Contact Lens Trends and Latest Technology

COPE 38973-CL

Pamela Lowe OD

Contact Lens Trends amp TechnologiesMaximizing Your Contact Lens

Patient Experience

Pamela A Lowe OD FAAODiplomate American Board of Optometry

Professional Eye Care Center IncChicagoNiles Illinois

Disclosures

Speakerrsquos Bureau for

-Alcon

-Diopsys

-Heidelberg

-Maculogix

-Optos

-Reichert

-Zeavision

Lecture Objectives

bull Look at contact lens history and trends

that affect the profession

bull Look at best practices for increasing

compliance

bull Create excitementwant for CL patients

bull Practicing good optometry is best for

patients and great for business

bull Challenge How does one maximize

performance in the world of contact

lenses

Evolution of Contact Lenses

bull 1887 First contact lens manufactured from

glass and fitted to cover the entire eye

bull 1939 Contact lenses first made from

plastic

bull 1948 Plastic contact lenses designed to

cover only the eyes cornea-PMMA

bull 1971 Introduction of soft contact lenses

bull 1978 Introduction of GP contact lenses

Evolution of Contact Lenses

bull 1981 FDA approval of new soft contact

lenses for extended (overnight) wear

bull 1986 Overnight wear of GP contact lenses

becomes available

bull 1987 Introduction of disposable soft

contact lenses-1-2 week replacement

bull 1987 GP contacts available in next-

generation fluorosilicone acrylate materials

Unique to Ubiquitous

Contact Lens Trends amp TechnologiesMaximizing Your Contact Lens

Patient Experience

Pamela A Lowe OD FAAODiplomate American Board of Optometry

Professional Eye Care Center IncChicagoNiles Illinois

Disclosures

Speakerrsquos Bureau for

-Alcon

-Diopsys

-Heidelberg

-Maculogix

-Optos

-Reichert

-Zeavision

Lecture Objectives

bull Look at contact lens history and trends

that affect the profession

bull Look at best practices for increasing

compliance

bull Create excitementwant for CL patients

bull Practicing good optometry is best for

patients and great for business

bull Challenge How does one maximize

performance in the world of contact

lenses

Evolution of Contact Lenses

bull 1887 First contact lens manufactured from

glass and fitted to cover the entire eye

bull 1939 Contact lenses first made from

plastic

bull 1948 Plastic contact lenses designed to

cover only the eyes cornea-PMMA

bull 1971 Introduction of soft contact lenses

bull 1978 Introduction of GP contact lenses

Evolution of Contact Lenses

bull 1981 FDA approval of new soft contact

lenses for extended (overnight) wear

bull 1986 Overnight wear of GP contact lenses

becomes available

bull 1987 Introduction of disposable soft

contact lenses-1-2 week replacement

bull 1987 GP contacts available in next-

generation fluorosilicone acrylate materials

Unique to Ubiquitous

Evolution of Contact Lenses

bull 1996 Introduction of one-day disposable

soft lenses

bull 1998 Silicone-hydrogel contact lenses for

30 day continuous wear

bull 2002 Overnight orthokeratology approved

by FDA

bull 2010 Custom-manufactured silicone-

hydrogel lenses become available

bull 2014 Water Gradient Technology

Contact Lens Correction 2017

What is your contact lens strategyWhat is your practice contact lens

strategy

bull Do you fit primarily HEMA

bull Do you fit primarily silicone

bull Do you fit 2 week lenses

bull Do you fit monthly lenses

bull Do you fit daily disposable lenses

bull Do you let the patient decide

14

516

467

434

393365

337318

389

432

463496 506 512 517

59 73 87 99120

143160

2009 2010 2011 2012 2013 2014 YTD 2015

2-Week Replacement EQ Sales Monthly Replacement EQ Sales Daily Disposable Replacement EQ Sales

EQ

mark

et

share

(

) by

soft c

onta

ct

lens r

epla

cem

ent schedule

The contact lens market is shifting to one-day

and one-month replacement

Reference GfK Business Review July 2015

Contact Lens Compliance Studies

- Jones L Dumbleton K Fonn D Dillehay S Comfort and compliance with frequent replacement soft contact lenses Optom Vis Sci

200279259

- Dumbleton K Woods C Jones L et al Patient and Practitioner Compliance With Silicone Hydrogel and Daily Disposable Lens

Replacement in the United States Eye amp Contact Lens 200935164-71

- Yeung K Forister J Forister E et al Compliance with soft contact lens replacement schedules and associated contact lensndashrelated

ocular complicationsThe UCLA Contact Lens Study Optometry 201081598-607

Percent of Patients Compliant with Manufacturerrsquos Recommended Replacement Frequency

