At Press Time

Eyeonics' Entrepreneurs to Spur B&L

New Owner Moves to Put B&L on Faster Track.

By Jerry Helzner, Senior Editor

■ A funny thing happened to premium IOL developer eyeonics on its way to becoming a publicly traded company. The impressive growth detailed on the documents that the company filed in connection with its planned stock offering brought out suitors who wanted to acquire eyeonics and its popular crystalens brand accommodative IOL.

Discussions resulted in eyeonics in late January accepting an offer from Bausch & Lomb, which itself had recently been acquired by the private equity firm Warburg Pincus. Financial terms of the eyeonics acquisition were not disclosed.

The move to acquire eyeonics, along with the hiring a few days later of industry veteran Gerald Ostrov to replace Ronald Zarrella as B&L's chairman and CEO (Zarrella has become chairman emeritus), served notice that Warburg Pincus is wasting no time in shaking up Bausch & Lomb. Analysts who follow eyecare companies have usually praised B&L for its excellent products but have often faulted the company for its lack of aggressive management and less-than-stellar execution of growth initiatives.

The acquisition of eyeonics not only brings to B&L the crystalens, which now holds an approximately 30% share of the premium IOL market while competing against Alcon's ReSTOR lens and Advanced Medical Optics' (AMO) ReZoom IOL, it also brings with it a highly successful entrepreneurial team. That team produced a year-over-year doubling of eyeonics' sales from $17 million in 2006 to approximately $34 million last year. Based largely on those results, J. Andy Corley, eyeonics' co-founder, chairman and CEO, has been chosen to head B&L's large U.S. surgical business.

Asked whether a poor stock market environment had led to eyeonics accepting the B&L offer rather than going ahead with the public offering, Corley said he and his team were "thrilled to be a part of Bausch & Lomb."

Corley says Warburg Pincus is known as "a high-growth, high-energy" firm that is encouraging an entrepreneurial spirit at Bausch & Lomb.

"The only way we were able to compete with Alcon and AMO was by being efficient in everything we do," says Corley. "We think we can bring a breath of fresh air to Bausch & Lomb."

Corley says the biggest advantage B&L will give to the crystalens is "distribution, distribution and distribution. With eyeonics, we had 30 sales reps. We will now be adding another 45 to 65 Bausch & Lomb reps, all of whom will be knowledgeable about the crystalens."

Corley also counts B&L "unparalleled knowledge of optics" as a plus in advancing crystalens technology.

Currently, the eyeonics team is developing the next-generation of the crystalens, the HD 500, with improved "near" vision.

"The HD will bring us one step closer to the goal of targeting plano in each eye," asserts Corley.

Corley says the plan is for the eyeonics name to fade away while the crystalens becomes a valued member of the B&L stable of brands.

GIVING BACK:
Warning: Volunteering Is Addictive

Philanthropic work can quickly become a habit.

By René Luthe, Senior Associate Editor

■ Robert P. Rivera, M.D., in practice at the Barnet Dulaney Perkins Eye Center in Phoenix, began eyecare missions in 1991 with Lions' Club International. The group's goal, of course, is to eradicate treatable blindness (primarily due to cataracts) in the Third World. Since that first trip to Nicaragua, he has participated in one mission per year, sometimes two, to countries including Mexico and the Philippines. The first lesson he learned, Dr. Rivera says, was "to be prepared."

"You have to be prepared to see anything," Dr. Rivera explains. "That oftentimes means the people who walk in the door will just be a surprise — you've never seen a condition like this before until it's right there in front of you." He and his fellow volunteers commonly encounter conditions they would never see in the United States, even in very poor regions, he says. "We will treat multiple cases of phacolytic uveitis and congenital cataracts and just the densest cataracts."

Missions typically run 1 to 2 weeks and involve a staff of up to 30 people. This includes anesthesiologists, the operating room crew and usually a couple of optometrists to perform the eyeglass screenings. "We always need translators and we're very fortunate that here in Phoenix, the anesthesiologists who help us arrange our trips to the Philippines are Filipinos themselves," Dr. Rivera says. "They have family back home and good connections with the local infrastructure, so we've been able to take advantage of their knowledge of the local culture and the way things work."

