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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

HL5879-1 SL7019

Contact Lens SPECTRUM®

Editorial Staff Editorial and Production Offices EDITOR, CONTACT LENS SPECTRUM: Jason J. Nichols, OD, MPH, PhD, FAAO 323 Norristown Road, Suite 200, Ambler, PA 19002 EDITORIAL MANAGER, SPECIAL PROJECTS: Angela Jackson Phone: (215) 646-8700 EDITOR & PROJECT MANAGER, SPECIAL PROJECTS: Leslie Goldberg Business Staff Design and Production GROUP PUBLISHER: Roger T. Zimmer PRODUCTION DIRECTOR: Leslie Caruso SALES: Dawn E. Schaefer & Scott Schmidt PRODUCTION MANAGER: Bill Hallman MARKETING: Amy Wauhop ART DIRECTOR: Michael F. Higgins PROMOTIONAL EVENTS MANAGER: Michelle Kieffer

Contact Lens Spectrum is published by Springer VisionCare. Copyright 2012, Springer Science + Business Media. All Rights Reserved.

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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 spherical aberration compensated lens. The large opti- patients often had to accept some compromise in clarity cal zone maximizes the optical benefit from this aberra- of vision or comfort in order to wear soft contact lenses. tion reduction, most notably in low-light conditions. Indeed, a recent survey of patients who wear toric soft The PureVision2 For Astigmatism lens also reduces contact lenses found that complaints of blurry, hazy, spherical aberration on both the cylinder and spherical distorted and fluctuating vision were common and meridians of the lens. bothersome for this population.1 Recently, Bausch + Lomb developed PureVision2 GREAT STABILITY and PureVision2 For Astigmatism lenses. Both have The stabilization of PureVision2 For Astigmatism, aspheric optics to deliver clear, consistent vision while Auto Align Design, uses thick and thin zones creating a reducing halos and glare in low light. The aspheric op- hybrid-ballasting design that incorporates stability char- tics are the result and convergence of improved optics, acteristics of a prism ballast and two peri-ballast areas better understanding of on-eye lens performance, and (Figure 2). The design was the result of studying blink the use of sophisticated manufacturing. These products mechanics and cornea-contact lens interactions. The have given my practice a high performance vision result was minimal rotation, quick alignment into posi- product with a fast-fitting toric alternative to the cur- tion, and phenomenal stability. In addition, the lens rent lens designs. design is comfortable and delivers consistently clear vision to patients. A large lens diameter (14.5 mm) along IMPROVED OPTICS with the 8.9-mm base curve, also aids in maintaining Spherical aberration occurs as light that travels both centration and stability. 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 +0.18 µm has been reported for myopic eyes,2 so understanding the interaction between cornea and contact lens is cru- cial 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 con- trast 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 Figure 1. With spherical aberration, light rays passing through the center and periphery fact that Bausch + Lomb devised a way to maintain a of the optical system do not simultaneously focus at the same focal point.

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DEMONSTRATING SUCCESS CASE 1 The patient, a 32-year-old Hispanic male, had used Pupils toric lenses in the past but reported being unhappy with OD: 4mm photopic pupil the quality and stability of vision. OS: 4mm photopic pupil Fitted with PureVision2 For Astigmatism Rx OD: -1.00 -1.75 X 170 8.9 14.5 20/20+ OD: -1.00 -2.00 X 170 20/20+ OS: -4.50 -1.25 X 030 8.9 14.5 20/20+ OS: -4.75 -1.50 X 030 20/20+ Keratometry The patient reported great stability of vision and OD: 45.25/45.75 mentioned that there was less glare when driving at OS: 44.75/45.50 night.

CASE 2 The patient, a 21-year-old white female, had used contact Pupils lenses before but reported some difficulty driving at night. OD: 6mm photopic Pupil OS : 6mm photopic Pupil Rx Fitted with PureVision2 OD : -7.00 -0.25 X 120 20/20 OD: -6.50 20/20+ OS : -7.55 -0.50 X 080 20/20 OS: -7.00 20/20+ Keratometry OD: 44.25/44.50 The patient reported improved night vision. The OS: 44.25/44.25 aspheric optics combined with the larger diameter provide great optical performance for patients with larger pupils and moderate to higher prescriptions.

of lenses has been extremely positive. The toric lens Figure 2. The Auto Align Design, stabilizes quickly on the eye, making the initial fitting a dual-ballasting system, keeps process easy for my technician. Initial rotation of the Prism the lens from rotating out of ballast position. It employs both prism- lens is minimal and could be compensated in the same ballast and peri-ballast systems. visit, rather than requiring a follow-up appointment. This makes my work more efficient and less complicated. Peri ballast In addition to ease of fit, the lenses provide crisp visual acuity for my patients. There is a high degree of acceptance ENHANCED COMFORT and satisfaction among patients fitted with the PureVision2 For added comfort, the PureVision2 family of lenses family of lenses.

