B&L's role in our ocular surface world
This week's vendor spotlight is more focused on the company's role in our community than on the Dry Eye Shop's history with them. We only stock one of their products (not through our own choice), but they are a very important player in both the dry eye and scleral lens worlds.
B&L and the dry eye community
Bausch & Lomb is home to the following well-known brands:
Soothe brand (5 products)
Soothe XP , sold in both preserved and preservative-free versions, is a mineral oil based eye drop, and was one of the first lipid drops on the US market.
Soothe Preservative Free, sold in PF vials, is a glycerin/propylene glycol drop for ordinary dry eye use.
Soothe Nighttime ointment is the original lanolin-free nighttime ointment, important to those needing overnight ointment but who do not tolerate lanolin or lanolin alcohol well. (Retaine PM is a knockoff.)
Soothe Hydration is a simple povidone lubricant drop with a mild preservative.
Soothe Maximum Hydration is, well, um, I really want to say it's an abomination. But technically it's just a higher concentration povidone drop and preserved with BAK (benzalkonium chloride, 0.005%). Got no problem with the povidone, got a big problem with the BAK. More about this later.
Biotrue Hydration Boost
Once solely a contact lens solution brand, Biotrue now has a lubricant drop with hyaluranon called Biotrue Hydration Boost in a multi-dose preservative-free bottle. It's sold at a relatively low price point, reminiscent of the sadly discontinued Clear Eyes Pure Relief from Heritage, making this a great low-cost starter product for people considering either MDPF bottles or hyaluronate drops or both. Their description is ever so slightly eyebrow raising, since, technically, manufacturers are not supposed to promote "inactive" ingredients. On the other hand, everyone knows the hyaluronate is the important part, I'm always talking it up myself, and I really do think it's unfortunate that the FDA's OTC monograph has not yet been updated to allow it as an active ingredient.
Lacrisert Ophthalmic Insert
This is a sort of slow-release lubricant in the form of a pellet placed in the lower eyelid. It has been on the market for a great many years. Over the years, though, it has been passed around from one company to another and has been subject to very long periods of unavailability. We are in the middle of one of the longest of those periods right now.
Lacrisert is not a well known product, but it is very, very important to those who use it. Kudos to B&L for remaining committed to Lacrisert - it can’t be easy, from a business standpoint.
Other types of eye drops
B&L also makes eyedrops for other ocular surface conditions which have relevance for the dry eye community, including:
Alaway PF, the first and only preservative-free allergy eye drop on the US market. I appreciate B&L’s leadership and hope other manufacturers follow suit.
Lumify, the much vaunted next-generation redness reliever eye drop - which is unfortunately preserved with 0.01% benzalkonium chloride (BAK), rendering it unsuitable for daily use due to the potential cumulative damaging effects of preservative toxicity. (See Wishlist below.)
Finally, B&L also makes some cheaper old school redness relievers - Advanced Eye Relief and Advanced Eye Relief Maximum. These types carry the double whammy of rebound redness and benzalkonium chloride, so we don't recommend them.
B&L's role in the scleral lens user world
Bausch & Lomb looms large in the contact lens world in general, and it’s no surprise that they are more prominent in the scleral lens world than perhaps any other major US ophthalmic pharma.
I have to start with Scleralfil, because I love this product so much, and it's their one product made specifically for scleral lens users! I’ve always raved about it. The vials are simply perfect. The tops come off so easily compared to other twist-off vials. The opening is wide, so you never, ever get that inconvenient effect of saline squirting in two directions at once, which almost every other brand will at least occasionally do. The bottom is wide, round and flat, so it stands up on its own and stays stable. And it’s pH balanced, so it is suitable for most users, even those with the most sensitive eyes. It’s sold in nice compact little boxes.
Scleralfil came on the scene several years ago to fill the void created by the intersection of a growing scleral lens marketplace and the discontinuation of Unisol 4 in 2015. Bausch has done a good job of keeping Scleralfil consistently available over the past six years with only a few brief interruptions - no mean feat, as most manufacturers have struggled to keep their supply consistent.
Boston brand contact lens solutions
Boston Simplus, Boston Advance, Boston Original multi-purpose solutions — these are some of the most familiar names in contact lens solutions for rigid lenses. Of these three, Boston Simplus is compatible with Hydra-PEG coating, making it probably the best-known MPS brand for scleral lens users in the US. (FYI, the only three MPS that are Hydra-PEG compatible are Boston Simplus, Unique pH and Tangible Clean.)
Wait, what about Biotrue?
Biotrue is a popular contact lens solution, but it is not labeled for use with gas permeable lenses. Sclerals are a type of gas permeable lens.
Ancient past: Peroxiclear
Peroxiclear, until it was recalled in 2016, was at one time an alternative to Alcon’s Clear Care hydrogen peroxide contact lens disinfection system. (The recall took place because the hydrogen peroxide was not getting completely neutralized.) They no longer manufacture it, and its absence has left a gap - even more so, of course, with the longstanding Clear Care shortages.
The scleral lens market badly needs another hydrogen peroxide product. We hope it won’t be too much longer before we have one. We imagine it will almost certainly come from one of the smaller companies with significant investments in the scleral lens market.
Dry Eye Shop's history with B&L
We began purchasing Scleralfil from B&L in early 2017 when it was launched with the help of a B&L consultant (Dave M, to whom I owe much!).
