As of September 17, Alcon owned 70 percent of the outstanding shares of WaveLight, and extended the period during which shareholders could sell Alcon their shares back to September 25 from the previous deadline of September 11.

Wolfgang Tolle, chief executive officer of U.S. operations for WaveLight, says that if Alcon's purchase goes through, it plays to each company's strengths. "You have a large, well-respected company with lots of resources, but maybe lacking the technology," he says. "Then you have a technology leader, but it's a middle-sized company without $40 billion dollars in resources. With the combination of the two, you have a technology leader and tremendous resources. It could mean better investment in studies and research and development and quicker turnaround for product approvals."

For a while, there was also the question of the intentions of Carl Zeiss Meditec, which announced over the summer that it owned 5 percent of WaveLight, and appeared to be making a bid of its own. In early September, however, Carl Zeiss Meditec tendered its WaveLight shares to Alcon for the offered price of 15 euros per share.

Some of WaveLight's current customers may wonder what Alcon's purchase might mean for them and the lasers they've bought. Mr. Tolle thinks they will be all right. "They are our customers and will remain our customers," he says. "And the customer intimacy we brought to them will not change."


B&L Shareholders Approve Merger

Bausch & Lomb announced that its shareholders voted to approve the proposed merger with affiliates of Warburg Pincus LLC, at a special shareholder meeting held on Sept. 21.

"We are pleased with the outcome of today's vote," said Ronald L. Zarrella, chairman and CEO of Bausch & Lomb. "On behalf of the Bausch & Lomb board and management team, I want to thank our shareholders, customers and dedicated employees for their support throughout this process. We look forward to promptly completing the transaction."

The tabulation indicates that more than two thirds of the total shares outstanding and entitled to vote at the meeting were voted in favor of the transaction.

In accordance with the terms of the merger agreement, at the closing, each outstanding share of common and Class B stock of Bausch & Lomb will be cancelled and converted into the right to receive $65 in cash, without interest, less any applicable withholding taxes. The transaction, which is subject to customary closing conditions, is expected to close early in the fourth quarter. Pursuant to the merger agreement, affiliates of Warburg Pincus are not required to consummate the merger until after expiration of a "marketing period" of 20 business days following the shareholder vote. Closing of the merger is not subject to a financing condition.


Further Emphasis on Diet in Latest AREDS Report

Further support for the role of dietary lutein and zeaxanthin emerges in the latest report (# 22) of the Age-Related Eye Disease Study (AREDS) Research Group, published in the September Archives of Ophthalmology. Higher dietary intake of lutein/zeaxanthin was independently associated with decreased likelihood of having neovascular age-related macular degeneration, geographic atrophy and large or extensive intermediate drusen.

The study evaluated the relationship of dietary carotenoids, vitamin A, alpha-tocopherol and vitamin C with prevalent age-related macular degeneration.

The investigators ascertained demographic, lifestyle and medical characteristics on 4,519 AREDS participants aged 60 to 80 years at enrollment. Stereoscopic color fundus photographs were used to categorize participants into four AMD severity groups and a control group (participants with <15 small drusen). Nutrient intake was estimated from a self-administered semiquantitative food frequency questionnaire at enrollment. Intake values were energy adjusted and classified by quintiles. The relationship between diet and AMD status was assessed using logistic regression analyses.

Dietary lutein/zeaxanthin intake was inversely associated with neovascular AMD (odds ratio, 0.65; 95-percent confidence interval, 0.45-0.93), geographic atrophy (OR, 0.45; CI, 0.24-0.86), and large or extensive intermediate drusen (OR, 0.73; CI, 0.56-0.96), comparing the highest vs. lowest quintiles of intake, after adjustment for total energy intake and non-nutrient-based covariates. Other nutrients were not independently related to AMD.


Alimera, Emory May Opt to Research ROS

Alimera Sciences will enter into an exclusive worldwide agreement with Emory University to explore oxidative stress management—specifically, the reduction of reactive oxygen species (ROS)—as a treatment for ophthalmic diseases. The agreement gives Alimera the exclusive option to license a unique class of compounds, NADPH (nicotinamide adenine dinucleotide phosphate reduced form) oxidase inhibitors, as a potential treatment for conditions such as the dry form of age-related macular degeneration, particularly the late stage of this condition, known as geographic atrophy.

A large body of evidence continues to target oxidative stress as a key aspect in both disease development and progression. The increased levels of ROS, which result from oxidative stress, appear to contribute to certain pathologic conditions, including dry AMD. Therefore, reducing ROS levels is becoming an important therapeutic strategy to treat AMD as well as other ophthalmic and non-ophthalmic conditions. While antioxidant compounds attack existing ROS, an NADPH oxidase inhibitor reduces superoxide production and, subsequently, limits the formation of ROS. The NADPH complex has long been recognized as the source of superoxide in phagocytic cells; scientists, however, are starting to appreciate its presence in other cells. Animal studies based on models of disease states, including ocular disease states, are producing evidence of the therapeutic implications of inhibiting this enzyme complex.

If the option is exercised, Alimera will hold an exclusive worldwide license for the NADPH oxidase inhibitor for ophthalmic indications. Also included in the agreement is an exclusive right to sublicense in ophthalmology and the exclusive option for non-ophthalmic use. Alimera will develop and commercialize the compounds. Emory will receive milestone payments and royalties from net sales.

"This agreement with Emory gives us the opportunity to apply a very unique class of compounds, which are potent inhibitors of NADPH oxidase, to a variety of ophthalmic conditions, including dry AMD," said Dan Myers, Alimera's president and CEO. "We believe that these unique molecules, combined with the array of delivery technologies now available to us, position Alimera to develop very promising therapies for serious ophthalmic disorders."

Emory has focused its successful technology transfer program in recent years on achieving proof-of-concept data with its early-stage inventions to make them more attractive to potential business partners. This program of licensing Emory's intellectual property has generated more than $650M for the university in the past four years.


Studies Shed Light on Physician Communication

Two recent studies offer some insights on improving patient communication skills. One showed that a physician's score in the patient-physician communication and clinical decision-making areas of a standardized licensure exam may predict later complaints to medical regulatory authorities.

The study was reported in the Sept. 5 Journal of the American Medical Association. It included all 3,424 physicians taking the Medical Council of Canada clinical skills examination from 1993 to 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed until 2005, including the first two to 12 years of practice.

The researchers analyzed patient complaints against study physicians filed with medical regulatory authorities in Ontario or Quebec. A two-standard deviation decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year. After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints, with scores in the bottom quartile explaining an additional 9.2 percent of complaints.

A second study, published in the June Archives of Internal Medicine, looked at greetings that physicians extend and how these affect patient attitudes. It combined a phone survey questionnaire and video recording of physician-patient interactions in a clinic setting.

Most (78 percent) of the survey respondents want the physician to shake their hand in greeting; 50 percent want their first name to be used when physicians greet them, and 56 percent want physicians to introduce themselves using their first and last names; these expectations vary somewhat by patient sex, age and race. Videotapes revealed that physicians and patients shook hands in 82 percent of visits. In 50 percent of the initial encounters, physicians did not mention the patient's name at all. Physicians tended to use their first and last names when introducing themselves.