According to a recent article in the Daily Mail, laser eye surgery chain Ultralase “is in talks with its bankers to refinance its debt just two years after a pre-pack administration saw the lending banks take over and owner 3i lose its entire £174million investment.”

Ultralase directors admit in the article that “…if business declines or the negotiations break down, there would be a ‘significant doubt’ that the company could continue.”

According to the Mail, “Recently filed financial documents show that Ultralase’s immediate parent company, CLVC Group, breached its banking covenants several times last year and also at the end of March this year.”

“Its backers, which include Royal Bank of Scotland and Barclays, have already agreed to defer some costs and interest payments and the company’s directors say they are ‘confident’ that the new financing will be agreed.

“Ultralase has been suffering from the slowdown in nonessential consumer spending.”

Read more: m.dailymail.co.uk/money/markets/article-2140284/Laser-eye-surgery-specialist-Ultralase-talks-banks-refinance-debt.html

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This article on corneal inlays by Dr Dan Durrie was featured in this month’s EyeWorld magazine. Dr Durrie describes the evolution of corneal inlays, culminating in the development of the most advanced version, the KAMRA inlay from AcuFocus.

Clarity for KAMRA

by Daniel S. Durrie, M.D.

The KAMRA corneal inlay Source: AcuFocus

The AcuFocus KAMRA inlay for the treatment of presbyopia Source: Perry S. Binder, M.D.
The KAMRA corneal inlay by AcuFocus (Irvine, Calif.) is gaining traction as a great option for treating presbyopia in markets that have access to it, such as Europe, the Middle East, and Asia-Pacific. The inlay works based on the principle of small aperture optics and provides improved depth of focus to improve near vision while having minimal impact on distance vision. The KAMRA inlay is the result of decades of study on corneal inlays. Jose Barraquer is accredited to be the first to experiment with corneal implants in 1949 (1).

A series of improvements took place, but early generations of inlays suffered from poor predictability, loss of acuity over time, haze, corneal thinning, and decent ration.(2-4) The development of new biocompatible materials and experimentation with optimal placement, however, have changed the history of corneal inlays and the treatment of presbyopia. I first started working with hydrogel inlays to correct aphakia in 1985. The porous nature of the hydrogel material made these well tolerated by the cornea, whereas inlays made out of polysulfone caused corneal thinning and melting due to their poor permeability. This was one of the first indications that in order for an inlay to be tolerated by the cornea, the biological principals of the cornea must be maintained. That includes an inlay of material that allows glucose to go through the cornea and nourish the corneal epithelium.

The KAMRA inlay has gone through six design iterations, starting with the original design that was made from Dacron fabric and was 25 microns thick. Over time, the platform has transitioned to polyvinylidene fluoride, a highly biocompatible material that is used routinely in IOL haptics. Further, the inlay has been reduced in size to just 5 microns thick in the current design. The number of microperforations has increased from 1,600 to 8,400, and these are arranged in a pseudorandom pattern to allow for appropriate nutrient flow and to minimize light scatter. Although melts occurred in a prior generation of inlay and with an earlier procedure, to date there have been no flap melts in the current clinical trial that will be submitted for approval next year.

In addition to the evolution in materials and design, numerous clinical studies over the past 7 years have led to the optimal depth placement in the cornea. Early studies demonstrated that shallow placement of the inlay has the potential to create some stress on the cornea, causing corneal shape change and thinning and ultimately resulting in an explant of the inlay. After performing a series of studies we also found that if the inlay was implanted too deeply, we had much lower visual recovery. The inlay should be implanted at an optimal depth of 200 microns. When kept at this depth, the cornea tolerates the inlay very well.

Development in other areas of ophthalmology has also aided in the advances in the corneal inlay procedure. The femtosecond laser allows surgeons to program what they want, and then it is executed with precision. This permits them to not only control the depth, but also the configuration of the incision. The precision of the laser allows us to make pockets at certain locations in the cornea, aiding with centration.

Another new technology now in use, the AcuTarget System, provides surgeons with real-time inlay placement guidance within 100 microns of the intended placement location, as well as objective placement assessment post-op. This surgical aid has the potential to reduce procedure time, resulting in quieter eyes in the immediate post-op period. In addition to historical data dating back to the 1960s, in-depth, international, multicenter clinical trials have provided evidence of the safety and efficacy of the KAMRA corneal inlay. With the transition from an investigational product for many years to a commercially available product outside of the U.S., there are now over 8,000 inlays implanted in Japan, Australia/New Zealand, Europe, the Middle East, and South America, without any corneal thinnings and with good patient satisfaction.

