Avenova presentation Nov 2015
60
AVENOVA (formerly i - Lid ™ Cleanser) A NEW DIMENSION IN LID AND LASH HYGIENE NovaBay Pharmaceuticals, Inc. (New York Stock Exchange: NBY) For more information contact: Ron Najafi, Ph.D. CEO & Founder And consult: www.Avenova.com
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Transcript of Avenova presentation Nov 2015
AVENOVA(formerly i-Lidtrade Cleanser)
A NEW DIMENSION IN LID AND LASH HYGIENE
NovaBay Pharmaceuticals Inc(New York Stock Exchange NBY)
For more information contact
Ron Najafi PhD
CEO amp Founder
And consult wwwAvenovacom
The San Francisco Bay Area
Home to NovaBay Pharmaceuticals(A view from our facilities)
NovaBay PharmaceuticalsEmployees 28 founded in 2000 by Ron Najafi PhD (chemist)
NovaBay Dedicated Sales Force 37 all across the US
Location Emeryville CA
Capital Structure Public Company listed on NYSE NBY
Focus Non-Antibiotic Antimicrobials
Marketed products (Neutrox platform)
ndash AVENOVA (formerly i-Lidtrade Cleanser ) Lid amp Lash Hygiene Blepharitis
MGD and Dry Eye
ndash NeutroPhase Diabetic Ulcer Venous and Pressure Ulcers including NF
ndash CelleRx Burn associated with Post Laser Resurfacing
Pre-Market Products (Aganocide platform)
ndash Bladder Irrigation Solution for patients with Spinal Cord Injury and recurrent
blockage and encrustation
ndash Skin Infection (Impetigo and Acne)
Global Partnerships PBE (in the US) IHT (USA) Galderma (France) Virbac
(France) Pioneer Pharma (China and Southeast Asia) Shin Poong (Korea) Biopharm
(North African and Middle East) Alpha Pharma (Ukraine) and Sarmedic (Israel)
ldquoThe Most Under-
recognized
The Most
Underappreciated
The Most Undertreated
disease
in Ophthalmic Carerdquo
Anatomy of Eye Eye Lid amp Meibomian Gland
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
The San Francisco Bay Area
Home to NovaBay Pharmaceuticals(A view from our facilities)
NovaBay PharmaceuticalsEmployees 28 founded in 2000 by Ron Najafi PhD (chemist)
NovaBay Dedicated Sales Force 37 all across the US
Location Emeryville CA
Capital Structure Public Company listed on NYSE NBY
Focus Non-Antibiotic Antimicrobials
Marketed products (Neutrox platform)
ndash AVENOVA (formerly i-Lidtrade Cleanser ) Lid amp Lash Hygiene Blepharitis
MGD and Dry Eye
ndash NeutroPhase Diabetic Ulcer Venous and Pressure Ulcers including NF
ndash CelleRx Burn associated with Post Laser Resurfacing
Pre-Market Products (Aganocide platform)
ndash Bladder Irrigation Solution for patients with Spinal Cord Injury and recurrent
blockage and encrustation
ndash Skin Infection (Impetigo and Acne)
Global Partnerships PBE (in the US) IHT (USA) Galderma (France) Virbac
(France) Pioneer Pharma (China and Southeast Asia) Shin Poong (Korea) Biopharm
(North African and Middle East) Alpha Pharma (Ukraine) and Sarmedic (Israel)
ldquoThe Most Under-
recognized
The Most
Underappreciated
The Most Undertreated
disease
in Ophthalmic Carerdquo
Anatomy of Eye Eye Lid amp Meibomian Gland
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
NovaBay PharmaceuticalsEmployees 28 founded in 2000 by Ron Najafi PhD (chemist)
NovaBay Dedicated Sales Force 37 all across the US
Location Emeryville CA
Capital Structure Public Company listed on NYSE NBY
Focus Non-Antibiotic Antimicrobials
Marketed products (Neutrox platform)
ndash AVENOVA (formerly i-Lidtrade Cleanser ) Lid amp Lash Hygiene Blepharitis
MGD and Dry Eye
ndash NeutroPhase Diabetic Ulcer Venous and Pressure Ulcers including NF
ndash CelleRx Burn associated with Post Laser Resurfacing
Pre-Market Products (Aganocide platform)
ndash Bladder Irrigation Solution for patients with Spinal Cord Injury and recurrent
blockage and encrustation
ndash Skin Infection (Impetigo and Acne)
Global Partnerships PBE (in the US) IHT (USA) Galderma (France) Virbac
(France) Pioneer Pharma (China and Southeast Asia) Shin Poong (Korea) Biopharm
(North African and Middle East) Alpha Pharma (Ukraine) and Sarmedic (Israel)
ldquoThe Most Under-
recognized
