Better Optics Deliver Clear, Consistent Vision

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2 Better Optics Deliver Clear, Consistent Vision Learn how the PureVision2 family can satisfy patients and help build your practice. By Agustin Gonzalez, OD Learning What Patients Want The NSIGHT study provides a new look at what our patients are really seeking when they come into our offices. By Scott Han, OD Joe s View A new design for crisp, clear, consistent vision By Joe Barr, OD, MS, FAAO, Bausch + Lomb Contact Lens SPECTRUM HL SL7019 Editorial Staff EDITOR, CONTACT LENS SPECTRUM: Jason J. Nichols, OD, MPH, PhD, FAAO EDITORIAL MANAGER, SPECIAL PROJECTS: Angela Jackson EDITOR & PROJECT MANAGER, SPECIAL PROJECTS: Leslie Goldberg Design and Production PRODUCTION DIRECTOR: Leslie Caruso PRODUCTION MANAGER: Bill Hallman ART DIRECTOR: Michael F. Higgins Editorial and Production Offices 323 Norristown Road, Suite 200, Ambler, PA Phone: (215) Business Staff GROUP PUBLISHER: Roger T. Zimmer SALES: Dawn E. Schaefer & Scott Schmidt MARKETING: Amy Wauhop PROMOTIONAL EVENTS MANAGER: Michelle Kieffer Contact Lens Spectrum is published by Springer VisionCare. Copyright 2012, Springer Science + Business Media. All Rights Reserved. 2 CONTACT LENS SPECTRUM / SEPTEMBER 2012

3 By Agustin Gonzalez, OD Better Optics Deliver Clear, Consistent Vision Learn how the PureVision2 family can satisfy patients and help build your practice. In the past, both spherical and toric contact lens patients often had to accept some compromise in clarity of vision or comfort in order to wear soft contact lenses. Indeed, a recent survey of patients who wear toric soft contact lenses found that complaints of blurry, hazy, distorted and fluctuating vision were common and bothersome for this population. 1 Recently, Bausch + Lomb developed PureVision2 and PureVision2 For Astigmatism lenses. Both have aspheric optics to deliver clear, consistent vision while reducing halos and glare in low light. The aspheric optics are the result and convergence of improved optics, better understanding of on-eye lens performance, and the use of sophisticated manufacturing. These products have given my practice a high performance vision product with a fast-fitting toric alternative to the current lens designs. IMPROVED OPTICS Spherical aberration occurs as light that travels through the periphery of the lens focuses at a different point from the light that travels through the lens center (Figure 1). A mean spherical aberration of µm has been reported for myopic eyes, 2 so understanding the interaction between cornea and contact lens is crucial to developing a product that performs better on eye. Spherical aberration can have a negative effect on quality of vision and is pupil size dependent. Larger pupil size increases the spherical aberration effect, which in turn negatively affects visual clarity and contrast sensitivity. When developing the PureVision2 family of lenses, Bausch + Lomb researchers used sophisticated computer models to study contact lens conformance to the eye and the optical impact in both the central and peripheral cornea. The uniqueness of this family of lenses is the fact that Bausch + Lomb devised a way to maintain a spherical aberration compensated lens. The large optical zone maximizes the optical benefit from this aberration reduction, most notably in low-light conditions. The PureVision2 For Astigmatism lens also reduces spherical aberration on both the cylinder and spherical meridians of the lens. GREAT STABILITY The stabilization of PureVision2 For Astigmatism, Auto Align Design, uses thick and thin zones creating a hybrid-ballasting design that incorporates stability characteristics of a prism ballast and two peri-ballast areas (Figure 2). The design was the result of studying blink mechanics and cornea-contact lens interactions. The result was minimal rotation, quick alignment into position, and phenomenal stability. In addition, the lens design is comfortable and delivers consistently clear vision to patients. A large lens diameter (14.5 mm) along with the 8.9-mm base curve, also aids in maintaining both centration and stability. Figure 1. With spherical aberration, light rays passing through the center and periphery of the optical system do not simultaneously focus at the same focal point. CONTACT LENS SPECTRUM / SEPTEMBER

