation with Lotemax®
The incidence of elevated IOP with Lotemax®
has been compared with both placebo and
prednisolone acetate. In a review of studies in
which Loteprednol was compared with
prednisolone in different indications, Novack et
al17 found that out of a total of 901 patients
who received Lotemax® for 28 days or longer,
only 15 patients experienced a significant rise
in IOP (>_10mm Hg).17 When patients wearing
contact lenses were excluded owing to the
possible reservoir effect, the number of cases
of elevated IOP with LE reduced to 4/624
patients, or 0.6%, comparable with the 0.5%
incidence found with placebo (3/583).
The incidence of elevated IOP in patients
receiving prednisolone acetate, however, was
significant at 11/164 or 6.7%.17
In a comparative study of known steroid
responders, Lotemax® demonstrated a lower
incidence of clinically significant IOP rise
(>_10mm Hg) than prednisolone acetate 1%.18
After 6 weeks of QID dosing in known steroid
responders, the average IOP for patients treated
with Lotemax® remained lower (average of
20.0mm Hg) than that in patients receiving
prednisolone acetate 1% (average of
26.6mm Hg). The mean change from baseline in
IOP was not significant for Lotemax® at days 14,
28 or 42, whereas prednisolone produced
B+L Newsletter 3rd edition:Layout 1
30/10/08
07:30
Page 11
PHARMACEUTICALS
significant increases in IOP at all these time
points. Patients receiving Lotemax® had a
maximum IOP elevation throughout the study of
4.1mm Hg compared with 9.0mm Hg for
prednisolone.
11
W
Conclusion
Lotemax® was developed with the aim of
reducing the propensity for unwanted side
effects to a minimum, while providing maximum
anti-inflammatory efficacy. Clinical studies have
demonstrated the safety and efficacy of
Lotemax® across a wide range of steroid
responsive ocular inflammatory conditions.
Lotemax® exhibits its anti-inflammatory action
immediately after application and is then
converted to an inactive metabolite, thus
ensuring minimal risk of systemic absorption.
Studies of IOP elevation have found no
significant difference in the number of patients
exhibiting a >10 mm Hg increase in IOP with
Lotemax®, compared with placebo. Furthermore,
any increases in IOP with Lotemax® were
significantly and consistently lower than with
prednisolone acetate.
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Based on the original article published in the
British Journal of Ophthalmology, May 2008
by C E Pavesio, Moorfields Eye Hospital,
London, UK and H H DeCory, Bausch & Lomb
Inc., Rochester, NY, USA1
For further medical information on Lotemax®
please contact us on 01748 828864
Lotemax® is a registered trademark of Bausch & Lomb Inc
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Prescribing Information can be found on the
adjoining Lotemax® advertisement.
References
1. Pavesio CE, DeCory HH. Treatment of ocular inflammatory
conditions with loteprednol etabonate. Br J Ophthalmol
2008:92:455-9.
2. Butrus S, Portela R. Ocular allergy: diagnosis and
treatment. Ophthalmol Clin North Am 2005;18:485–92.
3. Bielory L. Update on ocular allergy treatment. Expert Opin
Pharmacother 2002;3:541–53.
4. AMD Alliance International. 2005 Country Report UK.
Awareness of Age-related Macular Degeneration and
Associated Risk Factors.
5. Eye Research Australia. Clear Insight. The economic impact
and cost of vision loss in Australia. Access Economics Pty
Limited. August 2004. http://www.cera.org.au/
publications/clear_insight.html, accessed 14 July 2008.
6. Loteprednol Etabonate US Uveitis Study Group. Controlled
evaluation of loteprednol etabonate and prednisolone
acetate in the treatment of acute anterior uveitis. Am J
Ophthalmol 1999;127:537–44.
7. Carnahan MC, Goldstein DA. Ocular complicationsof topical,
peri-ocular, and systemic corticosteroids. Curr Opin
Opthalmol 2000;11:478-83.
8. Noble S, Goa KL. Loteprednol etabonate: clinical potential
in the management of ocular inflammation. BioDrugs.
1998;10:329-39.
9. Bartlett JD, Howes JF, Ghormley NR. Safety and efficacy of
loteprednol etabonate for treatment of papillae in contact
lens-associated giant papillary conjunctivitis. Curr Eye Res
1993;12(4):313-321
10. Asbell P, Howes J. A double-masked, placebo-controlled
evaluation of the efficacy and safety of loteprednol
etabonate in the treatment of giant papillary
conjunctivitis. CLAO J 1997;23:31–6.
