English Subtitles for Audio ID: 90811



Subtitles / Closed Captions - English

<font color="#E5E5E5">the conference is now being recorded</font>

[Applause] it is a bit<font color="#E5E5E5"> mesma have joined the</font> conference<font color="#E5E5E5"> hello Elizabeth</font> <font color="#CCCCCC">I'll</font><font color="#E5E5E5"> okay good</font><font color="#CCCCCC"> p.m.</font><font color="#E5E5E5"> thank you thank you</font> <font color="#E5E5E5">for agreeing to take part at quite short</font> notice that it's great I've got<font color="#E5E5E5"> nothing</font>

in<font color="#CCCCCC"> my</font><font color="#E5E5E5"> diary this afternoon</font> wonderful did you<font color="#E5E5E5"> manage</font><font color="#CCCCCC"> to read the</font> target product profile that<font color="#E5E5E5"> I said yes</font> they did I did yes I was really because later on the call<font color="#E5E5E5"> I</font> I want to get<font color="#E5E5E5"> your views on</font><font color="#CCCCCC"> that and how</font>

<font color="#CCCCCC">it</font><font color="#E5E5E5"> would fit in and because there are a</font> few nuances but I'll say<font color="#CCCCCC"> at the front of</font> the call is<font color="#CCCCCC"> that lamella</font><font color="#E5E5E5"> our client is</font> is not planning<font color="#CCCCCC"> on positioning this as a</font> and enhanced here<font color="#CCCCCC"> it's they're hoping it</font> will give sufficient clinical data to

have it as more advanced therapy so it's that sort<font color="#E5E5E5"> of positioning that I'd like</font> <font color="#E5E5E5">to get your viewer so let us see e</font> product by the medication<font color="#CCCCCC"> is this this</font> <font color="#E5E5E5">really it's in the</font><font color="#CCCCCC"> glowing</font><font color="#E5E5E5"> it's going to</font> this<font color="#CCCCCC"> well it</font><font color="#E5E5E5"> is already approved in your</font>

position<font color="#E5E5E5"> it's got a see mark in Europe</font> but<font color="#E5E5E5"> they haven't launched it it's it's</font> for sort<font color="#E5E5E5"> of practical reasons for being</font> a small<font color="#E5E5E5"> biotech it was a lot</font><font color="#CCCCCC"> cheaper</font><font color="#E5E5E5"> to</font> <font color="#E5E5E5">get it registered as a</font><font color="#CCCCCC"> see mark of</font> course<font color="#CCCCCC"> great but in order to</font><font color="#E5E5E5"> present its</font>

value they're actually running<font color="#E5E5E5"> clinical</font> trials now at Bradford Caledonian University <font color="#CCCCCC">so they'll hopefully</font><font color="#E5E5E5"> have the data then</font> to<font color="#E5E5E5"> support us a higher positioning but</font> that's but how<font color="#CCCCCC"> that might influence</font>

<font color="#CCCCCC">reimbursement and how people perceive it</font> <font color="#E5E5E5">is something I'd like</font><font color="#CCCCCC"> to discuss a bit</font> later on<font color="#E5E5E5"> and so first sort of does a</font> couple<font color="#CCCCCC"> of</font><font color="#E5E5E5"> interviews now and they've</font> tended to<font color="#E5E5E5"> run for 45 rather than 30</font> minutes<font color="#E5E5E5"> is that okay</font><font color="#CCCCCC"> with you</font><font color="#E5E5E5"> or yeah</font>

<font color="#CCCCCC">they do fine that's fine in which case</font> can<font color="#E5E5E5"> we just start off</font><font color="#CCCCCC"> just for you to</font> tell<font color="#E5E5E5"> me in your own words the type of</font> <font color="#CCCCCC">practice you see to understand what we'd</font> like<font color="#E5E5E5"> to understand is the patient flow</font> <font color="#E5E5E5">getting</font><font color="#CCCCCC"> to see a consultant such as</font>

yourself and<font color="#CCCCCC"> the type of patients and how severe</font> they have to be to get to<font color="#E5E5E5"> see somebody</font> such as yourself<font color="#CCCCCC"> okay so I'm</font><font color="#E5E5E5"> working at</font> <font color="#E5E5E5">the university</font><font color="#CCCCCC"> I</font><font color="#E5E5E5"> hospital and</font><font color="#CCCCCC"> I have a</font> dry practice every Wednesday and I'm

seeing mostly<font color="#E5E5E5"> more severe dry</font><font color="#CCCCCC"> pages I</font> see moderate to severe dry patients but I also see mild right cases<font color="#E5E5E5"> that are</font> yeah<font color="#E5E5E5"> reluctant to therapy or not yeah</font> don't don't<font color="#E5E5E5"> accept that it's a chronic</font> disease<font color="#E5E5E5"> and</font><font color="#CCCCCC"> things like this</font><font color="#E5E5E5"> so I I see</font>

