avenova news booklet
TRANSCRIPT
Avenova News
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Daily lid and lash hygiene.
2AVENOVA NEWS | LETTER FROM RON NA JAFI , PH .D. , CHAIRMAN & CEO OF NOVABAY PHARMACEUTICALS
Letter from Ron Najafi, Ph.D., Chairman & CEO of NovaBay Pharmaceuticals
Dear Friend,
Welcome to the first edition of Avenova News, a booklet of reprinted articles about our revolutionary eye care product.
We at NovaBay believe that Avenova is a breakthrough in eye care. It is the first prescription, non-detergent, non-antibiotic antimicrobial eye care product on the market. It is proving to be remarkably safe and an important component of the regimen for the successful management of blepharitis, meibomian gland dysfunction and associated dry eye syndrome.
But please don’t just take my word for it. A number of prominent ophthalmologists and optometrists have been writing articles that explain what’s unique about Avenova and how it works to improve the quality of care for countless patients. In addition, the eye care trade press has been covering the introduction of Avenova and the evidence of its benefits.
It is also worth mentioning that Avenova contains Neutrox™, the purest Hypochlorous acid commercially available today, with no bleach impurities.
We will be producing more editions of Avenova News on a regular basis as more educational news material is published. In the meantime, please enjoy reading what others have been writing about our product.
Ron Najafi, Ph.D. Chairman & CEO NovaBay Pharmaceuticals, Inc.
3AVENOVA NEWS | CONTENTS
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Letter from Ron Najafi, Ph.D., Chairman & CEO of NovaBay Pharmaceuticals
Wash Away Your Old Hygiene Strategy Christine W. Sindt, OD | Review of Cornea & Contact Lenses (RCCL)
Hypochlorous Acid Lid Cleanser Provides Novel Advantages Featuring Kathryn Najafi, MD and Steven Lichtenstein, MD | Ophthalmology Times
New Avenova Effectively Treats Common Eye Problems in Elderly, Says Phoenix Optometrist Dr. Arthur B. Epstein | Phoenix Eye Care
Rx Lid Cleanser Aids Blepharitis, MGD Optometry Times
New Blepharitis Treatments Alan G. Kabat, OD, and Joseph W. Sowka, OD | Review of Optometry
New Eye Treatment Is “One of the Best Tools I’ve Found,” Patient Reports Kathryn Najafi, MD | Eye Institute
Alternative Products Available to Combat Ocular Surface Disease Featuring Katherine Mastrota, MS, OD, FAAO | Primary Care Optometry News
New Study Shows Effectiveness of Avenova VMail Technology
*The name of “i-Lid Cleanser” has been changed to “Avenova” in the above articles to reflect the rebranding that occurred in January 2015.
4AVENOVA NEWS | WASH AWAY YOUR OLD HYGIENE STR ATEGY
Wash Away Your Old Hygiene Strategy
By Christine W. Sindt, OD | 5/15/2014 | Review of Cornea and Contact Lenses (RCCL)
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015.REFERENCES1. McCann LC, et al. Tear and meibomian gland function in blepharitis and normals. Eye Contact Lens. 2009 Jul;35(4):203-8. 2. Panaser A, Tighe BJ. Evidence of lipid degradation during overnight contact lens wear: gas chromatography mass spectrometry as the diagnostic tool. IOVS. March 2014;d55(3):1798. 3. Craig JP, et al. The TFOS international workshop on contact lens discomfort: report of the contact lens interactions with the tear film subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS71-97. 4. Willcox MD, et al. Potential sources of bacteria that are isolated from contact lenses during wear. Optom Vis Sci. 1997 Dec; 74(12):1030-8. 5. Stapleton F, et al. Changes to the ocular biota with time in extended- and daily-wear disposable contact lens use. Infect Immun. 1995 Nov; 63(11):4501-5. 6. Welling JD, et al. Chronic eyelid dermatitis secondary to cocamidopropyl betaine allergy in a patient using baby shampoo eyelid scrubs. JAMA Ophthalmol. 2014 Mar 1;132(3):357-9.
Early impressions of a new eyelid cleansing option to help keep your patients’ eyes clean and microbe-free
It really is no secret that clean eyelids promote healthy contact lens wear. As we’ve all seen clinically, patients who have blepharitis exhibit significant differences in tear physiology than those without blepharitis.1 Tear lipids are oxidatively stable in their native environment because meibomian glands predominantly secrete only saturated and monounsaturated lipids.2 Stable lipids don’t degrade and don’t cause discomfort or blur.
Blepharitis and meibomian gland dysfunction (MGD) patients typically experience heavy deposits of lipids on their lenses. This phenomenon is not limited to these patients, however. These lipid deposits may also be seen in those with no apparent MGD due to the individual composition of the meibum.
Over time, lipids associated with the contact lens will become unstable and degrade. Once formed, these deposits impair optical quality and the wettability of the lens surface (with the latter resulting in a quick break-up of the tear film), which can eventually lead to intolerance to contact lens wear.3
In addition to affecting the tear film, vision and comfort, the lids play host to myriad microorganisms. Bacterial contamination of soft lenses is
associated with microbial keratitis and corneal inflammatory events. Normal ocular organisms include coagulase-negative Staphylococci, Corynebacterium species, Micrococcus species, Bacillus species and Propionibacterium species.4
The lid margin, commonly colonized by microbes, is found to harbor organisms up to 70% of the time.5 Additionally, substantial lid bioburden is associated with a 2.5-fold greater risk of substantial lens bioburden, and is likely the major route of lens contamination.5
A New Option Keeping the lids clean, which in turn keeps the lens clean, directly benefits patient comfort, safety and quality of vision. The “old-school” lid hygiene method included the use of diluted baby shampoo to remove debris and contaminants. While it remains convenient and inexpensive, this is not as safe or simple as it may sound.
Baby shampoos—as well as some eyelid cleansers—contain cocamidopropyl betaine, a surfactant and lathering agent that may cause an eyelid dermatitis.6 Surfactants, the key ingredient in most lid scrub products, are also known to dry the skin and strip the area of oil—ironically, inducing increased production of oil in the glands.