11. Friedlaender MH, Howes J. A double-masked, placebocontrolled evaluation of the efficacy and safety of
loteprednol etabonate in the treatment of giant papillary
conjunctivitis. Loteprednol Etabonate Giant Papillary
Conjunctivitis Study Group I. Am J Ophthalmol
1997;123:455–64.
12. Stewart R, Horwitz B, Howes J, et al. Double-masked,
placebo-controlled evaluation of loteprednol etabonate
0.5% for postoperative inflammation. Loteprednol
Etabonate Post-operative Inflammation Study Group 1.
J Cataract Refract Surg 1998;24:1480–9.
13. Loteprednol Etabonate Postoperative Inflammation Study
Group 2. A double masked, placebo-controlled evaluation
of 0.5% loteprednol etabonate in the treatment of
postoperative inflammation. Ophthalmology
1998;105:1780–6.
14. McColgin AZ, Heier JS. Control of intraocular inflammation
associated with cataract surgery. Curr Opin Opthalmol
2000;11:3-6.
15. El-Harazi SM, Feldman RM. Control of intra-ocular
inflammation associated with cataract surgery. Curr Opin
Opthalmol 2001;12:4-8.
16. Schmeier J, Halpern M, Covert D, et al. Evaluation of
Medicare costs of endophthalmitis among patients after
cataract surgery. Opthalmology 2007;114:1094-9.
17. Novack GD, Howes J, Stephens Crockett R et al. Change in
intraocular pressure during long-term use of loteprednol
etabonate. J Glaucoma 1998;7:266-9.
18. Bartlett JD, Horwitz B, Laibovitz R et al. Intraocular
pressure response to loteprednol etabonate in known
steroid responders. J Ocular Pharmacol 1993;9:157-165.
BLNLA-4-2008, date of preparation September 2008
6YkZghZZkZcihh]djaYWZgZedgiZY#GZedgi^c\[dgbhVcY>c[dgbVi^dcXVcWZ[djcYVilll#nZaadlXVgY#\dk#j`#6YkZghZZkZcihh]djaYVahdWZgZedgiZYid7VjhX]AdbWJ@AiYdc%&,)--'--+)#
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PRESBYOPIA SPECIAL
12
®
Crystalens provides optimal
visual quality
The American refractive surgeon, Dr. Uday Devgan, is enthusiastic
about the new generation Crystalens® (‘Five 0’).
Dr. Devgan has gained broad
experience with the Crystalens® AT50, simply known as the ‘Five 0’. “The
AT-50 is the successor to the AT-45”,
explained Dr. Devgan. “The name
refers to the diameter of the optic. In
the new lens, this is 5.0 mm.
However, it performs just as well as a
regular 6mm lens because it is
positioned deeper within the eye.
There is, therefore, no difference in
terms of spherical aberrations.”
For four days a week, Dr. Devgan works at the
Maloney Vision Institute, a highly acclaimed
private clinic in Los Angeles. During the past
two years he has carried out approximately one
thousand procedures with the Crystalens® AT-50.
During the 9th Refractive Surgery Symposium of
the NGRC, which took place on 24 May at the
VU University Medical Centre in Amsterdam,
Dr. Devgan was unable to hide his enthusiasm.
“The Crystalens® provides optimal visual quality.”
His patients are extremely
satisfied with the
Crystalens® The most
famous amongst them is
actor Henry Winkler, better
known as The Fonz.
During his lecture, Dr. Devgan provided a few
keys to successful refractive cataract surgery. The
choice of the lens with optimal visual quality is
one of these keys. Just as important is that the
expectations of the patient are surpassed.
“I make it clear to patients, in advance, that they
will be able to see better but that I am unable to
give them the eyesight of a 21-year old. In terms
of the Crystalens®, I also tell them that, in certain
conditions such as when there is little light, they
will possibly still require reading glasses.”
After his lecture, Dr. Devgan admitted to
following the same strategy when informing
colleagues. “I know many American colleagues
who work with the Crystalens®. They have the
same experiences as I do, and often even
better. I actually prefer not to exaggerate my
accomplishments. I want to prevent my
patients’ expectations from being too high and
I do the same with my colleagues. Some of
them say: ‘In his lecture, Dr. Devgan provided
statistics with regard to sharp near-vision, but
if I use the Crystalens®, the results are even
better!’ That makes them feel good.
