CIBA vs. Acuvue Advance ...

Discussion in 'Optometry Archives' started by Domenic G., Dec 22, 2003.

  1. Domenic G.

    Domenic G. Guest

    So is CIBA going to sue J&J when this lens is released next month?
    After all, it is a silicone based lens, but the manufacturing
    technique is different -- no surface treatment. The lens has the blue
    tint, 123 indicator, and UV blockers built in. Apparently it does not
    dry out at all.

    So far the lens looks promising. It is my understanding that J&J
    intends to manufacture all its lenses (even the 1-days) using this
    material.

    Dom.
     
    Domenic G., Dec 22, 2003
    #1
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  2. Domenic G.

    Yeechang Lee Guest

    Hmm. My (re)try of the Night & Day is so far going well (doctor gave
    me the thumbs up after the first set), but the lack of a 123 indicator
    is very annoying. UV block would be nice, too. And yes, I think I'd
    still prefer the option of a 6/1 lens schedule as with the Acuvues,
    but in a silicone hydrogel form.
     
    Yeechang Lee, Dec 22, 2003
    #2
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  3. Actually, J&J (Vistakon) already made a preemptive strike against CIBA
    (back in September of this year), by filing for a declaratory
    judgement stating that they do not infringe on CIBA's patents. Smart
    move by Vistakon, if you ask me, considering that CIBA undoubtedly
    would have sued Vistakon as soon as the Acuvue Advance is released, in
    an effort to preserve their monopoly on the silicone hydrogel market
    in the U.S.

    Lothar
     
    Lothar of the Hill People, Dec 23, 2003
    #3
  4. Domenic G.

    Sam Guest

    I tried the CIBA Night and Days for about six months after wearing B&L
    Purevisions for years and was completely dissapointed in the quality
    of the lenses, they are much too thin and they are extremely easy to
    tear, not to mention the thinness of them makes them hard to handle
    and put in your eyes so I talked a friend of mine in Europe into
    ordering me a bunch of Purevision lenses so I can continue using them
    until this court decision expires.

    Just wanted to blow off some steam about this...it really made me mad
    that I was forced to use a completely inferior product.

    I check this group from time to time to see if anyone has any news
    about ISTA pharmaceutical's Corneaplasty procedure...or was that a
    pie-in-the-skie concept devised to inflate their stock price?....who
    knows,, maybe the Lasik industry buried it.

    Anyone know anything about the corneaplasty progress?

    thanks!

    -sam
     
    Sam, Dec 28, 2003
    #4
  5. Domenic G.

    LarryDoc Guest

    I would not agree. The Ciba lens works perfectly for thousands of
    people, and so does PureVision. They both have their place. We will see
    considerably more competition in the marketplace and more and different
    silicone hydrogel products available in the coming months. Begininng
    next week with J&J/Vistakon's Advance hybrid lens.
    18 months is a long time in the planning and clinical trial process. I
    think we will hear more about Corneaplasty from Ista in the next few
    months.

    The consipiracy theory of the Lasik industry burying the technology may
    have some merrit, but then again I am prone to believing conspiracies.
    Personally, I feel the Lasik industry will do it's own demise, with the
    help of the new silicone hydrogels and the fact that the "early
    adopters" have and the "I've waited and the technology is good enough
    for me" group has been depleted. Advertising that "it's better and safer
    than ever before" simply scares the daylights out of those who still are
    on the fence and pisses off those who have less than wonderful outcomes.

    But if corneaplasty does in fact work, and gets "approved" and the
    implantable contact lens takes off this spring, along with silicone
    hydrogel contact lenses, there's simply no market left for Lasik.

    I could be wrong, of course. I thought that AOL would crash and burn by
    now and it's still smoldering.

    It will be an interesting New Year in eye care, and I hope a safe and
    peaceful one in ways they matter to us all.

    --LB

    --
    Dr. Larry Bickford, O.D.
    Family Practice Eye Health & Vision Care

    The Eyecare Connection
    http//www.eyecarecontacts.com
    larrydoc at eye-care-contacts dot com (remove -)
     
    LarryDoc, Dec 30, 2003
    #5
  6. Domenic G.