2011-02-0191G

46

48

59

55

72

78

94

88

86

0 10 20 30 40 50 60 70 80 90 100

Jones 2002

Dumbleton 2009

Yeung 2010

1 Day

1 Month

2 Weeks

16

Replacement Schedule One Way to Help Improve

Patient Compliance

DAILIESreg brand (nelfilcon A) contact lenses include DAILIESreg AquaComfort Plusreg and FOCUSreg DAILIESreg

References 1 Dumbleton K et al Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United

States Eye Contact Lens 20094164-171 2 Alcon data on file 2009 3 In a 2013 survey of 9677 patients from 457 practitioners wearers of

silicone hydrogel (SiHy) and daily disposable contact lenses Alcon data on file 2013

Percentage of Patients Who Replace Their Contact Lenses On Time3

2013 Study of 9677 Contact Lens Patients

30

2-Week

79

Daily

65

Monthly

Most Compliant Modalities

bull Daily has the highest compliance rate on

average 79-87

bull Monthly shows next highest compliance

rate on average 65-74

bull 2 Week shows the least compliance

averaging 30-53

2012 Dumbleton Study of 9677 patients

Practice Management Impact of Increased

Compliance

bull Prescribing replacement schedules with

greater compliance results in

ndash Increased contact lens product

revenue

ndash Increased professional fee

revenue

ndash Increased optical revenue

ndash Greater loyalty to your practice

What is the purpose of a business

ldquoThe purpose of a business is not

to make a sale

- Peter Drucker

The purpose of a business is

to make and keep

customersrdquo

ldquoThe purpose of an optometric

practice is not to make a sale

The purpose of an

optometric practice is to

make and keep patientsrdquo

Reducing the average interval between contact

lens exams from 18 months to 16 months results in

a 125 increase in the number of exams

performed each year from existing wearer base

Patient Loyalty

Reference Best Practices of Contact Lens Management March 2010

22 | copy2012 Novartis 0112 MIX12013SK FOR EXTERNAL USE ONLY NOT FOR DISTRIBUTION

Reducing the average interval between contact lens

exams from 18 months to 14 months results in a

286 increase in the number of exams performed

each year from existing wearer base

Reference MBA Best Practices of Contact Lens Management March 2010

2010-12-1386

Annual Supply is Key

bull Take two words out of office vocabulary

ldquoboxesrdquo and ldquocoverrdquo

bull Replace with ldquosupplyrdquo and

ldquocontributionrdquo

Why Fit Daily Disposables

bull Offering the healthiest choice stresses

contacts as a medical choice vs offering a

ldquomenurdquo of options (no solutionsclean lens daily)

bull Daily compliance is the highest so

patients return yearly

bull Patients returning yearly is best for their

ocular health and best for practice

profitability

Daily Disposables Materials All the

Same

bull HEMA-Soflens Proclear Acuvue

Focus Dailies ClearSight

bull HEMA with blink activation moisture

-Dailies Aquacomfort Plus

bull HEMA to help biocombatiblity-Biotrue

bull Silicone-TruEye Clariti (Freshday) MyDay

Oasys 1 Dayavailable in toric

bull DIFFERENTIATE FOR YOUR PATIENT

AND TELL THEM WHY

WHERE IS INDUSTRY

RESEARCH TAKING CONTACT

LENSES TECHNOLOGY

28

Challenges for Soft Contact Lens Wearers

Dryness and Discomfort

bull Discomfort is the 1

cause of dropout1

bull The median future

value over the lifetime

of a single dropout to

an eye care practice in

the US is $216951

References 1 Rumpakis J New data on contact lens dropouts an international perspective Review of Optometry 201014737-42

2 Secor G Change is good encouraging the switch to multifocals Review of Cornea amp Contact Lenses 2014 Nov 12-14

The proportion of contact lens wearers drops off markedly even

as refractive need continues to increase2

2

Water Gradient Technology

bull A new polymer of contact lens

bull First time two different polymers are in a

single soft contact lens

bull A new era in contact lens comfort

bull New criteria-Lubricity

Comfort is the 1 reason for CL drop-out

Core

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

Silicone hydrogel material with

bull Low water content

bull High oxygen transmissibility

bull Low modulus

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Surface

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

bull 6 microns thick

bull Essentially no silicone present

bull Ultrasoft surface gel

bull Over 80 water1

bull Water-loving polymer chains

reduce friction helping to

minimize interaction with delicate

tissues of the eye

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Breakthrough Science

Water Gradient Contact Lenses

Surface cell microvilli

Natural Moisture of the Cornea

The glycocalyx is produced by corneal epithelial surface cells

Helps bind mucins and tears onto the hydrophobic corneal surface

Aqueous with

soluble mucins

Corneal epithelial cells

Glycocalyx with

soluble mucins

Water Gradient Contact LensCorneal Surface

daggerImage is for illustrative purposes only

Most Patients Are Silently Struggling with

Lens Discomfort1

Among contact lens patients who bought a new supply of the same brand of contact lenses at the last eye examReference 1 Based on a survey of 113 contact lens patients Alcon data on file 2006