Clinical trial
The Crystalens® is the only accommodating lens
implant to have received the approval of the
FDA. A clinical trial which lasted for two years
played a significant role in that approval. The
results achieved were 92% of the participants
saw 20/25 or better for distance, 96% saw
20/20 at arms length and 73% saw 20/25 for
near. All of which was without glasses or
contact lenses. The lens was also found to
perform excellently in daily activities 100% of
study subjects could see their computer screen
and the dashboard well, they could read prices
in the supermarket or apply their make-up.
98% could read the telephone directory or the
newspaper, once again without any aid. Only
one individual reported problems with glare,
Henry Winkler - The Fonz
halos or night vision. “The most important thing
that you are able to offer patients is visual
quality” stated Dr. Devgan. “People want to be
able to read or work on the computer without
having to wear glasses. However, even more
important is sharp and clear vision, good
contrast sensitivity and being able to observe
subtle colour differences all of which without
Crystalens®
Crystalens HD™
in “High Definition”
Available in the UK
April 2009
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PRESBYOPIA SPECIAL
13
Dr. Uday Devgan
unwanted side effects. Multifocal IOL lenses
result in traditional glare, halos and other visual
effects. A multifocal IOL lens is always a
compromise: reduced visual quality, the
objective being to improve the sharpness of
near vision. Most patients find this unacceptable
if they are instead able to opt for an
accommodating lens.”
Accommodation of the Crystalens® is enabled by
the unique hinges, which allow the ocular
muscle to move the optic forwards and
backwards when focusing. “The lens is
designed by analogy with the human eye. The
Crystalens® works just as well as the healthy
lens of a 40-45 year old. Somebody of that age
who has never needed to wear glasses, has
good distance vision, can work at the computer
and also read without reading glasses. An
eleven-year-old can read a book while the
letters are touching his nose. Somebody who is
40 years old has to hold the book a little
further away because the ability to focus
reduces as the age advances.”
Higher level of surgery
The Crystalens® has been implanted
approximately 100,000 times throughout the
world, especially in the US. “The use increases
every quarter. In the US, three ‘premium’ lenses
are available: two multifocal lenses and one
accommodating lens. Three years ago, the
Crystalens® only had a small share of that
market; 3% to 5%. The Crystalens® currently
has the second largest market share; 30% to
40% percent. Within the not too distant future,
it will be at number one. The popularity is
forever growing.”
Dr. Devgan expects that there will also be
considerable growth in the use of this
accommodating lens in Europe. “Part of the
challenge is that the surgery will differ. When
implanting a multifocal lens, the surgery is
identical to traditional cataract surgery, with an
“old fashioned” silicon lens. An accommodating
lens, such as the Crystalens®, is relatively large.
That demands a higher level of surgery. A larger
capsulorhexis opening is needed. It is not a lens
for relatively new surgeons. However, an
experienced ophthalmologist who has carried
out around a thousand cataract procedures will
learn this procedure in five to ten operations.”
The Stellaris® renders good service during these
operations. “Of the thousand Crystalens®
procedures, I have performed the majority of
them with the Stellaris®. At the clinic I have all
possible options available to the patient. We can
perform every surgical procedure that can
improve the sight from LASIK to premium lenses,
and everything in between. We take everything
into consideration and ultimately provide the
patient with individual advice. We also have four
phaco machines available. However, I use the
Stellaris® far more often than the other
machines. Why? The Stellaris® offers a higher
level of safety and is very efficient.”
Dr. Devgan speaks particularly highly of the
EQ Fluidics Management Technology, which
creates an ideal balance between aspiration and
irrigation. “The greatest risk is that I break the
patient’s capsule during surgery, in which case
I would be unable to implant the lens. The
balance of the fluidics guarantees stability in
the eye. Furthermore, everything works equally
“I use the Stellaris® far more often than the
other machines. Why? The Stellaris® offers a
higher level of safety and is very efficient.”
well from the updated handpiece to the tubing.
The tubing system is particularly exceptional.”
Satisfied patients
The customer is ‘king’ at the Maloney Vision
Institute in Los Angeles. Those who wish to
receive a ‘normal’ lens will be given one.
