GLG News by Steve Rubinstein, OD

Implications: A new study in Archives of Ophthalmology, November 2008 indicates that a reason for the large number of infections from Bausch & Lomb's Renu Moisture Loc solution was due to poor temperature control reducing antifungal and antimicrobial efficacy.

Analysis: The paper calls for more studies to evaluate the effect of high temperature in the processing shipping and storing of contact lens solutions.

I see the need to maintain temperature  in  certain parts of the world, especially near the equator.

This may explain why Hong Kong and Singapore, both in warmer areas of the globe, saw the first significant increase in fungal keratitis.

I am looking forward to more epidemiological, and toxicological studies evaluating this factor in storing and transporting contact lens solutions.

Implications: The article goes into the four major eye care markets that have a mix of reimbursed, and consumer driven areas. It describes the issues I face as a provider of these products. 

Analysis: Alcon, Cooper Companies, and AMO (Advanced Medical Optics) are the three companies that get evaluated for their exposure to the recession. The article looks at Lasik, Pharmaceutics, Contact Lenses, and Cataract markets in the United States and briefly touches on the international implications.

Lasik: I agree that the outlook for this almost entirely consumer driven market looks bad in total number of procedures. However, for the independent practitioner it may have a silver lining.

Many of the "big guys" in the field, namely TLC Vision and LCA Vision have released figures of between 25% and 40% drop off in the number of procedures. They have huge staffs and even larger advertising budgets. LCA reported laying off 25% of their staff last quarter. TLC is in the penny stock arena.

These factors effect small regional and independent lasik surgeons, but they have smaller staffs, and do not have "lifetime guarantees" to worry about. I predict this will leave the "little guys" in a better position in 18 to 24 months when we will hopefully have new economic growth.

As of now the big bulge in procedures for the end of the year has been effected by the economic downturn. Lasik is still being planned for using pre-tax dollars. I personally, and a number of my colleagues have stopped providing patients to TLC because we don't see how they can provide follow up care in bankruptcy.

Pharmaceutical sales: The article suggest that this is mostly a reimbursed expense. I disagree. I have been discussing the large copays for non generic drugs much more frequently than in prior years. My patients don't want to end up with $40 copays when there is a generic available. Some pharmaceutical companies have been providing rebates for the consumer, and this helps. I see myself prescribing more generic drugs than in the past as a result of the economic times.

Contact Lenses: The article states that patients will stretch their contacts even long er than before. I have been dealing with this issue all of my professional life. I don't think contacts can be stretched more than they already are. The cost of silicone hydrogel lenses now rivals the cost of HEMA lenses. The biggest issue I see is the increase in time between eye exams. That has happened before, and will probably happen again. Manufacturer's rebates have been waxing and waning with the full moon. I hope the level of reimbursement rises as the economy turns down.

Cataract: The cataract implant market is looking better than ever. It is a non-consumer expense for most people. It has started to be a consumer expense in two areas. Implants that correct astigmatism (toric), and multifocal implants. These two areas are the new growth markets in my field. I expect slower growth in the toric and multifocal area, but there is no alternative for the covered procedure. It will keep AMO in business! As America ages, there will be an increase in the number of catarct procedures.

I summary, I think the recession will effect my bottom line. It will not effect it as much as my neighbors in the financial services industry. However, my bottom line did not go up as much as those neighbors in the past few years.  

Implications: This eyeglass lens designer, Ron Blum has created a new type of Progressive Addition Lens about 6 years ago. It created a new market in Ultra-Premium lenses. Now he is attempting to create a new lens for computer users. I look forward to its introduction next month, and to the creation of new profit opportunity from selling his new design.

Analysis: The Panasonic Venture Group, The Carlyle Group, Delphi Ventures, Life Science Angels have put capital into this company. I think it is due to the expected need for a product like this.

This lens is for the computer user that is an "adult," or needs a different prescription for distance than near. This is the largest growing section of the US population coming into my office as a general practitioner in the mid-town New York City area.