8680

76

24

11 10

0

10

20

30

40

50

60

70

80

90

100

Eyes dried out when wearing

contact lenses

Contact lenses felt

uncomfortable at end of day

Eyes felt irritated when

wearing contact lenses

Total experiencing attime of appointment

Total mentioning todoctor at exam

Among patients who bought a new supply of thesame brand of contact lenses at last eye exam

Why Offer Daily Modality

bull Our industry partners are investing

their RampD in daily disposables

bull Most recent breakthrough of water

gradient is available only as a daily

disposable lens

bull Specialty lenses -toric and now MANY

multi-focal contacts are out in daily

lenses Proclear 1 Day Multifocal Dailies Aqua

Comfort Plus Multifocal Acuvue 1D Multi Biotrue1Day

Multi silicones-Clariti 1Day Multi

Dailies Total 1 Multifocal-has come

Why Offer Daily Modality

bull If you donrsquothellipsomeone else will

-Let your patients learn about the best

technology from YOU Let them experience it

bull Always set up patient expectations for

what is coming on the horizon

-Let patients know why you fit them with

your lens choice and that next year they will

be the first to know about whatrsquos new

Why Offer Multifocal CLrsquos

1986 1990

1994 1996

Ben

Franklin1980

1983 1985

1999 2004

2010-12-1350

DEMAND is REAL

91 of current

contact lens wearers

age 35 to 55 are

committed to

continuing with

contact lens wear1

1 Edmunds and Reindel (2003) as cited in Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Contact lens usage drops off after age 45 while the

need for vision correction steadily increases1

Contact lens usage by age1

CIBA VISION data on file 20062010-12-1350

Presbyopia = Opportunity

bull Presbyopia affects approximately 90 million adults in the

USA alone

bull About one in four patients seen by optometrists

Source httpwwwarticlesbasecomhealth-articlespresbyopia-and-bifocal-contact-lenses-2744577html2010-12-1350

Presbyopia = OpportunityGrowth

22 Bifocal or Progressive CLs

35 Monovision CLs

27 Distance CLs w or wo Readers

53 of the 169 million people in the United States who

wear vision correction are presbyopic

bullYet only 8 of

presbyopes wear

contact lenses as their

primary mode of

vision correction1

2010-12-1350

Ready or not here we come

bull Prospective US CL market

expected to increase to

almost 34 million over the

next decade1

ndash Those 50 years of age

and overhellip

bull Comprise single largest age

component of this projected

group

bull Projected to be 28 of all

potential CL wearers by 2018

bull gt 135 million people

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Ready or not here we come

In the US alone

42 or 135 million

people will be

presbyopic by 20201

1 Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Ready or not here we come

ndash ldquoGen-Xrdquo (born 1965 - 1980)

bull Next generation of new and

emerging presbyopes

bull Highly motivated to preserve

both visual function and

youthful appearance

More technologically

savvy greater task variability

Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Compared four correction alternatives for

emerging presbyopes

bull Low add SiHy multifocal lenses (AIR OPTIXreg AQUA

MULTIFOCAL contact lenses)

bull Monovision (AIR OPTIXreg AQUA contact

lenses)

bull Habitual Rx (no change)

bull Optimized distance spectacle Rx

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

AIR OPTIX is a trademark of Novartis AG2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

22 | copy2012 Novartis 0112 MIX12013SK FOR EXTERNAL USE ONLY NOT FOR DISTRIBUTION