“However, experience shows that more than
90% of my patients opt for a premium lens. This
is almost always the Crystalens®. Sometimes I
implant a multifocal lens. Most patients are well
educated and carry out substantial advance
research. Sometimes somebody will say ‘Under
no circumstances do I wish to wear reading
glasses and it doesn’t matter if I can see a glare,
halos or other effects.’ I would then implant a
multifocal lens. However, most patients do not
wish to lose visual quality. They want the
optimal visual quality that is conceivable and do
not mind if, in particular circumstances, they will
perhaps require reading glasses.”
His patients are extremely satisfied with the
Crystalens®. The most famous amongst them is
actor Henry Winkler, better known as ‘The Fonz’.
At www.maloneyvision.com, Winkler is full of
praise about the Crystalens® and his
ophthalmologist: “Devgan is my hero!”
Dr. Devgan added to this that he did not pay
Winkler for the video. “He is just very
enthusiastic, amongst other things, about the
colours, which he experiences as being very
vivid.” Dr. Devgan has no doubt that the
accommodating lens will become the norm
across the world.
“The ideal lens is that of a youngster. This has
sharp vision at all distances, without glasses,
with the very best visual quality. That is what
we must try to imitate. I am in no doubt that, in
five or ten years time, we will have even more
choice and will have fantastic accommodating
lenses available to us. It is possible that, by
then, they may even come close to the eyesight
of a 21-year old.”
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PRESBYOPIA SPECIAL
14
Too young for reading glasses?
Two very experienced and influential practitioners, Optometrist Susan
Bowers from the West Midlands and Contact Lens Optician Andrew
Watson from Ashington Northumberland, give an overview on their
experiences fitting patients with PureVision® Multi-Focal.
With an undeniable
expansion in the presbyopic
market, multifocal contact
lenses provide an attractive
opportunity to grow your
practice. This is highlighted
Susan Bowers
in an independent study of
BSc(hons),
50-60 year old spectacle
FCOptom, Dip CLP, wearers, of whom 51%
Dip Tp AS, FBCLA claimed they did not know
enough about contact lenses and 32% agreed
that they found wearing spectacles
uncomfortable.1
Susan Bowers states “I would never fit monovision
contact lenses as I prefer to maintain good
binocular vision for my patients. Just like varifocal
spectacles the younger the patient, the better they
can adapt to something new. The biggest problem
I find fitting the presbyopic patient with contact
lenses is that they may exhibit dry eyes, thus
resulting in a reduced wearing time.
In my experience, the presbyopic hypermetropic
patients much prefer extended wear if they do not
suffer from dry eyes. This results in the patients
feeling ten years younger as they can see the
time on their watch, text on their mobile and can
read microwave food instructions.
Over the years, I have found that if the patients’
astigmatism is 0.75D cyl or less they can change
over to centre-near design (PureVision® MultiFocal) easily with a little help and encouragement.
The high reading addition that is available can
occasionally reduce the distance acuity by one line,
although adding an extra -025D to distance helps
compensate for this. However, enthusiastic patients
who become more presbyopic can initially cope
with the high add and are delighted with the fact
that they no longer need reading spectacles.
I have always been a big advocate of corneal
health and maximum oxygen delivery to the
cornea, and prescribe silicone hydrogel contact
lenses because they give the most oxygen to the
cornea. Many of my first contact lens patients
have become presbyopic and so half my time is
spent working with the over 45 age group.
PureVision® Multi-Focal was the first silicone
hydrogel multifocal and still is the only multifocal
available for daily, flexible or extended wear.
I personally hate to have to wear reading
spectacles, so I can fully understand how my
patients feel. When patients reach the age of
45 they can delay visiting their Optometrist because
they find it hard to come to terms with the ageing
process and the need for reading spectacles. I
always ask new presbyopes if they would prefer
reading spectacles or contact lenses.
This is important as patients should
be aware of the options available to them
as I find that about 25% will consider trying
contact lenses instead of spectacles
for reading.
I feel that it is a great practice builder to fit
patients with such lenses as they will tell all
their friends. I recently fitted an interior
designer who has personally recommended a
dozen of her friends, family and clients as she
is so delighted with the performance of her
new multifocal contact lenses.
Case Study One
Case Study Two
Optician: Susan Bowers
Male, age 51
History: Mr J is a high myope who drives 30,000 miles a
year and uses the computer, on average, two and a half
hours per day. He is an asthma sufferer with relatively
steep corneas. Before he became presbyopic he changed
from wearing RGP lenses from his mid teenage years to
PureVision® 8.6 in 2003.