The prior product produced by PixelOptics founder was the Definity Progressive Addition Lens. I started using the Definity progressive addition lens before Essilor purchased the company. It was a Johnson & Johnson wholly owned company. The Definity is now one of my favorite lenses for both technology and profit. The concept has been copied by Pentax, Nikon, Essilor, Zeiss and others.

The largest number of patients I see are using the computer day in and day out. A lens that keeps things in focus from 72 inches to 14 inches is out already, but not popular.

There has not been a new "intermediate" type lens design in many years. What is available is not a profit center, but a niche product. I am hoping to see a quality product for the "second" pair of glasses for computer users. 

Implications: This article mentions two major contact lens manufacturers, CooperVision and Vistakon (a subsidiary of Johnson & Johnson), with difficulties actually making silicone hydrogel contact lenses that can be sold successfully.

Analysis: This article highlights the fact that silicone in contact lenses may be more comfortable, healthier, and give good clarity, but it is hard to work with.

Implications: A new material that is easier to produce contact lenses with may decrease the cost of producing contact lenses. A major difficulty in producing today's silicone hydrogels is production costs. 

Analysis: CooperVision's silicone hydrogel contact lenses, Biofinity and Avaira have encountered cost overruns from difficulty producing the product.

Bausch & Lomb's Purevison contact lenses and Novartis's Ciba Vision O2 Optix, Air Optix, and Night & Day materials have run into patent issues in the past year.

A new material that promises easier manufactuering, and has no prior patents with good oxygen transmissability may be an opportunity for a new lens to enter the market.

Implications: The new prostaglandin analog is not what i find interesting in this article. A new treatment for Diabetic Retinopathy sounds much more interesting

Analysis: I have a number of prostaglandin analog eyedrops to treat glaucoma. A new one with 12% greater efficacy may help with glaucoma treatment. However since it is not statistically different than Xalatan, it does not make me interested as a prescriber treating glaucoma.

In the same article, it mentions a new treatment for diabetic retinopathy. It is topical? Will it help decrease the significant loss of vision associated with diabetes.

I had a patient in my office a few days ago. She was a 52 year old female with HbA1c of around 8% after having the disease for over 10 years. A diagnosis of proliferative diabetic retinopathy was made. She did not want to undergo any laser treatment for diabetic retinopathy. If there was a topical or injectable treatment, she would have been happier.

I have had patients like this many times over the course of my years in practice. I am always looking for new methods to treat. I hope this one makes it out of the starting blocks.

Implications: A few months ago, a small company tried to import Lumigan (bimatoprost), licensed by Allergan, in an eyelash applicator. It was held by the FDA as an unapproved use of a prescription medication. Now the owner of the patent is trying to import the same drug legally.

Analysis: I just find it interesting that an unintended use of a drug can be so contentious. I also wonder if the packaging will also tell the public that in addition to promoting eyelash growth, it can change the color of your eyes.

Another unintended effect of Lumigan is to make blue eyes brown. I wonder if application to the eyelash will do the same as a drop and increase iris pigmentation?

I guess we will see what the marketing geniuses will do when the complaints start coming in.

Implications: This is the first announcement anywhere in the world about a daily disposable contact lens that is in a breathable silicone hydrogel material. Will it make it across the ocean?

Analysis: A new silicone hydrogel daily lens will grab market share away from all other one days lens manufacturers, except the "value brand," Focus Dailies.

How much will it cost? Vistakon is known for being a market leader in research as well as high prices. I expect it will cost more than the Acuvue One Day Moist product, their most expensive daily contact lens at the moment.

Will Ciba Vision ( a Novartis company) change their planned roll out of a new one day premium non Si-Hy product? I doubt it.

Will Cooper Vision try to make their new Avaira contact lens material in a one day product? I have heard that Cooper Vision will be coming out with a new two week toric Avaira contact lens.