Reducing the average interval between contact lens

exams from 18 months to 14 months results in a

286 increase in the number of exams performed

each year from existing wearer base

Reference MBA Best Practices of Contact Lens Management March 2010

2010-12-1386

Annual Supply is Key

bull Take two words out of office vocabulary

ldquoboxesrdquo and ldquocoverrdquo

bull Replace with ldquosupplyrdquo and

ldquocontributionrdquo

Why Fit Daily Disposables

bull Offering the healthiest choice stresses

contacts as a medical choice vs offering a

ldquomenurdquo of options (no solutionsclean lens daily)

bull Daily compliance is the highest so

patients return yearly

bull Patients returning yearly is best for their

ocular health and best for practice

profitability

Daily Disposables Materials All the

Same

bull HEMA-Soflens Proclear Acuvue

Focus Dailies ClearSight

bull HEMA with blink activation moisture

-Dailies Aquacomfort Plus

bull HEMA to help biocombatiblity-Biotrue

bull Silicone-TruEye Clariti (Freshday) MyDay

Oasys 1 Dayavailable in toric

bull DIFFERENTIATE FOR YOUR PATIENT

AND TELL THEM WHY

WHERE IS INDUSTRY

RESEARCH TAKING CONTACT

LENSES TECHNOLOGY

28

Challenges for Soft Contact Lens Wearers

Dryness and Discomfort

bull Discomfort is the 1

cause of dropout1

bull The median future

value over the lifetime

of a single dropout to

an eye care practice in

the US is $216951

References 1 Rumpakis J New data on contact lens dropouts an international perspective Review of Optometry 201014737-42

2 Secor G Change is good encouraging the switch to multifocals Review of Cornea amp Contact Lenses 2014 Nov 12-14

The proportion of contact lens wearers drops off markedly even

as refractive need continues to increase2

2

Water Gradient Technology

bull A new polymer of contact lens

bull First time two different polymers are in a

single soft contact lens

bull A new era in contact lens comfort

bull New criteria-Lubricity

Comfort is the 1 reason for CL drop-out

Core

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

Silicone hydrogel material with

bull Low water content

bull High oxygen transmissibility

bull Low modulus

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Surface

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

bull 6 microns thick

bull Essentially no silicone present

bull Ultrasoft surface gel

bull Over 80 water1

bull Water-loving polymer chains

reduce friction helping to

minimize interaction with delicate

tissues of the eye

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Breakthrough Science

Water Gradient Contact Lenses

Surface cell microvilli

Natural Moisture of the Cornea

The glycocalyx is produced by corneal epithelial surface cells

Helps bind mucins and tears onto the hydrophobic corneal surface

Aqueous with

soluble mucins

Corneal epithelial cells

Glycocalyx with

soluble mucins

Water Gradient Contact LensCorneal Surface

daggerImage is for illustrative purposes only

Most Patients Are Silently Struggling with

Lens Discomfort1

Among contact lens patients who bought a new supply of the same brand of contact lenses at the last eye examReference 1 Based on a survey of 113 contact lens patients Alcon data on file 2006

8680

76

24

11 10

0

10

20

30

40

50

60

70

80

90

100

Eyes dried out when wearing

contact lenses

Contact lenses felt

uncomfortable at end of day

Eyes felt irritated when

wearing contact lenses

Total experiencing attime of appointment

Total mentioning todoctor at exam

Among patients who bought a new supply of thesame brand of contact lenses at last eye exam

Why Offer Daily Modality

bull Our industry partners are investing

their RampD in daily disposables

bull Most recent breakthrough of water

gradient is available only as a daily

disposable lens

bull Specialty lenses -toric and now MANY

multi-focal contacts are out in daily

lenses Proclear 1 Day Multifocal Dailies Aqua

Comfort Plus Multifocal Acuvue 1D Multi Biotrue1Day

Multi silicones-Clariti 1Day Multi

Dailies Total 1 Multifocal-has come

Why Offer Daily Modality

bull If you donrsquothellipsomeone else will

-Let your patients learn about the best

technology from YOU Let them experience it

bull Always set up patient expectations for

what is coming on the horizon

-Let patients know why you fit them with

your lens choice and that next year they will

be the first to know about whatrsquos new

Why Offer Multifocal CLrsquos

1986 1990

1994 1996

Ben

Franklin1980

1983 1985

1999 2004

2010-12-1350

DEMAND is REAL

91 of current

contact lens wearers

age 35 to 55 are

committed to

continuing with

contact lens wear1

1 Edmunds and Reindel (2003) as cited in Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Contact lens usage drops off after age 45 while the

need for vision correction steadily increases1

Contact lens usage by age1

CIBA VISION data on file 20062010-12-1350

Presbyopia = Opportunity

bull Presbyopia affects approximately 90 million adults in the

USA alone

bull About one in four patients seen by optometrists

Source httpwwwarticlesbasecomhealth-articlespresbyopia-and-bifocal-contact-lenses-2744577html2010-12-1350