incorporates a thinner edge profile than the original DR. GONZALEZ OWNS TWO PRIVATE INDEPENDENT OPTOMETRY PRACTICES IN THE DALLAS PureVision lenses. The edge is also rounded to allow for a 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 smooth transition between the lens and the conjunctival FREQUENT LECTURER AT OPTOMETRY MEETINGS. HE IS AN ADJUNCT FACULTY MEMBER AND tissue. GRADUATE OF INTER AMERICAN UNIVERSITY SCHOOL OF OPTOMETRY IN PUERTO RICO. HESERVESASACOUNCIL ON OPTOMETRIC PRACTITIONER EDUCATION REVIEWER FOR THE The balafilcon A material is the same silicone hydrogel ASSOCIATION OF REGULATORY BOARDS OF OPTOMETRY AND ON THE EDITORIAL BOARD FOR PRIMARY CARE OPTOMETRY NEWS. DR. GONZALEZ IS A CONSULTANT/ADVISOR TO polymer used in the original PureVision contact lens. It ALCON, ALLERGAN, BAUSCH +LOMB AND ISTA. 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 oxy- REFERENCES gen permeability. 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 2011. ACCEPTANCE AND SUCCESS 2. Cox I, Kingston A, Vogt AKS. Wavefront aberrations of the human eye — a large population My clinical experience with the PureVision2 family study. Poster presented at annual BCLA meeting; Manchester, UK; 2011.

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By Scott Han, OD, FAAO Learning What Patients Want 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 +0.18um for myopic eyes.3 Both the PureVision2 and of contact lenses began when I learned about the PureVision2 For Astigmatism are designed to reduce Needs, Symptoms, Incidence, Global Eye Health positive spherical aberration — adjusted across the Trends (NSIGHT) study. The study influenced how I power range. The PureVision2 For Astigmatism lens think about what patients really want and how that does this in both the spherical and cylinder meridians. may differ from what we think they want or what we My patients consistently comment about their im- want for the patient. proved vision. The thin lens design maintains comfort throughout LEARNING FROM NSIGHT the day. One of my patients said he couldn’t feel any The NSIGHT study evaluated 3800 vision-corrected difference between the spherical lens and the toric individuals across seven global markets to determine lens. For the first time, he was able to tolerate wear- what motivates people to make decisions about eyecare ing contacts and he was excited to have an option products and identify unmet needs. This provides a other than eyeglasses. framework for identifying patient priorities and recom- mending products and services to help them. PUREVISION2 FAMILY DELIVERS According to NSIGHT, the most compelling features VISION AND COMFORT when choosing eye-related products center around The PureVision2 family of contact lenses has vision. Patients want us to give them the best vision enabled me to give my patients what they want — great possible. That means not only Snellen visual acuity on vision and comfort. This is achieved through aspheric the eye chart but also quality of vision. The study also optics that reduce spherical aberration and thin lens identified the incidence of glare (52%) and halos designs. The toric lens adds excellent centration and (35%) for contact lens wearers in the United States and rotational stability to provide consistently clear vision. the patients’ desire for a solution.1,2 Many patients The large optic zone and aspheric optics help to improve believed that no solutions existed for these problems. If nighttime vision by reducing glare and halos. The thin patients think there’s nothing that can be done, they lens design allows for comfortable all-day wear. The may not bother to tell you about the problem. PureVision2 family of contact lenses has been an impor- tant part of building my practice and helping patients. IDENTIFYING PATIENTS WHO NEED HELP

So, I simply began asking my patients if they expe- DR. HAN IS DIRECTOR OF OPTOMETRY AND A PARTNER IN A MULTISPECIALTY, MULTI- rience any glare and halos and if they would like to DISCIPLINARY, PRIVATE PRACTICE WITH FIVE LOCATIONS IN THREE COUNTIES IN FLORIDA. HE IS A CONSULTANT/ADVISOR TO ALLERGAN, BAUSCH + LOMB AND MERCK. 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. Editor’s note: please see case studies on page 6 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 REFERENCES them — until now. 1. Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) Study. Market Probe Europe. December 2009. PUREVISION2 FAMILY OF CONTACT LENSES 2 Mack CJ, Merchea MM, Thomas H. A global survey reveals vision needs of highest importance One of the barriers to high-quality vision and a amongst a vision-corrected population. Optom Vis Sci. 2010;87:E-abstract:105233. contributor to glare and halos, especially in dim light- 3. Cox I, Kingston A, Vogt AKS. Wavefront aberrations of the human eye — a large population ing, is spherical aberration. The average amount of study. BCLA. Manchester, UK, 2011. spherical aberration in the general population is