References

1. Barraquer JI. Queratoplatica Refractiva. Estudios e informaciones Oftalmologicas. 1949;2:10.
2. Deg JK, Binder PS. Histopathology and clinical behavior of polysulfone intracorneal implants in the baboon model. Polysulfone lens implants. Ophthalmology. 1988;95:506-515.
3. Alió JL, Mulet ME, Zapata LF, Vidal MT, De Rojas V, Javaloy J. Intracorneal inlay complicated by intrastromal epithelial opacification. Arch Ophthalmol. 2004;122:1441-1446.
4. Choyce P. The present status of intracameral and intracorneal implants. Can J Ophth.1968;3:295-311.

Editors’ note: Dr. Durrie has financial interests with AcuFocus.

Contact information

Durrie: 913-491-3330, ddurrie@durrievision.com

The KAMRA Inlay is a breakthrough in correcting the need for reading glasses, and is now our primary treatment for anyone aged 45 upwards. You can read an article from yesterday’s London Evening Standard all about KAMRA. It features Karen who had the Keyhole KAMRA version, where no LASIK-type flap is created, and the inlay is simply inserted into a tiny pocket through a keyhole entrance. Unlike LASIK, there is no significant dry eye and the patient could even rub their eyes afterwards without risk of dislodging anything.

You can see the full article here: www.thisislondon.co.uk/standard/article-24014966-london-clinic-develops-10-minute-operation-to-freeze-failing-eyesight.do

You can learn more about KAMRA and presbyopia here at KAMRAvision.com

A direct mail advertisement by Optimax Laser Eye Clinics, which said ‘we’re the UK’s number one Laser Eye Surgery specialists’ has been banned by the ASA, according to the drum.co.uk. A complaint had been made by Optical Express about the advert, which also claimed that Optimax had ‘the best corrective vision treatment in the country’.

Optimax said the ad was an oversight because they had been ensuring they were careful to avoid comparative and superlative claims in their advertising. Since the advertising Standards Authority did not receive any evidence to back the claims of being number one for laser eye surgery, or for having the best vision corrective treatment in the country, the regulatory body decided that the advert breached the CAP code on misleading advertising and substantiation. It said that the advert must not be shown again in that form.

Cataracts develop as part of the aging process, so everyone is at risk eventually. According to a recent article from the American Academy of Ophthalmology, the risk factors include:

Advanced age;
Diabetes;
A family history of cataracts;
Extensive exposure to sunlight;
Smoking;
Obesity;
High blood pressure;
Previous eye injury or inflammation (swelling) in the eye;
Previous eye surgery;
Long-term use of steroid medication (especially combined use of oral and inhaled steroids).

If you have any of these risk factors, and your vision is not as clear as it once was, then you may be developing cataracts. Visit your local optometrist as the first port of call for an eye health check and refraction.

Cataracts are readily treatable with a local anaesthetic operation. Multi-focal implants are also available to restore both distance and near vision, reducing or eliminating your dependence on all glasses.

According to a news report in Cataract and Refractive Surgery Today, vegetarians may have a reduced risk of developing cataracts, based on a study in the American Journal of Clinical Nutrition.

Researchers at the University of Oxford in England studied the lifestyle characteristics of 27,670 self-reported nondiabetic participants aged 40 years and more by using data from the Hospital Episode Statistics in England and Scottish Morbidity Records.

Participants were asked to fill out dietary surveys between 1993 and 1999; their medical records between 2008 and 2009 were monitored to see if they developed cataracts. Almost 1,500 participants had cataracts during the follow-up period. The data showed that vegetarians and vegans were 30% to 40% less likely to develop cataracts than individuals who consume high amounts of meat.

“There are many good reasons to follow a healthy diet, and our study suggests that lowering your risk of cataract can now be added to these,” lead author Paul Appleby, senior statistician, Cancer Epidemiology Unit at the University of Oxford, said in an e-mail to Cataract & Refractive Surgery Today. “How far individuals move along the path toward a plant-based diet is a matter of personal choice.”