A novel product, Avenova* (NovaBay Pharma ceuticals), which contains pure hypochlorous acid 0.01%, offers practitioners a new option for lid
hygiene. Hypochlorous acid is a naturally occurring chemical released by neutrophils to kill microorganisms and neutralize toxins released from pathogens and inflammatory mediators. As it is neutralized quickly, it’s nontoxic to the ocular surface.
Other hypochlorous acid products (e.g., Dakin) contain impurities (such as bleach), which are toxic to the ocular surface. In my experience, Avenova offers excellent lid cleansing capability without extraneous ingredients such as surfactants.
Pure hypochlorous acid 0.01% has shown to be fast acting against the five major bacterial pathogens associated with blepharitis during in-vitro laboratory tests. Although some conventional lid scrubs may lack antimicrobial activity even after prolonged exposure, efficacy of pure hypochlorous acid 0.01% was documented after just seconds of exposure, according to NovaBay Pharmaceuticals. In direct comparisons, the company says, pure hypochlorous acid 0.01% demonstrated a similar antibacterial spectrum of activity to Betadine—with 1,000 times less toxicity.
Its antibacterial properties make Avenova a welcome addition to any blepharitis or MGD-related dry eye treatment regimen. Additionally, the product can be useful in make-up removal and as an adjunct to contact lens wear.
5AVENOVA NEWS | HYPOCHLOROUS ACID LID CLE ANSER PROVIDES NOVEL ADVANTAGES
6/1/2014 | From Ophthalmology Times
New product associated with excellent results, high patient acceptance in management of blepharitis
A novel eye-care product containing a stabilized form of pure hypochlorous acid (0.01%) in saline (Advanced Avenova*, NovaBay) offers a safe and effective alternative for cleansing the lids, lashes, and periocular skin of debris and microorganisms, which can cause irritation, inflammation, and ocular surface disease.
Hypochlorous acid is a bactericidal component of the innate immune system. Incorporation into a commercial product required engineering a formulation that would maintain the stability of the acid and avoid other impurities.
Results from laboratory studies evaluating the stabilized hypochlorous acid show it has fast-acting, broad-spectrum activity against microorganisms found in the external ocular flora, including methicillin-resistant Staphylococcus aureus, plus the ability to disrupt biofilm that harbors bacteria. Laboratory testing has also established that the product is non-toxic to human tissues and non-irritating.
Merits of hypochlorous acid cleanser
Kathryn Najafi-Tagol, MD, founder, Eye Institute of Marin, San Rafael, CA, has been involved in research evaluating
the properties of hypochlorous acid.
In clinical practice, she has found that when used in the management of blepharitis, the lid cleanser is associated with excellent results and high patient acceptance.
“Blepharitis is a common problem seen by eye-care practitioners. It can have cosmetic, structural, and functional sequelae, and the availability of different options for use by affected patients is desirable,” Dr. Najafi-Tagol said. “Based on its unique characteristics, the hypochlorous acid cleanser is a welcome addition to our toolbox.
“In my experience, it is extremely helpful, and I appreciate that unlike topical antibiotics and steroids, it can be used safely on a regular, ongoing basis,” she said. “Furthermore, the hypochlorous acid cleanser is a simple and elegant formulation with reduced
potential to cause skin irritation compared with other commercial lid cleansers containing buffering ingredients, surfactants, and preservatives. My patients have been very pleased with the product, enjoying not only its efficacy as a cleanser but also what many describe as a refreshing feeling.”
Managing blepharitis
Steven J. Lichtenstein, MD, associate professor of clinical surgery and pediatrics, University of Illinois
College of Medicine at Peoria and Chicago,
and medical director of pediatric ophthalmology, Children’s Hospital of Illinois, Peoria, said he first began recommending the hypochlorous acid cleanser for use by patients with blepharitis at the beginning of 2014, and the results achieved have been excellent.
Dr. Lichtenstein noted that his standard treatment for children with chronic blepharitis has been dilute baby shampoo lid scrubs combined with a topical antibiotic and a steroid as needed to control significant inflammation. With this regimen, however, he was always concerned about the development of bacterial resistance and steroid-related complications, especially considering the likelihood that parents might be initiating repeat treatment on their own using medication leftover from a previous prescription.
Continued on next page.
BEFORE AFTER
Hypochlorous Acid Lid Cleanser Provides Novel Advantages
6AVENOVA NEWS | HYPOCHLOROUS ACID LID CLE ANSER PROVIDES NOVEL ADVANTAGES
Hypochlorous Acid Lid Cleanser Provides Novel Advantages“The hypochlorous acid cleanser is not any harder or any easier to use than the dilute baby shampoo, but it seems to provide better results while eliminating or reducing the need for antibiotics and steroids along with their associated costs and concerns,” he said.
The cleanser is packaged in a spray top bottle and should be dispensed onto a cotton pad or cotton-tipped applicator that is then used to scrub along the lashes, lids, and as needed, the periocular skin.
Dr. Najafi-Tagol noted that she only suggests a cotton-tipped applicator when she is confident the patient will be able to use it safely and confirms her impression by asking patients to demonstrate their technique before they leave the office.
Both Dr. Najafi-Tagol and Dr. Lichtenstein said they have used the lid cleanser for the management of patients with both anterior and posterior blepharitis.
In patients with meibomian gland dysfunction (MGD), the lid cleanser is combined with other lid hygiene methods, such as warm compresses directed at relieving gland obstruction, Dr. Najafi-Tagol said.
“Using the lid cleanser to reduce the bacterial burden on the eyelids is useful in patients with MGD because the organisms produce exotoxins and lipases that can lead to the development of evaporative dry eye disease through their inflammatory properties and effects on the meibomian gland secretions,” she explained.
Dr. Lichtenstein said he recommends twice-daily use of the lid cleanser, in the morning and at bedtime. So far, it has been consistently effective, with resolution occurring in some patients within 2 weeks.
“I have not yet seen any child whose blepharitis has recurred after the successful use of this regimen incorporating the lid cleanser,” he said. “However, because of the safety of this product, I am comfortable telling parents that they can re-initiate its use if they notice returning signs of redness or debris.”
Steven J. Lichtenstein, MD [email protected] Dr. Lichtenstein has no relevant financial interest to disclose.
Kathryn Najafi-Tagol, MD [email protected] Dr. Najafi-Tagol is also a member of NovaBay’s Ophthalmic Advisory Board and serves as medical monitor for NovaBay’s conjunctivitis clinical trials.