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DEMONSTRATING SUCCESS

Patient MH, a 36-year-old female, came in for an annual exam and CASE 1 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 Keratometry showed OD 44.75/45.00@089 and OS 45.00/45.75@090. about an hour away. I asked if she experienced any glare and halos at Medical history and ocular examination were unremarkable. night. She thought the glare she experienced with her contacts was Fitted with PureVision2 normal. She reported sometimes wearing her eyeglasses instead because OU -1.75 8.6 14.0 it became too distracting and tiring for her eyes to drive with contact Vision was 20/20 OD+OS with good centration, coverage and move- lenses at night. Like many patients, she never complained about it ment. She was going to visit her mother that night and was excited to because she didn’t think anything could be done. drive with the new contact lenses. Rx She called the office the next day to tell me how clear her vision was OD: -1.75 sph 20/20 — both day and night — and how the glare was minimized during night OS: -1.50-0.50x180 20/20 driving.

CASE 2 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 The rotational markings were aligned at the 6 o’clock position OD+OS. 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, Most doctors are looking for ways to minimize chair time and many patients don’t realize that the lens is rotating, but the most common improve efficiency. complaint I hear with toric contact lenses is that vision fluctuates and becomes blurry with their contact lenses but not with their eyeglasses. I’ve found that PureVision2 For Astigmatism lenses have fast Rx rotational alignment. With this lens, my fitting process is quick and it’s OD: -2.50-1.50x175 20/20 simplified because I can assess the fit right away without having the OS: -3.00-1.50x005 20/20 patient go back to the waiting room and wait for the lens to rotate and Keratometry showed OD 45.25/47.00@085 and OS 45.00/46.75@093. stabilize. The novel hybrid ballasting design combines features of both Patient medical history and ocular examination were unremarkable. prism- and peri-ballasting designs to deliver consistent and stable vision. Fitted with PureVision2 For Astigmatism OD: -2.50-1.25x180 8.9 14.5 20/20 When KS returned for her 2-week follow-up visit, she said she no OS: -3.00-1.25x180 8.9 14.5 20/20 longer had to manually move the contact lenses in her eyes to sharpen Vision was 20/20 OD+OS with good centration, coverage and movement. her vision.

CASE 3 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 Fitted with PureVision2 OD and PureVision2 For Astigmatism OS that because he had astigmatism in one eye, contact lenses had been too OD: -4.25 8.6 14.0 20/20 uncomfortable in the past. I told him about the new options and encour- OS: -4.00-1.75x010 8.9 14.5 20/25 aged him to try again. He agreed but was not very enthusiastic. With these lenses, we found good centration, coverage and movement Rx with rotational marking at 6 o’clock OS. OD: -4.50-0.25x165 20/20 The thin lens design maintains comfort throughout the day. JS said he OS: -4.25-2.00x015 20/25 couldn’t feel any difference between the spherical lens and the toric lens. Keratometry showed OD 45.50/45.75@080 and OS 45.25/47.00@104. For the first time, he was able to tolerate wearing contacts and he was Patient medical history and ocular examination were unremarkable. excited to have an option other than eyeglasses.

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{ JOE’S VIEW } Clinical insights from Joe Barr, OD, MS, FAAO, Bausch + Lomb

Toric, and support the Auto Align A New Design for Crisp, Clear, Design. Consistent Vision Both lenses have two key features: 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- 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 came out of this process was our lat- When fitting patients with toric est toric lens design – PureVision®2 contact lenses, it’s important to For Astigmatism. consider all aspects of successful contact lens wear: vision, comfort, PureVision2 For Astigmatism is the and health. Patients are looking for only silicone hydrogel toric lens contact lenses that off er crisp, con- FIGURE 1. Thickness profi les of PureVision Toric (A) designed with aspheric optics in and PureVision2 For Astigmatism (B), where the sistently clear vision throughout all meridians to reduce the positive red color indicates the thickest portions of the lens the day without compromising and the blue color represents the thinnest portions spherical aberration that is natu- of the lens. comfort. As Dr. David Geff en, 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 Joe Barr, OD, MS, FAAO Toric (Figure 1). This helps create Vice President In addition to the improved optics, a more comfortable wearing Global Clinical & Medical Affairs and Professional Services several experiments were under- experience, maintain the same Vision Care taken to understand eyelid move- large optic zone as PureVision Bausch + Lomb

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