There was a strong relationship between cataract risk and dietary group. A progressive decrease in the risk of cataract was shown in those who consumed high amounts of meat—100 g (? 3.5 oz) daily—to moderate meat eaters (1.7- 3.4 oz), low meat eaters (> 1.7 oz), fish eaters (participants who ate fish but not meat), vegetarians, and vegans, with risk ratios of 0.96, 0.85, 0.79, 0.70 and 0.60, respectively.

The authors point out that eating meat does not necessarily promote cataract formation, rather it is vegetables that may have protective nutrients that lower cataract risk. Additionally, vegetarians may practice other healthy behaviors that can contribute to a lower risk of developing cataracts.

“There was no obvious explanation of our findings in terms of specific nutrients. It may be that diet group is simply a better marker of a healthy diet than the intake of any given nutrient,” Mr. Appleby said.

Watch Denise in her own words talking about her recent laser eye surgery at FOCUS Laser Vision. Denise explains about her problems wearing glasses or contact lenses while working as a TV presenter and what led up to her decision to go ahead with laser eye surgery.

Denise opted for the most advanced treatment of Z-LASIK, which is blade free using two lasers for maximum accuracy and safety, plus wavefront optics to give her an outstanding quality of vision.

Click on play below to see the video:

I recently treated Denise Van Outen at my clinic and you can see the full story in today’s Daily Mail. We also made the front page with a leader. The phone’s are ringing non-stop!
You can click here to see the full story on Denise Van Outen and her laser eye surgery in London at the Daily Mail’s website.

Denise can now see better than 20/20 in each eye and is delighted with the result. She had the operation to get ready for climbing Kilimanjaro next month for Comic Relief without her contact lenses.

You might want to take a look at the laser eye surgery Lifetime Care Guarantee introduced at FOCUS Laser Vision (www.focusclinics.com/treatments_after.php). There are millions of people who would like to have laser eye surgery, although worries about possible complications is the quoted main reason that people have not yet gone ahead.

People have been looking for peace of mind and want to know that a clinic will take care of them afterwards.

Currently only FOCUS Laser Vision and Ultralase offer a lifetime care guarantee after laser eye surgery.

The biggest thought in every patient’s mind is about safety and that is exactly how it should be. As a prospective laser eye surgery patient (LASIK or PRK) you need to do a little research beforehand, so take a look at various clinics’ websites. Check the FOCUS Laser Vision or Ultralase websites for more details of their Lifetime Care Guarantees.

You can also check out Optimax, Optical Express or Moorfields (or any other UK clinics in fact) but none of these clinics offer a lifetime guarantee.

The number of people having laser eye surgery in the UK has increased following a boost in March 2006 when the National Institute for Health and Clinical Excellence (NICE) issued their guidance that laser eye treatment was sufficiently safe and effective to be carried out on appropriately selected patients.

Since then, the number of clinics offering laser eye surgery has increased. The three UK laser eye chains – Optical Express, Optimax and Ultralase – have all stated plans to increase the number of clinics they run.

The credit crunch and stock market falls have led to a dip in recent weeks reported by most consultants doing private laser eye correction. However the overall trend has been a rise in the number of procedures carried out in the UK.

THIS is a question I often get asked. It’s a very good question.

Preview post…

Some new research from Professor John Marshall has helped shed light on this key topic and is something that everyone who is thinking about LASIK laser eye surgery needs to know.

Check back next week for my post on this topic…

Advanced Medical Optics Inc. in Santa Ana, announced on Wednesday that the Food and Drug Administration (FDA) has approved a new laser for use in laser eye correction. The iFS femtosecond laser is set to be at the centre of AMO’s iLasik products for laser vision surgery. The laser has an increased speed of 150kHz, up from the existing 60kHz.

However, competitor Ziemer from Switzerland recently launched its own femtosecond laser offering more than 1000kHz speed, integral to its Z-LASIK offering. Click here for a discussion blog post comparing iLASIK and Z-LASIK.

AMO has pushed into laser vision correction, including its $800 million buy of Irvine, California-based IntraLase Corporation last year. The iFS laser uses technology from IntraLase. The femtosecond laser is used to create a corneal flap which is the first step in laser vision surgery. Advanced Medical’s lasers have been gaining market share over traditional metal blades. The laser is due to be shipped to U.S. laser eye surgeons in the third quarter, according to Advanced Medical Optics.