6/1/2014 | From Ophthalmology Times
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015.
7AVENOVA NEWS | NEW AVENOVA EFFECTIVELY TRE ATS COMMON E YE PROBLEMS IN ELDERLY, . . .
New Avenova Effectively Treats Common Eye Problems in Elderly, Says Phoenix Optometrist
By Dr. Arthur B. Epstein | 6/11/2014 | Phoenix Eye Care
In a recent webinar, Dr. Arthur B. Epstein of Phoenix Eye Care explains how Avenova can alleviate the suffering from blepharitis and other common eye conditions, such as dry eye syndrome, in the elderly
Dr. Arthur Epstein, Director of the Dry Eye - Ocular Surface Disease Center and Director of Clinical Research at Phoenix Eye Care, announced in a recent webinar that the elderly now have a potent new solution for eye problems such as inflammation of the eyelids associated with blepharitis and dry eye syndrome. These eye conditions are especially common in Arizona because of the large number of retirees and the desert climate, said Dr. Epstein.
The new treatment is Avenova*. It was discovered and developed by Kathryn Najafi-Tagol, MD, Founder and Medical Director of the Eye Institute of Marin in Marin County, California and scientists from NovaBay Pharmaceuticals (NYSE MKT: NBY) in Emeryville, Calif. Avenova is preserved by a stable form of hypochlorous acid, a substance naturally made by the body’s immune system as a first defense against microbial invaders. Lab tests show that Avenova not only kills bacteria, it also neutralizes the toxins produced by
bacteria and is also completely safe to skin around the eye. The Food & Drug Administration has cleared Avenova for the removal of foreign material, including microorganisms, from skin.
“Those properties made Avenova an ideal treatment for eye conditions,” Dr. Epstein explained. “Blepharitis is the most common and most visible problem that eye care professionals encounter,” he said. “We see a tremendous amount in our practice in Phoenix.”
Blepharitis is typically caused by Staph bacteria that grow on eyelids, causing swelling, redness, inflammation, irritation and a crusty build-up. “It can be very irritating,” Dr. Epstein said. “The Avenova safely removes the bacteria and the crusty material, providing significant relief.”
Doctors have been using Avenova regularly at Phoenix Eye Care and at the Eye Institute of Marin to treat blepharitis, as this video and this product backgrounder explain.
“Two-thirds of the patients I see are coming in for dry eye therapy,” said Dr. Epstein. Dry eye is typically a result of meibomian gland disease, where the growth of Staph bacteria cause the meibomian glands to be obstructed by thick waxy secretions, causing dry eye. The Avenova removes both the bacteria and the bacterial toxins from eye lids and lashes. “It has tremendous utility for this condition,” said Dr. Epstein.
“Overall, control of lid flora is one of the most important things we can do as physicians,” said Dr. Epstein. Now, Avenova makes that possible.
Phoenix Eye Care, PLLC and the Dry Eye Center of Arizona, PLLC combine the skills and experience of two highly respected optometrists, a caring staff and state-of-the-art instrumentation and diagnostic equipment. Phoenix Eye Care provides a full range of primary eye care services including comprehensive eye examinations, LASIK evaluations, pre-and post-operative management, contact lenses, diabetic eye examinations and much more.
Contact: Dr. Arthur B. Epstein Phoenix Eye Care Phone: (602) 549-2020 Fax: (602) 325-5536 Email: [email protected]
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015. SOURCE: Phoenix Eye Care
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Contact lens wearers also see benefit
Everything from our high-tech lifestyles1 outdoor environmental factors, and the general aging of the population can lead to blepharitis, dry eye disease (DED) and meibomian gland dysfunction (MGD). Sustained tasks, such as reading, can reduce the blink rate to as low as five blinks per minute.2 This slow blink rate can cause additional stress on an ocular surface that is already compromised due to one of the aforementioned disorders.
It is not surprising that the limited prevalence data currently available suggest ocular disorders, such as dry eye, are increasing in prevalence.3 Patients experience discomfort as well as reductions in both productivity and overall quality of life. Blepharitis, for example, tends to be a chronic condition, and no one treatment has proven curative thus far.4 Some of the treatments used for these ocular diseases have included: lid scrubs, mild shampoos, warm compresses, and antibiotic ointments. The FDA recently cleared the novel Rx eyelid cleanser (NovaBay Pharmaceuticals, Inc.), which is designed to enhance lid hygiene and help to alleviate these conditions.
Assess dry eye from a systemic standpoint
DED, MGD, and blepharitis DED is typically the result of insufficiency of tear quality or volume, which leads to inadequate lubrication of the ocular surface.5 A variety of signs and symptoms are associated with DED, including: grittiness, burning, irritation, foreign body sensation, redness, fluctuating vision, and increased blink rate.6,7 The link
between the signs and symptoms of DED has proven inconclusive to date.8
MGD is one of the leading causes of DED throughout the world.9 The Tear Film and Ocular Surface Society (TFOS) described MGD as “a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.”9
Blepharitis is one of the most common eye disorders,10,11 but the condition often goes undiagnosed due to the fact that it can sometimes be perceived by the patient as being a nuisance rather than a legitimate medical concern. Blepharitis is an inflammatory disease of the lid margin with a multifactorial etiology.10This condition encompasses pathologic conditions of the pilosebaceous unit of the anterior lid or the meibomian gland of the posterior lid.12 The anterior form is usually caused by bacterial overgrowth and/or sebaceous gland activity, while the posterior form is caused by MGD, the most common causative factor for evaporative dry eye. Blepharitis is typically diagnosed using several hallmark signs and symptoms including:12
• Heavy/puffy eyelids • Itching/burning eyelids
• Dry, irritated eyes • Crusting or flaking of the lids on awakening
Currently, there is a paucity of prevalence data regarding blepharitis.10,11 This is due, in part, to the fact that the disease often exists as a comorbid condition with DED, seborrheic dermatitis, atopy, acne rosacea, etc.,12 which makes a differential diagnosis more challenging. To address this knowledge gap and increase our understanding of blepharitis, Lemp and Nichols conducted a survey of 5,000 individuals in the U.S. and found that 79.3 percent had experienced at least one symptom related to blepharitis during the previous 12 months.12 Furthermore, 32 percent of respondents experienced at least one symptom half of the time.