4 DEMONSTRATING SUCCESS The patient, a 32-year-old Hispanic male, had used toric lenses in the past but reported being unhappy with the quality and stability of vision. OD: X /20+ OS: X /20+ Keratometry OD: 45.25/45.75 OS: 44.75/45.50 The patient, a 21-year-old white female, had used contact lenses before but reported some difficulty driving at night. OD : X /20 OS : X /20 Keratometry OD: 44.25/44.50 OS: 44.25/44.25 CASE 1 Pupils OD: 4mm photopic pupil OS: 4mm photopic pupil Fitted with PureVision2 For Astigmatism OD: X /20+ OS: X /20+ The patient reported great stability of vision and mentioned that there was less glare when driving at night. Pupils OD: 6mm photopic Pupil OS : 6mm photopic Pupil Fitted with PureVision2 OD: /20+ OS: /20+ CASE 2 The patient reported improved night vision. The aspheric optics combined with the larger diameter provide great optical performance for patients with larger pupils and moderate to higher prescriptions. Prism ballast Peri ballast Figure 2. The Auto Align Design, a dual-ballasting system, keeps the lens from rotating out of position. It employs both prismballast and peri-ballast systems. ENHANCED COMFORT For added comfort, the PureVision2 family of lenses incorporates a thinner edge profile than the original PureVision lenses. The edge is also rounded to allow for a smooth transition between the lens and the conjunctival tissue. The balafilcon A material is the same silicone hydrogel polymer used in the original PureVision contact lens. It has 36% water content with a Dk of 99 (Dk/T of 130 at center [-3.00 D]) which allows for a high degree of oxygen permeability. ACCEPTANCE AND SUCCESS My clinical experience with the PureVision2 family of lenses has been extremely positive. The toric lens stabilizes quickly on the eye, making the initial fitting process easy for my technician. Initial rotation of the lens is minimal and could be compensated in the same visit, rather than requiring a follow-up appointment. This makes my work more efficient and less complicated. In addition to ease of fit, the lenses provide crisp visual acuity for my patients. There is a high degree of acceptance and satisfaction among patients fitted with the PureVision2 family of lenses. DR. GONZALEZ OWNS TWO PRIVATE INDEPENDENT OPTOMETRY PRACTICES IN THE DALLAS AREA. HE HAS A SPECIAL INTEREST IN THE USE OF SOCIAL MEDIA AND INTERNET MARKETING AS WELL AS CHANGING TRENDS IN MEDICATION USE BY OPTOMETRISTS. DR. GONZALEZ IS A FREQUENT LECTURER AT OPTOMETRY MEETINGS. HE IS AN ADJUNCT FACULTY MEMBER AND GRADUATE OF INTER AMERICAN UNIVERSITY SCHOOL OF OPTOMETRY IN PUERTO RICO. HE SERVES AS A COUNCIL ON OPTOMETRIC PRACTITIONER EDUCATION REVIEWER FOR THE ASSOCIATION OF REGULATORY BOARDS OF OPTOMETRY AND ON THE EDITORIAL BOARD FOR PRIMARY CARE OPTOMETRY NEWS. DR. GONZALEZ IS A CONSULTANT/ADVISOR TO ALCON, ALLERGAN, BAUSCH +LOMB AND ISTA. REFERENCES 1. Mack CJ, Rah MJ. Visual benefits of highest importance to eye care professionals and patients when choosing contact lenses for astigmatism. Poster presented at AAO Cox I, Kingston A, Vogt AKS. Wavefront aberrations of the human eye a large population study. Poster presented at annual BCLA meeting; Manchester, UK; CONTACT LENS SPECTRUM / SEPTEMBER 2012

