The Bausch & Lomb story - a history of innovation€¦ · is ‘The Bausch & Lomb story – a history of innovation’. In 1853 John Jacob Bausch and Henry Lomb started a business

Life through my mother’s eyesCrystalens® provides optimal visual quality

Too young for reading glasses?

Autumn 08/Issue 03

The Bausch & Lomb story- a history of

innovation

B+L Newsletter 3rd edition:Layout 1 30/10/08 07:30 Page 1001

02

market has increased substantially in the lastyear, and the trend is set to continue. This isdriven by product innovation and the desire of‘young’ 40-50 year olds to live life spectaclefree. After all, 50 is the new 40!

More and more people are asking for products thatare not only comfortable and healthy for theireyes, but also provide a quality of vision that reallymeets their personal needs. Multifocal contactlenses provide an attractive opportunity to helpOptometrists create happy and loyal customers andgrow their business as a result. The article ‘Tooyoung for reading glasses?’ shares the experienceof two Optometrists who now routinely fit thePureVision® Multi-Focal in their practice.

We really appreciate your support of this quarterlymagazine and I am proud to announce that thenew ‘Letters’ page will be a regular feature. Thissection gives you the opportunity to ‘Have yoursay...’ and to read the thoughts and comments ofyour peers. As our valued partners in eye health,we hope that you will take the opportunity to joinus in developing this tool further so that it providesongoing value to the Ophthalmic and Optometriccommunities.

Best regards

Gareth Steer, General ManagerUK, Nordics, Netherlands

Dear ColleaguesThe cover story for the Autumn edition of ‘Visions’is ‘The Bausch & Lomb story – a history ofinnovation’. In 1853 John Jacob Bausch andHenry Lomb started a business with one purpose –to improve the way people see. Now 155 yearslater we are privileged to be able to continue inthe same spirit as our founders, as we strive toperfect the vision and enhance the lives of thepeople who use our products. With the treatmentof presbyopia very much a hot topic for bothOphthalmologists and Optometrists at themoment, this edition of ‘Visions’ devotes a wholesection of the magazine to covering presbyopia.

Earlier this year, Bausch & Lomb acquired eyeonics inc.,the highly innovative company that has developedwhat is still the only FDA approved accommodatingintraocular lens on the market - the Crystalens®. Thislens is not only used to restore vision in patients withcataracts, but also to correct presbyopia. The lens isdesigned to work with the natural functions of the eyeto achieve focus at all distances.

Crystalens® is the result of over 14 years ofresearch and development and has undergoneextensive clinical testing. To date, more than100,000 lenses have been implanted and theresponse from both eye care practioners andpatients has been extremely positive. In thearticle Crystalens® provides optimal visualquality’, hear how actor Henry Winkler, bestknown as The Fonz in ‘Happy Days’, benefittedfrom the Crystalens®.

The speciality contact lens market is alsogrowing rapidly. For example, the multifocal

“Multifocal contact lensesprovide an attractiveopportunity to helpOptometrists create happyloyal customers and growtheir business as a result.”

SCIENCE &TECHNOLOGY

Aberration-Freecataract surgery

HEALTH

Life through mymother’s eyes

PHARMACEUTICALS

Lotemax® -a new solution

PRESBYOPIA SPECIAL

Too young forreading glasses?

B&L IN FOCUS

The Bausch & Lombstory - a history ofinnovation

SCIENCE &TECHNOLOGY

Aberration-Freecataract surgery

HEALTH

Life through mymother’s eyes

PHARMACEUTICALS

Lotemax® -a new solution

PRESBYOPIA SPECIAL

Too young forreading glasses?

B&L IN FOCUS

The Bausch & Lombstory - a history ofinnovation

Inside this issue at a glance...


Product Update

Introducing ReNu® 'OnTheGo' pack - an exciting new product is brought to youby Bausch & Lomb to meet yourcustomers' busy lifestyle needs!

This special ReNu® MPS™ 'OnTheGo' pack ismade for going to the gym, participating insports, on a night out or those simply needingto carry ReNu® in their handbag.

Around half of EU citizens exercise at leastonce a month. Of these citizens, 11.9 millionare contact lens wearers who would greatlybenefit 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

• 1 Special 'OnTheGo' pouch - this ultraconvenient zipped pouch is ideal for carryingyour solution with you anywhere!

Order online at www.bauschonline.co.uk

ReNu® MPS™

OnTheGo pack

Millennium®

Vitrectomy Enhancer(MVE) with NEW 23 Gauge Solution

03PRODUCT UPDATE

EasySept®

Peroxide Solution Simple One Step System Bausch & Lomb has just launched new packaging for theEasySept® hydrogen peroxide contact lens solution andupgraded the consumer friendly lens case. The new look isdesigned to:

• Assist you in communicating the benefits of hydrogenperoxide 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!

New

The Millennium Microsurgical System with theMillennium Vitrectomy Enhancer (MVE) delivershigh-speed cutting now with 20, 23 and 25gauge cutters designed for superior aspirationperformance and better control. The optimalplatform for posterior segment surgery, MVEoffers versatile performance and exceptionalpatient outcomes.

The MVE offers surgeons:

Safety• The MVE delivers cut rates up to 2500cpm in 20G,

23G and 25G. Higher cut rates reduce retinaltraction, lowering the risk for iatrogenic retinaltears and increasing patient safety.

Efficiency• Optimised duty cycles, together with an increased

port size area promote faster tissue removal andhigher aspiration flow in all gauge sizes.

• Higher cut rates also reduce turbulence, whichenhances fluidic stability and predictability. As aresult, surgeons can cut closer to the retina withthe cutter itself, reducing the need to usescissors and forceps. With fewer instrumentexchanges surgeries can proceed more efficiently.

Versatility• The MVE 25G cutter features a rigid probe shaft

that enables surgeons to reach the anteriormargin. Increased shaft rigidity also enables awider variety of techniques due to better globemanipulation.

These benefits are delivered utilising a lightweight, ergonomic cutter that will be included inMillennium vitreoretinal procedure packs therebyoffering cost savings and streamlining yourordering process.


SCIENCE & TECHNOLOGY 04

Beginning the era of Aberration-Free cataract surgeryBy Roberto Bellucci and Simonetta Morselli, Ophthalmic Unit, Hospital and University of Verona, Italy

In addition, the hydrophilic acrylic material of theAkreos® series is the best material for theavoidance of photopsias.7

Advanced Optics (AO) lenses can be implanted inany eye, regardless of the optical conditions of thecornea and the IOL position inside the eye, with noimpairment of the optical aberrations present onthe corneal surface (Figure 1). With theseaberration-free lenses, the optical aberrations andquality in the implanted eyes can be anticipatedfrom corneal topography analysis. The question is:Does cataract surgery impair the optical charactersof the cornea? And if so, what can be done toimprove this?

MICS™ surgery and corneal optical aberrations From previous and recent studies we know thatthe optical properties of the cornea are changedby the 3.2mm incision performed for cataractsurgery.8,9 As for low-order aberration, there issome change in astigmatism (induced cylinder)that accounts for up to 1D in the meridian of theincision, with variable coupling effect. This changealso affects coma (3rd order aberration), as thecorneal flattening is asymmetrical and morepronounced near the incision site. Secondaryastigmatism and spherical aberration (4th order)are changed as well, making it impossible topredict the aberration outcome based on pre-operative assessment, even with aberration-correcting IOLs.

Tecnis Adv.Optics SA60WF-0.1

-0.08

-0.06

-0.04

-0.02

0

0.02

0.04

0.06

0.08 Corneal Ocular Internal

Spherical Aberration Z4 (0) 4mm Optical Zone

Mic

rons

Figure 1:

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 arecorrected only for their own spherical aberration,and not charged with an optical modification(negative spherical aberration) to correct a defectof another optical surface of the eye (the cornea).

Asphericity is lower than that of “hyperaspheric”lenses, and divided between the anterior and theposterior surface. As a result, their opticalbehaviour is independent from centration or tilt,and also from the optical properties of the corneaor from any other refractive surface of the eye.Photopsias are avoided because the anterior surfaceis more curved than that of aberrated lenses.