Lemp and Nichols also surveyed 120 ophthalmologists and 84 optometrists to evaluate the frequency of ocular surface symptoms associated with blepharitis.12 About 47 percent of optometry patients and 37 percent of ophthalmology patients were suffering from these symptoms. Most ODs (97 percent) agreed or strongly agreed that DED is a common comorbidity with blepharitis/MGD. Most (94 percent) of ODs agreed or strongly agreed
Continued on next page.
BEFORE AND AFTER: These images show a patient’s lid both before and after usage of Avenova. Note the difference in lashes and lash margin.
AVENOVA NEWS | R X LID CLE ANSER AIDS BLEPHARITIS , MGD
Rx Lid Cleanser Aids Blepharitis, MGD
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that posterior blepharitis/MGD is the most common cause of DED. This is important because MGD is a major component of DED and contact lens intolerance. Optometrists rated their most important treatment goals for anterior blepharitis:12
• Reduced symptoms: 44 percent • Decreasing the bacterial load: 30 percent • Reducing inflammation: 14 percent
According to the optometrists surveyed, the most important product attributes for the management of blepharitis and MGD were: safety beyond short-term exposure, tolerability, dosing regimen, and antibacterial properties. The two most important factors for blepharitis patients to seek treatment were blepharitis symptoms (34 percent) and dry eye symptoms (41 percent).
Clinicians should be aware of the effect of blepharitis, dry eye, and other disorders on contact lens patient dropout rates. Mean rates in the U.S. have been estimated at about 16 percent.13 A survey by Rumpakis found the number one reason for dropouts in the U.S. appeared to be discomfort (50 percent of respondents). Furthermore, dropouts can constitute a substantial loss of practice revenue.
The value of a contact lens patient
Treatment paradigms for blepharitis appear to be changing.12 Although, lid hygiene is still important, the recent trend is moving away from traditional antibiotic ointments and toward Rx products.
A new treatment option The Avenova* product was developed to enhance lid hygiene.
The cleanser is formulated with 0.01 percent hypochlorous acid,14 a naturally occurring compound15 that provides an oxidative burst produced by neutrophils and monocytes. Hypochlorous acid in solution is a fast-acting/broad spectrum15-17 antimicrobial agent, with >99.99 percent kill for numerous pathogens including:
• S. aureus • Methicillin-resistant S. aureus (MRSA) • S. epidermidis • H. influenzae
This rapid bacterial kill results in reduced levels of bacterial toxins, which would otherwise stimulate the inflammatory cascade. Biofilms are know to delay wound healing.18 Hypochlorous acid disrupts biofilms in solution.19 This agent also reduces bacterial loads in animal model studies20 and is associated with a low toxicity profile in solution.16 Hypochlorous acid has been used successfully in other medical applications such as nasal irrigation17 and wound therapy.14,16,20
Clinical experience with Avenova Christine Sindt, OD, FAAO, associate professor of clinical ophthalmology at the University of Iowa Hospitals and Clinics, manages patients with blepharitis. She has been using the hypochlorous acid cleanser with her patients for several months and seen positive results.
“We are constantly looking for better treatments for their eyelid disease,” she said. “We shouldn’t just be thinking of blepharitis as a benign condition. It can actually be viewed as very devastating, both visually and in terms of comfort for the patient.”
She also points out that it is important to reduce the bacterial bioload on the eyelid. She said this refers back
to Loretta Szczotka-Flynn’s work21 which shows people who have had marginal infiltrative events have higher lid flora than those who haven’t. Dr. Sindt believes that the hypochlorous acid cleanser should be given to every contact lens wearer who has had a contact lens peripheral ulcer. She also feels the product has a benefit for any patient who has rosacea.
“All of my patients have come back and said that they have found this to be very effective in making their eyes more comfortable and increasing their contact lens wear time,” said Dr. Sindt. Others have even resumed contact lens wear. She also pointed out that her patients are experiencing reductions in both itching and dry eye symptoms.
Art Epstein, OD, FAAO, who practices in Phoenix, has had success with Avenova and now keeps the product in stock so that his patients have immediate access to it. Previously, his patients were using baby shampoos that were stripping a lot of the oils from the skin, which was a significant concern with MGD and blepharitis. “In some cases of lid disease,” he said, “the Staph bacteria produce lipases, which lead to saponification, and you end up with only ‘soaps’ on the lids, which is why patients have burning eyes.”
Dr. Epstein said the hypochlorous acid cleanser works effectively without the detergent action and also counteracts some of the toxins that are produced by bacteria. Therefore, his patients get a lot of relief using the product.
He noted that treatments for eyelid disease have not changed for a number of years and that the hypochlorous acid cleanser is really an ideal solution for a very prevalent problem. The development of bacterial resistance with the cleanser is not a
Continued on next page.
AVENOVA NEWS | R X LID CLE ANSER AIDS BLEPHARITIS , MGD
Rx Lid Cleanser Aids Blepharitis, MGD
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Rx Lid Cleanser Aids Blepharitis, MGD
9/29/2014 | Optometry Times
concern. His patients appreciate Avenova’s results, not only in terms of the efficacy and gentleness of the product, but also in their overall cosmetic appearance.
Use in therapeutic regimens The 0.01 percent hypochlorous acid eyelid cleanser has a useful place in the therapeutic armamentarium for any instance where enhanced lid hygiene is needed:
• Blepharitis for better management of signs and symptoms • Dry eye (MGD) to decrease irritation associated with dry eye • Preoperative/perioperative care for cataract, refractive, glaucoma surgery, and retinal surgery • After contact lens wear • Other ocular irritation
How to create a dry eye center Recolonization of bacteria can be a chronic problem. For example, women routinely reuse eye makeup and inoculate themselves with bacteria during each application. Rubbing the eyes with the fingers can also be a source of bacterial and allergen contamination.
The cleanser can be used in place of baby shampoo and other commercially available lid scrubs. Data to be presented this fall demonstrates that the cleanser produces a faster bacterial kill than other agents that are currently available. The product can be used in conjunction with other products. It provides a complimentary mechanism of action to add to the treatment of Demodex sp. It helps to prevent secondary bacterial colonization and reduce the inflammatory response caused by exotoxins from the mites.