B&L used to have an online scleral lens supply store for eye care providers and they set us up with an account to purchase that way as well. It was an ideal situation for us - convenient to order, and orders were filled promptly. Sadly, in late 2021 they ended up having to close that specialty supply store down in favor of selling exclusively (well, almost exclusively) on Amazon. They have continued selling us Scleralfil directly, for which we are very grateful, though we still miss being able to get the Boston products. But at this point, it's just Amazon and us for Scleralfil! Yes, we feel quite special :)
At the moment, we’re actually selling Scleralfil for a lower price than Amazon is. Our cost went up quite a bit and I couldn’t bring myself to change the retail pricing immediately (though we will have to soon) because so many other things were going up as well.
The people at B&L have always been very nice to work with.
One of the more trivial-sounding things that we really appreciate about Scleralfil is that the case packaging (it comes in packages of 24 boxes, and we receive 30 of these cases on a pallet) is incredibly heavy gauge, comparing quite favorably to one or two other vendors whose products frequently have to be sent back for replacements due to damage in transit when their cases get squashed or bumped. Scleralfil cases also make terrific book boxes when you're moving house.
So what's missing here in my Bausch + Dry Eye Shop story?
Just, well, all the other B&L products - especially the dry eye ones.
It is an ongoing source of sad frustration to me that we are not able to get ANY of the other Bausch products that we want - Boston Simplus, Biotrue Hydration and Soothe XP, in particular. We have tried over and over, and even with the intervention of sympathetic contacts at B&L, it never works. After a lot of roundabout communications, we always end up with someone who politely tells us to go buy it from a distributor (e.g. McKesson, Cardinal) - which we cannot do, because we’re not a pharmacy.
Someday, maybe, we’ll find a way to persuade them.
Our wishlist for B&L
My top two requests for B&L are unrelated to the Dry Eye Shop.
1. Create a preservative-free (or at least BAK-free) Lumify.
How do you write a really nice blog post about a company that you're mad at?
This blog series really is about introducing and honoring and encouraging our vendors and challenging them to do more and better. But in B&L's case, my emphasis is necessarily focused on the “challenging them” part. Honestly, I feel even more scathingly critical of Lumify today than I did when it first came out, and I’m not inclined to muffle my opinion about it in any context.
This product has implications for all eye drop consumers, whether they've been been diagnosed with dry eye or not. As a redness reliever, Lumify was a breakthrough because - unlike all the others - it is not a decongestant and has a lower risk of the notorious “rebound redness” effect that other redness relievers have. On the other hand, Lumify is preserved with 0.01% BAK.
I want to be clear about what is so offensive to me about Lumify. It isn’t the fact that it contains BAK. I mean, yes, that bothers me, but it’s a problem in common with nearly all OTC redness reliever and allergy eye drops.
No, what offends me so much about Lumify is that doctors all over the country tout it as a “safe” redness reliever - apparently, according to our community, often stating that it is perfectly safe for daily use, even multiple times a day. But it isn’t. The damaging effects of BAK - which are directly related to frequency of exposure - are well documented. (See TFOS DEWS II Iatrogenic Report, 184.108.40.206, which explains that toxicity starts at a lower concentration than that used in most eye drops.
Why would doctors be so ready to vouch for the safety of using Lumify regularly and frequently when it has a high concentration of BAK and is for cosmetic use rather than medical need - thus contradicting the product’s own labeling? The only plausible explanation is that this is how it has been marketed to them - perhaps even by the “key opinion leaders” amongst their peers. For years myths have circulated that Lumify has a low concentration of BAK (not true) or at least lower than that of most glaucoma medications (also not true).
Even today, Bausch & Lomb continues to actively downplay the significance of Lumify's BAK content in its online descriptions by stating that "the majority of commercially available topical eye drops contain BAK" - glossing over the fact that that is only true of allergy and redness reliever eye drops, which are far outnumbered by the lubricant products on the market, very few of which contain BAK anymore. They also state that "the concentration of BAK is... lower than the maximum 0.02% allowed by the FDA." There are very, very few drops that actually use the highest allowed (the only glaucoma med that I know of with that high of a concentration is Xalatan). Read more here.
Please urge B&L to make a preservative-free Lumify by calling their customer service at 1-800-553-5340.
2. Discontinue Soothe Maximum Hydration or make it BAK-free.
I shake my head in puzzlement over the fact that B&L could sell Soothe Hydration with milder preservatives and then name a BAK-preserved version “Maximum Hydration”. Obviously those who have worse symptoms will want the "maximum", and are likely to use it more frequently - and thus they'll unknowingly give themselves frequent exposure to BAK.
It's 2023. Selling any lubricant eye drop preserved with BAK is retrogressive and unworthy of Bausch & Lomb's reputation.
3. Let us in?
Okay, here is the one request I have on behalf of the Dry Eye Shop: Please, Bausch & Lomb, pretty please, with cherries and whipped cream on top: let Dry Eye Shop buy your dry eye products like your industry brethren do!
We exist to educate - and we can educate most effectively about things that we can stock here. We love so many of your products and want to stock them. We want the Boston brand contact lens solutions, we want the Soothe brand drops and ointment, we want the Biotrue brand, and we want Alaway PF.
About this blog series
A key part of what the Dry Eye Shop does is to gather together a wide variety of dry eye and scleral lens products and wrap them up in information and practical tips to help you understand them from the patient's perspective.
We purchase from a growing number of companies, ranging from "mom & pop" developers of niche products for certain special needs of the corneal disease world to multi-national pharmaceutical companies selling familiar brands of eye drops.
We appreciate our vendors of all sizes and types and want to tell you more about them! This year, every week or so I'll be sharing about one of these companies - who they are, how and why (and what) we started purchasing from them and when, and what they mean to us.