Among the many advancements observed afterthe year 2000, two outweigh the others - thecontrol of spherical aberration obtained bymodifying the profile of intraocular lenses andthe advent of micro incision cataract surgery (MICS™).

Hyperaspheric and aspheric intraocular lensesThe control of spherical aberration began withlenses designed with the purpose of counter-actingthe positive spherical aberration of the cornealsurface.1,2 I have termed these kinds of lenseshyperaspheric, which are also known as asphericaberrated IOLs. These lenses have a negativespherical aberration, an optical modification, whichaims to compensate for this opposite optical defectpresent on another refracting surface, the cornea.While early results in implanted eyes wereencouraging,3,4 some issues with these“hyperaspheric” lenses have arisen5,6 (a) the lensoffers good results only when centred without tilt;(b) results are affected by the lack of centration ofthe eye as an optical system; (c) results are poor ineyes with low positive spherical aberration of thecornea; (d) due to the flat anterior surface,photopsias are more common especially with low-power lenses; (e) the induction of coma is by nomeans lower than with spherical lenses.

To overcome these issues, a new lens design wasdeveloped with a perfectly aspheric optic, the


SCIENCE & TECHNOLOGY 05

Because of the optical impairment of the eyecaused by the cataract before surgery, theaberration-free technique can only be verifiedin two ways. The first way is a comparison ofcorneal topography between the pre-operativeand the post-operative, analysing the opticalaberration at different optical zones. Figure 2is an example of this comparison, indicatingno change in the aberration level at 6mmoptical zone. The second way is a comparisonof the aberration of the cornea with those ofthe entire eye in the post-operative. Figure 3is an example of this computation, againindicating the same aberration level for thecornea and for the entire eye.

ConclusionThe era of aberration control in cataractsurgery is here. We can select the proper intraocular lens for any specific eye, but thischoice will be of little value if we cannotcontrol the corneal aberrations, and we onlycan do so by reducing the incision size to lessthan 2mm. Then we can choose to implant theAkreos® MI60 IOL, and the aberration profileof the eye in pseudophakia will be theaberration profile of the cornea in the pre-operative. As the Akreos® MI60 IOL offers thesame results as the Akreos® Adapt AO lens,this technique has no disadvantages.

Advantages •optical improvement over spherical IOLs inevery implanted eye

•no need for patient selection•no dependency on the incision location•no negative effect of small IOL decentrationor tilt, and without the disadvantages ofhyperaspheric lenses

We believe that Aberration-Free cataractsurgery 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] [email protected]

Micro-incision cataract surgery made a clearrevolution in this area, because sub-2mmincisions allow the surgeon to performphacoemulsification without changing theoptical properties of the cornea.10,11 With bothBiaxial and Coaxial MICS™ we are now able tomaintain the astigmatism, the coma and thespherical aberration of the cornea in the post-operative, making it possible to predict theaberration outcome if the optical properties ofthe intraocular lens are known and maintainedafter implantation. With MICS™, the aim ofcataract surgery towards the least anatomicalimpairment comes to its endpoint, and we canspeak of “Aberration-Freephacoemulsification”. In a short time, MICS™surgery will be used routinely by mostophthalmic surgeons, especially because ofthe MICS™ Platform now provided by Bausch &Lomb, encompassing the new Stellaris®

system, new MICS™ instruments, and a newMICS™ intraocular lens – the Akreos® MI60 IOL.

Akreos® MI60 IOL and MICS™ for Aberration-Free cataract surgeryBy designing the Akreos® MI60 micro incisionIOL, Bausch & Lomb developed an intraocularlens with Advanced Optics that can beimplanted through 1.8mm incisions. This lenshas aberration-free aspheric surfaces, a thinoptic and haptics designed to counter balanceboth capsular bag contraction and vitreouspressure. After the first year of use, this lensshowed stability and optical performanceequal to the Akreos® Adapt AO lens i.e. offersthe same results as lenses designed to fit3.0mm incisions.

The combination of MICS™ phacoemulsificationwith the implantation of the Akreos® MI60 IOLresults in a particular type of cataract surgery:same surgical quality of standard surgeryusing 3.0mm incisions, but no opticalimpairment of the cornea by the incision, andno induction of optical aberrations by theintraocular lens. We have termed thiscombination “Aberration-Free cataract surgery”.

References

1.Holladay JT, Piers PA, Koranyi G, van der Mooren M,Norrby NE. A new intraocular lens design to reducespherical aberration of pseudophakic eyes. J Refract Surg2002;18:683-691

2.Packer M, Fine IH, Hoffman RS, Piers PA. Prospectiverandomized trial of an anterior surface modified prolateintraocular lens. J Refract Surg 2002;18:692-696

3.Mester U, Dillinger P, Anterist N. Impact of a modifiedoptic design on visual function: clinical comparativestudy. 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 contrastsensitivity comparison between Tecnis and AcrySofSA60AT intraocular lenses: A multi center randomizedstudy. J Cataract Refract Surg. 2005;31:712-717

5.Altmann GE, Nichamin LD, Lane SS, Pepose JS. Opticalperformance of 3 intraocular lens designs in thepresence of decentration. J Cataract Refract Surg2005;31:574-585

6.Bellucci R, Morselli S, Pucci V. Spherical aberration andcoma with an aspherical and a spherical intraocular lensin normal age-matched eyes. J Cataract Refract Surg.2007 Feb;33(2):203-209

7.Radford SW, Carlsson AM, Barrett GD. Comparison ofpseudophakic dysphotopsia with Akreos® Adapt andSN60-AT intraocular lenses. J Cataract Refract Surg2007;33:88-93

8.Pesudovs K, Dietze H, Stewart OG, Noble BA, Cox MJ.Effect of cataract surgery incision location and intraocularlens type on ocular aberrations. J Cataract Refract Surg2005;31:725-734

9.Yao K, Tang X, Ye P. Corneal astigmatism, high orderaberrations, 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 beforeand after small-incision cataract surgery. InvestOphthalmol Vis Sci 2004;45:4312-4319

11.Elkady B, Alió JL, Ortiz D, Montalbán R. Cornealaberrations after micro incision cataract surgery. JCataract Refract Surg 2008;34:40-45

As the Akreos®

MI60 IOL offersthe same resultsas the Akreos®

Adapt AO lens,this technique hasno disadvantages.

Aberrations with Akreos® MI60 IOL MICS™

-0.200

-0.150

-0.100

-0.050

0.050

0.100

0.150

0.200

-0.200Z3 Z4 Z5 Z6Z3 Z4 Z5 Z6

-0.150

-0.100

-0.050

0.050

0.100

0.150

0.200

Mic

rons

RM

S

Mic

rons

RM

S

Zernike Order Zernike Order

Optical Aberrationsof the cornealsurface (6mm)

Optical Aberrationsof the entire eye (6mm)

Note:Optical zone = 6mmPupil diameter = 6.69mmWF Analyser Centre = PupilWF Centre Shift = 0.470mm

Figure 3


HEALTH 06

Life through my mother’s eyesLowri Turner reveals why her mother’s AMD diagnosis has changed her outlook.

Lowri Turner doesn’t mince her words. TheLondon born and bred fashion journalist comeTV presenter, 42, is also as well known for hercontroversial newspaper columns and saysthat she is still coming to terms with hermother’s diagnosis of Age-related MacularDegeneration (AMD).

“I’d never heard of AMD before Mum’sdiagnosis,” says Lowri. “I was aware that failingeye sight was something that often happenedto people as they grew older but neverexpected to hear that AMD was not only verycommon but that it also led to blindness.

I was also shocked to find out it was incurable.Most conditions can be treated these days so Iassumed it would simply be a matter of gettingthe right help.”

