Paragon CRT® Contact Lens Certification & Resource Guide

Paragon CRT® Contact Lens Certification and Resource Guide

EXPAND YOUR TREATMENT OPTIONS AND GROW YOUR PRACTICE WITH PARAGON CRT® CONTACT LENSES.

INTRODUCTION TO PARAGON CRT® CONTACT LENSES Paragon CRT® Contact Lenses were the first FDA-approved overnight orthokeratology lens (June 2002):

• Paragon CRT® Contact Lenses are approved for up to -6.00D sphere, with or without 1.75D cylinder

• There are no age restrictions when prescribing Paragon CRT® Contact Lenses

• Paragon CRT® Contact Lens parameters are laser marked with their parameters for:

• lens identification and verification

• brand recognition

• practitioner convenience

• Paragon CRT Dual Axis® Contact Lenses may enhance the fit of the lens for corneal astigmatism

• Paragon HDS®100 (101 Dk / EW), green, blue, red and yellow tint

PARAGON CRT® CONTACT LENS CERTIFICATION • Before prescribing Paragon CRT® Contact Lenses, you must become certified.

• This booklet is designed to provide the required training and education to become certified.

• In addition, Paragon CRT® Contact Lens certification is available online at paragonvision.com/getcertified.

• Once certified:

• Select the best method to prescribe Paragon CRT® Contact Lenses in your practice:

• Paragon CRT® Contact Lens Diagnostic Dispensing System (100 Lens standard)

• Paragon CRT® Contact Lens Diagnostic Dispensing System (136 Lens extended)

• Empirical fitting with or without the warranty exchange option • Practice information will be listed on the consumer section of the Paragon Vision Sciences website, paragonvision.com, under the doctor locator section.

• Customized Paragon CRT® marketing material available with your practice information.

Paragon CRT® Contact Lenses

Traditional Ortho-k

The harmonic front and back surfaces of Paragon CRT® Contact Lenses provides up to 30% thinner lenses than other ortho-k designs

2

OVERVIEW OF THE PARAGON CRT® CONTACT LENS DESIGN & FITTING GUIDE On June 13, 2002 Paragon Vision Sciences received FDA approval for overnight Corneal Refractive Therapy using Paragon CRT® Contact Lenses. The approval includes up to -6.00D myopia with or without -1.75D astigmatism.

The FDA does not have an age restriction when prescribing Paragon CRT® Contact Lenses.

Corneal reshaping of the epithelium, which is 50 microns thick is accomplished by a combination of compression and redistribution of fluids within the epithelial cells. The temporary effect is reversible with the cessation of lens wear.

1. BASE CURVE/TREATMENT CURVE

2. RETURN ZONE & RETURN ZONE DEPTH

The central Optic Zone of Paragon CRT® is fixed at 6.0mm and the design contains the Base Curve or Treatment Curve. The Base Curve/Treatment Curve is calculated to be flatter than the underlying corneal radius in order to reduce myopia and should be centered over the pupil.

Key elements of successful Corneal Refractive Therapy are centration and central applanation.

The Return Zone Depth (RZD) is the primary parameter used to change the overall sagittal depth of the Paragon CRT® Contact Lens. Paragon’s Proximity Control Technology® allows for precise control of sagittal depth by manipulating the RZD. The RZD is variable in 25-micron increments.

Manipulation of the Base Curve/Treatment Curve is not used for fit adjustment purposes.

The Base Curve is not a “fitting curve”; it is the “treatment curve” to help reduce or eliminate the myopic prescription. When making lens centration adjustments, do not change the Base Curve. Always use the RZD, LZA, or a combination of both.

3. LANDING ZONE & LANDING ZONE ANGLE

Base Curve/ Treatment Curve

The peripheral Landing Zone is a flat surface with a radius of infinity. Through fluorescein observation, the prescriber selects the appropriate Landing Zone Angle (LZA) for the correct edge lift. Changing the LZA by 1° affects the overall sagittal depth by 15 microns. Flattening the edge lift or decreasing the LZA by 1° decreases the overall sagittal depth by 15 microns.

CRT paragonvision.com/ecp 3

®

PARAGON CRT® CONTACT LENS SELECTOR SLIDE RULE The parameters of the initial diagnostic lens are calculated by using the Paragon CRT® Contact Lens Selector Slide Rule.

The Slide Rule is included with your Diagnostic Dispensing System or Technical Kit. The only necessary data are the patient’s flat “K” Reading and their Manifest Refraction Sphere (MRS). An electronic version of the slide rule is available to download at paragonvision.com/ecp Patient Ks & Rx

Example: 42.00/42.25D, Flat “K” Reading = 42.00D

-3.75-0.25x180, MRS =-3.75 When using the Lens Selector Slide Rule, follow these simple steps:

1

2

Slide the tab until the arrow appears pointing either up or down at the correct Flat “K”.

Find the MRS to the right of the window.

2 1

3

Locate the recommended initial diagnostic Paragon CRT® Contact Lens number and lens parameters in the window immediately next to the MRS.

4

Prior to insertion of the lens, a topical anesthetic is optional to reduce reflex tearing and maximize patient comfort during the fitting process.

5

Perform an Refraction Over the Lens (ROL) to confirm the accuracy of selected BC. The ROL should be Plano to +0.50D for optimal results.

96. 88 - 550 -33 BC = 8.8 RZD = .550 LZA = °33

Example:

3

LENS SELECTOR The Paragon CRT® Contact Lens Selector Slide Rule algorithm is designed to create a -0.50D tear layer over-correction.

All lenses in the Diagnostic Dispensing System are +0.50D in power to compensate.

If the ROL yields a “minus power over-refraction”, the BC is too steep and should be flattened in 0.10mm steps for every -0.50D over-refraction.