The Most
Underappreciated
The Most Undertreated
disease
in Ophthalmic Carerdquo
Anatomy of Eye Eye Lid amp Meibomian Gland
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
ldquoThe Most Under-
recognized
The Most
Underappreciated
The Most Undertreated
disease
in Ophthalmic Carerdquo
Anatomy of Eye Eye Lid amp Meibomian Gland
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Anatomy of Eye Eye Lid amp Meibomian Gland
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Meibomian Gland
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Blepharitis Causes
Meibomian Gland Dysfunction (MGD)
Gland Oil Keep
the water from
evaporating amp
preventing Dry
Eye
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Expressing the Meibomian Gland
Shows Dysfunction present
Tooth Paste
like
consistency is
bad
Doctor is
pressing
against lower
eye lid
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Blepharitis Infection and
Inflammation of EyeLid
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Blepharitis Meibomian Gland Dysfunction
Associated Dry Eye Pre-Operative Lid
Hygiene
Chronic lid amp lash hygiene
- 24 million blepharitis patients
- 65 million MGD dry eye patients
- 3 million cataract patients
- 15 million refractive surgery patients
Total Potential Market $700 million
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Antibiotics (topical or systemic)
Steroid (topical or systemic)
Warm Eye Compress to help with
Meibomian Glands
Gland Expression
Food supplements such as Omega 3 fatty
Acid
No FDA approved Therapy
Standard of Care includes
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Traditional Therapies for
Blepharitis MDG amp Associated
Dry Eye
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Traditional Warm Compress + Gland
Expression
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Omega 3
Fatty Acid
Omega 3 Fatty Acid
Rich in EPA amp DHA
Eicosapentaenoic Acid (EPA) 20 carbons and 5 double bonds
Docosahexaenoic Acid (DHA) 22 carbons and 6 double bonds
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
PHARMA Blepharitis MGD managementndash Meibomian Gland Dysfunction (MGD) with secondary staph
overpopulation Demodex Blepharitis
PRE-OP Manage Blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
CONTACT LENS Contact Lens intolerancendash Reducing microbial load and improving tear film while
dealing with removal of inflammatory modulators are
supportive of reducing contact lens intolerance
Application of Avenova
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Why Control of Lid Flora Matters
Blepharitis
MGD with secondary staph
overpopulation
Pre-op application to manage blepharitis
ndash Refractive
ndash Cataract
ndash Retinal
Contact lens wearer
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Blepharitis
MGD
Multifactorial
Chronic
Disease
Affects
Quality of life
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Avenova (formerly i-Lidtrade Cleanser)for Conditions of the Lids and Lashes
Proprietary Technology
ndash Neutrox NovaBay Proprietary (gt99 Pure) 001 Pure (99)
hypochlorous solution in saline is by prescription only
ndash No hypochlorite impurity which is often present in OTC
solutions
ndash No resistance is expected based on novel mechanism of
action
Significant Market Poorly Served
ndash Eyelid hygiene therapy part of the treatment for blepharitis
ndash Currently marketed products have little to no benefit
ndash 4 of 18 ndash 22 year olds
ndash 71 of 65+ year olds
ndash US Market Estimate of $500+ mil
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Why Neutroxtrade
PURE Hypochlorous Acid [ HOCl ]
Cl
O
H
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Neutroxtrade(NovaBayrsquos Proprietary Pure Hypochlorous Acid)
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Organism (ATCC number) Time to Kill Reduction
Aspergilus brasiliensis 16404 60 seconds gt9999
Bacteroides fragilis 25285 60 seconds gt99999
Candida albicans 10231 60 seconds gt9999