Discovering that AMD is often hereditary was anadded blow for Lowri. “Like any single parentI’m very aware that I need to keep myself in

Case studyMr 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 homeone evening, and as the light began to fade hehappened to close one eye and noticed that hisvision was cloudy in the open eye. This came asa complete surprise to him, as when both eyesare open, a ‘good’ eye often compensates forthe poorer sight in the second, making visionloss in one eye particularly difficult to detect.

He promptly called his optician to book anappointment and, upon examination, he wasinformed that the condition was in fact Wet AMD.Mr Acres was understandably concerned about

For now the focus is firmly on her mother whois helping to preserve her sight by takingPreserVision® Lutein® Soft Gels. “It’s very mucha case of ‘wait and see’,” she says, “Mygreatest fear is that there might be a timewhen Mum will no longer be able to see hergrandchildren which would be a great shame.But my family has always coped with whateverlife has thrown at it and come out the otherside. When the going gets tough, the Turnersget fighting!”

good health to be able to perform both as aMum, and at work, which is why looking aftermy sight is all the more important to me.” shesays. “I’ll certainly be ensuring my eyes areregularly 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 testedregularly and takes Bausch & Lomb’s OcuviteLutein®. “I began to look in to the benefits ofLutein® after my mother was recommended itby her doctor to help slow down her AMDsymptoms.” she says.

Now keener than ever to protect her health andsupport her Mum, Lowri’s latest big project hasbeen a nutritional therapy course which she hasbeen doing for the last two years. She says: “Inmy twenties and thirties my weight went up anddown by as much as three stone at a time and itwasn’t until I was working on ‘Celebrity Fit Club’and started interviewing doctors and nutritioniststhat I realised the importance of maintainingyour blood sugar level by eating sensibly.

I began to apply some of what I’d seen andheard about on the show to my own diet andreally noticed a difference. That spurred me onto sign up for the course on nutritional therapy.I’m hoping to be able to practice after a furtheryear of study.”

To give your patients access to continuedsupport and guidance outside your clinic,you may refer patients diagnosed withmacular disease to the Macular DiseaseSociety. To join, patients can register onlinewww.maculardisease.org or contact theMacular Disease Society as follows:

The Macular Disease SocietyPO Box 1870, Andover, Hants, SP10 9AD

Registered Charity No. 1001198 Tel: 01264 350551Fax: 01264 350558email: [email protected]

SUPPORT AND GUIDANCE SUPPORT AND GUIDANCE

the situation and, having never heard of thecondition previously, feared it would simply be adownward spiral towards blindness. After seekingthe advice of his optician and conducting his ownresearch via the internet, he discovered that thebest 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 wentfor private healthcare and at a price of £2,000 pertreatment, he was delighted to find something totreat his condition.

Following his injection, the hospital recommendedhe take PreserVision® to help prevent furtherdeterioration of the macula. He is thrilled that theinjection was a success and is confident that, sincetaking PreserVision®, he has not seen any furtherdeterioration in the quality of his vision.

Following his experience, Mr Acres now offersthe following advice to others: “I would urge

people who have any concerns about theirvision to get in touch with an eye specialist oroptician, and don’t delay in the hope that thesituation will just rectify itself.”

“I never expected to hearthat AMD was not onlyvery common but that italso led to blindness.”


HEALTH 07

11th Jeantex Transalpmarathon 8 day raceIn the first of a two-part story Mark Wevill, Consultant Ophthalmologist, serialises hisexhilarating ordeal as he cycles over 650km in 8 days (19-26 July 2008) for charity.

“I completed the 2008 Jeantex Transalpmountain bike race, which crossed the Alpsfrom Fussen (south of Munich in Germany) toRiva del Garda (south of the Dolomites inItaly), with my team mate Hein. The racepassed through Austria and Switzerland and,at times, ascended over 21,000m. We rode insupport of "Sightsavers" and receivedgenerous donations for this charity.”

Day 1 Stage 1 - 1200 racers crossed the start line androde out through the small castle village of Fussento the thumping beat of AC/DC's "Highway toHell". The pack seemed endless and splintered intogroups of 30-40 riders. The profile was misleadingdue to multiple steep climbs and a mix of fastopen road and narrow gravel bike trails. At 50kmwe started the ascent of Marienbergloch. The pack,now miles long, could be seen snaking its way upthe climb which kept pitching up steeper andsteeper. The sun shone and the views werebeautiful; it was hard to remember that we weresupposed to be racing.

Nearing the top of the ski lift, the trail turned leftand pitched up to 25% heading to a notch in thepeaks above the ski runs. The leaders road thissection but the rest of us were off our bikes andwalking! The thinner air at 2000m, and pushing

the bike, was exhausting. Once over the top, weflew down 10km dropping 1000m on fast roadsbefore the final stretch of fast, flat 10km of dirtpaths into Imst, a beautiful Alpine village.

Day 2 Stage 2 - Throughout the night rain drummeddown on the gymnasium roof - not a good omenfor the tougher day ahead. The rain stopped andwe set off for the ascent of Venetaim - 3170m anda distance of 76km. The top was cold and coveredin mist. The fast descent on forest roads wasfollowed by another steep ascent to Pillerhoehe.This descent was technical (slippery roots andloose rocks) and down the historical Via Claudia, a2000 year old roman-built road, which forcenturies was the main commercial route acrossthe Alps transporting wine, olive oil and oystersfrom the Mediterranean. It is now a perfect bikingroute with stunning views and historical sites.

The final 20km trail and dirt roads up the valley toIschgl seemed endless. We had enjoyed sun andlight cloud during the day but 6 riding hours andtired legs later, dark storm clouds came upon us,closely followed by hail. Being wet through, cold

Sightsavers International is a registered UK charity (Registered charity numbers 207544 and SC038110) thatworks in more than 30 developing countries to prevent blindness, restore sight and advocate for social inclusionand equal rights for people who are blind and visually impaired. Since 1950, Sightsavers has restored sight tomore than 5.65 million people and treated over 100 million more. Donations to support Sightsavers' work can bemade using the 24-hour donation line 0800 089 2020 or via their website www.sightsavers.org

0 m0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80.1 km

100 m200 m300 m400 m500 m600 m700 m800 m900 m

1000 m1100 m1200 m1300 m1400 m1500 m1600 m1700 m1800 m

Fussen

Hohenschwangau

Reutte Heiterwang

Lermoos

Ehrwald

Marienbergloch

Marienberglalm

NassereithStrad Imst

Day 1 (Stage 1) Fussen to Imst

“We rode through the hailpassing other cyclists huddledunder the trees.”

and hungry and eager to get to Ischgl, we rodethrough the hail passing other cyclists huddledunder the trees.

Read the whole detailed story with stage routemaps at www.bausch.co.uk/charity

Mark Wevill


HEALTH 08

Proven performances in soft lens careFresh lens comfort and eye health with silicone hydrogel contact lenses.

It is essential that eye careprofessionals are able to recommendan effective lens care system forsilicon hydrogel lenses that deliverscomfort and maintains health. In thisstudy, we consider the patients’rating of lens care systems forcomfort and eye health.

Fresh Lens ComfortWhen recommending care regimens forsilicone hydrogel lenses, it is necessary toconsider performance in real world situations,such as when patients switch from one caresystem to another.

In this multi-site study, 45 independentclinicians enrolled OPTI-FREE Express and OPTI-FREE RepleniSH subjects who were wearingsilicone hydrogel lenses (Bausch & LombPureVision® contact lesnses, CIBA Night & Day,CIBA AirOPTIX, ACUVUE Advance, and ACUVUEOasys). Using a 10-point Likert scale, subjects(201 OPTI-FREE Express and 187 OPTI-FREERepleniSH) rated their habitual lens caresolution on a variety of performanceattributes.

After two weeks of using ReNu® MultiPlus®

solution with a rub regimen, subjects ratedReNu® MultiPlus® solution on the sameattributes and participated in a forced choicepreference questionnaire. Figure 1 presents theaverage rating results for performanceattributes associated with the ‘end-of-day’ timepoint. The results indicated that Opti-FreeExpress and Opti-Free RepleniSH users ratedReNu® MultiPlus® significantly higher for ‘end-of-day’ cleanliness (lenses feel fresh and cleanat 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 inthe forced choice preference (Figure 2).