Conversely, if the ROL yields a “plus power over-refraction”, the BC is too flat and should be steepened in 0.10mm steps for every +0.50D over-refraction.

4

RETURN ZONE & RETURN ZONE DEPTH The appropriate Return Zone has the “shallowest” Return Zone Depth that provides overall lens centration and results in a 3-4mm area of central applanation, as observed by fluorescein pattern evaluation. (Figure 1) However, if a greater Return Zone Depth is necessary to achieve centration, a smaller area of central applanation may be initially acceptable. Once a central area of treatment has been established, the sagittal depth can be adjusted during followup. (Figure 2)

• An RZD that is too shallow may exhibit apical touch but have

insufficient tear layer in the periphery and may decenter upwards.

• An RZD that is too great will not demonstrate the desired 3-4mm area

of central applanation.

In both cases, the correction is to change the overall sagittal depth (either shallower or deeper) by adjusting the the Return Zone Depth. See below for RZD problem solving techniques as it relates to overall sagittal depth.

Remember:

• The RZD can be customized in meridional depth differences

with an RZD1 and RZD2.

• Base Curve changes should not be used to alter or change the

sagittal depth.

3-4mm

Figure 1

RZ D

Figure 2

RETURN ZONE DEPTH IN RELATION TO OVERALL SAGITTAL DEPTH The most critical fitting goal is centration. Once a Paragon CRT® Contact Lens is well-centered, adjustments to the RZD may be required to achieve the desired 3-4mm zone of applanation.

Below are three different RZD’s on the same cornea. In each case, the only varied parameter is a 25-micron RZD adjustment.

.575 RZD

Observation 1

Excessive clearance; bubble in the RZD. The depth of the RZD is too great. The Base Curve (or Treatment Curve) may not applanate the central cornea with the optimal 3-4mm treatment zone. Solution: Reduce the RZD 25 microns (Example: move from 575 to 550)

.550 RZD

Observation 2

While the reduction of the RZD by 25 microns resulted in the loss of the bubble, there is still insufficient applanation to the center of the cornea. A further reduction in sagittal depth is required. Solution: Reduce the RZD 25 microns. (Example: move from 550 to 525) Note: If the reduction in the RZD by 25 micron results in a decentered lens, return to the previous RZD. 5

.525 RZD

LANDING ZONE & LANDING ZONE ANGLE

CORRECT LANDING ZONE ANGLES PROVIDE APPROPRIATE EDGE LIFT

The primary function of the Landing Zone is to provide a safe, tangential landing on the peripheral cornea. The Landing Zone Angle (LZA) is adjustable by degrees to create the appropriate edge lift. If the LZA suggested by the Slide Rule demonstrates edge lift that is not optimal, the angle of the Landing Zone is adjustable in 1° degree steps.

- - - - - - - -31 -32 -33

-33° LZA

-34

-35

In this example, the appropriate LZA provides sufficient edge lift.

The LZA is a flat surface with a radius of curvature, and can only meet the curved peripheral corneal surface tangentially.

- - - - - - - -31 -32 -33

-32° LZA

-35

-34

In this example, the -32° LZA is creating excessive edge lift. An increase in the LZA will reduce the edge lift. (Example: Change LZA from -32° to -33°)

33° LZA

- - - - - - - -31

LZA FACTS

-34° LZA

Landing Zone Angles are available in varying degrees to provide appropriate and adequate edge lift.

-32 -33 -35

-34

In this example, the -34° LZA is not creating adequate edge lift. A decrease in the LZA will increase the edge lift. (Example: Change LZA from -34° to -33°)

LZAs can be ordered with custom meridians separated up to 2 degrees to align to the flat and steep meridian of an eye that displays limbus-to-limbus or extensive corneal cylinder, ex: LZA1=-33, LZA2=-34. These custom parameters constitute a Paragon CRT Dual Axis® lens.

DIAMETER CHANGES Patients with larger HVIDs may need an increased diameter for the lens. For every 0.5mm change in diameter, the LZA must be modified by 1°. The LZA this modification keeps the edge lift relationship to the cornea the same.

The most common LZAs are -32°, -33°, and -34°.

SAGITTAL DEPTH CHANGES Any increase in the number value of either the RZD or the LZA will increase overall sagittal depth. Conversly, any decrease in the number value of either the RZD or the LZA will decrease overall sagittal depth.

For example, if the diameter is increased from 10.5mm to 11.0mm, increase the LZA by 1°. If the diameter is decreased from 10.5mm to 10.0mm, decrease the LZA by 1°.

6

SOLVING PARAGON CRT® CONTACT LENS DECENTRATION PROBLEMS Fluorescein Pattern

Goal: Bull’s Eye Fluorescein Pattern In the fluorescein pattern of a properly fit Paragon CRT® Contact Lens the Base Curve/Treatment Curve should be well-centered over the pupil and exhibit a 3-4mm area of central touch/applanation.

A Plano/+0.50D ROL (Refraction Over Lens) will provide the patient with maximum treatment results.

Observation: Superior / Superior Lateral Decentration Lenses that are too shallow in overall sagittal depth may decenter superiorly / superiorly laterally. An increase in overall sagittal depth is necessary.

Solution: Increase Sagittal Depth 1. Increase RZD one step (25 microns) 2. Increase LZA one degree (~15 microns) 3. Increase Overall Diameter

Observation: Inferior Decentration Lenses that are too deep may decenter inferiorly.

Solution: Decrease Sagittal Depth 1. Decrease LZA one degree (~15 microns) 2. Maintain the LZA and decrease the RZD 25 microns

Observation: Pure Lateral Decentration Lenses that are too shallow in overall sagittal depth may decenter laterally. An increase in diameter size by 0.5mm is necessary.