Presbyopia = OpportunityGrowth

22 Bifocal or Progressive CLs

35 Monovision CLs

27 Distance CLs w or wo Readers

53 of the 169 million people in the United States who

wear vision correction are presbyopic

bullYet only 8 of

presbyopes wear

contact lenses as their

primary mode of

vision correction1

2010-12-1350

Ready or not here we come

bull Prospective US CL market

expected to increase to

almost 34 million over the

next decade1

ndash Those 50 years of age

and overhellip

bull Comprise single largest age

component of this projected

group

bull Projected to be 28 of all

potential CL wearers by 2018

bull gt 135 million people

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Ready or not here we come

In the US alone

42 or 135 million

people will be

presbyopic by 20201

1 Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Ready or not here we come

ndash ldquoGen-Xrdquo (born 1965 - 1980)

bull Next generation of new and

emerging presbyopes

bull Highly motivated to preserve

both visual function and

youthful appearance

More technologically

savvy greater task variability

Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Compared four correction alternatives for

emerging presbyopes

bull Low add SiHy multifocal lenses (AIR OPTIXreg AQUA

MULTIFOCAL contact lenses)

bull Monovision (AIR OPTIXreg AQUA contact

lenses)

bull Habitual Rx (no change)

bull Optimized distance spectacle Rx

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

AIR OPTIX is a trademark of Novartis AG2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Water Gradient Technology

bull A new polymer of contact lens

bull First time two different polymers are in a

single soft contact lens

bull A new era in contact lens comfort

bull New criteria-Lubricity

Comfort is the 1 reason for CL drop-out

Core

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

Silicone hydrogel material with

bull Low water content

bull High oxygen transmissibility

bull Low modulus

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Surface

The First and Only Water Gradient Contact Lens

FEATURING AN INCREASE FROM 33 TO OVER 80 WATER CONTENT FROM CORE TO SURFACE1

CONTACT LENS CROSS-SECTION

WITH WATER CONTENT VALUES

bull 6 microns thick

bull Essentially no silicone present

bull Ultrasoft surface gel

bull Over 80 water1

bull Water-loving polymer chains

reduce friction helping to

minimize interaction with delicate

tissues of the eye

1 Based on in vitro measurement of unworn lenses Alcon data on file 2011

Breakthrough Science

Water Gradient Contact Lenses

Surface cell microvilli

Natural Moisture of the Cornea

The glycocalyx is produced by corneal epithelial surface cells

Helps bind mucins and tears onto the hydrophobic corneal surface

Aqueous with

soluble mucins

Corneal epithelial cells

Glycocalyx with

soluble mucins

Water Gradient Contact LensCorneal Surface

daggerImage is for illustrative purposes only

Most Patients Are Silently Struggling with

Lens Discomfort1

Among contact lens patients who bought a new supply of the same brand of contact lenses at the last eye examReference 1 Based on a survey of 113 contact lens patients Alcon data on file 2006

8680

76

24

11 10

0

10

20

30

40

50

60

70

80

90

100

Eyes dried out when wearing

contact lenses

Contact lenses felt

uncomfortable at end of day

Eyes felt irritated when

wearing contact lenses

Total experiencing attime of appointment

Total mentioning todoctor at exam

Among patients who bought a new supply of thesame brand of contact lenses at last eye exam

Why Offer Daily Modality

bull Our industry partners are investing

their RampD in daily disposables

bull Most recent breakthrough of water

gradient is available only as a daily

disposable lens

bull Specialty lenses -toric and now MANY

multi-focal contacts are out in daily

lenses Proclear 1 Day Multifocal Dailies Aqua

Comfort Plus Multifocal Acuvue 1D Multi Biotrue1Day

Multi silicones-Clariti 1Day Multi

Dailies Total 1 Multifocal-has come

Why Offer Daily Modality

bull If you donrsquothellipsomeone else will

-Let your patients learn about the best

technology from YOU Let them experience it

bull Always set up patient expectations for

what is coming on the horizon

-Let patients know why you fit them with

your lens choice and that next year they will

be the first to know about whatrsquos new

Why Offer Multifocal CLrsquos

1986 1990

1994 1996

Ben

Franklin1980

1983 1985

1999 2004

2010-12-1350

DEMAND is REAL

91 of current

contact lens wearers

age 35 to 55 are

committed to

continuing with

contact lens wear1

1 Edmunds and Reindel (2003) as cited in Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Contact lens usage drops off after age 45 while the

need for vision correction steadily increases1

Contact lens usage by age1

CIBA VISION data on file 20062010-12-1350

Presbyopia = Opportunity

bull Presbyopia affects approximately 90 million adults in the

USA alone

bull About one in four patients seen by optometrists

Source httpwwwarticlesbasecomhealth-articlespresbyopia-and-bifocal-contact-lenses-2744577html2010-12-1350