These results are particularly significant, sincepatients generally have the most complaintstowards the end of the day.

ReNu Multiplus® Opti-Free Express Opti-Free RepleniSH

ReNu Multiplus® Opti-Free Express Opti-Free RepleniSH

End-of-daycleanliness

7.36.8

End-of-daycomfort

7.36.7

4.0 5.0 6.0 7.0 8.0


7.3

End-of-daycomfort

7.36.7

6.7

Patient Ratings


61.5%38.5%

End-of-daycomfort

62.2%37.8%

30% 40% 50% 60% 70%


61.5%38.5%

End-of-daycomfort

61.3%38.7%

Patient Preference

Ratings (over all visits) 0 = totally disagree 10 = totally agree

Figure 2

Figure 1


HEALTH 09

Slit lamp evaluations were conducted at theinitial visit and at two weeks (study completion).

HealthFigure 3 and 4 summarise the proportion ofeyes by grade of slit lamp findings. Overall,the proportion of eyes with grade 2 or greaterfindings was equivalent between the OptiFreesolutions and ReNu® MultiPlus®.

These findings indicate that Bausch & LombReNu® MultiPlus® solution, which offers freshand clean feeling lenses and end of daycomfort, also helps maintain eye health.

ConclusionIt is essential that eye care professionals areable to recommend an effective care systemthat delivers comfort and health with siliconehydrogel lenses. Bausch & Lomb ReNu®

MultiPlus® solution is an excellent choice.Based on the data, eye care professionals whoprescribe silicone hydrogel lenses for theirpatients can confidently recommend Bausch &Lomb ReNu® MultiPlus® solution.

Proportion of eyes by grade of slit lamp findings

0

92.7

96.8

76.8

69.5

69.0

69.1

77.4

98.2

1

6.8

3.3

19.8

25.3

23.5

24.9

18.6

1.8

2

0.5

-

3.5

5.3

7.5

6.0

4.0

-

3

-

-

-

-

-

-

-

-

4

-

-

-

-

-

-

-

-

0

96.3

99.0

80.1

71.4

70.6

68.8

83.5

99.8

1

3.7

1.0

14.7

25.6

23.6

27.3

13.5

0.3

2

-

-

4.2

3.0

5.7

3.0

3.0

-

3

-

-

1.0

-

-

1.0

-

-

4

-

-

-

-

-

-

-

-

Events Opti-Free Express at Initial Visit ReNu Multiplus® after 2 Weeks

Grade

Epithelial Edma

Epithelial Microcysts

Corneal Staining

Limbal Injection

Bulbar Injection

Tarsal Conj. Abnormalities

Neovascularization

Corneal Infiltrates

Events Opti-Free Express at Initial Visit ReNu Multiplus® after 2 Weeks

0

92.5

96.5

76.1

63.9

63.4

60.2

82.4

99.2

1

7.0

3.2

18.0

30.5

27.5

33.7

16.6

0.8

2

0.5

0.3

5.9

5.6

9.1

5.6

1.1

-

3

-

-

-

-

-

0.5

-

-

4

-

-

-

-

-

-

-

-

0

96.3

99.5

78.9

69.3

66.3

65.0

86.4

100

1

3.7

0.5

16.0

27.8

27.5

32.1

12.6

-

2

-

-

5.1

2.9

5.9

2.9

1.1

-

3

-

-

-

-

0.3

-

-

-

4

-

-

-

-

-

-

-

-

Grade

Epithelial Edma

Epithelial Microcysts

Corneal Staining

Limbal Injection

Bulbar Injection

Tarsal Conj. Abnormalities

Neovascularization

Corneal Infiltrates

Grade 0 = None 1 = Trace 2 = Mild 3 = Moderate 4 = Severe

Professionals who prescribesilicone hydrogel lenses fortheir patients canconfidently recommendBausch & Lomb ReNu®

MultiPlus® solution.

It is the only multi-purpose solutionthat contains HYDRANATE®, a clinicallyproven ingredient that removes proteindeposits while you clean your lenses.

Giving you exceptional cleaning, ReNu® MultiPlus® offers superiordisinfection against a broad range of micro-organisms to help ensure your patients are compliant with lens care.

ReNu® MultiPlus®

ReNu® MultiPlus®

multi-purpose solutionFresh Lens comfort.

Figure 3 Figure 4


PHARMACEUTICALS 10

Lotemax® - a new solutionLoteprednol etabonate in the treatment of post-operative ocular inflammation.

Carlos Pavesio gives an outline of thetreatment of ocular inflammatory conditionswith Loteprednol etabonate (LE) and providesevidence from clinical studies on the efficacyand safety of LE in the treatment of post-operative ocular inflammation.

IntroductionOcular inflammatory diseases affect a significantproportion of the population. The incidence in developed nations has been estimated at 15-20%2, although other studies have suggestedthat the actual number might be double thisfigure. Such a high incidence imposes asignificant medical and economic burden onsociety. In the USA, prescription costs alone forocular medication are over $200 million.3 In theUK, the RNIB estimates that the costs associatedwith sight loss are in the region of £4.9 billion a year4, whilst more comprehensive studiesfrom Australia indicate that vision disorders costan estimated 0.6% of GDP.5

When treating ocular inflammatory conditions,ophthalmologists rely on corticosteroids for theiroverall effectiveness in reducing intraocularinflammation in the anterior segment, as wellas to relieve symptoms.6 However, despite theirclinical advantages, corticosteroids can causeundesirable side effects.7 When administeredtopically to the eye, these side effects includeincreases in intraocular pressure (IOP), inductionor exacerbation of glaucoma, cataract formation,decreased resistance to infection and decreasedwound healing.7

The objective of all drug development is to havean improved therapeutic index, i.e to maximisethe therapeutic response whilst minimisingadverse effects. The ester corticosteroidloteprednol etabonate (Lotemax®) has beenspecifically designed for ocular use.8 Although

structurally similar to prednisolone, Lotemax®

has a substitution of an ester for the ketone atcarbon-20. Lotemax® is highly lipophilic to allowexcellent penetration into the cornea and has a4.3 fold greater affinity for steroid receptorbinding than dexamethasone in vitro.8 Since LE israpidly converted to an inactive metabolite, therisk of systemic and local adverse effects isminimised.8 Furthermore, Lotemax® may bepotentially less cataracterogenic than othersteroids, since it is the ketone group (absent withLotemax®) which has been implicated in theformation of cataracts.1

The efficacy and safety of Lotemax® has beenevaluated in common ocular inflammatoryconditions including Keratoconjunctivitis sicca(Dry eye syndrome), Anterior Uveitis, Seasonalallergic conjunctivitis (SAC) and Giant PapillaryConjunctivitis (GPC).6,9-11 The use of Lotemax® inpost-operative ocular inflammation has alsobeen demonstrated with great success.12,13

The treatment of post-operativeocular inflammation with Lotemax®

Advances in surgical techniques in recent yearshave significantly reduced the amount of physicaltrauma associated with ocular surgery and hence the degree of inflammatory response.14

Nevertheless, post-operative inflammation stilloccurs as a result of prostaglandin release,recruitment of neutrophils and macrophages, and production of inflammatory mediators.15

Post-operative inflammation is most commonafter cataract surgery16 and usually consists ofmild iritis and flare in the anterior chamber.13

Post-operative inflammation is commonlytreated with topical corticosteroids and NSAIDs.Whilst corticosteroids offer the widest range ofanti-inflammatory effect, their use still causesconcern regarding the potential for raised IOP.13

The safety and efficacy of Lotemax® 0.5% was evaluated in two identical studies in thetreatment of post-operative ocular inflammationfollowing cataract surgery.12,13 Patients wererandomised to receive LE or placebo four timesdaily (approximately every 4 hours for 14 days)and anterior chamber cells and flare weremeasured. Results showed that anterior chamberinflammation was resolved in significantly moresubjects receiving Lotemax®, compared with

placebo (p<0.001). Furthermore, the incidence ofclinically significant elevations in IOP (defined as>_10 mm Hg) was similar in patients receivingLotemax® compared with placebo.