Three out of the four major contact lens manufacturers have come out with a new one day lens in the past year. Is this Vistakon's entry?

I hope to see this product in the United States soon.

Implications: Can Cooper take over the 2 week spherical contact lens market? Can it make a dent in the market share of the industry leader in the silicone hydrogel field? Initial results look good. A definite maybe!

Analysis: I have been fitting the Acuvue Oaysis from Vistakon a subsidiary of Johnson & Johnson for a few years now. It has been a simple upgrade from the Acuvue, Acuvue 2 and Acuvue Advance spherical lenses. Just about anyone in the old Acuvue line tried the new Oaysis lens with success. It was easy, and usually worked!

Vistakon is doing so well with the Oaysis in New York City, that they recently expanded the already generous parameters by coming out with a new base curve in January 2008. I will supposedly be fitting a new Oaysis for Astigmatism in the next 45 days.

And then came the Avaira!

Sales material from CooperVision, a subsidiary of Cooper Cos., says that the Avaira has the same "modulus of elasticity" or "softness" as the Oaysis. Other sales material says the Avaira is as permeable (breathable) as the Oaysis. Is it the Oaysis?...No. It costs less, and fits differently.

I have put the Avaira lens on about 20 patients in the last 3 weeks. A good start. The Avaira can take a previous generation Acuvue wearer, and upgrade them to silicone hydrogel with comfort and clarity. The Avaira can take a Ciba Vision O2 Optix patient and make them happy also. I think the lens works!

Pricing can make or break a lens. Oaysis is the most expensive two week sphere on the market today. The largest online retailer of contact lenses, 1-800 Contacts sells Acuvue Oaysis for $35 a box before rebate. My large New York City practice sells a box for approximately $7.50 less a box.

The Avaira costs about the same as a box of O2 Optix sphere. 1-800 Contacts sells O2 Optix for about $25 per box before rebates. I expect the Avaira to sell for about the same. My New York City practice sells the O2 Optix and Avaira for $22.50 per box. That puts a $10 per box premium on the Oaysis from 1-800 Contacts, and a $5 premium from my practice.

Lets see what happens. I expect the Avaira to do well based on the first month or so of contact lens fittings. It took a few months for me to know that the Biofinity, also by CooperVision did not meet expectations. It will take at least that long to know how well the Avaira does against the Oaysis and the O2 Optix.

Implications: Alcon becomes part of a larger group that is very interested in profiting from eye care. The patient will probably not see any changes in labeling or distribution for a few years. The companies interlock well, but do not have a lot of overlap.....except for sales reps!

Analysis: I think Alcon will do well from this acquisition. It moves from Nestle, which has few eye care holdings to Novartis, which wholly owns Ciba Vision, and Ciba Vision Ophthalmics.

Novartis is currently purchasing only 25% of Alcon, I expect it to remain as an independent label. Novartis retains the option to purchase a majority of Alcon within 4 years. This allows Ciba Vision into places that Alcon had the lead space, the drugstore shelf. Alcon produces various versions of Opti-Free contact lens solution. It is by far the largest supplier of contact lens solutions in the United States with over 35% of the market. It was helped by the two leading competitors having recalls within the past 2 years. Bausch & Lomb Renu and AMO Complete were both recalled with a subsequent loss of market share. Novartis has an entry in this field, Aquify, but has made few inroads into the market. It was rumored that Aquify was being phased out.

For the patient, I don't expect much change unless, and until Novartis exercises its option to purchase a majority of Alcon. It will probably put a stop to production of Aquify multipurpose contact lens solution.

As far as competition in the eye care industry, a consolidation in solutions may be needed and a further result of the prior contact lens solution recalls. Ciba Vision Ophthalmics has a few products in the over the counter (OTC) pharmaceuticals, and a few prescription drugs. Alcon is a large provider of common antibiotics, anti-allergy and anti-inflammatory medications. All things I commonly prescribe on a daily basis.