Dr. Epstein recommends the cleanser for lid hygiene as a stand-alone agent. He also has his patients use it in conjunction with other agents, such as antibiotics, for more severe cases of MGD and blepharitis. In some cases, the patients were able to discontinue their antibiotic therapy after using the cleanser. He also recommends Avenova for his patients who have undergone LipiFlow therapy.
Dr. Sindt often recommends a natural oil product, such as coconut oil, to soften the tissue around the eye and help with cleaning the flaking debris.
She then has her patients use Avenova to remove the bacterial bioburden effectively on the eyelid surface.
The cleanser formulation does not contain other buffers, preservatives, or surfactants and is therefore gentle enough for everyday use. This contributes to one of the side-benefits of the product that patients feel more comfortable in their contact lenses or are often even able to resume wearing their lenses.
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015. REFERENCES1. Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt. 2011 Sep;31:502-15.2. Bentivoglio AR, Bressman SB, Cassetta E, et al. Analysis of blink rate patterns in normal subjects. Mov Disord. 1997 Nov;12(6):1028-34.3. Ellwein LB, Urato CJ. Use of eye care and associated charges among the Medicare population: 1991-1998. Arch Ophthalmol. 2002 Jun;120(6):804-11.4. Lindsley K, Matsumura S, Hatef E, et al. Interventions for chronic blepharitis. Cochrane Database Syst Rev. 2012 May 16;5:CD005556.5. Asbell PA. Increasing importance of dry eye syndrome and the ideal artificial tear: consensus views from a roundtable discussion. Curr Med Res Opin. 2006 Nov;22(11):2149-57.6. American Academy of Ophthalmology. Preferred Practice Pattern Guidelines. Dry eye syndrome. San Francisco, CA: American Academy of Ophthalmology; 2011.7. Albietz JM. Dry eye: an update on clinical diagnosis, management and promising new treatments. Clin Exp Optom. 2001 Jan-Feb;84(1):4-18.8. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004 Nov;23(8):762-70.9. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1922-9.10. Lindstrom RL, Donnenfeld ED, Foulks GN, et al. Blepharitis 2010. Update on research and management. Ophthal Times. 2010; 1-15.11. Foulks GN. Enhancing our knowledge of blepharitis. Ocul Surf. 2009 Apr;7(2 Suppl):S15-6.12. Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7(2 Suppl):S1-14.13. Rumpakis JMP. New data on contact lens dropouts: an international perspective. Rev Optom. 2010;1:1-4.14. Crew JR, Varilla R, Rocas TAI, et al. Treatment of acute necrotizing fasciitis using negative pressure wound therapy and adjunctive neutrophase irrigation under the foam. Wounds. 2013; 25:272-7.15. Albric M, McCarthy CA, Hurst JK. Biological reactivity of hypochlorous acid: implications for microbicidal mechanisms of leukocyte myeloperoxidase. Proc Natl Acad Sci USA. 1981 Jan;78(1):210-4.16. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007 Apr;6:e5.17. Kim HJ, Lee JG, Kang JW, et al. Effects of a low concentration hypochlorous Acid nasal irrigation solution on bacteria, fungi, and virus. Laryngoscope. 2008 Oct;118(10):1862-7.18. Harrison-Balestra C, Cazzaniga AL, Davis SC, et al. A wound-isolated Pseudomonas aeruginosa grows a biofilm in vitro within 10 hours and is visualized by light microscopy. Dermatol Surg. 2003 Jun;29(6):631-5.19. LeChevallier MW, Cawthon CD, Lee RG. Inactivation of biofilm bacteria. Appl Environ Microbiol. 1988 Oct;54(10):2492-9.20. Robson MC, Payne WG, Ko F, et al. Hypochlorous Acid as a Potential Wound Care Agent: Part II. Stabilized Hypochlorous Acid: Its Role in Decreasing Tissue Bacterial Bioburden and Overcoming the Inhibition of Infection on Wound Healing. J Burns Wounds. 2007 Apr;6:e6.21. Szczotka-Flynn L, Lass JH, Sethi A, et al. Risk factors for corneal infiltrative events during continuous wear of silicone hydrogel contact lenses. Invest Ophthalmol Vis Sci. 2010 Nov;51(11):5421-30.
AVENOVA NEWS | R X LID CLE ANSER AIDS BLEPHARITIS , MGD
11AVENOVA NEWS | NEW BLEPHARITIS TRE ATMENTS
A decade ago, we looked at the latest treatment options for blepharitis. It’s high time we eye them up again.
We’ve been authoring the “Therapeutic Review” column for 10 years now. In one of our very first entries, “Put a Lid on Blepharitis,” we discussed the importance of differentiating the various forms of blepharitis and creating an individualized treatment strategy for each patient.1
Like many procedures and protocols in eye care, blepharitis management has evolved during the last decade. It’s time to revisit this topic and examine some of the newest, most promising treatment options.
Calling your bleph
A recently published survey of eye care providers suggested that some form of blepharitis is present in nearly half of our patients––whether or not they are symptomatic upon presentation.2 This means that every practicing optometrist likely sees this condition in one form or another on a daily basis.
Unfortunately, our traditional therapies for blepharitis have relied heavily on ongoing patient-administered intervention and compliance. Newer treatment modalities not only provide more targeted therapy, but also offer the promise of rapid recovery for most individuals.
Scrub-a-dub-dub
Lid scrubs have long been the mainstay of blepharitis management. Detergent-based products, such as
OcuSoft Lid Scrub or TheraTears SteriLid, applied to the lids and lashes help to remove accumulated debris and excessive oils from the eyelid margins. Also, these products diminish bacterial reservoirs, combating the overgrowth of flora that incites and perpetuates staphylococcal blepharitis.
BlephEx As mentioned previously, the effectiveness of home-based lid scrubs is directly contingent upon the patient’s level of dexterity, thoroughness and overall compliance. Recently, however, RySurg introduced BlephEx—a handheld device that allows physicians to perform an in-office “deep cleansing” of the lid margins. James Rynerson, MD, principal developer of BlephEx and CEO of Rysurg, LLC, refers to this new treatment as “microblepharoexfoliation.”