Clostridium perfingens 13124 60 seconds gt9999
Enterobacter aerogenes 51697 60 seconds gt99999
Enterococcus faecium (VRE) 51559 60 seconds gt9999
Haemophilus influenzae 49144 60 seconds gt99999
Klebsiella pneumoniae 10031 60 seconds gt99999
Proteus mirabilis 14153 60 seconds gt99999
Pseudomonas aeruginosa 27853 60 seconds gt999999
Serratia marcescens 14756 60 seconds gt99999
Corynebacterium amycolatum 49368 60 seconds gt9999
Staphylococcus aureus (MRSA) 33591 60 seconds gt99999
Staphylococcus aureus 29213 60 seconds gt99999
Staphylococcus epidermidis 12228 60 seconds gt99999
Staphylococcus haemolyticus 29970 60 seconds gt9999
Staphylococcus hominis 27844 60 seconds gt9999
Staphylococcus saprophyticus 35552 60 seconds gt9999
Streptococcus pyogenes 49399 60 seconds gt9999
Propionibacterium acnes 29399 60 seconds gt99999
Vibrio vulnificus 27562 60 seconds gt99999
Neutroxreg
NovaBayrsquos Proprietary Pure (gt99) 001 hypochlorous Acid in saline
Skin pathogens are highlighted The CLSI guideline for evaluating the bactericidal activity of an antimicrobial agent was adapted for this study A 500 ul aliquot of each test organism was
added to separate tubes containing 5 mL AVENOVA (final inoculum 107 CFUmL) After 1 min a 30 ul aliquot was removed from each tube and diluted 110 in DeyEngley (DE) neutralizing
broth followed by three additional ten-fold dilutions in DE This procedure was repeated at 4 minutes and 10 minutes post-inoculation Each dilution was plated onto the appropriate agar
media in duplicate for quantitation Plates were then incubated under the appropriate conditions for each organism and CFU were counted Details of the procedures can be found in Report
FD-1403R00
Excellent in-
solution
activity
against a
broad range
of pathogens
Fast acting
onset of
activity
Effective
against
pathogens
commonly
found on the
lids amp lashes
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
27
Avenovatrade demonstrated excellent activity in solution
compared with the market leading lid and lash cleanser
Organism S aureus MRSA S epidermidis S haemolyticus P acnes
NovaBay
Avenovareg
lt 1 minute lt 1 minute lt 1 minute lt 1 minute lt 1 minute
OcuSoftreg Lid
Scrub Foam
gt 30 minute gt 30 minute gt 30 minute gt 30 minute gt 30 minute
NovaBayrsquos in-house methodology for determining therapeutic index was utilized
fibroblast cells were used to assess safety Each agent was serially diluted to arrive at a ldquocell saferdquo concentration At that concentration
antimicrobial time kill was measured vs various microorganism (shown above) More on this methodology at
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Avenova has higher Therapeutic
Index than Betadine
bull Fast acting onset of microbial activity
bull Extremely low toxicity levels
bull 1000 times less toxicity than Betadinereg
28
Tested AVENOVAreg Betadinereg Surgical
Scrub (Povidone-
iodine 75)
Nontoxic
Dilution
110 110000
Time to 4 log10
kill
lt1 minute gt24 hours
Tested Against S aureus ATCC 33591
Antimicrobial Activity Comparison of Pure Hypo-chlorous Acid (001) with other Wound and Skin Cleansers at Non-Toxic Concentrations
Russell Hoon Suriani Abdul Rani Ramin Najafi Lu Wang Dmitri Debabov SAWC Spring 2013 and WHD 2013
The In Vitro Antimicrobial Activity of Wound and Skin Cleansers at Nontoxic Concentrations
Suriani Abdul Rani MS Russell Hoon Ramin (Ron) Najafi PhD Behzad Khosrovi PhD Lu Wang PhD and Dmitri Debabov PhD
ADVANCES IN SKIN amp WOUND CARE FEBRUARY 2014 VOL 27 NO 2 page 66-69
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Bacteria Biofilm Complicates Blepharitis
29
bull Hypothesis is that bacterial biofilm plays a significant role in delaying wound healing
(Mertz ndash Wounds ndash May 2003)
A scanning electron micrograph of a porcine wound surface with Staphylococcus aureus biofilm (6000X)
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
31
NovaBay Avenovareg has Potent Anti-biofilm
Activity Compared to Saline