Refraction: Rx RE -7.75/-0.75 x 10 V/A 6/6-1 Reading
Add +1.50 N5
LE -10.00/-1.25 x 175 V/A 6/6-1 Reading Add +1.50 N5
Contact Lens Fitting:
PureVision® Multi-Focal: Diameter 14.00 Base Curve 8.6
Power: RE -9.00 V/A 6/9 High Add (wore the low add for the first year)
Power: LE -10.00 V/A 6/9+2 High Add
Binocular vision 6/6-2 N5
Outcome: This patient had a tendency to rub his eyes when he wore the RGP
lenses and the photographs show all the small haemorrhages. He has no
haemorrhages wearing PureVision® and his 3 and 9 o’clock staining has
disappeared. The patient stated “They are fantastic for comfort and
convenience. I don’t need to take my lenses out at night anymore and I can
dispense with my reading glasses.” The patient reported he was happy with his
vision regardless of his astigmatism.
Optician: Susan Bowers
Female, age 64
History: Ms H is a teacher of the piano and organ who
sings in a cathedral choir. She started wearing varifocal
spectacles in 1999. She drives 13,000 miles per year and has difficulty reading
the music that she sings. When wearing her varifocal spectacles she has to lift
her head to see the music. She works on a computer three hours per day. Her
hobby is bird watching.
Refraction: Rx RE -3.75/-0.75 x 170 V/A 6/6 Reading Add +2.25
LE -4.25/-1.00 x 170 V/A 6/6 Reading Add +2.25
Contact Lens Fitting:
PureVision® Multi-Focal: Diameter 14.00 Base Curve 8.6
Power: RE -4.75 V/A 6/6-1 High Add
Power: LE -5.00 V/A 6/7.5 High Add
Binocular vision 6/6-2 N5
Outcome: This patient has meibomian gland dysfunction with telangiectasia.
She uses lid scrubs daily and has managed to wear her lenses, during the
day, since 2005. She uses re-wetting drops twice a day, morning and evening
and also applies hot compresses to her eyelids. The eyelids have responded
to three years of treatment. The patient is happy with the lens and
especially when reading sheet music.
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PRESBYOPIA SPECIAL
Near Vision Chart
15
Andrew Watson explains his
personal journey on why he
came to fit PureVision®
Multi-Focal contact lenses.
“After a CET event I got
Andrew Watson
talking to some other contact
FBDO CL
lens practitioners, and it
seemed most of us fitted daily disposables to
the majority of our patients and most were
fitting a patient demographic nearly devoid of
presbyopes. I raised this issue and the
justification as to why they were avoiding fitting
the over 40’s with anything other than monovision or distance contacts and reading
spectacles. The responses I was given were
“they don’t work”, “too time consuming”,
“too expensive” and “too complicated”.
I had similar thoughts myself, although I had
a reasonable amount of success with
multifocal contact lens fittings. However, I felt
it was still a bit ‘hit and miss’. This was until
I tried using Bausch and Lomb PureVision®
Multi-Focal contact lenses. When I heard that
this optical design was available in the
Please contact your
local representative
for details on the
Presbyopia Practice
Resource Kit.
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PRESBYOPIA SPECIAL
silicone hydrogel PureVision® material, I thought
this was great. It solves any challenges with
oxygen transmissibility I had with the SofLens®
Multi-Focal material but retains the excellent
optics of the SofLens® Multi-Focal that had an
excellent track record. The PureVision® MultiFocal has two reading addition profiles, Low for
early presbyopes and High for older presbyopes;
a simple but quite powerful system.
What has been a revelation is that I’ve found
only a few fits require more than a total of 3
lenses to achieve a satisfactory result, rarely
requiring more chair time than a single vision
lens fitting.
Patients in this visual arena want good
functional vision and convenience. I feel this is
16
exactly what PureVision® Multi-Focal offers.
Such patients want to work, shop, drive, play
sports, eat out, and use computers; none of
these are a problem for this lens.
Our practice is in an old mining town, where
there are socio-economic factors that would
lead you to believe that “low-cost” rules but
most of our contact lens dispensing involve
lenses of a high calibre and thus a higher cost.
Therefore, in our practice we have a saying that
“patients are NOT price driven but value
conscious” and this seems to be the case with
the multifocal lenses that we dispense.