Presbyopia = OpportunityGrowth

22 Bifocal or Progressive CLs

35 Monovision CLs

27 Distance CLs w or wo Readers

53 of the 169 million people in the United States who

wear vision correction are presbyopic

bullYet only 8 of

presbyopes wear

contact lenses as their

primary mode of

vision correction1

2010-12-1350

Ready or not here we come

bull Prospective US CL market

expected to increase to

almost 34 million over the

next decade1

ndash Those 50 years of age

and overhellip

bull Comprise single largest age

component of this projected

group

bull Projected to be 28 of all

potential CL wearers by 2018

bull gt 135 million people

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Ready or not here we come

In the US alone

42 or 135 million

people will be

presbyopic by 20201

1 Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Ready or not here we come

ndash ldquoGen-Xrdquo (born 1965 - 1980)

bull Next generation of new and

emerging presbyopes

bull Highly motivated to preserve

both visual function and

youthful appearance

More technologically

savvy greater task variability

Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Compared four correction alternatives for

emerging presbyopes

bull Low add SiHy multifocal lenses (AIR OPTIXreg AQUA

MULTIFOCAL contact lenses)

bull Monovision (AIR OPTIXreg AQUA contact

lenses)

bull Habitual Rx (no change)

bull Optimized distance spectacle Rx

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

AIR OPTIX is a trademark of Novartis AG2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Most Patients Are Silently Struggling with

Lens Discomfort1

Among contact lens patients who bought a new supply of the same brand of contact lenses at the last eye examReference 1 Based on a survey of 113 contact lens patients Alcon data on file 2006

8680

76

24

11 10

0

10

20

30

40

50

60

70

80

90

100

Eyes dried out when wearing

contact lenses

Contact lenses felt

uncomfortable at end of day

Eyes felt irritated when

wearing contact lenses

Total experiencing attime of appointment

Total mentioning todoctor at exam

Among patients who bought a new supply of thesame brand of contact lenses at last eye exam

Why Offer Daily Modality

bull Our industry partners are investing

their RampD in daily disposables

bull Most recent breakthrough of water

gradient is available only as a daily

disposable lens

bull Specialty lenses -toric and now MANY

multi-focal contacts are out in daily

lenses Proclear 1 Day Multifocal Dailies Aqua

Comfort Plus Multifocal Acuvue 1D Multi Biotrue1Day

Multi silicones-Clariti 1Day Multi

Dailies Total 1 Multifocal-has come

Why Offer Daily Modality

bull If you donrsquothellipsomeone else will

-Let your patients learn about the best

technology from YOU Let them experience it

bull Always set up patient expectations for

what is coming on the horizon

-Let patients know why you fit them with

your lens choice and that next year they will

be the first to know about whatrsquos new

Why Offer Multifocal CLrsquos

1986 1990

1994 1996

Ben

Franklin1980

1983 1985

1999 2004

2010-12-1350

DEMAND is REAL

91 of current

contact lens wearers

age 35 to 55 are

committed to

continuing with

contact lens wear1

1 Edmunds and Reindel (2003) as cited in Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Contact lens usage drops off after age 45 while the

need for vision correction steadily increases1

Contact lens usage by age1

CIBA VISION data on file 20062010-12-1350

Presbyopia = Opportunity

bull Presbyopia affects approximately 90 million adults in the

USA alone

bull About one in four patients seen by optometrists

Source httpwwwarticlesbasecomhealth-articlespresbyopia-and-bifocal-contact-lenses-2744577html2010-12-1350

Presbyopia = OpportunityGrowth

22 Bifocal or Progressive CLs

35 Monovision CLs

27 Distance CLs w or wo Readers

53 of the 169 million people in the United States who

wear vision correction are presbyopic

bullYet only 8 of

presbyopes wear

contact lenses as their

primary mode of

vision correction1

2010-12-1350

Ready or not here we come

bull Prospective US CL market

expected to increase to

almost 34 million over the

next decade1

ndash Those 50 years of age

and overhellip

bull Comprise single largest age

component of this projected

group

bull Projected to be 28 of all

potential CL wearers by 2018

bull gt 135 million people

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Ready or not here we come

In the US alone

42 or 135 million

people will be

presbyopic by 20201

1 Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Ready or not here we come

ndash ldquoGen-Xrdquo (born 1965 - 1980)

bull Next generation of new and

emerging presbyopes

bull Highly motivated to preserve

both visual function and

youthful appearance

More technologically

savvy greater task variability

Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Compared four correction alternatives for

emerging presbyopes

bull Low add SiHy multifocal lenses (AIR OPTIXreg AQUA

MULTIFOCAL contact lenses)

bull Monovision (AIR OPTIXreg AQUA contact

lenses)

bull Habitual Rx (no change)

bull Optimized distance spectacle Rx

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

AIR OPTIX is a trademark of Novartis AG2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Presbyopia = Opportunity

bull Presbyopia affects approximately 90 million adults in the

USA alone

bull About one in four patients seen by optometrists

Source httpwwwarticlesbasecomhealth-articlespresbyopia-and-bifocal-contact-lenses-2744577html2010-12-1350