BlephEx is indicated for removal of lid debris and microbial biofilm, which Dr. Rynerson touts as the primary source of all ocular surface inflammation. The device incorporates a disposable, high-speed, rotating microsponge designed to clean both the anterior and posterior lid margins, making it appropriate for all forms of blepharitis. In practice, we use BlephEx in cases of staphylococcal and seborrheic blepharitis, demodicosis and even MGD as a form of debridement scaling for the meibomian glands.3
Be aware that there is no ICD-9 code associated with BlephEx at this time, and thus no insurance coverage. Patients’ out-of-pocket costs for the procedure typically range from $150 to $200, or more in some cases. Like dental cleanings, this procedure is recommended semi-annually—or even more frequently in severe cases.
Dropping Acid (on the Lids)
While surfactant cleaners certainly have a role in blepharitis management, they can be messy, irritating and unpleasant for some patients. Moreover, if conventional cleansers fail to control bacterial replication adequately, practitioners may need to resort to more aggressive therapies, such as topical antibiotics or antibiotic-steroid combinations.
Continued on next page.
By Alan G. Kabat, OD, and Joseph W. Sowka, OD | 10/15/2014 | Review of Optometry
This 80-year-old woman presented with severe blepharitis secondary to Demodex folliculorum infestation (top). Following microblepharoexfoliation, she exhibited improvement (bottom).
New Blepharitis Treatments
12AVENOVA NEWS | NEW BLEPHARITIS TRE ATMENTS
New Blepharitis Treatments
By Alan G. Kabat, OD, and Joseph W. Sowka, OD | 10/15/2014 | Review of Optometry
Avenova* Recently, NovaBay Pharmaceuticals introduced this novel antiseptic agent specifically indicated for the treatment of blepharitis. The company describes it as “the first FDA 510K-cleared prescription product to clean the lids and lashes, removing the debris and microorganisms that cause chronic inflammation.”
Avenova is a stabilized solution comprised of 0.01% hypochlorous acid (HOCl), a microbicidal component of the innate immune system.4 HOCl is naturally produced by neutrophils in response to pathogenic organisms, and can kill bacteria, block bacterial-derived toxins and blunt the effects of human cell-derived pro-inflammatory mediators.5,6
The product is packaged in a glass bottle with a pump sprayer, and can be applied to the lids via a cotton ball, cosmetic pad or gauze. While there aren’t yet any specific clinical studies demonstrating its efficacy, colleagues employing the product in their blepharitis treatment regimen have noted substantial improvement in both signs and symptoms when applied BID for just 10 days.7 Avenova is sold exclusively through physicians’ offices and online by the manufacturer. It retails for approximately $30 for a 40mL bottle.
Demodex Demolition
During the time that we’ve been writing the “Therapeutic Review” column, Demodex has gone from being a
vague, rarely-recognized and poorly managed lid pathogen to one of the most common causes of blepharitis that we see in clinical practice. We’ve known for some time that it is resistant to most conventional lid cleansers and antimicrobial agents, but is highly responsive to tea tree oil.8
Cliradex A recently published study identified the most potent demodicidal element in tea tree oil to be terpinen-4-ol, or 4-terpineol.9 This chemical compound is the active ingredient in Bio-Tissue’s Cliradex lid wipes. The company suggests that it is “a natural, preservative-free lid, lash and facial cleanser that helps manage symptoms associated with blepharitis, meibomian gland dysfunction, rosacea, dry eye, Demodex, chalazia and other lid margin diseases.”
Since its release last September, Cliradex has become a mainstay treatment for our patients with demodicosis and ocular rosacea (which also seems to have a probable association with Demodex).10 Also, it has eliminated the need to obtain pharmaceutically compounded agents of varying concentrations for Demodex infestation.
We typically prescribe Cliradex BID for 10 days, and then QD at bedtime for another 10 days in cases of Demodex blepharitis, ideally after performing microblepharo-exfoliation. The product is sold exclusively
through physicians’ offices and online, and retails for about $40 per carton, which contains 24 lid wipes.
Bio-Tissue also recently introduced the Cliradex Complete kit, which contains one carton of Cliradex lid wipes, a tube of Cliradex Advanced Care gel (a slightly more concentrated version of 4-terpineol for in-office application to the lids and lashes), a dual-sided applicator and instructions for the doctor and patient. This kit is designed for use by eye care clinicians only, and so individual providers typically will determine patient cost as a combination in-office/at-home therapeutic procedure.
Time marches on––but fortunately, each passing year brings a greater understanding of the physical maladies that plague our patients, as well as provides us with new tools to control their deleterious effects. Even something as seemingly common as blepharitis warrants consideration and intervention to help improve our patients’ vision and overall quality of life.
We would also like to express our gratitude to the editors who have worked with us on this column throughout the past 10 years, including Jen Kirby, Leah Addis and especially our current editor, Mike Hoster.
Dr. Kabat is a paid consultant to Bio-Tissue and Alcon Laboratories. Neither he nor Dr. Sowka has any direct financial interest in the products mentioned.
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015. REFERENCES1. Kabat AG, Sowka JS. Put a lid on blepharitis. Rev Optom. 2004 Nov; 141(11):123-4. 2. Lemp MA, Nichols KK. Blepharitis in the United States 2009: A survey-based perspective on prevalence and treatment. Ocul Surf. 2009 Apr;7(2 Suppl):S1-S14. 3. Korb DR, Blackie CA. Debridement-scaling: a new procedure that increases Meibomian gland function and reduces dry eye symptoms. Cornea. 2013 Dec;32(12):1554-7. 4. Wang L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J Burns Wounds. 2007 Apr 11;6:e5. 5. Gray MJ, Wholey WY, Jakob U. Bacterial responses to reactive chlorine species. Annu Rev Microbiol. 2013;67:141-60. 6. Ono T, Yamashita K, Murayama T, Sato T. Microbicidal effect of weak acid hypochlorous solution on various microorganisms. Biocontrol Sci. 2012;17(3):129-33. 7. Krader CG. Ophthalmology Times. Hypochlorous acid lid cleanser provides novel advantages. Available at: http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/hypochlorous-acid-lid-cleanser-provides-novel-advantages. Accessed September 14, 2014. 8. Gao YY, Di Pascuale MA, Li W, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005 Nov;89(11):1468-73. 9. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Transl Vis Sci Technol. 2013 Nov;2(7):2. 10. Holmes AD. Potential role of microorganisms in the pathogenesis of rosacea. J Am Acad Dermatol. 2013 Dec;69(6):1025-32.