5 Learning What Patients Want By Scott Han, OD, FAAO The NSIGHT study provides a new look at what our patients are really seeking when they come into our offices. My use of the Bausch + Lomb PureVision2 family of contact lenses began when I learned about the Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) study. The study influenced how I think about what patients really want and how that may differ from what we think they want or what we want for the patient. LEARNING FROM NSIGHT The NSIGHT study evaluated 3800 vision-corrected individuals across seven global markets to determine what motivates people to make decisions about eyecare products and identify unmet needs. This provides a framework for identifying patient priorities and recommending products and services to help them. According to NSIGHT, the most compelling features when choosing eye-related products center around vision. Patients want us to give them the best vision possible. That means not only Snellen visual acuity on the eye chart but also quality of vision. The study also identified the incidence of glare (52%) and halos (35%) for contact lens wearers in the United States and the patients desire for a solution. 1,2 Many patients believed that no solutions existed for these problems. If patients think there s nothing that can be done, they may not bother to tell you about the problem. IDENTIFYING PATIENTS WHO NEED HELP So, I simply began asking my patients if they experience any glare and halos and if they would like to reduce or minimize them. I found the frequency of glare and halos in my patient population to be even higher than that found in the NSIGHT study. For our spectacle-corrected patients, we re quick to offer anti-reflective lens coatings, but what about our contact lens patients? We didn t have much to offer them until now. PUREVISION2 FAMILY OF CONTACT LENSES One of the barriers to high-quality vision and a contributor to glare and halos, especially in dim lighting, is spherical aberration. The average amount of spherical aberration in the general population is +0.18um for myopic eyes. 3 Both the PureVision2 and PureVision2 For Astigmatism are designed to reduce positive spherical aberration adjusted across the power range. The PureVision2 For Astigmatism lens does this in both the spherical and cylinder meridians. My patients consistently comment about their improved vision. The thin lens design maintains comfort throughout the day. One of my patients said he couldn t feel any difference between the spherical lens and the toric lens. For the first time, he was able to tolerate wearing contacts and he was excited to have an option other than eyeglasses. PUREVISION2 FAMILY DELIVERS VISION AND COMFORT The PureVision2 family of contact lenses has enabled me to give my patients what they want great vision and comfort. This is achieved through aspheric optics that reduce spherical aberration and thin lens designs. The toric lens adds excellent centration and rotational stability to provide consistently clear vision. The large optic zone and aspheric optics help to improve nighttime vision by reducing glare and halos. The thin lens design allows for comfortable all-day wear. The PureVision2 family of contact lenses has been an important part of building my practice and helping patients. DR. HAN IS DIRECTOR OF OPTOMETRY AND A PARTNER IN A MULTISPECIALTY, MULTI- DISCIPLINARY, PRIVATE PRACTICE WITH FIVE LOCATIONS IN THREE COUNTIES IN FLORIDA. HE IS A CONSULTANT/ADVISOR TO ALLERGAN, BAUSCH + LOMB AND MERCK. REFERENCES Editor s note: please see case studies on page 6 1. Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) Study. Market Probe Europe. December Mack CJ, Merchea MM, Thomas H. A global survey reveals vision needs of highest importance amongst a vision-corrected population. Optom Vis Sci. 2010;87:E-abstract: Cox I, Kingston A, Vogt AKS. Wavefront aberrations of the human eye a large population study. BCLA. Manchester, UK, CONTACT LENS SPECTRUM / SEPTEMBER