bull In vitro Biofilm of P fluorescens breaks up upon
introduction of Avenovareg
SALINE (control) NovaBay AVENOVAreg
For literature references pointing to anti-biofilm activity of Avenova
Click here
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Hypochlorous Acid
Hypochlorous acid (HOCL) released from neutrophil cells
Part of bodyrsquos immune response
Kills microorganisms
Neutralizes toxins released from pathogens and inflammatory mediatorsndash helps suppress the bodyrsquos
inflammatory response
32
neutrophil
cell
HOCL
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Representation of bacteria-produced toxins
which attack human cells
34
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Representation of human cell response to
bacteria-produced toxins
35
Biological reactivity of hypochlorous acid Implications for microbicidal mechanisms of leukocyte myeloperoxidase
J MICHAEL ALBRICH CAROL A MCCARTHY AND JAMES K HURST
Proc National Acad Sci Vol 78 No 1 pp 210-214 January 1981
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Representation of the Mechanism of Action of
Hypochlorous 01 in In-Vitro Models
Kills
bacteria
Blocks
bacteria
produced
toxins
Blocks
human
cell
produced
pro-
inflammat
ory
mediators
Different effects of hypochlorous acid on human neutrophil metalloproteinases activation of collagenase and inactivation of collagenase and
gelatinase Michaelis J1 Vissers MC Winterbourn CC Arthritis Rheum 1994 Mar37(3)424-7
Inhibition of collagenase activity by N-chlorotaurine a product of activated neutrophils Davies JM1 Horwitz DA Davies KJ Department of Medicine
Albany Medical College New York 12208
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Dx of DES and Blepharitisco irritation pain used Maxitrol drops and
ointment for 2 wks + warm compress and eye scrub with Baby Shampoo Was
shown how to clean his lids and lashes in the office with Saline
Still returned 2 wks later with similar symptoms Maxitrol was dcrsquod and
Avenova given After 2 wks RTC with improved symptoms and improved
clinically on Exam
After Use of Baby Shampoo After use of Avenova
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Typical Blepharitis Case
Vision
ndash OD 2030
ndash OS 2020-
TAP OD 21 OS 23
Exam
ndash Blepharitis
ndash Debris on lashes
ndash Conjunctival
hyperemia
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
bull From end of 2008 until end of 2012
bull Patient was seen 25 times
bull Between visits he would call and get Rx for Ab
bull Received courses of
bull Bacitracin neomycin polymyxin tobradex
maxitrol zylet oral doxy used Ocusoft
bull Patient developed skin ulcer from Ocusoft use
bull 10 of patients who use these over the counter
eye lid scrubs will develop contact dermatitis
bull Eczema type reaction due to their detergent
based components
Patient Case History Chronic Blepharitis
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
40
Avenovatrade
(formerly i-Lid Cleanser)
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
41
with
Neutrox
as preservative
Avenovatrade
(formerly i-Lid Cleanser)
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Severe Ocular Surface Disease
with Demodex
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Overpopulation of Demodexmay be the cause for Blepharitis
Regular Microscope
Electron Microscope
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Patient with Demodex
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
After 3 wks of use of Avenovatradefewer Demodex amp better looking Lids and Lashes
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Patients with acute or early stage meibomian gland
disease have a frothy tear film or bubbles which is
evident of soapy like substance here at the lid margin
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Avenova has potent in-vitro
anti-toxin and anti-lipase activity
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Staph aureus is a consistent Lipase producer
Breaking down natural lipids (triglycerides)