Questions that I have for the industry are:

When will Vistakon, owned by Johnson & Johnson come out with a new contact lens solution?

When will Ciba Vision come out with a new Multifocal contact lens?

Will AMO survive without contact lenses?

Will Cooper Vision's new two week lenses actually work better than the Biofinity?

Will I have less sales reps visiting my office?

Implications: The recent purchase by Bausch & Lomb of Eyeonics shows a good move to capture the growing presbyopic correction market. The company has also sent Ronald L. Zarrella to become chairman emeritus. One of the best moves I have heard since the whole Renu problem.

Analysis: Eyeonics has the first FDA approved implantable presbyopic correction available in the United States. An important tool in today's greying eyecare market.

Many of my older patients are now looking at, and purchasing implantable presbyopic correction when they get their cataracts removed. Some patients are even having their "not yet ripe" cataracts removed early to do away with eyeglasses and contact lenses. That is where the Crystalens is one of the best contenders for new business in the next decade.

The end result of cataract surgery,  and laser vision correction is the same! However, with the new implantable presbyopic cataract procedures, it is even better than laser for vision correction of the "adult" patient over 45 years of age.

The implications of this lens are far larger than the "cataract" population. I have one patient who is 54 yrs old, and has been attempting to get laser vision correction for years. He is outside the normal range of laser patients. This year I have suggested the Crystalens. It will replace his presbyopic correcting contact lenses. It is the first technology that can make him happy! Surgery is scheduled for Spring 2008.

The product works, the patients are available. After laser vision correction, it is not a big leap to exchange the crystalline lens that is just starting to get a cataract with a new one that will keep the reading glasses off your nose for a long time!

I can't mention Bausch without also saying that I am glad they will have a new staffing. The new CEO Gerald M. Ostrov has worked with two companies connected to eyecare, Johnson & Johnson, and Ciba. I look forward to having a sales rep in Westchester County from Bausch & Lomb for the first time in many years. He takes over day to day operations of the hopefully reinvigorated company just recently taken private.

Implications: Macular degeneration is a condition where the central part of the retina is lost. This item places an image on the retina that is so big, it allows the use of the remaining, useful retina. Sounds great! It may be, however, as with many low vision devices, there are some potential pitfalls.

Analysis: Macular degeneration effects a greater number of patients each year as the population ages. The implantation of the telescope seems easy from the small number of patients studied. The results are great for patients that are highly motivated.

The surgical issues will decrease in the future, however, the incision needs to be larger than on standard cataract  procedures.  The actual miniature telescope is much larger than the "foldable" intraocular lenses used for many standard cataract procedures in the western world. The size of the mini telescope will decrease with more research.

The biggest obstacle to this item becoming a commonplace is the difficulty in adjusting to the "new" type of sight. The image is magnified at this point between 2.5 to 3 times. Imagine looking through a pair of binoculars for more than a few minutes at a time. It takes an openness to new visual stimuli. Not the easiest process in the aged.

On the whole, this is a welcome new addition to the telescopic market. It may not become a large competitor to Eschenbach, Zeiss, Walters, or other manufacturers of Low Vision devices.

I have been a Low Vision certified practitioner in New York State for the past 19 years. One thing I have seen is many new technologies come into the marketplace. I have yet to see a "blockbuster." This product has the ability to create a new option for the wealthier person that sees substantially worse than "normal" in both eyes. It has been "dreamed" about in Low vision circles for years. It is nice to see it come to fruition.

Implications: The article points out that a small percentage of contact lenses and laser vision correction procedures, and cataract procedures deal with presbyopia. The field is wide open for improvement and exploitation. Numerous companies are looking for the "next best" idea.

Analysis: Presbyopia is the need for a different prescription for distance viewing, than near viewing. It occurs naturally to people between the ages of 38 and 43 years of age. Often called, "my arms are too short to read."