A lot of new fittings come from
recommendations of our existing multifocal
wearing patients. It would seem you could
not find a better advocate than a contented
contact lens wearer.”
“In our practice we have
a saying that ‘patients
are NOT price driven but
value conscious’ and this
seems to be the case
with the multifocal lenses
that we dispense.”
Reference
1 *Vision corrected 50-60 year olds EU, Independent study,
Consumer A&U 2006, Simpson Carpenter Ltd
Case Study Three
Case Study Four
Optician: Andrew Watson
Male, age 62
History: Mr S is a retired general practitioner. He previously tried
daily disposables 5 years ago and did not proceed with them as he
felt the vision was not good enough. He occasionally does locum
work. He enjoys sailing and skiing.
Refraction: Rx RE -0.75 DS V/A 6/5 Reading Add +2.25 N5
LE -2.00/-0.25 x 50 V/A 6/5 Reading Add +2.25 N5
Contact Lens Fitting:
PureVision® Multi-Focal: Diameter 14.00 Base Curve 8.6
Power: RE -0.50 High Add
Power: LE -2.00 High Add
Initial Binocular VA 6/6-2 and N6
Outcome: At the follow up visit the VA had improved to 6/5 and N5
and the patient reported this improvement happened within 48 hours
of using the lenses. Comfort was excellent and he had slept in the
lenses for 2 consecutive nights whilst away for the weekend without
any issues. No over refraction was found and the patient went on to
wear lenses as initially prescribed. He wears them for flexi-wear
(occasional overnight wear).
Optician: Andrew Watson
Female, age 44
History: Ms C is a long-term contact lens wearer of lenses for DV
correction, NV problems now starting to cause issues. Previously tried
monovision but this was not tolerated by the patient. The concept of
continuous wear appealed to the patient.
Refraction: Rx RE –2.50 / -0.25 x 100 6/5 V/A 6/5 Reading Add +1.25 N5
LE –2.25 / -1.00 x 88 V/A 6/5 Reading Add +1.25 N5
Contact Lens Fitting:
PureVision® Multi-Focal: Diameter 14.00 Base Curve 8.6
Power: RE -2.00 Low Add
Power: LE -3.00 Low Add
Initial Binocular VA 6/5 and N5
Outcome: At the follow up appointment the patient is overjoyed with
the lenses as they are more comfortable, more convenient and give
good vision at all distances. The fact the lenses cost more than her
previous lenses was not even a concern. No over refraction was found
and the patient carried on with the lenses as initially prescribed.
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EDUCATION
17
The Bausch & Lomb Academy of
Vision Care™ website goes live!
Bausch & Lomb is the eye health company dedicated to ‘Perfecting Vision. Enhancing Life.™’ and
we are pleased to announce the launch of the Bausch & Lomb Academy of Vision Care™
continuous education and development website www.academyofvisioncare.co.uk
The website also includes a news section,
a people page (including a link to careers
at Bausch & Lomb in the UK and Europe),
a resources page including key industry web
links, a product image bank, photo library
and educational tools for ordering.
This easy to navigate website has been
specifically designed to provide eye care
professionals with practical and experiencebased learning resources and tools that
address day-to-day practice and business
challenges.
This website will be the portal for all
education initiatives for the Bausch & Lomb
Academy of Vision Care™ and caters for eye
care practitioners, all students including those
undertaking their pre-registration year, and
practice support staff.
On the new site you will find:
Professional Education and Resources
CET accredited materials are available across a
wide range of important Vision Care topics and
our aim as the experts in eye health is to
provide and update practitioners with relevant
and topical CET materials on a regular basis.
Support Staff Resources
We recognise that a knowledgeable practice
team is essential. This site provides useful and
practical materials written by Sarah Morgan for
Bausch and Lomb, to assist training and
development of practice support staff to
enhance customers’ experience.
Student Education and Resources
We believe that great students are the future
of the Vision Care industry. This section of the
website is dedicated to providing support to all
students, trainee contact lens opticians,
undergraduate and pre-registration
optometrists through invaluable tools and
resources.
The academyofvisioncare.co.uk website will
ensure that Academy members will be the first
to be informed when new and updated CET
and support materials become available, and
will also automatically alert them of the latest
technological and scientific breakthroughs from
Bausch & Lomb.