Solution: 1. Increase LZA (ex: -33 --> -34) when increasing diameter size (from 10.5mm to 11.0mm) to maintain same edge lift relationship to the peripheral cornea.

7

Topography Pattern

RECOMMENDED FOLLOW-UP SCHEDULE On the first morning follow-up visit, the patient should arrive wearing their Paragon CRT® Contact Lenses.

WHAT TO EXPECT AFTER THE FIRST MORNING FOLLOW-UP

STEP 1 With the lenses on: • Check visual acuity • Perform a Refraction Over Lens (ROL)

• Result should be “Plano to +0.50D” • Perform a slit lamp evaluation with white light and fluorescein:

• Confirm:

• Corneal integrity

• Appropriate edge lift

• Lens centration

The patient’s treatment will not likely last throughout their waking hours during the first day following overnight treatment. Vision may be managed with Paragon CRT® Contact Lenses or soft disposable lenses during the day and throughout the 7-14 day treatment period.

The patient should see clearly while wearing their Paragon CRT® Contact Lenses, provided the Base Curve and Refraction Over Lens are correct.

At the end of the treatment period, the patient should enjoy excellent visual acuity for all or most of their waking hours.

STEP 2 Remove the Paragon CRT® Contact Lenses: • Check visual acuity • Perform a manifest refraction to determine the amount of treatment achieved during the first night of therapy.

RECOMMENDED FOLLOW-UP SCHEDULE FOR NEW PATIENTS IN YEAR ONE Visit 1: First-morning visit

REORDER DISPENSED LENS

Visit 2: One-week visit Visit 3: One-month visit

Call the Paragon Vision Sciences Customer Service Department to reorder your dispensed lens by lens number to keep your Paragon CRT® Contact Lens Diagnostic System complete. Always having a complete Diagnostic Dispensing System will ensure the highest rate of first fit success.

Visit 4: Three-month visit Visit 5: Six-month visit Visit 6: One-year visit

8

PARAGON CRT® SUREFIT® CONTACT LENS FITTING & DISPENSING SYSTEM The Paragon CRT® Contact Lens Diagnostic Dispensing System is the preferred fitting method to fit Paragon CRT® Contact Lenses. The 100 or 136-Lens Diagnostic Dispensing Systems will allow immediate access to a full range of parameters for making fit adjustments.

An alternative to the Diagnostic Dispensing System is the Paragon CRT® SureFit® Contact Lens Fitting & Dispensing System, which provides certified practitioners with a 3-lens per eye fitting and dispensing system that has a high probability of first-fit success. Certified practitioners can order Paragon CRT® SureFit® Contact Lenses using “K” Readings and Spectacle Rx. Patient perscriptions that qualify for Paragon CRT® SureFit® Contact Lenses have the following criteria:

• Flat keratometric readings of 42.50D to 44.50D • Spectacle refractions of -1.00D to -4.00D MRS (Manifest Refraction Sphere) • Up to -1.00D of corneal cylinder (Astigmatism should be “with the rule”)

PARAGON CRT® SUREFIT® CONTACT LENS DIAGNOSTIC FITTING SEQUENCE Paragon CRT® SureFit® Contact Lenses are clearly identified with the proper sequence of fitting for each eye OD/OS: Lens #1. Lens #2. Lens #3. The first lens in the Paragon CRT® SureFit® Contact Lens Fitting & Dispensing System, Lens #1, is the lens that has the highest probability of first fit success.

Open the #1 lens and place on the patient’s eye. Follow the standard Paragon CRT® Contact Lens fitting assessment guidelines found on page 4.

Should Lens # 1 not be dispensable due to improper positioning, move to Lens #2. If Lens #2 positions well, dispense and follow-up accordingly. If Lens #2 does not show proper treatment position , verified by topography, discontinue treatment and contact Paragon consultation. If the dispensed Lens #2 centers well, but the refractive result is slight under-treatment, move to Lens #3. If successful fitting criteria are not met with lenses #1, #2, or #3, call the Consultation Department at Paragon Vision Sciences to determine if a fourth lens is required to achieve a successful fit: 800-5288279.

CRT

®

We don’t just change vision, we change lives.™ 9

CRT

®

Visit paragonvision.com/getcertified to take the certification test online, or complete the certification test on the following pages and fax your test and order form to Paragon Vision Sciences: (480) 393-7361.

A passing score is 14 out of 16 questions answered correctly. Once certified, you will receive an official Paragon CRT® Contact Lens Certificate which can be displayed in your office.

PARAGON CRT® CONTACT LENS CERTIFICATION TEST 1. What is the approximate thickness of the corneal epithelium? a. 130 microns b. 50 microns c. 80 microns 2. What is the fixed optic zone diameter in the Base Curve of a Paragon CRT® Contact Lens? a. 5.0mm b. 7.0mm c. 6.0mm 3. Which Paragon CRT® Contact Lens parameter is never adjusted to change the fit or centration of a lens? a. LZA b. BC c. RZD 4. What is the target Refraction Over Lens (ROL) with Paragon CRT® Contact Lens? a. -0.50D b. Plano to +0.50D c. +0.50D to -0.50D 5. If the ROL is -1.00D, what adjustment should be made in the Base Curve to achieve a Plano ROL? a. Steepen .20mm b. Flatten .10mm c. Flatten .20mm 6. Which would indicate the Paragon CRT® Contact Lens with the greatest sagittal depth? a. 8.5 .550 -33 b. 8.6 .550 -32 c. 8.6 .575 -33 7. Which is the best option to improve centration of a superiorly positioned Paragon CRT® Contact Lens? a. Increase RZD b. Decrease RZD c. Steepen BC 8. Which is the best option to improve centration of an inferiorly positioned Paragon CRT® Contact Lens? a. Increase LZA b. Decrease LZA c. Flatten BC 9. Return Zone Depths are available in micron increments of: a. 15 microns b. 7 microns c. 25 microns 10