6 DEMONSTRATING SUCCESS Patient MH, a 36-year-old female, came in for an annual exam and renewal of her contact lens prescription. She reported that she was doing a great deal of night driving to visit her mother who was sick and living about an hour away. I asked if she experienced any glare and halos at night. She thought the glare she experienced with her contacts was normal. She reported sometimes wearing her eyeglasses instead because it became too distracting and tiring for her eyes to drive with contact lenses at night. Like many patients, she never complained about it because she didn t think anything could be done. OD: sph 20/20 OS: x180 20/20 CASE 1 Keratometry showed OD 44.75/45.00@089 and OS 45.00/45.75@090. Medical history and ocular examination were unremarkable. Fitted with PureVision2 OU Vision was 20/20 OD+OS with good centration, coverage and movement. She was going to visit her mother that night and was excited to drive with the new contact lenses. She called the office the next day to tell me how clear her vision was both day and night and how the glare was minimized during night driving. Patient KS is a 29-year-old female who presented for a routine eye exam and contact lens prescription. My contacts always move around and it makes my vision blurry, she said. This type of complaint is common in toric contact lens wearers. It may not always be as specific. For example, many patients don t realize that the lens is rotating, but the most common complaint I hear with toric contact lenses is that vision fluctuates and becomes blurry with their contact lenses but not with their eyeglasses. OD: x175 20/20 OS: x005 20/20 Keratometry showed OD 45.25/47.00@085 and OS 45.00/46.75@093. Patient medical history and ocular examination were unremarkable. Fitted with PureVision2 For Astigmatism OD: x /20 OS: x /20 Vision was 20/20 OD+OS with good centration, coverage and movement. CASE 2 The rotational markings were aligned at the 6 o clock position OD+OS. Most doctors are looking for ways to minimize chair time and improve efficiency. I ve found that PureVision2 For Astigmatism lenses have fast rotational alignment. With this lens, my fitting process is quick and it s simplified because I can assess the fit right away without having the patient go back to the waiting room and wait for the lens to rotate and stabilize. The novel hybrid ballasting design combines features of both prism- and peri-ballasting designs to deliver consistent and stable vision. When KS returned for her 2-week follow-up visit, she said she no longer had to manually move the contact lenses in her eyes to sharpen her vision. Patient JS, a 25-year-old male, came to me for a new patient exam. During the exam, I asked if he d ever considered contact lenses. He said that because he had astigmatism in one eye, contact lenses had been too uncomfortable in the past. I told him about the new options and encouraged him to try again. He agreed but was not very enthusiastic. OD: x165 20/20 OS: x015 20/25 Keratometry showed OD 45.50/45.75@080 and OS 45.25/47.00@104. Patient medical history and ocular examination were unremarkable. CASE 3 Fitted with PureVision2 OD and PureVision2 For Astigmatism OS OD: /20 OS: x /25 With these lenses, we found good centration, coverage and movement with rotational marking at 6 o clock OS. The thin lens design maintains comfort throughout the day. JS said he couldn t feel any difference between the spherical lens and the toric lens. For the first time, he was able to tolerate wearing contacts and he was excited to have an option other than eyeglasses. 6 CONTACT LENS SPECTRUM / SEPTEMBER 2012

7 CLS qxd:POLY 9/25/12 3:43 PM Page 7 { JOE S VIEW } Clinical insights from Joe Barr, OD, MS, FAAO, Bausch + Lomb A New Design for Crisp, Clear, Consistent Vision Toric, and support the Auto Align Designing a contact lens to meet ment, one of the main drivers of a thin rounded lens design that the needs of astigmatic patients toric lens instability. In doing so, enables a smooth, gentle transi- presents a challenge to the best our lens designers and clinicians tion of the lid from the lens to the lens designers. To meet this chal- created an orientation and stabi- conjunctiva to provide a natural lenge, the vision scientists at lization design that is unique - feel throughout the day and a Bausch + Lomb started with a blank Auto Align Design. moisture-rich packaging solu- Design. Both lenses have two key features: slate. There were no ideas too far- tion to provide excellent comfort fetched, too small or too insignifi- upon insertion. cant no barriers to success. What When fitting patients with toric came out of this process was our lat est toric lens design PureVision 2 contact lenses, it s important to For Astigmatism. consider all aspects of successful contact lens wear: vision, comfort, and health. Patients are looking for PureVision2 For Astigmatism is the only silicone hydrogel toric lens designed with aspheric optics in all meridians to reduce the positive spherical aberration that is natu- FIGURE 1. Thickness profiles of PureVision Toric (A) and PureVision2 For Astigmatism (B), where the red color indicates the thickest portions of the lens and the blue color represents the thinnest portions of the lens. contact lenses that offer crisp, consistently clear vision throughout the day without compromising comfort. As Dr. David Geffen, OD, rally occurring in the human eye as FAAO, says, They want that crisper well as what is naturally induced by vision for their active lifestyles, and spherical lens designs due to their In order to improve centration, it gets them excited about referring spherical surfaces. Incorporating PureVision2 For Astigmatism was patients to me. aspheric optics across the entire designed with a larger diameter. power range provides patients with In addition, the larger diameter clear, crisp vision all day, even in optimizes the thickness of the low light. ballasting compared to PureVision Toric (Figure 1). This helps create In addition to the improved optics, a more comfor table wear ing several experiments were under- experience, maintain the same taken to understand eyelid move- large optic zone as PureVision Joe Barr, OD, MS, FAAO Vice President Global Clinical & Medical Affairs and Professional Services Vision Care Bausch + Lomb ADVERTORIAL 2012 Bausch & Lomb Incorporated. / are trademarks of Bausch & Lomb Incorporated or its affiliates. All other brand/product names are trademarks of their respective owners. PNS06439 HL5646

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