    Trev Glasbey Guest

    At least if a lens causes problems, you can take it out: a botched lasik is
    not just for christmas, its for life!

    Trev
     
    Trev Glasbey, Dec 31, 2003
    #6
  7. Domenic G.

    LarryDoc Guest

    Having just met with a J&J rep..........

    Advance (BTW, national advertising to begin in about 10 days---watch
    out!) does not have FDA (USA) approval for overnight use. J&J thought it
    better (read: quicker to see profit) to get the lens to market without
    the hassle (read: delay, loss of potential revenue) of messing with FDA
    paperwork. But, one day, soon if the lens is successful, it will be
    approved for extended wear.

    Think this, though: Acuvue IS approved for overnight use and has a DK of
    21, one fourth the theoretical level needed to provide safe sleep-in
    use, and Advance has a DK of 85----just the right amount. So much for
    the process of protecting consumers.

    I don't know about them manufacturing all of their lenses from the
    si-hydrogel material. That doesn't make much sense, especially for the
    one-day disposable, and Sureview is slated to be discontinued shortly.
    A more likely end-point marketting strategy is Acuvue for 1 week
    disposable at a lower price point, Advance for 2 week daily or extended
    wear use, and One Day as it is. Or if they want to be somewhat sleezy,
    repackage Advance for monthly use and keep Acuvue for weekly.

    --LB

    --
    Dr. Larry Bickford, O.D.
    Family Practice Eye Health & Vision Care

    The Eyecare Connection
    http//www.eyecarecontacts.com
    larrydoc at eye-care-contacts dot com (remove -)
     
    LarryDoc, Jan 25, 2004
    #7
  8. Domenic G.

    Dr. Leukoma Guest

    There is still no consensus on the minimum DK, and at 85, the Acuvue
    Advance trails the other silicone hydrogels (Focus N&D and Purevision). It
    will not be approved for 30 day wear anytime soon, IMHO. The bar keeps
    getting moved upwards.

    DrG
     
    Dr. Leukoma, Jan 26, 2004
    #8
  9. I'd be surprised if it were possible to express overnight
    safety simply as a matter of Dk which is an intrinsic
    material property.

    Lens design matters, and this depends on mechanical
    properties during mfg and in-eye as well as lens power
    and rim design.

    A lens that is strong enough to be used at half thickness
    lets in just as much Oxygen as a thicker lens with double
    the Dk. Not that I expect silicone hydrogels of having
    inferior mechanical properties, or requiring thickness.

    -- Robert
     
    Robert Redelmeier, Jan 26, 2004
    #9
  10. Just a minor correction here, Larry... Advance has a Dk/t of 85, not a
    Dk of 85. I actually have no idea what their Dk value is (unless you
    were told that the Dk and Dk/t values were exactly the same, which is
    certainly possible, though not likely), and am curious if anybody here
    knows. The theoretical level I presume you are referring to (the
    Holden & Mertz criteria for extended wear) refers to Dk/t > 87, and
    arguably should be as high as 125 (Harvitt & Bonnano, 1999). Based on
    that criteria, it is questionable whether the Advance is safe for
    extended wear compared with a lens like the Focus Night and Day, which
    has nearly double the Dk/t of the Advance. You're the doc, not me, so
    I'd be curious to hear your (very respected) opinion.

    I eagerly await the next generation silicone hydrogel to be released
    by Johnson & Johnson that is true competition for the Night & Day for
    extended wear applications.

    Lothar
     
    Lothar of the Hill People, Jan 26, 2004
    #10
  11. Domenic G.

    LarryDoc Guest

    Yeah. There's lot's of stuff we dont really know for certain, and
    consensuses that don't last.

    The bar doesn't seem to raised far enough, fast enough, though. In OUR
    minds and, hopefully, practice it does. Based on science and real-life
    outcomes, it does. But "the authorities and agencies" that regulate
    such things (in the U.S.A, at least) go right ahead and approve and
    allow continued marketing of far less than adequate lenses for overnight
    use. (I won't get into the monolopy thing.)