10. A one° change in LZA affects overall sagittal depth by: a. 15 microns b. 25 microns c. 7 microns 11. If the LZA reflects an excessive amount of edge lift. What adjustment is needed? a. Decrease LZA b. Increase LZA c. Make no adjustment 12. If the LZA reflects an insufficient amount of edge lift. What adjustment is needed? a. Decrease LZA b. Increase LZA c. Make no adjustment 13. What is the age restriction for wearing Paragon CRT® Contact Lens? a. No age restriction b. Must be over 18 c. Must be over 21 14. How long is the average treatment period for a new Paragon CRT® Contact Lens wearer? a. 7 to 14 days b. 1 Month c. 2 Months 15. When using the Selector Slide Rule, what two components are needed to determine the Paragon CRT® Contact Lens? a. Steep K / Manifest Refraction Sphere b. Flat K / Spherical Equivalent c. Flat K / Manifest Refraction Sphere 16. Who would be considered a candidate for Paragon CRT® Contact Lens based on our FDA approval? a. Up to -8.00D myopia, with or without up to -2.50D astigmatism b. Up to -6.00D myopia, with or without up to -2.00D astigmatism c. Up to -6.00D myopia, with or without up to -1.75D astigmatism

To complete the certification and order process, fax the certification test and order form to Paragon Vision Sciences: (480) 393-7361.

11

FAX YOUR CERTIFICATION TEST ANSWERS AND ORDER INFORMATION TO (480) 393-7361

CRT Record Your Answers A Ex 1

B

C

®

If you are purchasing a Diagnostic Dispensing System, please complete the partnership agreement on page 14.

List your name as it should appear on your Paragon account and your Paragon CRT® Contact Lens Certification Certificate: __________________________________________________________ MD

OD Other

2

State License #: _____________________ Country: _________ Student? Y

3

Practice: _____________________________________________________________

4

N

Practice Address: ______________________________________________________ City: __________________________________ State: _______ Zip: _____________

5

Phone: _____________________________ Fax: ___________________________

6

E-mail: ____________________________________________ Will be used for correspondence.

7

COMPLETE YOUR ORDER BY SELECTING ONE OPTION BELOW

8

I will use Paragon CRT® SureFit® Contact Lenses. I will not order a Diagnostic Set at this time. I understand I can order the Diagnostic Dispensing System at anytime.

9 10 11 12 13 14

I will use the Diagnostic Dispensing Set belonging to the practice I work for.

It is listed under my colleagues name: $50.00 MSRP: Practice Management Kit. Includes: Practice management book, “My Children Are Nearsighted Too” book by Nick Despotidis, OD, certification & resource guide, in-office continual play consumer DVD, 8-18 consumer brochures & brochure stand, 8-18 consumer recall cards, adult consumer brochures & brochure stand, adult consumer recall cards, “Considering Paragon CRT® Contact Lenses” booklet. $50.00 MSRP: Technical Kit. Includes: certification & resource guide, practice management guide, checklist for evaluation & dispensing Paragon CRT® Contact Lenses, Paragon CRT® Contact Lens selector slide rule, fitting & troubleshooting card, yellow slit lamp filter, DMV.

15 16

12

WHEN PRESCRIBING SPECIALTY CONTACT LENSES, ASK YOUR LABORATORY FOR PREMIUM PARAGON VISION SCIENCES GP MATERIALS

HDS

®

40 Dk* 14.7 Wetting Angle Extended Wear UV Availability Deposit Resistant Superior Wettability

FluoroPerm 30 ®

101 Dk*

Used in Paragon CRT® Contact Lenses

HDS 100 ®

THIN

™

Extended Wear Deposit Resistant Proven Stability Promotes Corneal Health

FluoroPerm 60 ®

23Dk* Daily Wear UV Availability Deposit Resistant Proven Stability Superior Wettability

FluoroPerm 92 ®

30 Dk* 12.8 Wetting Angle Daily Wear UV Availability Deposit Resistant Structural Integrity Superior Wettability

43 Dk* 14.7 Wetting Angle Extended Wear UV Availability Deposit Resistant Proven Stability

64 Dk* 16 Wetting Angle Extended Wear UV Availability Deposit Resistant Reliable Material *ISO/ANSI Method

U.S. & CANADA AUTHORIZED PARAGON CRT® CONTACT LENS LABORATORIES

ABB Optical Group • 800-772-3911 CA

PC OPTICAL - A Walman Company • 800-926-6822 MN

Art Optical Contact Lens, Inc. • 800-253-9364 MI

X-Cel Contact - A Walman Company • 800-241-9312 GA • 800-342-2724 CA • 800-432-3838 FL • 800-221-9235 MD • 800-926-6822 MD • 800-245-0797 PA • 800-426-6241 WA

Essilor USA Contact Lens • 800-366-6342 TX • 800-362-4233 CO • 800-331-2015 GA GP Specialists • 800-889-0379 CA

13

CRT

®

Paragon CRT® Contact Lens Certification and Partnership Agreement Record Your Answers A 1

B

C

List your name as it should appear on the Paragon CRT® Contact Lens Certification Certificate: _________________________________________________________________ MD OD Other

2 3

State License #: __________________________

4

Country: U.S.A.

Puerto Rico

Canada

Practice: ______________________________________________________________________

5 6

Practice Address: _______________________________________________________________

7

City: ____________________________________

8 9 10 11 12 13 14 15 16

Phone: _________________________________

State: _______

Zip: ______________

Fax: _______________________________

E-mail: _________________________________ Office Manager: _______________________ Select the Authorized Paragon CRT® Contact Lens Distributor to bill your orders through. See page 13. You will receive your bill from your primary Distributor of choice.