13
New Eye Treatment Is “One of the Best Tools I’ve Found,” Patient Reports
10/30/2014 | Eye Institute
An informal survey of doctors and patients finds that NovaBay Pharmaceuticals’ Avenova is improving the quality of patients’ lives all across the U.S.
The Eye Institute, located in Marin County, California, announced today that an informal nationwide survey of eye doctors and patients shows success with the use of a recently launched product, Avenova*, as part of the treatment for Evaporative Dry Eye Syndrome associated with Blepharitis and Meibomian Gland Dysfunction. The condition is the result of over-colonization of Staph bacteria, resulting in inflammation of eye lids and blockage of meibomian glands that help lubricate the eye surface. “We’re finding this innovative product has had significant impact in helping many patients,” said Kathryn Najafi-Tagol, MD, Founder and Medical Director of the Eye Institute.
One grateful patient in the survey is Ramsey Flynn of Towson, Maryland. Blepharitis “has impaired my life for over 20 years,” Flynn reported. But recently, his eye doctor, renowned eye surgeon Sheri Rowen, MD, introduced him to what he described as “a remarkably simple prescription called Avenova. It’s a gentle solution that I can spray onto a cotton ball and wipe across my closed eyelids.”
The product finally brought him relief. “It’s one of the best tools I’ve found in my fight against the unruly beast of blepharitis,” he reported. “Much recommended!”
Dr. Rowen commented, “Blepharitis is an often very uncomfortable and can be a chronic condition where Staphylcocci bacteria grow on eyelids, causing swelling, redness, inflammation, irritation, a crusty build-up. It often causes enough inflammation to block the Meibomian glands that provide lubrication to the surface of cornea. This is a widespread problem affecting an estimated 23 million sufferers across the United States.”
Avenova is made by NovaBay® Pharmaceuticals, Inc. (NYSE MKT: NBY) and has been cleared by the FDA as a skin and wound cleanser. It has in-vitro broad antimicrobial activity because of NovaBay’s proprietary ingredient, Neutrox™, which mimics the substance used by white blood cells as their first line of defense against bacteria and other microbial invaders. Lab tests also show Neutrox not only kills bacteria, it also neutralizes the bacterial toxins that contribute to Blepharitis and associated dry eye syndrome.
John Moore, a retired professional from Walnut Creek, CA, is another satisfied patient. He suffered from Blepharitis for over ten years. Nothing brought him relief—until he was prescribed Avenova. “I am so happy with the results,” he reported.
Similarly, other Blepharitis patients—and their doctors—say that Avenova has finally brought them relief.
The survey also asked ophthalmologists and optometrists for their experiences with Avenova. A sampling of responses:
— “I have to say that it really is amazing and patients love it,” reported Scott Kamena, O.D., at Murrieta Optometry in Livermore, CA.
— “Under the microscope on a wet prep done by two of our interested O.D.’s who specialize in Ocular Surface Disease, NovaBay Avenova appears to kill Demodex,” said Dick Lindstrom, M.D., founder and attending surgeon of Minnesota Eye Consultants as well as Adjunct Clinical Professor Emeritus at the Department of Ophthalmology, University of Minnesota and Chair, ASCRS Foundation.
— “NovaBay Avenova offers a long term solution and is a safe option for the management of over colonized lid flora,” wrote Eric Donnenfeld, M.D., F.A.C.S. National Medical Director of TLC Laser Eye Centers, based in Connecticut, New York and New Jersey.
— “We have had very nice results,” wrote S. Barry Eiden, O.D., F.A.A.O., President and Medical Director of North Suburban Vision Consultant, Ltd. and assistant clinical professor at the University of Illinois, Chicago.
— “I’ve been using it for a few months and I am impressed with it. Patients seem to like it and appear improved on it,” wrote Steven G. Safran, M.D., PA, an ophthalmologist in Lawrenceville, NJ.
— “i-Lid has been a huge improvement over soap-based lid scrubs,” reported Susan J. Gromacki, O.D., M.S., F.A.A.O. of Washington Eye Physicians & Surgeons in Chevy Chase, MD.
Kathyrn Najafi-Tagol, MD (Ophthalmologist) The Eye Institute 415-444-0300
AVENOVA NEWS | NEW E YE TRE ATMENT IS “ONE OF THE BEST TOOLS I ’ VE FOUND,” PATIENT REPORTS
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015.
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11/2014 | Primary Care Optometry News
Clinicians can look beyond eye drops for options to treat dry eye, blepharitis and meibomian gland dysfunction
Schaeffer recommends the compresses to other doctors, with one note of caution.
“It’s important to keep a clean environment, and heating these masks in the office in a microwave that’s used for food is not good medical technique,” he explained. “I highly suggest buying a small microwave just for the compresses.”
Cliradex lid hygiene kit
The Cliradex Complete Advanced Lid Hygiene Kit (Bio-Tissue), which contains a gel as well as cleansing wipes, “represents a significant advantage over other commercially produced blepharitis kits as well as the
‘homemade’ versions involving diluted concentrations
of raw tea tree oil,” according to Scott G. Hauswirth, OD, FAAO, a PCON Editorial
Board member.
He noted that he uses it for in-office treatments of aggressive blepharitis, especially types involving Demodex mites.
“It contains the active ingredient in tea tree oil, 4-terpineol, in a topical cream,” Hauswirth explained. “There is a double-sided applicator included, as well as a box of Cliradex wipes.”
Hauswirth prefers using the Cliradex kit for multiple reasons, he told PCON.
“First, studies have shown that 4-terpineol is more effective with a faster kill rate than raw tea tree oil,” he said. “Second, the cream-like consistency of the product makes for safer application to the lids and lash base, so there is less likely a chance of over-application and resultant oil draining into the eye. Third, the thicker consistency means longer residence time on the surface with potentially greater potency against the offending organism.”
Patients are complaining less of discomfort and irritation after using the product, Hauswirth has found.
“From an integration standpoint, it is an easy adjustment to this kit from the product we were using prior,” he said. “I generally do two applications of the 4-terpineol cream at the visit, then give the patient a carton of Cliradex cleansing wipes to use at home on the eyelids.”
Hauswirth said the Cliradex wipes are sold in his optical, but that he uses the Cliradex kit as an in-office application.
Avenova
Katherine Mastrota, MS, OD, FAAO, has found Avenova* (NovaBay), a prescription solution,
to be “an excellent adjunct to familiar
commercially available and well established products.