Tags: Z-LASIK, iLASIK, AMO, FDA, femtosecond, eye, laser, surgery

Optimax, one of the UK’s big 3 laser eye chains, has made a significant price hike for their wavefront LASIK treatment, the UK’s most popular type of vision correction.

Patients will now pay an additional £480 to have both eyes correct with blade free wavefront LASIK. Bilateral (both eyes) treatment has risen from £2,890 in August last year up to £3,370 today.

One of the big changes in the laser eye treatment industry is the battle for a low headline price. Optical Express lead the way with a “from £395” price headline with a huge marketing campaign across the UK. Optical Express have raced ahead over the past few years and now do more treatments than any other UK laser provider.

Optimax has responded to the challenge by dropping their headline price to match OE’s at £395 per eye (Epi-LASEK).

However, you have to look closely to see what is on offer. For Optimax, £395 will not get you either LASIK or superior wavefront vision correction. For that you will have to pay £1,290. The £395 headline is for non-wavefront surface laser which lacks the comfort and rapid recovery that makes the LASIK procedure the most popular amongst patients.

And if you want the advanced blade free Intralase laser rather than a blade, there is an additional £395 (up from £300 per eye last year) to make an Optimax price of £1,685 per eye or £3,370 for both eyes.

Optimax prices in blue as of April 30th 2008. You can compare to prices from August last year just below, in green. You can see how all prices have risen, except for the Epi-LASEK entry price of £395 per eye, which does not include wavefront advanced optics.

A complaint we hear from LASIK patient is just how much more the price escalates to once you attend for a consultation, above the advertised ‘from’ price.

As I wrote about in a recent post, Ultralase have also raised their prices to £1.945 per eye for blade free wavefront LASIK vision correction.

Both Optimax and Ultralase charge a fixed fee for all prescriptions, while Optical Express have a sliding scale based upon the strength of the prescription glasses correction required; the worse the vision, the higher the cost.

The patient attending Optical Express will find typically 3 jumps in price:

1. Additional cost for a prescription above the mild prescription of the headline price
2. Additional cost for wavefront correction ( an upgrade issued back in 2002 by VISX)
3. Additional cost for Intralase blade free dual laser correction

So overall, the UK trend is to offer a low headline price, while actual LASIK prices are on the increase.

I should add here, humbly, that FOCUS Laser Vision prices are against the trend, and we have lowered our advanced blade free wavefront correction price to the best available in the UK. However, we are a specialist clinic serving London and the South-East and without a nationwide footprint. Sorry to the rest of the UK! Blade free ‘Intralase-type’ wavefront LASIK starts at £595 per eye and most patients are not spending much more than around £1,000 per eye for this advanced treatment at FOCUS. OK, personal plug over!

Ultralase laser eye surgery chain has increased prices again. They recently moved to only offering blade free LASIK using the American Intralase femtosecond laser, removing the cheaper option of keratome LASIK.

Ultralase laser eye clinics price for Intralase LASIK including the upgrade for wavefront based correction is now £1,945 per eye.

Click here to the US govnerment clinical laser eye surgery trial results for the Bausch and Lomb laser used by Ultralase and how it compares to the VISX laser used at major competitor Optical Express and the WaveLight laser used at FOCUS Laser Vision.

Private equity company 3i recently paid a whopping £174 million to purchase Ultralase (read the blog post here) so perhaps they would like to start getting some money back…? Just a thought.

Leading ophthalmologists plus LASIK patients at the Food and Drug Administration (FDA) Ophthalmic Devices Advisory Panel (ODP) presented two conflicting perspectives on the LASIK laser eye surgery procedure last week.

After hearing data and moving stories from both sides, the action taken was a number of recommendations on how to improve patient labeling of eye lasers and the FDA’s LASIK website page; how the FDA should recognize the American National Standards Institute’s (ANSI) standard for laser systems for corneal reshaping (Z80.11); and possible amendments for a list of LASIK-related adverse events for self-monitoring of the procedure.

After hearing stories from dissatisfied LASIK patients, Jayne S. Weiss, M.D., professor & Director of Refractive Surgery and Ophthalmic Pathology, Kresge Eye Institute, Wayne State University, Detroit plus ODP acting chairwoman, noted that while the stories are important the panel’s goal is to see the big picture. “Individual stories are compelling, but we need to put it into context,” said Dr. Weiss.