Primary Distributor: _______________________________ Secondary Distributor: _____________________________

I am committing to the Paragon CRT® Contact Lens Partnership Agreement by electing to purchase the DDS below.

Paragon CRT® Contact Lens DDS (100 Lens) $996.00 - With Signed Agreement1

Paragon CRT® Contact Lens DDS (136 Lens) $1,354.56 - With Signed Agreement1

The Paragon CRT® Contact Lens Partnership Agreement between Paragon Vision Sciences, Inc., (hereinafter referred to as Paragon) and ___________________________ (hereinafter referred to as Eye Care Professional) is effective on ___/___/___ (MM/DD/YY). Paragon is investing in the Eye Care Professionals practice by selling the Paragon CRT® Contact Lens DDS identified above at a significantly reduced rate. Paragon will further invest in the Orthokeratology category to increase awareness about myopia and the benefits of Paragon CRT® Contact Lenses, thereby increasing consumer interest, which the Eye Care Professional may benefit from.

Paragon Agrees to provide the Eye Care Professional:

Eye Care Professional Agrees To:

90-day money back guarantee. If not satisfied, return the DDS and Practice Management kit within 90 days for a full refund.

30-60-90 day billing terms.

Official Paragon CRT® Contact Lens Certificate.

Include your practice on “Find-A-Doctor” at paragonvision.com.

Practice Management liaison assigned to your practice for scheduled communication with the Eye Care Professional and key staff to establish training and practice goals.

Customized consumer brochures and postcards (1,500 qty/ea).

Practice Management Kit. 180-day wholesale pricing on customized in office displays.

Complimentary lenses for two staff members.

Unlimited access to on-line clinical and staff training modules.

Customer Service care from 5am MT - 5pm MT, M-F. Consultation support from 8am MT -5pm MT, M-F.

Maintain a full DDS or, at minimum, an 85% fulfillment rate.

Allow a Paragon representative to audit the DDS, and if necessary, bring the set up to an 85% fulfillment level (at current MSRP).

Within 30 days, appoint a Paragon CRT® Contact Lens staff champion to be the liaison between the Eye Care Professionals practice and Paragon’s appointed Practice Management representative.

Complete the Paragon CRT® Contact Lens clinical training modules and, with the staff champion, complete the Practice Management training modules on paragonvision.com within 90-days.

Place the Paragon CRT® contact Lens consumer brochures in the office, message on the phone system, message on the practice website and on the practice social media channels, if applicable.

Mail customized postcards to data-mined patient list within 90-days.

Maintain trained key staff members who understand Paragon CRT® Contact Lenses and ensure accurate communication to consumers.

By signing below, you agree to fulfill the Partnership Agreement.4

Rich Jeffries Paragon Vision Sciences, Inc., President

Eye Care Professional Signature

14

SIGN HERE

PRICE, POLICY, MARKETING TIPS AND SUPPLIES

15

CRT

®

Welcome to the growing clinical practice of orthokeratology with Paragon CRT® Contact Lenses for Myopia Management!

Orthokeratology has entered the mainstream of contact lens clinical practice. The Global Eye Care Community has recognized the powerful clinical significance of orthokeratology in the management of myopia. Data has confirmed an unprecedented rise in myopia.2

MYOPIA RATES RISING?

In a survey of Paragon CRT® Contact Lens fitters, 60% agree that the prevalence of myopia has reached unprecedented levels. They are not alone.

More than 70% of Paragon CRT® Contact Lens patients are between the ages of 8 and 18.

“It is estimated that approximately 50% of the world will be myopic by the year 2050 based on current trends.” 2

Practices around the world have begun capturing new market share, while enjoying the incremental revenue that Paragon CRT® Contact Lenses can provide. With mainstream practices focused on increasing their profitper-patient, orthokeratology with Paragon CRT® Contact Lenses provides a seamless way to achieve higher profit margins while minimizing chair time.

“Myopia now affects 42% of the population in America.” 3 “High levels of myopia doubles the risk of serious ocular health problems such as retinal detachment, cataract and glaucoma, which can lead to vision loss and blindness.” 4

Isn’t it time Paragon CRT® Contact Lenses become your primary treatment option for childhood myopia?

YOU DECIDE!

1 Paragon Vision Sciences, CRT Data Report, 2017.

2 Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S, Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050, Ophthalmology, May 2016 Volume 123, Issue 5, Pages 1036–1042.

3 Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. British Journal of Ophthalmology.

2011.

4 Xu L, Wang Y, Wang S, Wang Y, Jonas JB. High myopia and glaucoma susceptibility the Beijing Eye Study.

Ophthalmology. 2007;114(2):216-20.

16

996

Paragon CRT® Contact Lens Diagnostic Dispensing System (100 Lens)

WHAT ABOUT MY FEES? No one should tell you what to charge; that is your decision. But, we would like to share what your fellow Paragon CRT® Contact Lens colleagues reported in a related survey t.

We asked other practitioners their global fee for the first year, including fitting, follow up visits, and one pair of Paragon CRT® Contact Lenses.

11%

26%

26%

999 or less

1,000 to 1,299

1,300 to 1,599

23%

9%

1,600 to 1,999

$2,000 or more

31%

Paragon CRT® Contact Lens w/ Lasermark

PARAGON CRT® CONTACT LENS DIAGNOSTIC DISPENSING SYSTEM • Paragon HDS®100 (Dk 101*/EW), green tint • Paragon CRT® Contact Lens parameters are identifiable with a laser mark • Lens vials are marked with a lens number and lens parameters • 7 to 10-day treatment period • When the initial treatment period is over, the patient should be dispensed their permanent Paragon CRT® Contact Lens

Percentage of fitters who provide a spare pair in their global fee.