Incidence of intraocular pressureelevation with Lotemax®

The incidence of elevated IOP with Lotemax®

has been compared with both placebo andprednisolone acetate. In a review of studies inwhich Loteprednol was compared withprednisolone in different indications, Novack etal17 found that out of a total of 901 patientswho received Lotemax® for 28 days or longer,only 15 patients experienced a significant risein IOP (>_10mm Hg).17 When patients wearingcontact lenses were excluded owing to thepossible reservoir effect, the number of casesof elevated IOP with LE reduced to 4/624patients, or 0.6%, comparable with the 0.5%incidence found with placebo (3/583). The incidence of elevated IOP in patientsreceiving prednisolone acetate, however, wassignificant at 11/164 or 6.7%.17

In a comparative study of known steroidresponders, Lotemax® demonstrated a lowerincidence of clinically significant IOP rise (>_10mm Hg) than prednisolone acetate 1%.18

After 6 weeks of QID dosing in known steroidresponders, the average IOP for patients treatedwith Lotemax® remained lower (average of 20.0mm Hg) than that in patients receivingprednisolone acetate 1% (average of 26.6mm Hg). The mean change from baseline inIOP was not significant for Lotemax® at days 14,28 or 42, whereas prednisolone produced

In the UK, the RNIBestimates that thecosts associated withsight loss are in theregion of £4.9 billion a year.

Of a total of 901patients whoreceived Lotemax®

for 28 days or longer,only 15 patientsexperienced a significant rise in IOP


PHARMACEUTICALS 11

significant increases in IOP at all these timepoints. Patients receiving Lotemax® had amaximum IOP elevation throughout the study of4.1mm Hg compared with 9.0mm Hg forprednisolone.

ConclusionLotemax® was developed with the aim ofreducing the propensity for unwanted sideeffects to a minimum, while providing maximumanti-inflammatory efficacy. Clinical studies havedemonstrated the safety and efficacy ofLotemax® across a wide range of steroidresponsive ocular inflammatory conditions.Lotemax® exhibits its anti-inflammatory actionimmediately after application and is thenconverted to an inactive metabolite, thusensuring minimal risk of systemic absorption.

Studies of IOP elevation have found nosignificant difference in the number of patientsexhibiting a >10 mm Hg increase in IOP withLotemax®, compared with placebo. Furthermore,any increases in IOP with Lotemax® weresignificantly and consistently lower than withprednisolone acetate.

Prescribing Information can be found on theadjoining Lotemax® advertisement.

Based on the original article published in theBritish Journal of Ophthalmology, May 2008 by C E Pavesio, Moorfields Eye Hospital,London, UK and H H DeCory, Bausch & LombInc., Rochester, NY, USA1

For further medical information on Lotemax®

please contact us on 01748 828864

Lotemax® is a registered trademark of Bausch & Lomb Inc

8. Noble S, Goa KL. Loteprednol etabonate: clinical potentialin the management of ocular inflammation. BioDrugs.1998;10:329-39.

9. Bartlett JD, Howes JF, Ghormley NR. Safety and efficacy ofloteprednol etabonate for treatment of papillae in contactlens-associated giant papillary conjunctivitis. Curr Eye Res1993;12(4):313-321

10. Asbell P, Howes J. A double-masked, placebo-controlledevaluation of the efficacy and safety of loteprednoletabonate in the treatment of giant papillaryconjunctivitis. CLAO J 1997;23:31–6.

11. Friedlaender MH, Howes J. A double-masked, placebo-controlled evaluation of the efficacy and safety ofloteprednol etabonate in the treatment of giant papillaryconjunctivitis. Loteprednol Etabonate Giant PapillaryConjunctivitis Study Group I. Am J Ophthalmol1997;123:455–64.

12. Stewart R, Horwitz B, Howes J, et al. Double-masked,placebo-controlled evaluation of loteprednol etabonate0.5% for postoperative inflammation. LoteprednolEtabonate Post-operative Inflammation Study Group 1. J Cataract Refract Surg 1998;24:1480–9.

References1. Pavesio CE, DeCory HH. Treatment of ocular inflammatory

conditions with loteprednol etabonate. Br J Ophthalmol2008:92:455-9.

2. Butrus S, Portela R. Ocular allergy: diagnosis andtreatment. Ophthalmol Clin North Am 2005;18:485–92.

3. Bielory L. Update on ocular allergy treatment. Expert OpinPharmacother 2002;3:541–53.

4. AMD Alliance International. 2005 Country Report UK.Awareness of Age-related Macular Degeneration andAssociated Risk Factors.

5. Eye Research Australia. Clear Insight. The economic impactand cost of vision loss in Australia. Access Economics PtyLimited. August 2004. http://www.cera.org.au/publications/clear_insight.html, accessed 14 July 2008.

6. Loteprednol Etabonate US Uveitis Study Group. Controlledevaluation of loteprednol etabonate and prednisoloneacetate in the treatment of acute anterior uveitis. Am JOphthalmol 1999;127:537–44.

7. Carnahan MC, Goldstein DA. Ocular complicationsof topical,peri-ocular, and systemic corticosteroids. Curr OpinOpthalmol 2000;11:478-83.

13. Loteprednol Etabonate Postoperative Inflammation StudyGroup 2. A double masked, placebo-controlled evaluationof 0.5% loteprednol etabonate in the treatment ofpostoperative inflammation. Ophthalmology1998;105:1780–6.

14. McColgin AZ, Heier JS. Control of intraocular inflammationassociated with cataract surgery. Curr Opin Opthalmol2000;11:3-6.

15. El-Harazi SM, Feldman RM. Control of intra-ocularinflammation associated with cataract surgery. Curr OpinOpthalmol 2001;12:4-8.

16. Schmeier J, Halpern M, Covert D, et al. Evaluation ofMedicare costs of endophthalmitis among patients aftercataract surgery. Opthalmology 2007;114:1094-9.

17. Novack GD, Howes J, Stephens Crockett R et al. Change inintraocular pressure during long-term use of loteprednoletabonate. J Glaucoma 1998;7:266-9.

18. Bartlett JD, Horwitz B, Laibovitz R et al. Intraocularpressure response to loteprednol etabonate in knownsteroid responders. J Ocular Pharmacol 1993;9:157-165.

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PRESBYOPIA SPECIAL 12

Crystalens® provides optimalvisual qualityThe American refractive surgeon, Dr. Uday Devgan, is enthusiasticabout the new generation Crystalens® (‘Five 0’).

Dr. Devgan has gained broadexperience with the Crystalens® AT-50, simply known as the ‘Five 0’. “TheAT-50 is the successor to the AT-45”,explained Dr. Devgan. “The namerefers to the diameter of the optic. Inthe new lens, this is 5.0 mm.However, it performs just as well as aregular 6mm lens because it ispositioned deeper within the eye.There is, therefore, no difference interms of spherical aberrations.”

For four days a week, Dr. Devgan works at theMaloney Vision Institute, a highly acclaimedprivate clinic in Los Angeles. During the pasttwo years he has carried out approximately onethousand procedures with the Crystalens® AT-50.During the 9th Refractive Surgery Symposium ofthe NGRC, which took place on 24 May at theVU University Medical Centre in Amsterdam, Dr. Devgan was unable to hide his enthusiasm.“The Crystalens® provides optimal visual quality.”

During his lecture, Dr. Devgan provided a fewkeys to successful refractive cataract surgery. Thechoice of the lens with optimal visual quality isone of these keys. Just as important is that theexpectations of the patient are surpassed. “I make it clear to patients, in advance, that theywill be able to see better but that I am unable togive them the eyesight of a 21-year old. In termsof the Crystalens®, I also tell them that, in certainconditions such as when there is little light, theywill possibly still require reading glasses.”