“Avenova is a lid hygiene maintenance product,” she explained. “It is a bottled, liquid solution containing Neutrox, which is pure hypochlorous acid. Clinically, hypochlorous acid is generated in activated neutrophils and contributes to the destruction of bacteria. The solution is non-sensitizing and oxidizes quickly after application, so it is ideal for de-bulking microbial load and the associated biofilms from the eyelash base and lid margins.”
Mastrota told PCON that she has investigated the product on numerous types of patients, including those with dry eye complicated with meibomian gland dysfunction and blepharitis, those with atopic dermatitis, ocular rosacea or mild blepharoconjunctivitis as well as contact lens wearers.
For those in whom she also prescribes hot compress therapy, she suggests they use the Avenova first.
“It makes sense to me to de-bulk the lids both mechanically and therapeutically before a compress process,” Mastrota said.
“I generally show patients the spray-delivered product in the office, describe how to use it and send them with a prescription for their pharmacist to supply it,” she said. “I explain to them that although the product has a chlorine-like scent, it will not sting as they might expect.
Mastrota told PCON that NovaBay has early evidence that Avenova is acaracidal. From white paper studies, however, they have in vitro evidence that the hypochlorous acid solution
Continued on next page.
AVENOVA NEWS | ALTERNATIVE PRODUCTS AVAIL ABLE TO COMBAT OCUL AR SURFACE DISE ASE
Alternative Products Available to Combat Ocular Surface Disease
15
Alternative Products Available to Combat Ocular Surface Disease
11/2014 | Primary Care Optometry News
AVENOVA NEWS | ALTERNATIVE PRODUCTS AVAIL ABLE TO COMBAT OCUL AR SURFACE DISE ASE
has significant activity against a host of microbes, both gram-positive and gram-negative.
“It is presumed from these studies that iLid Cleanser would be efficacious against Bacillus oleronius, a Demodex-associated bacteria,” she said. “The bacillus may incite pathology as opposed to the mite.”
The only suggestion she has in terms of product improvement is the addition of an adjunct surfactant product.
“As Avenova contains only Neutrox and saline, it has no surfactant properties,” she said. “It will not remove most eye makeup, nor is it designed to do so. Akin to the dermatology and cosmetology practice of ‘cleaner and toner,’ Avenova, in my mind, is best used after makeup remover with a doctor-recommended surfactant product. Going forward, I would like to see a paired surfactant product as well as application pads added to Avenova.”– by Chelsea Frajerman
FOR MORE INFORMATION: Scott G. Hauswirth, OD, FAAO, is a Primary Care Optometry News Editorial Board member. He is a member of the Minnesota Eye Consultants clinical staff, leads the optometric student externship program at Minnesota Eye Consultants and is adjunct faculty at the Southern California College of Optometry as well as the Illinois College of Optometry. He can be reached at [email protected].
Katherine Mastrota, MS, OD, FAAO, is the center director of Omni Eye Surgery in New York. She can be reached at [email protected].
Jack Schaeffer, OD, specializes in general optometry. He is the president and CEO of Schaeffer Eye Center, which has 16 locations in Alabama. He can be reached at [email protected].
Steve Silberberg, OD, practices in New Jersey. He can be reached at [email protected].
Disclosures: Hauswirth is a consultant to Bio-Tissue. Mastrota is on the advisory boards of Bio-Tissue and NovaBay. Schaeffer has attended an advisory board meeting for Bruder. Silberberg is a consultant for Bausch + Lomb and CooperVision.
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015. REFERENCEMcMahon F, et al. Invest Ophthalmol Vis Sci. 2014; doi: 10.1167/iovs.14-15018. Accessed October 20, 2014.
16
New Study Shows Effectiveness of Avenova
11/20/2014 | VMail Technology
AVENOVA NEWS | NEW STUDY SHOWS EFFECTIVENESS OF AVENOVA
Product: Avenova
Top Line: The Eye Institute, located in Marin County, Calif., recently announced that an informal nationwide survey of eye doctors and patients shows success with the use of a recently launched product, Avenova from NovaBay Pharmaceuticals, to treat Evaporative Dry Eye Syndrome associated with Blepharitis and Meibomian Gland Dysfunction. The condition is the result of over-colonization of Staph bacteria, resulting in inflammation of eye lids and blockage of meibomian glands that help lubricate the eye surface. “We’re finding this innovative product has had significant impact in helping many patients,” said Kathryn Najafi-Tagol, MD, founder and medical director of the Eye Institute.
Close Up: Avenova has broad in-vitro antimicrobial activity and has been cleared by the FDA as a skin and wound cleanser.
Avenova* maintains its antimicrobial activity by the use of NovaBay’s proprietary ingredient, Neutrox, which contains the same active ingredient used by white blood cells as their first line of defense against bacteria and other microbial invaders. Lab tests show Neutrox not only kills bacteria, it also neutralizes the bacterial toxins that contribute to blepharitis and another condition called dry eye syndrome.
Vital Stats: The active ingredient in Avenova is a proprietary pure and stable form of hypochlorous acid or HOCI. HOCI is a bacterial component of the innate immune system. Incorporation into a commercial product required Dr. Najafi-Tagol to engineer a formulation that would maintain the stability of the acid and avoid other impurities. Results from pharmaceutical laboratory studies conducted by NovaBay Pharmaceuticals in coordination with Dr. Najafi-Tagol’s Eye Institute evaluating the stabilized hypochlorous acid proved that it has fast-acting, broad-spectrum activity against microorganisms found in the external ocular flora plus the ability to disrupt biofilm that harbors bacteria. Dr. Najafi-Tagol’s testing also established that Avenova is non-toxic to human tissues, non-irritating, and hypoallergenic.
Avenova is available by prescription only. It comes in a 40ml glass bottle with a fine mist spray pump included. The product has recently been added to the Vision Source Network, and is also available through local pharmacies and major retail chains across the U.S., such as Wal-Mart, Costco, CVS and Target, through a distribution agreement between NovaBay Pharmaceuticals and McKesson Corp. Click here to see a video about Avenova.
www.avenova.com (800) 890-0329
*The name of “i-Lid Cleanser” has been changed to “Avenova” in this article to reflect the rebranding that occurred in January 2015.