When deciding what your practice will charge for Paragon CRT® Contact Lenses, carefully consider the demographics of your patient base. Often, eye care professionals new to orthokeratology price their global fee too high for their practice demographic. Consequently, patients interested in Paragon CRT® Contact Lenses may decline and choose an alternative modality that generates less revenue.

†9% charge $2,000 or more. Survey data on file.

17

*ISO/ANSI Method

PARAGON CRT® CONTACT LENS PRICE AND POLICY • EFFECTIVE JANUARY 1, 2016 Billing and credit policies will be administered through the practitioner’s Authorized Paragon CRT® Contact Lens Laboratory.

Returns require a return authorization and must be mailed to: Paragon Vision Sciences • 947 E Impala Ave, Mesa AZ 85204 • Attention: Returns Department Stock Paragon Paragon CRT® Z CRT® Contact Lens Contact Lens Green Blue HDS®100 Menicon Z

Paragon CRT Dual Axis® Contact Lens Green HDS®100

Paragon Z CRT Paragon CRT® Paragon Z CRT® Product Description Dual Axis® SureFit® SureFit® Contact Lens Contact Lens Contact Lens Blue Green Blue Menicon Z HDS®100 Menicon Z

$92.50

N/A

N/A

N/A

N/A

Paragon CRT® Diagnostic Stock Lens (Green tint, HDS®100 material)

$92.50

$107.50

$102.50

$117.50

N/A

N/A

Paragon CRT® Contact Lens Rx

$47.50

$57.50

$52.50

$62.50

N/A

N/A

Paragon CRT® Contact Lens Spare

$112.50

$127.50

$122.50

$137.50

N/A

N/A

Paragon CRT® Contact Lens Warranty Exchange Rx Program

$996.00

N/A

N/A

N/A

N/A

N/A

Paragon CRT® Contact Lens Diagnostic Dispensing System 100 (Green , HDS®100)

$358.56

N/A

N/A

N/A

N/A

N/A

Paragon CRT® Contact Lens Extended Diagnostic Dispensing System Extended 36 (Green , HDS®100)

$89.64

N/A

N/A

N/A

N/A

N/A

Paragon CRT® Contact Lens Base Curve Extended Diagnostic System Extended 9 (Green , HDS®100)

N/A

N/A

$2,776.00

$3,536.00

N/A

N/A

Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 80

N/A

N/A

$1,388.00

$1,768.00

N/A

N/A

Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 40

N/A

N/A

$555.20

$707.20

N/A

N/A

Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 16

N/A

N/A

N/A

N/A

$149.00

$159.00

Paragon CRT® SureFit® Contact Lens Dispensing System (3 lenses per eye)

All Paragon CRT® Contact Lenses are automatically plasma treated, unless otherwise requested, and have the parameters laser marked on the lens. Shipping and handling fees are charged separately. The prices reflected above are MSRP for Certified Practitioners. Valid in U.S. only. Pricing and policies are subject to change without notice.

Paragon CRT® Contact Lens Marketing Literature Paragon CRT® Contact Lens consumer marketing literature is provided as a complimentary service from Paragon Vision Sciences. To receive complimentary marketing materials, the Eye Care Practitioner’s account must be active within a 90-day period of placing the marketing literature order. The Practice Management Kit can be ordered for $50 if the account is inactive.

Stock Paragon CRT® Contact Lenses Pricing is per lens and non-warranted. Stock Paragon CRT® Contact Lenses can only be ordered by a Paragon CRT® Contact Lens certified practitioner with a 100 or 136-Lens Diagnostic Dispensing System. Stock lenses can be ordered in any quantity and parameters must fall within the 136 Paragon CRT® Contact Lens Diagnostic Dispensing System. Exchanges are not permitted for stock lenses, opened or unopened.

Rx Paragon CRT® Contact Lenses Pricing is per lens and non-warranted. With every two full-priced Rx lenses purchased on the same order, you are eligible to receive one free Patient Care Kit. Please notify Paragon Vision Sciences Customer Service Department when you are in need of the care kits. Your qualifying kits will be shipped via ground delivery, unless you request the kit(s) shipped next day delivery with a patient order. Factory sealed exchanges are allowed up to 12 months from the date of purchase.

Spare Paragon CRT® Contact Lenses Pricing is per lens and non-warranted. Spare lenses allow you to offer patients a reduced price on a spare pair to ensure uninterrupted treatment, in case of lost or broken lenses. Spare lenses must be ordered within 90 days of the primary Rx Paragon CRT® Contact Lens order, manufactured in Paragon HDS®100, green tint. Spare lens orders must indicate the original serial number, a patient name, or patient ID, and must be clarified as a spare lens at the time of order.

Only one spare lens order per primary Rx Paragon CRT® Contact Lens order is permitted. Parameters must match the primary dispensed lens. Failing to meet these requirements will result in a declined spare lens order. Spare lens orders do not qualify to receive a Patient Care kit.

Paragon CRT® Contact Lens Warranty Exchange Rx Program The Warranty Exchange Rx Program is a simple and cost effective way for practitioners to fit Paragon CRT® Contact Lenses empirically, with or without a Paragon CRT® Contact Lens Diagnostic Dispensing System. Practitioners ordering under the Warranty Exchange Rx Program must request the lens(es) as being either a new warranty or a warranty exchange at the time of order. Please call Paragon Vision Sciences Customer Service Department at 800-5288279 to initiate the exchange lens order.

The Warranty Exchange Rx Program provides up to two exchanges within 90 days of the original warranted order date. Exchange lenses must be returned to Paragon Vision Sciences within 90 days to receive credit. Paragon Vision Sciences will provide a return authorization with instructions for returning the exchange lens. One lens per eye must be maintained and is not eligible for return/exchange/credit. If a third exchange lens is needed, the Warranty Exchange Rx Program will re-start or the practitioner can choose to purchase a non-warranted Rx lens. Once a spare lens has been purchased from a lens ordered under the Warranty Exchange Rx Program, the warranty process will be considered complete and no additional exchanges will be available.