After his lecture, Dr. Devgan admitted tofollowing the same strategy when informing

colleagues. “I know many American colleagueswho work with the Crystalens®. They have thesame experiences as I do, and often evenbetter. I actually prefer not to exaggerate myaccomplishments. I want to prevent mypatients’ expectations from being too high andI do the same with my colleagues. Some ofthem say: ‘In his lecture, Dr. Devgan providedstatistics with regard to sharp near-vision, butif I use the Crystalens®, the results are evenbetter!’ That makes them feel good.

Clinical trialThe Crystalens® is the only accommodating lensimplant to have received the approval of theFDA. A clinical trial which lasted for two yearsplayed a significant role in that approval. Theresults achieved were 92% of the participantssaw 20/25 or better for distance, 96% saw20/20 at arms length and 73% saw 20/25 fornear. All of which was without glasses orcontact lenses. The lens was also found toperform excellently in daily activities 100% ofstudy subjects could see their computer screenand the dashboard well, they could read pricesin the supermarket or apply their make-up. 98% could read the telephone directory or thenewspaper, once again without any aid. Onlyone individual reported problems with glare,

halos or night vision. “The most important thingthat you are able to offer patients is visualquality” stated Dr. Devgan. “People want to beable to read or work on the computer withouthaving to wear glasses. However, even moreimportant is sharp and clear vision, goodcontrast sensitivity and being able to observesubtle colour differences all of which without

His patients are extremelysatisfied with theCrystalens® The mostfamous amongst them isactor Henry Winkler, betterknown as The Fonz.

Henry Winkler - The Fonz

Crystalens®

Crystalens HD™in “High Definition”

Available in the UKApril 2009



unwanted side effects. Multifocal IOL lensesresult in traditional glare, halos and other visualeffects. A multifocal IOL lens is always acompromise: reduced visual quality, theobjective being to improve the sharpness ofnear vision. Most patients find this unacceptableif they are instead able to opt for anaccommodating lens.”

Accommodation of the Crystalens® is enabled bythe unique hinges, which allow the ocularmuscle to move the optic forwards andbackwards when focusing. “The lens isdesigned by analogy with the human eye. TheCrystalens® works just as well as the healthylens of a 40-45 year old. Somebody of that agewho has never needed to wear glasses, hasgood distance vision, can work at the computerand also read without reading glasses. Aneleven-year-old can read a book while theletters are touching his nose. Somebody who is40 years old has to hold the book a littlefurther away because the ability to focusreduces as the age advances.”

Higher level of surgeryThe Crystalens® has been implantedapproximately 100,000 times throughout theworld, especially in the US. “The use increasesevery quarter. In the US, three ‘premium’ lensesare available: two multifocal lenses and oneaccommodating lens. Three years ago, theCrystalens® only had a small share of thatmarket; 3% to 5%. The Crystalens® currentlyhas the second largest market share; 30% to40% percent. Within the not too distant future, it will be at number one. The popularity isforever growing.”

Dr. Devgan expects that there will also beconsiderable growth in the use of thisaccommodating lens in Europe. “Part of thechallenge is that the surgery will differ. Whenimplanting a multifocal lens, the surgery isidentical to traditional cataract surgery, with an“old fashioned” silicon lens. An accommodatinglens, such as the Crystalens®, is relatively large.That demands a higher level of surgery. A largercapsulorhexis opening is needed. It is not a lensfor relatively new surgeons. However, anexperienced ophthalmologist who has carriedout around a thousand cataract procedures willlearn this procedure in five to ten operations.”

The Stellaris® renders good service during theseoperations. “Of the thousand Crystalens®

procedures, I have performed the majority ofthem with the Stellaris®. At the clinic I have allpossible options available to the patient. We canperform every surgical procedure that canimprove the sight from LASIK to premium lenses,and everything in between. We take everythinginto consideration and ultimately provide thepatient with individual advice. We also have fourphaco machines available. However, I use theStellaris® far more often than the othermachines. Why? The Stellaris® offers a higherlevel of safety and is very efficient.”

Dr. Devgan speaks particularly highly of the EQ Fluidics Management Technology, whichcreates an ideal balance between aspiration andirrigation. “The greatest risk is that I break thepatient’s capsule during surgery, in which case I would be unable to implant the lens. Thebalance of the fluidics guarantees stability inthe eye. Furthermore, everything works equally

well from the updated handpiece to the tubing.The tubing system is particularly exceptional.”

Satisfied patientsThe customer is ‘king’ at the Maloney VisionInstitute in Los Angeles. Those who wish toreceive a ‘normal’ lens will be given one.“However, experience shows that more than90% of my patients opt for a premium lens. Thisis almost always the Crystalens®. Sometimes Iimplant a multifocal lens. Most patients are welleducated and carry out substantial advanceresearch. Sometimes somebody will say ‘Underno circumstances do I wish to wear readingglasses and it doesn’t matter if I can see a glare,halos or other effects.’ I would then implant amultifocal lens. However, most patients do notwish to lose visual quality. They want theoptimal visual quality that is conceivable and donot mind if, in particular circumstances, they willperhaps require reading glasses.”

His patients are extremely satisfied with theCrystalens®. The most famous amongst them isactor Henry Winkler, better known as ‘The Fonz’.At www.maloneyvision.com, Winkler is full ofpraise about the Crystalens® and hisophthalmologist: “Devgan is my hero!” Dr. Devgan added to this that he did not payWinkler for the video. “He is just veryenthusiastic, amongst other things, about thecolours, which he experiences as being veryvivid.” Dr. Devgan has no doubt that theaccommodating lens will become the normacross the world.

“The ideal lens is that of a youngster. This hassharp vision at all distances, without glasses,with the very best visual quality. That is whatwe must try to imitate. I am in no doubt that, infive or ten years time, we will have even morechoice and will have fantastic accommodatinglenses available to us. It is possible that, bythen, they may even come close to the eyesightof a 21-year old.”

“I use the Stellaris® far more often than theother machines. Why? The Stellaris® offers ahigher level of safety and is very efficient.”

Dr. Uday Devgan



Too young for reading glasses?Two very experienced and influential practitioners, Optometrist SusanBowers from the West Midlands and Contact Lens Optician AndrewWatson from Ashington Northumberland, give an overview on theirexperiences fitting patients with PureVision® Multi-Focal.

With an undeniableexpansion in the presbyopicmarket, multifocal contactlenses provide an attractiveopportunity to grow yourpractice. This is highlightedin an independent study of50-60 year old spectaclewearers, of whom 51%claimed they did not know

enough about contact lenses and 32% agreedthat they found wearing spectaclesuncomfortable.1

Susan Bowers states “I would never fit monovisioncontact lenses as I prefer to maintain goodbinocular vision for my patients. Just like varifocalspectacles the younger the patient, the better theycan adapt to something new. The biggest problemI find fitting the presbyopic patient with contactlenses is that they may exhibit dry eyes, thusresulting in a reduced wearing time.

In my experience, the presbyopic hypermetropicpatients much prefer extended wear if they do not

hydrogel multifocal and still is the only multifocalavailable for daily, flexible or extended wear.

I personally hate to have to wear readingspectacles, so I can fully understand how mypatients feel. When patients reach the age of 45 they can delay visiting their Optometrist becausethey find it hard to come to terms with the ageingprocess and the need for reading spectacles. Ialways ask new presbyopes if they would preferreading 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 tryingcontact lenses instead of spectacles for reading.

I feel that it is a great practice builder to fitpatients with such lenses as they will tell alltheir friends. I recently fitted an interiordesigner who has personally recommended adozen of her friends, family and clients as sheis so delighted with the performance of hernew multifocal contact lenses.

Case Study OneOptician: Susan Bowers

Male, age 51

History: Mr J is a high myope who drives 30,000 miles ayear and uses the computer, on average, two and a halfhours per day. He is an asthma sufferer with relativelysteep corneas. Before he became presbyopic he changedfrom wearing RGP lenses from his mid teenage years toPureVision® 8.6 in 2003.