This website will
be the portal for all
education initiatives
for the Bausch &
Lomb Academy of
Vision Care™
Events
The Bausch & Lomb Academy of Vision Care™
is committed to providing eye care professionals
with a range of educational opportunities, through
a variety of methods that are specifically chosen to
suit the busy and diverse lifestyles of our
colleagues.
Earlier this year, the Bausch & Lomb Lectures were
held in a series of successful 1 day CET events
across the UK. Developed through consultation
with key opinions leaders to communicate some of
the latest issues in contact lens practice, topics
include Presbyopia, Science of Compliance,
Nutritional Supplements and achieving optimal
vision for contact lens patients.
The academyofvisioncare.co.uk website will also
give members the first opportunity to sign up for
upcoming CET events. Finally, we welcome you and
your colleagues to join the Bausch & Lomb
Academy of Vision Care™ by registering on our
new website www.academyofvisioncare.co.uk
and we hope that you will continue to view the
Bausch & Lomb Academy of Vision Care™ as your
partner in continuous education and development.
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BAUSCH & LOMB IN FOCUS
18
The Bausch & Lomb story a history of innovation
Here we tell the story of how Bausch & Lomb developed from its humble
beginnings to become the global leader in eye health that it is today.
Historic Innovations
From family business to global leader
in eye health
As it approached its one hundredth anniversary,
Bausch & Lomb was poised in the balance
between past and future. Senior management was
still largely made up of members of the Bausch
and Lomb families.
Jacob Bausch and Henry Lomb
Sixty dollars and a handshake
In 1853, John Jacob Bausch opened a small shop in
the Reynolds Arcade in Rochester, New York.
Displayed in the window was an array of
spectacles, telescopes, microscopes and opera
glasses – all European imports sent by his brother
in Germany. After three years in business, Bausch’s
fledgling company was losing money and he was
in debt to his brother. Bausch turned to his friend,
Henry Lomb, who loaned him sixty dollars.
The two men shook hands on the deal, and Bausch
promised that if the business ever became
profitable, he would make Lomb an equal partner.
True to his promise, Bausch made Lomb an equal
partner and they renamed the firm “The Bausch &
Lomb Optical Company”.
Turbulent times, extraordinary
accomplishments
The year was 1905. Intent on proving that the United
States was ready to take its place as a work power,
President Theodore Roosevelt was building the ‘Great
White Fleet’. The U.S Navy’s gunsites had been
produced since 1896 by the Saegmuller Company,
which bought its lenses from Bausch & Lomb.
Bausch & Lomb purchased the Saegmuller Company
and moved its entire operation to Rochester, thereby
entering the field of optical measurement.
1861, J.J. Bausch’s revolutionary Vulcanite
eyeglass frames became the first great
success for the young company.
1903, the company had patented
microscopes, binoculars and a camera
shutter designed to mimic the workings
of the human eye.
1915, Bausch & Lomb produced the first
optical quality glass made in the US.
In the late 1940s and 1950s, Bausch & Lomb
returned to its well-established strengths and
redirected itself to research and development – a
decision that would take it in very new directions.
1937, developed ground breaking Ray-Ban®
aviator goggles for military pilots. They also
created the lenses for the cameras that took
the first satellite pictures of the moon.
Staying true to a vision
In World War II, 70% of Bausch & Lomb’s
production was for the military, providing
three million pounds of optical glass, aerial
mapping lenses, vision testers, binoculars,
range finders, periscopes, spotting scopes,
gas masks and improved Ray-Ban goggles.
Over the years, Bausch & Lomb has made, and
continues to make, a difference in the lives of
millions of people around the world because of the
products we make and our contributions to the
communities in which we work and live.
The respect and confidence eye care professional,
customers, employees, suppliers and investors
have in our Company and our products is rooted in
the hard work and integrity of the thousands of
people who have dedicated their professional lives
to our business throughout our history.
As we celebrate over 150 years in business, we
take pride in our heritage of scientific discovery,
technological innovation, quality and perseverance,
much as J.J. Bausch did nearly a century ago.
Bausch wrote, ‘Perseverance, industry, honesty,
and striving for knowledge have been my
maxims.’ In 1853, John Jacob Bausch and Henry
Lomb started a business with one purpose – to
improve the way people see. Today, in Bausch &
Lomb’s continuing dedication to ‘Perfecting Vision.
Enhancing Life.™’ around the world, the sprit of
the founders and of the many dedicated people
who have followed them through the long years of
the company’s history lives on.