Exchange lenses must be returned in their original factory-sealed vial.

18

Paragon CRT® Contact Lens Diagnostic Dispensing System (100 Lens) The Paragon CRT® Contact Lens Diagnostic Dispensing System (100 Lens) is manufactured in Paragon HDS®100 green tint. This system includes Base Curves of: 7.9 to 8.8 in 0.10 steps with various RZD/LZA combinations, fitting manual, Paragon CRT® Contact Lens selector, one yellow slit lamp filter, three patient care kits, practice management tools, unlimited consultation, and clinical support. The Paragon CRT® Contact Lens Diagnostic Dispensing System (100 lens) offers a 90-day Risk Free Test Drive with three equal installment payments (30/60/90 day terms). The practitioner will receive up to two complimentary Rx orders to be used for two staff members (patient orders do not apply), and receive a 50% discount for up to three immediate family members that meet the FDA approved treatment guidelines for Paragon CRT® Contact Lenses.

The Paragon CRT® Contact Lens Diagnostic Dispensing System is fully refundable within 90 days of the original shipment date (shown on the Paragon Vision Sciences Packing Slip). If the System is returned with the original 100 lenses, opened or unopened with all labeling intact, and the Practice Management Kit and Paragon CRT® Contact Lens Certificate are returned, full credit will be issued, less shipping and handling charges. Paragon CRT® Contact Lenses that are missing will be billed at $92.50 per lens. Failure to return all items listed above will delay credit processing. To initiate the return of the Paragon CRT® Contact Lens Diagnostic Dispensing System, contact Paragon Vision Sciences Customer Service Department at 800-528-8279.

Paragon CRT® Contact Lens Diagnostic Dispensing System 36 and 9 The Paragon CRT® Contact Lens Diagnostic Dispensing System Extended 36 is manufactured in Paragon HDS®100, green tint. This System includes Base Curves of: 8.9 to 9.2 in 0.10mm steps with various RZD/LZA combinations. Each base curve in the Diagnostic Dispensing System Extended 36 consists of 9 lenses each. The individual Paragon CRT® Contact Lens Diagnostic Dispensing System Extended 9 may be ordered by requesting a desired base curve: 8.9, 9.0, 9.1, 9.2.

Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 80, 40, and 16 Paragon Vision Sciences offers three Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing Systems. All Paragon CRT Dual Axis® Contact Lens Systems are manufactured in Paragon HDS®100, green tint.

• The Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 80 includes the same lenses in the 40 lens set with additional Base Curves of 8.1, 8.2, 8.7, 8.8, & 8.9.

• The Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 40 includes Base Curves of 8.3 to 8.6 in 0.10 mm steps with RZD of 50 microns and LZA’s from -32 to -34.

• The Paragon CRT Dual Axis® Contact Lens Diagnostic Dispensing System 16 includes Base Curves of 8.4 and 8.9 with RZD of 25 and 50 microns with a -33 LZA only.

All Paragon CRT Dual Axis® Contact Lenses have 50 micron RZD and -31 LZA’s in the 8.7 – 8.9 Base Curves.

Paragon CRT® SureFit® Contact Lenses Paragon CRT® SureFit® Contact Lenses provide a 3-lens per eye fitting and dispensing system which should ensure a high probability of first-fit success.

Certified Paragon CRT® Contact Lens practitioners, with or without a Diagnostic Dispensing System, can order Paragon CRT® SureFit® Contact Lenses by calling Paragon Vision Sciences Customer Service Department at 800-528-8279 with the patient’s “K” Readings and Spectacle Refraction. Non-dispensed Paragon CRT® SureFit® Contact Lenses must be returned to Paragon Vision Sciences in the pre-paid, self-addressed envelope within 90 days of the original invoice date to avoid additional charges of $92.50 per lens. A $25 cancellation fee applies within 90 days of invoice date. Orthokeratology patients qualify for Paragon CRT® SureFit® Contact Lenses when they meet the following criteria: Flat “K” Readings between 42.50D - 44.50D, Spectacle refractions of -1.00D to -4.00D MRS, up to -1.00D of corneal cylinder. Within 60 days of becoming certified under the Paragon CRT® SureFit® Contact Lens program, the practitioner is entitled to receive up to two complimentary Paragon CRT® SureFit® Contact Lens orders to be used for staff members only.

Manufacturers Defect • Broken Lenses Paragon Vision Sciences guarantees each Paragon CRT® Contact Lens to be free from manufacturing defects and will provide a replacement lens within 90 days of the original invoice date for any lens found to be defective. If an Rx lens breaks within 90 days of the original invoice date, a replacement lens will be provided. To receive a replacement lens under either circumstance, call Paragon Vision Sciences Customer Service Department at 800-528-8279.

You will be billed full price for the replacement lens. Return the defective/broken lens with the return authorization in its original vial to Paragon Vision Sciences within 90 days to receive full credit. If the original vial is not available, the appropriate Serial Number must accompany the lens with the return authorization. Paragon Vision Sciences will issue credit for the returned lens. Lenses returned due to defect will be inspected for the noted defect(s). Lenses showing evidence of wear or mishandling are not eligible for credit.

19

CONSUMER MARKETING TIPS

ORDERING BROCHURES We make it easy to order consumer brochures, and we can customize brochures with your practice information.

KEEP IT SIMPLE Implementing a Paragon CRT® Contact Lens marketing campaign doesn’t have to cost a fortune, involve an outside marketing firm, or consume your valuable time.