Presbyopia = OpportunityGrowth

22 Bifocal or Progressive CLs

35 Monovision CLs

27 Distance CLs w or wo Readers

53 of the 169 million people in the United States who

wear vision correction are presbyopic

bullYet only 8 of

presbyopes wear

contact lenses as their

primary mode of

vision correction1

2010-12-1350

Ready or not here we come

bull Prospective US CL market

expected to increase to

almost 34 million over the

next decade1

ndash Those 50 years of age

and overhellip

bull Comprise single largest age

component of this projected

group

bull Projected to be 28 of all

potential CL wearers by 2018

bull gt 135 million people

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Ready or not here we come

In the US alone

42 or 135 million

people will be

presbyopic by 20201

1 Tan J Contact Lens Options for Presbyopia httpwwwsiliconehydrogelsorgeditorialsprevious_editorial_jackie_tanasp

2010-12-1350

Ready or not here we come

ndash ldquoGen-Xrdquo (born 1965 - 1980)

bull Next generation of new and

emerging presbyopes

bull Highly motivated to preserve

both visual function and

youthful appearance

More technologically

savvy greater task variability

Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Compared four correction alternatives for

emerging presbyopes

bull Low add SiHy multifocal lenses (AIR OPTIXreg AQUA

MULTIFOCAL contact lenses)

bull Monovision (AIR OPTIXreg AQUA contact

lenses)

bull Habitual Rx (no change)

bull Optimized distance spectacle Rx

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

AIR OPTIX is a trademark of Novartis AG2010-12-1350

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Which is betterhellip

Monovision vs Multifocal SCLs

bull Woods J et al (2009)

ndash Assessed both objective and subjective

resultsratings

bull Utilized BlackBerryreg hand-held device facilitating

real-time assessment of assigned tasks

bull Objective testing ndashMonovision ldquobest performerrdquo for

high- and low-contrast near vision tests

bull Subjective ratings ndash Monovision ldquolowest performerrdquo in

all ratings multifocal contact lenses ldquohighest

performerrdquo in 15 of 16 ratings

bull Objective testing (exam room) may not be best

indicator of potential ldquosuccessrdquo

Woods J et al ldquoEarly Symptomatic Presbyopes ndash What Correction Modality Works Bestrdquo Eye amp Contact Lens 20095 221 ndash 226

Of those ratings that demonstrated any significant difference

BlackBerry is a trademark of Research in Motion Limited2010-12-1350

Managing Patient Expectations

Fitting Tips for Success

Have patient state one or two visual ldquoGOALSrdquo and document

in patientrsquos record for review purposes

Discuss these visual goals

Determine if these goals are realistic

For instance a patient expecting to see the

microscopic print on the insert for a

prescription is not a realistic goal Remind patients of what they can see vs what they cannot see

Emphasize good direct light and the need to assess their work

environment for appropriate lighting

Emphasize that the vision typically improves after

wearing the lenses for a few days

Encourage patients to be open minded and have patience2010-12-1350

FORGET OLD HABITS

Fitting Tips for Success

Follow recommended fitting guides Thousands of patients used in clinical protocols

Let patients EXPERIENCE the lenses

Staff are essential in fitting process and key messages

Think of every patient as a potential successful contact lens

wearer

2010-12-1350

Need to be proactivebull Survey of 500 presbyopic patients1

ndash Only 8 of current CL wearers reported being told about multifocal CLs when first complaining about their near vision

ndash Once informed about multifocal contact lenses one-third of regular CL wearers and monovision patients were likely to try them

ndash One-third of respondents indicated they would likely seek services of another practitioner if their current practitioner did not inform them of multifocal options

1 Studebaker J ldquoSoft Multifocals Practice Growth Opportunityrdquo Contact Lens Spectrum June 2009

2010-12-1350

Why Offer Multifocal Lenses

bull Baby boomers all in presbyopic years and

Gen X approaching presbyopia

bull Presbyopic patient base more tech savvy

and has the means to meet their needs

bull New lens designs offer better choices for

patient adaptation

bull Generates referrals without marketing

Promote Daily Multifocals in Your

Practice

Proactively discuss daily multifocal with your patients

ndash Many patients may have unsuccessfully tried multifocal soft

lenses or monovision in the past and are not aware of

advances

Communicate effectively Would you be interested in contact

lenses that would allow you to read without

glasses

Do your glasses hinder you when you

fish play tennis play golf exercise

Are there times when you would like to

see clearly without wearing glasses

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Optometric RootsVision

bull Quality vision that meets patientrsquos lifestyle

needs is the foundation of optometry

bull Utilize the latest in daily disposable

contact lens technologies to excite and

surpass visual demands and needs

Challenge How does one maximize

performance in the world of contacts

A Emphasize long term corneal

healthcomfort-(reason for returning

regularly)