Another crucial key to the success of these missions, Dr. Rivera reports, is the generosity of the manufacturers who provide the supplies the staff will use — mainly IOLs and surgical packs. The group takes approximately $1 million worth of donated supplies on their trips. Dr. Rivera says that all the IOL manufacturers contribute. "It's really phenomenal, the level of their participation," he says. Manufacturers also deliver the phaco machines the staff will use in their cataract surgeries, saving the mission significant shipping charges.

Dr. Rivera in the Philippines with a pediatric cataract patient and her mother.

A network of local eyecare providers help with follow-up care once the mission staff leave. It is a job that has been made much easier, Dr. Rivera reports, by the Internet and e-mail. "We can communicate back and forth if there are any issues," he says.

The eyecare missions need all the technological help they can get to deal with profound blindness in the Third World, Dr. Rivera says. The level of the problem, even in northern Mexico, in areas so close to the U.S. border that one can see the American flag flying, is astounding to anyone who has never visited before, Dr. Rivera reports. It was in Mexico that he had a patient who was diabetic, with one leg amputated and blind in both eyes. A previous unsuccessful surgery somewhere else had left the patient irreversibly blind in one of his eyes. "In the other eye, he was light-perception vision from cataract, yet being an amputee, the only way he could get around was on crutches," Dr. Rivera explained. "If you're on crutches and blind, that's a double-whammy. People can't guide you comfortably when you're on crutches or an amputee. When we took his cataract out, the next day, his face was just on fire. All he could wait to do was walk outside under his own power and guidance just to see the world around him."

The ability to so powerfully affect someone's life and the gratitude they show in return, Dr. Rivera warns, can hook doctors. "It's so touching on a personal level," he says.

"It's very humbling to see how people will take food away from their children to give it to you as a gift in gratitude for what we've done for them. Once you see the effect this has on the poorer peoples of the world, get prepared to be addicted to doing this work. It re-establishes your faith in humanity."

Glaucoma Linked to Gene

Finding Could Lead to New Sight-Saving Treatments.

■ A breakthrough in glaucoma diagnosis and treatment may be near. Researchers have found that a gene and a related signaling pathway play a role in the development of glaucoma. The team was led by Alcon Research and included investigators from the University of Iowa and the National Cancer Institute (NCI), part of the National Institutes of Health.

The study, which revealed that over-expression of the gene, sFRP1, elevates pressure in the eye, could help improve glaucoma diagnosis and lead to the development of sight-saving treatments. The study results appeared online in the Journal of Clinical Investigation.

"The cause of glaucoma and the resulting elevation of intraocular pressure has been poorly understood," said Abe Clark, Ph.D., Alcon's vice president of discovery research and head of glaucoma research. "This new discovery may allow researchers to develop therapies to treat the underlying cause of the disease."

Jeffrey Rubin, M.D., Ph.D., at NCI's Center for Cancer Research, who was involved in the study, had previously discovered the sFRP1 gene. The team compared the genes that are expressed in the eyes of people with glaucoma to the genes that are expressed in people with healthy eyes. They saw that some genes, including sFRP1, are much more active, or "expressed," in cells from eyes with glaucoma.

sFRP1 is part of a signaling pathway involving a series of other genes known as the WNT-signaling pathway. The team tested the effects of the gene on the pressure in both human donor eyes and mouse eyes. When the investigators delivered sFRP1 protein to the eyes, the pressure in these eyes became elevated.

Antioxidants May Aid in Cataract Prevention

35,000 Women in Study.

■ The antioxidants vitamin E and lutein, derived either from food and supplements, may help prevent cataracts in women, researchers report. A study in the January issue of The Archives of Ophthalmology enrolled more than 35,000 women who were followed for an average of 10 years.

This is not the first study to show that antioxidants can contribute to the prevention of eye disease. In the initial Age-Related Eye Disease Study (AREDS), antioxidants were proven to be of value in lowering the risk of macular degeneration.

After statistically adjusting for smoking, alcohol use, body mass index and other variables, the latest study found that the more vitamin E and lutein the women used, the less likely they were to have cataracts. Compared with the one-fifth of women who consumed the least antioxidants, the one-fifth who consumed the most reduced their risk for cataracts by 14% with vitamin E and 18% with lutein.

Vegetable oils, nuts, leafy green vegetables and whole grains are sources of vitamin E. Lutein is found in various fruits, corn, kale, spinach and other vegetables.

William G. Christen, Sc.D., O.D., the lead author and an associate professor of medicine at Brigham and Women's Hospital in Boston, said this study was observational only and that "there is no solid randomized trial for any specific nutrient to prevent eye disease."