produced by Meibomian Glands
Bacteria Lipase activity is responsible for the
breakdown of lipid to fatty acids ndash [Invest Ophthalmol Vis SciApril 1986 vol 27 no 4 486-491]
Assuming Lipase causes saponification of lipid
and conversion to fatty acid and soap Can
Avenova breakdown Lipase and prevent
saponification (soap making)
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
In Laboratory Testing Avenovatrade(formerly i-Lid
Cleanser) inactivates Rapidly Bacterial Lipase
Comparison of Bacterial Lipase Activity in the Presence of Eye Lid Cleansers
A Epstein L Pang K Najafi-Tagol R Najafi D W Stroman D Debabov
Accepted for presentation at ARVO 2015
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
bull Serial dilutions of AVENOVAtrade were incubated for
1 h with S aureus alpha-hemolysin toxin (1
ugmL) and S pyogenes streptokinase (175 umL)
bull 01 ugmL AVENOVAtrade (1000 dilution)
completely inactivated S aureus alpha-hemolysin
toxin
bull 0001 ugmL AVENOVAtrade (100000 dilution)
completely inactivated S pyogenes streptokinase
Activity of AVENOVAtrade against
Bacterial Toxins
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Mechanism of Action
for Anti-Toxin and anti-Lipase Activity
SS
RRrsquo + HOCl
SS
R
Rrsquo
O O
O O
SS
RRrsquo
Cl
Cl
H2O
HOCl
Cl
Very Fast
Reaction
Kinetics of the reactions of hypochlorous acid and amino acid chloramines with thiols methionine and ascorbate Free Radic Biol Med
200130(5)572-9
Herbert Spiegel Advances in Clinical Chemistry Vol 35 2001 Academic Press
Oxidized
And unfolded Protein
Highly water soluble and
non-immunogenic
Waldemar Gottardi Dmitri Debabov and Markus Nagl N-Chloramines a Promising Class of Well-Tolerated Topical Anti-Infectives Antimicrob
Agents Chemother 2013 57(3)1107
Staphylococcus aureus alpha toxin
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Chronic use of antibiotic will
result in antibiotic resistant
strainshellip we must be vigilant
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Product Comparison (Ingredients)
59
OCuSoft SteriLid Oasis
Lid
and
Lash
LIDCLE
NZ
VisiClean
se
Eye
Scrub
Ingredient 001 pure
(gt99)
Hypochlorous
acid saline
Water PEG-
80 Sorbitan
Laurate
Sodium
Tricedeth
Sulfate
PEG-150
Distearate
Disodium
Lauroamphod
iacetate
Cocamidopro
pyl
Hydroxysultai
ne Sodium
Laureth-13
Carboxylate
Sodium
Chloride
Quaternium-
15
Water PEG 80
Sorbitan
Laurate
Sodium
Trideceth
Sulfate
Cocamidopropyl
Betaine
Sodium
Lauroamphoace
tate PEG 150
Distearate
Sodium Laureth
13 Carboxylate
Linalool Oil
Hepes Acetate
Sodium
Perborate
Monohydrate
Panthenol
Allantoin
(Comfrey Root)
Sodium
Chloride Tea
Tree (Melaleuca
Alternifolia) Oil
Tris EDTA
Water
Poloxamer
Polyethylen
eGlycolBo
rateHyalur
onanMethy
lparaben
Carbopol
940
non-foaming
pH balanced
formulation of
non-ionic
surfactant in
purified water
Water
Cocamidopropyl
Betaine PEG-
80 Sorbitan
Laurate
Sodium
Trideceth
Sulfate PEG-
150 Distearate
Aloe
Barbadensis
Leaf Extract
Chamomilla
Recutita
(Matricaria)
Flower Extract
Cucumis
Sativus
(Cucumber)
Fruit Extract
Althaea
Officinalis Root
Extract Avena
Sativa (Oat)
Kernel Extract
Tetrasodium
EDTA Citric
Water USP
(Purified)
PEG 200
Hydrogenated
Glyceryl
Palmate
Disodium
Laureth
Sulfosuccinat
e
Cocoamidopr
opylamine
Oxide PEG
80 Glyceryl
Cocoate
Benzyl
Alcohol
Edetate
Disodium
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Does not generate
Resistance
Mechanical Debridement
Anti-ToxinAnti-biofilm
Activity
Bacterial Removal
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
To Open an account contact
NovaBay by calling
1-800-890-0329
Retail to patients $30-40
If used according to instructions
1st bottle will last 2 weeks
(2X per day application)
2nd bottle will last 1 month
(1X per day application)
Thank you
Thank you
![Mba presentation políticaspúblicasii-nov[1].inocencio melendez222003](https://static.fdocuments.ec/doc/165x107/55d171a6bb61eb01198b460f/mba-presentation-politicaspublicasii-nov1inocencio-melendez222003.jpg)