B Increase patient compliance-(daily

wearers will return regularly with less

complications)

C Capture annual supply sales-(will return

regularly-have everything they need)

D Give the ldquoWhyrdquo and set up the ldquoWhatrsquos

Nextrdquo- (Always discuss technologylens

selection)

Donrsquot forget about UV Protection Donrsquot forget about UV Protection

bull Educate and prescribe CLrsquos and sunwear

Donrsquot forget about Blue Light

bull Educate and prescribe indoor protection

Whatrsquos Old is New

Proactively discuss the use of distance center multifocal

lenses when fitting younger myopes

Myopia Control Good science now tells us we can

reduce the progression of myopia with

multifocal contacts

More effectivepermanent than ortho-k

Parents who lived through higher

myopia as a child are hugely receptive to

any means that can reduce myopia in

there children

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

Myopia Control Studies

bull In November 2013 researchers in the US published the results

of Soft multifocal contact lens wear (commercially available) resulted

in a 50 reduction in the progression of myopia and a 29

reduction in axial elongation during the 2-year treatment period

compared to a historical control group

bull Eight- to eleven-year-old children with -100 D to -600 D spherical

component and less than 100 D astigmatism were fitted with soft

multifocal contact lenses with a +200 D add (Proclear Multifocal

D CooperVision Fairport NY) They were age- and gender-

matched to participants from a previous study who were fitted with

single-vision contact lenses (1 Day Acuvue Vistakon Jacksonville

FL)

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Study Results

bull Results from this and other investigations indicate a need for a long-

term randomized clinical trial to investigate the potential for soft

multifocal contact lens myopia control

bull httpcontactlensupdatecom20130327busting-myths-about-kids-and-contact-

lenses

bull Optom Vis Sci 2013 Nov90(11)1207-14 doi 101097OPX0000000000000036

bull Multifocal contact lens myopia control

bull Walline JJ1 Greiner KL McVey ME Jones-Jordan LA

Myopia Control Studies

bull PURPOSE

bull Most studies have reported only minimal reductions in myopia

progression with bifocal or progressive multifocal spectacles

although somewhat larger although mostly still clinically

insignificant effects have been reported in children with nearpoint

esophoria andor accommodative dysfunctions The CONTROL

study was a 1-year prospective randomized clinical trial of bifocal

contact lenses for control of myopia in children with eso fixation

disparities at near

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies

bull Myopia Control with Bifocal Contact Lenses A Randomized

Clinical Trial

bull Methods

bull Eighty-six myopic subjects aged 8 to 18 years were enrolled in

the study after passing the screening examination Subjects were

randomly assigned to wear either Vistakon Acuvue 2 (single-

vision soft contact lenses [SVSCLs]) or Vistakon Acuvue Bifocal

(bifocal soft contact lenses [BFSCLs])

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

Myopia Control Studies-Results

bull RESULTS

bull The BFSCLs significantly slowed myopia progression with

statistically significant differences between the treatment groups

after 6 months After 12 months of treatment the SVSCL group had

progressed by -079 plusmn 043D compared with -022 plusmn 034D for the

BFSCL group

bull CONCLUSIONS

bull The distance center bifocal contact lenses tested in this study

achieved greater control over myopia progression and axial

elongation (gt70) compared with most published results with

multifocal spectacles Further studies are warranted to identify the

critical factors and mechanisms underlying this myopia control

effect

bull Myopia Control with Bifocal Contact Lenses A Randomized Clinical Trial

bull Aller TA1 Liu M Wildsoet CF

What About Hyperopia Control

bull ldquoAs a clinician scientist and inventor I just think it would be very

cool to prove that the same contact lens prescribed a bit differently

could either cause a myopic eye to slow its excessive growth or

could encourage a shorter hyperopic eye to grow to a more normal

sizerdquo says Dr Aller

bull The new clinical trial Optical Defocus to Stimulate Eye Elongation in

Hyperopia or the ODSEEH trial is listed on httpwwwclinicaltrialsgov

as NCT00950924

bull httpwwwprwebcomreleases201503prweb12561264htm

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