Thanks to the greying of America, the need for presbyopic correction is huge, and growing bigger every day. Novartis (Ciba Vision), Johnson & Johnson (Vistakon), CooperVision, and Baush & Lomb all have contact lenses that try to correct for this natural life process. Synergeyes is a small company that has released the newest presbyopic correcting lens. The only problem is the optics may work, but the product rips easily, and is difficult for an eye care practitioner to fit a patient with comfort, clarity and health.

No manufacturer does it well. All are looking for the next best design due to the large size of the potential market. Is this design by a small start up able to do what it says, create a situation whereby presbyopia is corrected?

They have FDA approval to market a contact lens to correct presbyopia. This is often called a bifocal, or multifocal contact lens. Ciba & Vistakon are both seeking the "next best" design. The contact lens, and intraocular lens fields are littered with "wannabes" that didn't make it.

I think this is where a new design will come from, the small inventor with a great idea. The history of contact lenses shows this has been a good source of sound new ideas, such as the "soft hydrophilic" contact lens, designed in Hungary in the 1960s.

Implications: How much should packaging of a drug cost?

Analysis: The article brings out the point that similar drugs cost the patient/insurance company different amounts depending on its intended use.

One type of medication works well to improve vision in patients with Age Related Macular Degeneration (ARMD). It comes as a anti cancer drug, or anti ARMD drug. They are slightly different, but in the same family of drugs.

Why should anyone pay $2000 per intraocular injection if  a similar drug can be had for $50. It makes no sense to me.

Avastin is sold in large quantities to be administered to a whole body. Lucentis is sold to be administered inside the eyeball itself. Both drugs work, although a study is now being conducted to determine if one is better than the other for ARMD.

Pending the results of the aforementioned study.....why spend so much more? It makes Genentech look bad. Why not change the pricing structure of the Lucentis? The stuff works! I see it in my patients. The company has a right to an return on investment, but the cost differential is ridiculous.

Implications: AMO has come out with a "new" product to be released in Sept 2007. But they have not announced what the key active ingredient is. The active ingredient(disinfectant) can determine where it stands compared to other products available on the market in the US. I list most of the various contact lens care systems available in the US now from Ciba Vision, Allergan, and AMO.

Analysis: As of August 2007 there are three different types of soft contact lens solutions available. There is Renu, Aquify, Optifree and Hydrogen peroxide systems. (Renu and Aquify use the same disinfectant)

Renu with MoistureLoc was called off the market after a rash of fungal keratitis cases. AMO's Complete was called off the market after a number of Acanthamoeba keratitis cases. Only Optifree, Aquify and Hydrogen Peroxide systems have not been called off the market due to concerns with large scale infections of contact lens users eyes.

Renu (with and without MoistureLoc), Aqufiy, and Complete all use the same disinfectant. What is the New Complete disinfectant? Will it be based on the "old" no rub complete, or just be the old "no rub" repackaged to add "please rub"?

It has been rumored that AMO is using a Complete formulation that was/is available in Japan. The new advertising (as listed in the title to this analysis) says that rubbing is required. Will that make a difference in the infection rate?

The announcement a few weeks ago of a new Complete is welcome in my office. I like to have a few different solution choices to discuss with patients.  These include:

Aquify has a very small market share, and the manufacturer, Ciba Vision a subsidiary of Novartis does not give eye care practitioners samples to give patients. I rarely discuss this option.

ClearCare, also by Ciba Vision has been available for sampling to patients for a number of years. It is the most popular Hydrogen Peroxide product on the market, having been changed little from its previous incarnation as AoSept which has large market awareness.

UltraCare, manufactured by AMO has been available to consumers for many years as a Hydrogen Peroxide contact lens care system. I have just recently (the past 2 weeks) gotten some product to dispense to patients in my office. AMO stopped sampling this product a number of years ago. I think they may start sampling it in the near future to compete with ClearCare.