Did You Know?
1952, Twentieth
Century Fox
released ‘The
Robe’, the first
movie shot using
Bausch & Lomb’s
CinemaScope
lenses. Three years later, the Motion Picture
Academy of America presented Bausch &
Lomb with an “Oscar” in honour of the
company’s contributions to the film industry.
1971, the company introduced the world’s
first soft contact lenses with 1 million
patients wearing them by 1974.
1998, launch of ReNu® MultiPlus® the
world’s first all-in-one contact lens
cleaning solution.
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LETTERS
19
Have your say...
In the last issue of Visions we invited your comments and letters. Thank you
for your response. Here is a small selection of the many we received.
Som Prasad
Frank Green
Arrow Park Hostpital
University of Aberdeen
“We have just returned from our latest visit
to Thailand which was our busiest yet. For
the first week Prof John Forrester was with
us teaching 2 of our senior eye medics
cataract surgery on our new microscope.
Our hope is that with time they may be able
to become independent cataract surgeons
although this is still a long way off.
We ended up doing almost 300 cases, the vast
majority cataracts. Once again we are indebted
to you for your help with your very generous
donation of IOLs. Your donation really makes a
big difference enabling us to carry out these
operations. Many of these patients are
completely blind from cataract, such is the
desperate lack of care available in Burma.”
Jeff Kwartz
Zak Koshy
Bolton General Hospital
Ayr Hospital
“I have just been reading 'Celebration - a
decade of the Akreos® IOL' in the summer
edition of Visions; I am really enjoying the
magazine. I have been using the Akreos® lens
since its launch, and the Hospital (Bolton
General) has probably implanted over 16,000
lenses in the last 8-10 years, with my own
team implanting 3,000.
“In January 2008, following the first trial of
the Stellaris® Vision Enhancement System, we
implanted the Akreos® Micro Incision Lens.
A total of 8 patients had the procedure, using
CMICS and the 1.8mm wound-assisted
technique for lens insertion.
It is my lens of choice in the private sector
because of its reliability, and I can honestly say
that we have had no problems with these
lenses. There have been no complaints and we
have very happy patients. As far as I know, not
one Akreos® lens has needed to be explanted
for glare or dysphotopsia...how good is that!"
I found the lens quick and easy to load, and it
centred beautifully in the eye. The surgery took
no longer than traditional surgery and there
were no complications.”
Zak Koshy
(pictured standing second from the left)
“I read the summer edition of 'Visions' with great
interest, especially the article about the Akreos®
lens and its evolution over the last decade.
Having used bimanual irrigation/aspiration for
years and being an advocate of splitting the
infusion from the aspiration wherever possible
(eg anterior vitrectomy), I was very interested in
trying Bimanual Micro Incision phaco (BMICS™)
when a lens became available which could be
implanted through a sub 2mm incision. I have
tried both BMICS™ and Coaxial Micro Incision
phaco (CMICS™) using the B&L Millennium and
both procedures work very well, although my
personal preference is for a bimanual technique.
The MI60 is easily implanted through a 1.8mm
incision following BMICS, or a 2.2mm incision
following CMICS, using the Millennium. It is a very
flexible lens, and therefore easy to handle in the
anterior chamber and capsular bag and it centres
very well. The capsule remains clear postoperatively. In certain patients who need
combined lens and vitrectomy surgery, this lens is
very stable even with deep indentation of the
sclera during the posterior segment procedure,
and there is no compatibility issue, even if silicon
oil has to be used. A few months ago I switched
to performing all my cases with BMICS through
two 1.6mm incisions with implantation of a MI60
IOL through a 1.8mm incision using a wound
assisted implantation technique as my standard
IOL. I have been very pleased with the results,
and patients are very happy with their outcome.”
Your opinion is greatly valued…
Do you have an interesting topical news
story to tell, or a worthy article that you
would like to share with the rest of the
readers. We would very much like to hear
from you. Please send your letters (including
your full name, email, postal address and
postcode) to Jill Collishaw, Visions Editor
at: [email protected] or by post
using the address on the back cover.
B+L Newsletter 3rd edition:Layout 1
30/10/08
07:30
Page 1000
Coming up in the winter issue...
Find out more about Bausch & Lomb's toric heritage,
the new coloured Minims® packaging, how we aid
Optometry giving sight and a new VR focus for 2009.
www.bausch.co.uk
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