Refraction: Rx RE -7.75/-0.75 x 10 V/A 6/6-1 ReadingAdd +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 8.6Power: 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 RGPlenses and the photographs show all the small haemorrhages. He has nohaemorrhages wearing PureVision® and his 3 and 9 o’clock staining hasdisappeared. The patient stated “They are fantastic for comfort andconvenience. I don’t need to take my lenses out at night anymore and I candispense with my reading glasses.” The patient reported he was happy with hisvision regardless of his astigmatism.

Case Study TwoOptician: Susan Bowers

Female, age 64

History: Ms H is a teacher of the piano and organ whosings in a cathedral choir. She started wearing varifocalspectacles in 1999. She drives 13,000 miles per year and has difficulty readingthe music that she sings. When wearing her varifocal spectacles she has to lifther head to see the music. She works on a computer three hours per day. Herhobby 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 8.6Power: RE -4.75 V/A 6/6-1 High AddPower: 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 theday, since 2005. She uses re-wetting drops twice a day, morning and eveningand also applies hot compresses to her eyelids. The eyelids have respondedto three years of treatment. The patient is happy with the lens andespecially when reading sheet music.

Susan BowersBSc(hons),FCOptom, Dip CLP, Dip Tp AS, FBCLA

suffer from dry eyes. This results in the patientsfeeling ten years younger as they can see thetime on their watch, text on their mobile and canread microwave food instructions.

Over the years, I have found that if the patients’astigmatism is 0.75D cyl or less they can changeover to centre-near design (PureVision® Multi-Focal) easily with a little help and encouragement.The high reading addition that is available canoccasionally reduce the distance acuity by one line,although adding an extra -025D to distance helpscompensate for this. However, enthusiastic patientswho become more presbyopic can initially copewith the high add and are delighted with the factthat they no longer need reading spectacles.

I have always been a big advocate of cornealhealth and maximum oxygen delivery to thecornea, and prescribe silicone hydrogel contactlenses because they give the most oxygen to thecornea. Many of my first contact lens patientshave become presbyopic and so half my time isspent working with the over 45 age group.PureVision® Multi-Focal was the first silicone



Andrew Watson explains hispersonal journey on why hecame to fit PureVision®

Multi-Focal contact lenses.

“After a CET event I gottalking to some other contactlens practitioners, and it

seemed most of us fitted daily disposables tothe majority of our patients and most werefitting a patient demographic nearly devoid ofpresbyopes. I raised this issue and thejustification as to why they were avoiding fittingthe over 40’s with anything other than mono-vision or distance contacts and readingspectacles. 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 hada reasonable amount of success withmultifocal contact lens fittings. However, I feltit was still a bit ‘hit and miss’. This was untilI tried using Bausch and Lomb PureVision®

Multi-Focal contact lenses. When I heard thatthis optical design was available in the

Andrew WatsonFBDO CL

Near Vision Chart

Please contact yourlocal representativefor details on thePresbyopia PracticeResource Kit.



Case Study ThreeOptician: 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 hefelt the vision was not good enough. He occasionally does locumwork. 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 8.6Power: RE -0.50 High AddPower: 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 N5and the patient reported this improvement happened within 48 hoursof using the lenses. Comfort was excellent and he had slept in thelenses for 2 consecutive nights whilst away for the weekend withoutany issues. No over refraction was found and the patient went on towear lenses as initially prescribed. He wears them for flexi-wear(occasional overnight wear).

Case Study FourOptician: Andrew Watson

Female, age 44

History: Ms C is a long-term contact lens wearer of lenses for DVcorrection, NV problems now starting to cause issues. Previously triedmonovision but this was not tolerated by the patient. The concept ofcontinuous wear appealed to the patient.

Refraction: Rx RE –2.50 / -0.25 x 100 6/5 V/A 6/5 Reading Add +1.25 N5LE –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 8.6Power: RE -2.00 Low AddPower: LE -3.00 Low Add Initial Binocular VA 6/5 and N5

Outcome: At the follow up appointment the patient is overjoyed withthe lenses as they are more comfortable, more convenient and givegood vision at all distances. The fact the lenses cost more than herprevious lenses was not even a concern. No over refraction was foundand the patient carried on with the lenses as initially prescribed.

silicone hydrogel PureVision® material, I thoughtthis was great. It solves any challenges withoxygen transmissibility I had with the SofLens®

Multi-Focal material but retains the excellentoptics of the SofLens® Multi-Focal that had anexcellent track record. The PureVision® Multi-Focal has two reading addition profiles, Low forearly presbyopes and High for older presbyopes;a simple but quite powerful system.

What has been a revelation is that I’ve foundonly a few fits require more than a total of 3lenses to achieve a satisfactory result, rarelyrequiring more chair time than a single visionlens fitting.

Patients in this visual arena want goodfunctional vision and convenience. I feel this is

exactly what PureVision® Multi-Focal offers.Such patients want to work, shop, drive, playsports, eat out, and use computers; none ofthese are a problem for this lens.

Our practice is in an old mining town, wherethere are socio-economic factors that wouldlead you to believe that “low-cost” rules butmost of our contact lens dispensing involvelenses of a high calibre and thus a higher cost.Therefore, in our practice we have a saying that“patients are NOT price driven but valueconscious” and this seems to be the case withthe multifocal lenses that we dispense.

A lot of new fittings come fromrecommendations of our existing multifocalwearing patients. It would seem you could

not find a better advocate than a contentedcontact lens wearer.”

Reference1 *Vision corrected 50-60 year olds EU, Independent study,

Consumer A&U 2006, Simpson Carpenter Ltd

“In our practice we havea saying that ‘patientsare NOT price driven butvalue conscious’ and thisseems to be the casewith the multifocal lensesthat we dispense.”


EDUCATION 17

The Bausch & Lomb Academy ofVision Care™ website goes live!Bausch & Lomb is the eye health company dedicated to ‘Perfecting Vision. Enhancing Life.™’ andwe are pleased to announce the launch of the Bausch & Lomb Academy of Vision Care™continuous education and development website www.academyofvisioncare.co.uk

This easy to navigate website has beenspecifically designed to provide eye careprofessionals with practical and experience-based learning resources and tools thataddress day-to-day practice and businesschallenges.

This website will be the portal for alleducation initiatives for the Bausch & LombAcademy of Vision Care™ and caters for eyecare practitioners, all students including thoseundertaking their pre-registration year, andpractice support staff.

On the new site you will find:

Professional Education and ResourcesCET accredited materials are available across awide range of important Vision Care topics andour aim as the experts in eye health is toprovide and update practitioners with relevantand topical CET materials on a regular basis.

Support Staff ResourcesWe recognise that a knowledgeable practiceteam is essential. This site provides useful andpractical materials written by Sarah Morgan forBausch and Lomb, to assist training anddevelopment of practice support staff toenhance customers’ experience.

Student Education and ResourcesWe believe that great students are the futureof the Vision Care industry. This section of thewebsite is dedicated to providing support to allstudents, trainee contact lens opticians,undergraduate and pre-registrationoptometrists through invaluable tools andresources.

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 weblinks, a product image bank, photo library and educational tools for ordering.

The academyofvisioncare.co.uk website willensure that Academy members will be the firstto be informed when new and updated CETand support materials become available, andwill also automatically alert them of the latesttechnological and scientific breakthroughs fromBausch & Lomb.

This website will be the portal for alleducation initiativesfor the Bausch &Lomb Academy ofVision Care™

EventsThe Bausch & Lomb Academy of Vision Care™ is committed to providing eye care professionalswith a range of educational opportunities, througha variety of methods that are specifically chosen tosuit the busy and diverse lifestyles of ourcolleagues.

Earlier this year, the Bausch & Lomb Lectures wereheld in a series of successful 1 day CET eventsacross the UK. Developed through consultationwith key opinions leaders to communicate some ofthe latest issues in contact lens practice, topicsinclude Presbyopia, Science of Compliance,Nutritional Supplements and achieving optimalvision for contact lens patients.