    Of course you're right. Even if Advance gets "approved" for sleep-in
    use, the other si-hydros are indeed better choices. At least until
    proved otherwise. One would guess that J&J would want a piece of the
    monthly market, or at least have the moral sense produce a lens that
    really does move the bar. Sure.



    The whole concept of "continuous wear" is far more complex than "Dk or
    Dk/l or Dk/t, I'd think that bacteria attaching into the lens, proteins
    and lipids coating the surface, lens edge interaction with the lid and
    bulbar conjunctiva and cornea epithelium cell replication rate are
    perhaps some of the real important issues.

    Personally, I'm not ready to accept as OK the little dimples in the
    cornea surface caused by lipid bumps on the lens that some people get.
    Or that cell turn-over rate decreases, even if current clinical and post
    marketing data indicate that those two issues don't matter in the vast,
    vast majority of wearers.

    And back to real-life: I have dozens of patients safely using
    si-hydrogels on a continuous wear schedule. Including myself (when I'm
    not trying various other lenses). Most remove the lenses at least weekly
    for cleaning. I also have a few patients for whom it is not safe or
    practical to sleep-in, and quite a few who prefer to remove their lenses
    daily.

    Whatever works. And is safe and healthy and, well......works.

    --LB

    --
    Dr. Larry Bickford, O.D.
    Family Practice Eye Health & Vision Care

    The Eyecare Connection
    http//www.eyecarecontacts.com
    larrydoc at eye-care-contacts dot com (remove -)
     
    LarryDoc, Jan 26, 2004
    #11
  12. Domenic G.

    Dr. Leukoma Guest

    One thing that is generating discussion is exactly what is the "true"
    overnight degree of corneal swelling in the closed eye. If one accepts 2%,
    then the lens dk will have to be 125 instead of 80. Then there is the
    concept of design, and the overall thickness of the lens, not just the
    thickness of a -3.00 measured directly in the center at the thinnest point.

    DrG
     
    Dr. Leukoma, Jan 26, 2004
    #12
  13. Domenic G.

    Ira Kostman Guest

    Acuvue advance is only approved as daily wear as it was easier to get FDA
    approval and the lens out into the market. The J&J rep told me that
    vistakon will be coming out with their 30 night EW silicone hydrogel to go
    up against Night & Day. She didn't say when however. She also mentioned
    they had other exciting lenses coming out as well, toric hydrogel??
    Time will tell.


    Ira Kostman, O.D.
     
    Ira Kostman, Jan 28, 2004
    #13
  14. Domenic G.

    Ira Kostman Guest

    oooopppps,
    Make that toric SILICONE hydrogel
     
    Ira Kostman, Jan 28, 2004
    #14
  15. Advance may not have the worlds greatest Dk, but the ability to
    produce a silicone lens without surface treatment has its own
    advantages, mainly cost. The lack of an EW approval at this stage is
    again probably not a biggie, from my understanding, both the Ciba and
    B&L silicones are often prescribed on a DW basis anyway. No doubt many
    practicioners will recommend it for EW on an off-label basis anyway.

    When it comes to EW, Dk is not the be all and end all. Many other
    factors come into play, one being the build-up of cellular debris
    under the lens. Since the corneal epithelium has a high turnover, the
    presence of sloughed cells etc trapped under the lens must be of
    concern: a soft lens surely does not generate sufficient tear pumping
    to shift this debris.

    To my way of thinking, this is equivalent to only changing your
    underpants once a month: some people can probably get away with it,
    but I wouldnt fancy trying it, despite the convenience of not having
    to open my underwear drawer every day!

    A lens with a Dk higher than a standard hydrogel can also offer other
    significant advantages. If the water content is low (as in the Ciba
    and B&L lenses), then lens dehydration and corneal descication is
    significantly reduced. If the surface can remain wetted and
    lubricious, this must provide for a more comfortable lens.

    I will be most interested to hear how Advance feels in the eye at the
    end of the day, since its water content is on the high side.

    Winston
     
    Winston Wombat, Feb 2, 2004
    #15
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