Optifree, is made by Allergan, and is readily available to sample patients. The company has a deal to pay practitioners to give sample to patients if we sample it almost exclusively. It is available in many different formulations, but has the same active ingredient in all of them.

Renu Multiplus has been sold and is available in the US for a number of years. The MoistureLoc version of Renu had an added ingredient to create a more comfortable experience for the contact lens user. However that added ingredient may have created a condition that promotes fungus growth, and was pulled off the market. Renu Multiplus is the previous version. Bausch & Lomb, the manufacturer has made it available for sampling to patients.

There are a few other products with a limited distribution, such as eye care practitioners' offices only. I don't think they have any sizable market share. They include "no rub" all in one solutions, as well a hydrogen peroxide systems.

Where does the new Complete "easy rub" solution fall in the scheme of things? I don't know for now. I have asked a number of representatives from the company to no avail. We will see in a few days.

It has been rumored that Johnson & Johnson's eyecare subsidiary Vistakon will come out with a new contact lens solution in the near future. The sales representatives claim no knowledge of this "new product."

Implications: This is a highly publicized event that eye care practitioners have been telling patients since hard contacts were first invented. Will it prevent some infections in the future?

Analysis: It is considered a popular thing to do to put a contact lens into your mouth to wet it before putting it back in your eye. Eye doctors have been telling patients not to do that since the beginning of contact lens manufacturing at the end of World War II.

Now I can show patients that it is fully documented how dangerous it is to do!

I have printed this article to refer my patients to it since it first came out a few weeks ago. All of my staff have read it!

I feel for the patient. It is not the smartest thing to do, but you usually can't relate the infection to the event so clearly as has been done in this case.

I hope the publicity of this event can prevent further cases of these types of preventable ocular infections.  

Implications: This "fast track" exposure for the LX211 may allow for a new type of uveitis treatment by the end of 2008. the hope is to decrease toxicity, and increase effectivity.

Analysis: Uveitis is usually treated with antibiotic, steroid, and cycloplegic eye drops. LX211 is attempting to treat uveitis by stopping the T-cells from creatign the inflammation.

This is a novel technique to keep patients off steroids for long periods of time. Steroids decrease the effect of the body attacking the uveal tract of the eye, namely the iris and ciliary body. It is a form of the body attacking itself. It may be mediated by T-cells.

Steroids reduce all types of the bodies' immune response (or over response in the case of uveitis). Steroids taken long term can raise intra ocular pressure resulting in glaucoma. Lotemax produced by Bausch & Lomb (BOL) is a patented form of ocular eye drop steroid that reduces the potential for a rise in intraocular pressure.

Steroids will also produce cataracts after 6 grams of total body uptake.

In order to reduce the need of steroids, as well as the side effects of steroids, Lux Biosciences has developed the new
treatment. If it works we will have a new, hopefully less toxic method of treating a potentially sight threatening autoimmune disease.

Implications: Current management is not responsive to my needs as a practitioner, nor my patient's needs. Let someone else try to make a venerable name good again.

Analysis: Current management, including the CEO who has admitted to lying on his resume, has not helped B&L rebound from its current difficulties in either the contact lens solution industry, nor the contact lens industry.

The contact lens solution plant that was recently re certified by the FDA could have been done a year ago when the FDA first stated problems occurred there. It took an additional 6 months, and a second recall to get it correct.

The contact lenses are the same design as previous HEMA lenses, in a silicone hydrogel material that has been around for years. Why wasn't the design switch years ago before Vistakon and Ciba?

Management has been responding to market challenges instead of creating them for other companies.

B&L has been a name in the optics industry for  over 60 years. It has been decimated by  poor management in the B & L  sunglass division sold to Luxottica. B&L was the first company to come with a marketable soft contact lens, now it is a laggard. B&L had the best in soft lens solutions, and RGP solutions. Now it hasn't had anything new for years in either field.

Lets breath some new life into a stoodgy, poorly run company. Lets get a company that can make new markets instead of try to keep old ones.