The academyofvisioncare.co.uk website will alsogive members the first opportunity to sign up forupcoming CET events. Finally, we welcome you andyour colleagues to join the Bausch & LombAcademy of Vision Care™ by registering on ournew website www.academyofvisioncare.co.ukand we hope that you will continue to view theBausch & Lomb Academy of Vision Care™ as yourpartner in continuous education and development.


BAUSCH & LOMB IN FOCUS 18

The Bausch & Lomb story -a history of innovationHere we tell the story of how Bausch & Lomb developed from its humblebeginnings to become the global leader in eye health that it is today.

Sixty dollars and a handshakeIn 1853, John Jacob Bausch opened a small shop inthe Reynolds Arcade in Rochester, New York.Displayed in the window was an array ofspectacles, telescopes, microscopes and operaglasses – all European imports sent by his brotherin Germany. After three years in business, Bausch’sfledgling company was losing money and he wasin 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 Bauschpromised that if the business ever becameprofitable, he would make Lomb an equal partner.

True to his promise, Bausch made Lomb an equalpartner and they renamed the firm “The Bausch &Lomb Optical Company”.

Turbulent times, extraordinaryaccomplishmentsThe year was 1905. Intent on proving that the UnitedStates was ready to take its place as a work power,President Theodore Roosevelt was building the ‘GreatWhite Fleet’. The U.S Navy’s gunsites had beenproduced since 1896 by the Saegmuller Company,which bought its lenses from Bausch & Lomb.Bausch & Lomb purchased the Saegmuller Companyand moved its entire operation to Rochester, therebyentering the field of optical measurement.

From family business to global leader in eye healthAs it approached its one hundredth anniversary,Bausch & Lomb was poised in the balancebetween past and future. Senior management wasstill largely made up of members of the Bauschand Lomb families.

In the late 1940s and 1950s, Bausch & Lombreturned to its well-established strengths andredirected itself to research and development – adecision that would take it in very new directions.

Staying true to a visionOver the years, Bausch & Lomb has made, andcontinues to make, a difference in the lives ofmillions of people around the world because of theproducts we make and our contributions to thecommunities in which we work and live. The respect and confidence eye care professional,customers, employees, suppliers and investorshave in our Company and our products is rooted inthe hard work and integrity of the thousands ofpeople who have dedicated their professional livesto our business throughout our history.

As we celebrate over 150 years in business, wetake 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 mymaxims.’ In 1853, John Jacob Bausch and HenryLomb started a business with one purpose – toimprove the way people see. Today, in Bausch &Lomb’s continuing dedication to ‘Perfecting Vision.Enhancing Life.™’ around the world, the sprit ofthe founders and of the many dedicated peoplewho have followed them through the long years ofthe company’s history lives on.

Jacob Bausch and Henry Lomb

Historic Innovations

1861, J.J. Bausch’s revolutionary Vulcaniteeyeglass frames became the first greatsuccess for the young company.

1903, the company had patentedmicroscopes, binoculars and a camera shutter designed to mimic the workings of the human eye.

1915, Bausch & Lomb produced the firstoptical quality glass made in the US.

1937, developed ground breaking Ray-Ban®

aviator goggles for military pilots. They alsocreated the lenses for the cameras that tookthe first satellite pictures of the moon.

In World War II, 70% of Bausch & Lomb’sproduction was for the military, providingthree million pounds of optical glass, aerialmapping lenses, vision testers, binoculars,range finders, periscopes, spotting scopes,gas masks and improved Ray-Ban goggles.

Did You Know?1952, TwentiethCentury Foxreleased ‘TheRobe’, the firstmovie shot usingBausch & Lomb’sCinemaScope

lenses. Three years later, the Motion PictureAcademy of America presented Bausch &Lomb with an “Oscar” in honour of thecompany’s contributions to the film industry.

1971, the company introduced the world’sfirst soft contact lenses with 1 millionpatients wearing them by 1974.

1998, launch of ReNu® MultiPlus® theworld’s first all-in-one contact lenscleaning solution.


LETTERS 19

Have your say...In the last issue of Visions we invited your comments and letters. Thank youfor your response. Here is a small selection of the many we received.

Frank GreenUniversity of Aberdeen

“We have just returned from our latest visitto Thailand which was our busiest yet. Forthe first week Prof John Forrester was withus teaching 2 of our senior eye medicscataract surgery on our new microscope.Our hope is that with time they may be ableto become independent cataract surgeonsalthough this is still a long way off.

We ended up doing almost 300 cases, the vastmajority cataracts. Once again we are indebtedto you for your help with your very generousdonation of IOLs. Your donation really makes abig difference enabling us to carry out theseoperations. Many of these patients arecompletely blind from cataract, such is thedesperate lack of care available in Burma.”

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.

Your opinion is greatly valued…

Jeff KwartzBolton General Hospital

“I have just been reading 'Celebration - adecade of the Akreos® IOL' in the summeredition of Visions; I am really enjoying themagazine. I have been using the Akreos® lenssince its launch, and the Hospital (BoltonGeneral) has probably implanted over 16,000lenses in the last 8-10 years, with my ownteam implanting 3,000.

It is my lens of choice in the private sectorbecause of its reliability, and I can honestly saythat we have had no problems with theselenses. There have been no complaints and wehave very happy patients. As far as I know, notone Akreos® lens has needed to be explantedfor glare or dysphotopsia...how good is that!"

Zak KoshyAyr Hospital

“In January 2008, following the first trial of the Stellaris® Vision Enhancement System, weimplanted the Akreos® Micro Incision Lens. A total of 8 patients had the procedure, usingCMICS and the 1.8mm wound-assistedtechnique for lens insertion.

I found the lens quick and easy to load, and itcentred beautifully in the eye. The surgery tookno longer than traditional surgery and therewere no complications.”

Zak Koshy (pictured standing second from the left)

Som PrasadArrow Park Hostpital

“I read the summer edition of 'Visions' with greatinterest, especially the article about the Akreos®

lens and its evolution over the last decade.Having used bimanual irrigation/aspiration foryears and being an advocate of splitting theinfusion from the aspiration wherever possible(eg anterior vitrectomy), I was very interested intrying Bimanual Micro Incision phaco (BMICS™)when a lens became available which could beimplanted through a sub 2mm incision. I havetried both BMICS™ and Coaxial Micro Incisionphaco (CMICS™) using the B&L Millennium andboth procedures work very well, although mypersonal preference is for a bimanual technique.

The MI60 is easily implanted through a 1.8mmincision following BMICS, or a 2.2mm incisionfollowing CMICS, using the Millennium. It is a veryflexible lens, and therefore easy to handle in theanterior chamber and capsular bag and it centresvery well. The capsule remains clear post-operatively. In certain patients who needcombined lens and vitrectomy surgery, this lens isvery stable even with deep indentation of thesclera during the posterior segment procedure,and there is no compatibility issue, even if siliconoil has to be used. A few months ago I switchedto performing all my cases with BMICS throughtwo 1.6mm incisions with implantation of a MI60IOL through a 1.8mm incision using a woundassisted implantation technique as my standardIOL. I have been very pleased with the results,and patients are very happy with their outcome.”


Bausch & Lomb IncorporatedBausch & Lomb House106 London RoadKingston-upon-ThamesSurrey, KT2 6TN, UK

Tel: 020 8781 2900Fax: 020 8781 2901Website: www.bausch.co.uk

™ and ® denotes trademark and registration mark of Bausch & Lomb Incorporated. © Copyright 2008 Bausch & Lomb Incorporated. All rights reserved.

Coming up in the winter issue...

Find out more about Bausch & Lomb's toric heritage,the new coloured Minims® packaging, how we aidOptometry giving sight and a new VR focus for 2009.

www.bausch.co.uk


The Bausch & Lomb story - a history of innovation€¦ · is ‘The Bausch & Lomb story – a history of innovation’. In 1853 John Jacob Bausch and Henry Lomb started a business

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