Paragon Vision Sciences strongly recommends taking action to alert your existing patients about the innovative technology offered in your practice. Here are some quick, easy, and inexpensive ways to begin your marketing campaign.

START WITH CONSUMER BROCHURES After more than a decade of post FDA clearance, the “teen and tween” markets have evolved as one of the leading growth segments for Paragon CRT® Contact Lenses.

Children and adolescents between the ages of “8-to-18” are great candidates for Paragon CRT® Contact Lenses because: • There is no age restriction with Paragon CRT® Contact Lenses

• They may be too young for LASIK

• They have active, sport related lifestyles

• Glasses or daytime contacts may interfere with

some activities

70 %

CONSUMER WEBSITE Having an online presence is more important today than ever before. But keeping your website content up to date and relevant to the services offered in your practice is even more crucial to achieving practice growth.

Paragon Vision Sciences makes it easy to market Paragon CRT® Contact Lenses on your website, or on a variety of social media outlets you may be using. Linking directly from your practice website to paragonvision.com ensures that your practice is providing existing and potential new patients with current information on Paragon CRT® Contact Lenses.

MORE THAN 70% OF PARAGON CRT® CONTACT LENS PATIENTS ARE BETWEEN THE AGES OF 8-TO-18.1

Paragon Vision Sciences provides your office with educational consumer brochures to explain what orthokeratology with Paragon CRT® Contact Lenses is and how a patient’s quality of life can be improved.

You can also follow us on Facebook, for example, and share status updates on your own practice Facebook page.

It may sound “too simple”, but by placing the Paragon CRT® Contact Lens consumer brochures at your checkin counter and having your receptionist offer the patient a brochure which explains “the innovative technology offered in the practice”, you’re marketing to someone who you’ve already won over. The patient is in your office and ready for an eye exam by the doctor they trust.

www. paragonvision.com

1 Survey data on file. Paragon Vision Sciences, 2014

20

/crtvision

USE YOUR STAFF TO IDENTIFY CANDIDATES

BOOKS

Behind every successful practice is a strong and focused staff! A well-trained staff is the key to having a successful practice. Your staff comes into contact with your patients before you see them in the chair, and in your patient’s eyes, your staff is an extension of the services they expect from you. Use your staff to help you identify potential Paragon CRT® Contact Lens candidates during the workup process, and reward them when you develop a new Paragon CRT® Contact Lens patient in the practice.

Rewards can be as simple as gift certificates or a nominal bonus in their paycheck. Without the support of your staff, integrating Paragon CRT® Contact Lenses into your practice may be a challenge.

Paragon Vision Sciences has supported the distribution of one of the best, well-written books on nearsightedness, “My Children Are Nearsighted Too”, by Nicholas Despotidis, O.D. “Dr. D,” as he is commonly referred to by his patients and colleagues, takes the reader through personal experiences, frustrations and ultimately the moments of triumph that Ortho-K provided his patients.

Dr. D talks about how his two sons have successfully worn ortho-k lenses for years and this book can be a useful tool to have in your waiting room.

To place your order, visit: paragonvision.com.

Educate your staff on what a good Paragon CRT® Contact Lens candidate looks like: • Paragon CRT® Contact Lenses are FDA approved up to -6.00D, with or without 1.75D astigmatism, and unlike LASIK, there is no age restriction • Between the ages of 8-to-18 • Has an active or athletic lifestyle and currently wears spectacles or daytime soft contact lenses that interfere with their daily activities • Adults who suffer from uncomfortable daytime soft contact lens wear due to dryness

Available in English, Spanish, & Chinese

• Adults who are apprehensive about having eye surgery or afraid of a bad surgical result, the reversibility of Paragon CRT® contact lenses is attractive • Patients that are unsuitable for LASIK because of age, thin corneas, etc.

CRT 21

®

CARECREDIT® GIVES YOUR PATIENTS A PAYMENT OPTION Often it’s not the total cost of recommended refractive or other ophthalmic procedures that causes patients to delay or decline care – It is fitting payments into their monthly budget. That’s why more than 20 million patients have used the CareCredit™ healthcare credit card to get the care they need and want.

For over 25 years CareCredit™ has been serving the healthcare community, earning the exclusive recommendation of refractive and ophthalmology practices.

CareCredit™ can be used in your practice for your patient’s out-of-pocket healthcare expense. CareCredit™ picks up where insurance leaves off. Your patients can use it for copayments and deductibles. CareCredit™ makes it easy for patients to say “yes” to Paragon CRT® Contact Lenses!

Visit carecredit.com for more Healthcare Provider information.

22

CONSUMER MARKETING ITEMS AND SUPPLIES

Brochures

Consumer Education

Recall Cards

A-Frame Sidewalk Sign

Poster Stand

Snap Wall Poster Frame

“My Children Are Nearsighted Too” English, Spanish & Chinese $15 plus s/h

CUSTOMIZING AVAILABLE Paragon Vision Sciences can customize your Paragon CRT® Contact Lens marketing items with your practice information. Call our marketing department today for more information: 800-528-8279 or mkt@paragonvision.com

Banner Stand

Window & Door Cling

Lightweight aluminum frame, fast and easy set-up portable and includes travel bag. Banner Size 33” x 72” $125 plus S/H

Available for inside or outside use, custom sizes available, quick and easy installation Paragon Vision Sciences will assist in development Pricing starts at $50 plus S/H

CRT

®

We don’t just change vision, we change lives.™

23

CRT

®

We don’t just change vision, we change lives.™ 947 E. IMPALA AVENUE MESA, AZ 85204 | US & CANADA: 800-528-8279 | PARAGONVISION.COM

ZNL100114E - 1/19 © Paragon Vision Sciences. All Rights Reserved.

A Paragon CRT® Contact Lens Partnership Agreement must be signed.