Is there some reason that Mr. Zarella doesn't want an AMO takeover? Does it have to do with stock options, or golden parachutes?

Implications: This machine tries to be able to predict what is now unpredictable. It proposes to be able to measure the propensity for a cornea to lose its structural integrity after Laser Vision Correction.

It also may be able to discern why intra ocular pressure measurements don't always reflect the risk of vision loss due to glaucoma.

Reichert has a number of interesting, non-mainstream instruments that may one day be more mainstream.

Analysis: I think that further analysis will show all that this test may become one of a battery of current tests to prevent a negative outcome from the cosmetic procedures known collectively as laser vision correction(LVC).

If it works as proposed, then the difficulty in predicting who will lose vision due to keratoconus after LVC will be solved. As of now, there have been a number of multi million dollar lawsuits that have been lost due to keratoconus formation in patients that are post LVC.

The studies I have seen, and the lectures I have been to reveal no accurate way to predict who would have a negative outcome from laser if they pass the Orbscan (Bausch & Lomb) topography and corneal thickness measurements. This is a problem for the growing LVC industry.

The other, potentially more widespread use of this machine may be to predict vision loss from glaucoma. It claims to be a better measure of intra ocular pressure(IOP), and can eliminate the effect of corneal thickness on the IOP. As of now, I have a nomogram that proports to show how the IOP changes when the cornea deviates in thickness from normal, either from congenital issues, or from LVC.

Further studies from other facilities need to be done to determine if the machine preforms as advertised.

Implications: The new product recall of Complete manufactured by AMO is very different from the Renu with MoistureLoc product recall manufactured by Bausch & Lomb (B&L). Both recalls will have an impact on the health and safety of Americans and the world public. Will these product recalls have a long lasting impact on the manufacturers?

Analysis: Health authorities in Japan have recently found two bottles of contaminated Complete multipurpose contact lens solution on the shelves of stores. Other contaminated product has been found in China. All of the potentially contaminated lots of product have been recalled. This process has been substantially different from what happened to B&L in December 2005 and January 2006. Therein lies the difference between the corporate views of what to do in the event of a product recall.

As a practicing optometrist that sees over a 150 patients a week, it is much easier for me to deal with AMO. They have been straightforward and communicative to me as an eye care professional in the trenches. AMO has sent me notices via email, overnight messenger, and through their established sales force documenting the problem, and what they have done to deal with it.

I have been informed that a plant in China produced a series of contaminated products because of a problem with their production line. All lot numbers of the product have been pulled from around the world. Very few of the potentially contaminated product has been available in the US. Most is in Asia. Public health authorities have been notified in a timely manner in the US and Japan.

The contaminated product may cause an eye infection that is treatable with today's standard antibiotics. That is a relief to me as a practicing.

The Renu product recall was handled very differently. The manufacturer took from 3 to 6 months to inform US health authorities about any problems. It only discussed the issue with the CDC and the FDA after a CDC warning to eye care practitioners in the US, prompted by an astute eye doctor noticing an increase in a rare type of fungal eye infection.

B&L then decided to mention that they would not ship any of the product that "may" be causing a problem in the US. B&L continued to inform European eye doctors that the product available in Europe came from a different plant, and was safe. A few weeks after "not shipping" the potentially disease causing product, it actually recalled it. At this time, it told eye care practitioners about the problem through their sales force. Many US eye care practitioners had not been visited by a B&L sales rep for years. They had to find out about the problems from a televised commercial on morning news shows.

The B&L product Renu with MoistureLoc may cause a potentially devastating fungal eye infection. This type of infection is not easily amenable to today's available antibiotics, or anti fungals. People have lost vision from this less controllable infection.

There are numerous differences in these two product recalls. One handled with openness and transparency, one not. I have stopped prescribing any Renu multipurpose products. I will probably continue to prescribe AMO products, after checking for bad lot numbers!