all<font color="#CCCCCC"> kinds</font><font color="#E5E5E5"> of</font><font color="#CCCCCC"> patients but mostly the</font> more severe kind of patients<font color="#E5E5E5"> sure grens</font> patient patients after stem cell transplantation<font color="#CCCCCC"> yeah all kinds</font><font color="#E5E5E5"> okay so</font> this when they<font color="#E5E5E5"> come to see you can you</font> just<font color="#E5E5E5"> talk me through what you would see</font>

is<font color="#CCCCCC"> the normal patient</font><font color="#E5E5E5"> pathway</font><font color="#CCCCCC"> interns</font> with a number<font color="#E5E5E5"> of</font><font color="#CCCCCC"> people who have dry eye</font> that they just self treat or the proportion<font color="#CCCCCC"> that just</font><font color="#E5E5E5"> sells trees and</font> <font color="#E5E5E5">happy with that versus the percentage</font> <font color="#E5E5E5">that would be seen by an ophthalmology</font>

<font color="#E5E5E5">or an optometrist and be treated through</font> them now as you know in Germany<font color="#E5E5E5"> we don't</font> have optometrists<font color="#E5E5E5"> so all saw the</font> <font color="#CCCCCC">opthamologist see all the dr patients i</font> mean<font color="#E5E5E5"> what we don't</font><font color="#CCCCCC"> see those dry eyes</font> that have a little bit<font color="#E5E5E5"> of dry eye when</font>

they're working<font color="#E5E5E5"> on the computer and</font> things<font color="#E5E5E5"> like this because they self treat</font> <font color="#E5E5E5">so we don't see these cases</font><font color="#CCCCCC"> and I guess</font> this is quite a number but it's not<font color="#CCCCCC"> an</font> official number I<font color="#E5E5E5"> don't really have a</font> number<font color="#CCCCCC"> for that</font><font color="#E5E5E5"> but I guess it's</font><font color="#CCCCCC"> around</font>

<font color="#CCCCCC">50% that that has mild disease either</font> <font color="#CCCCCC">self treat or are treated by the local</font> ophthalmologists<font color="#E5E5E5"> in private practice</font> <font color="#E5E5E5">okay and then there's a number</font><font color="#CCCCCC"> of cases</font> <font color="#E5E5E5">like the motor to severe cases that are</font> seen by either<font color="#E5E5E5"> more</font><font color="#CCCCCC"> specialists in</font>

private<font color="#CCCCCC"> practice or are seen at the</font> office are are seen at the<font color="#CCCCCC"> University in</font> <font color="#E5E5E5">our specific clinic undergo more you</font> know also<font color="#E5E5E5"> more diagnostic</font> <font color="#E5E5E5">than in private practice I</font><font color="#CCCCCC"> think people</font> have<font color="#E5E5E5"> estimators has never done staining</font>

maybe perform but maybe not perform so I guess when they come to<font color="#CCCCCC"> our institution</font> they also come because they have<font color="#E5E5E5"> more</font> they want to have more<font color="#E5E5E5"> diagnosis more</font> more<font color="#CCCCCC"> Diagnostics done in their case that</font> was<font color="#E5E5E5"> going to be one of my</font><font color="#CCCCCC"> questions that</font>

<font color="#E5E5E5">in order to get referred and up the</font> treatment chain is it based on<font color="#E5E5E5"> patient</font> reported symptoms or are there specific measurements<font color="#CCCCCC"> he assigns</font><font color="#E5E5E5"> that</font><font color="#CCCCCC"> that have</font> to present<font color="#E5E5E5"> with in order to get referred</font> <font color="#E5E5E5">no</font><font color="#CCCCCC"> actually some patient even come</font>

without referral they come on their<font color="#CCCCCC"> own</font> <font color="#E5E5E5">to the University they</font><font color="#CCCCCC"> can make</font> appointments<font color="#CCCCCC"> even without referral in</font> our<font color="#CCCCCC"> University</font><font color="#E5E5E5"> but normally we preferred</font> <font color="#CCCCCC">Ventura to have been seen by somebody</font> <font color="#E5E5E5">else and know that the person in private</font>

<font color="#CCCCCC">practice is is thinks he is not capable</font> <font color="#E5E5E5">anymore to treat this patient and they</font> are referred<font color="#E5E5E5"> but this</font><font color="#CCCCCC"> doesn't</font><font color="#E5E5E5"> really</font> this is not there's not a certain<font color="#E5E5E5"> level</font> <font color="#E5E5E5">of disease or not a certain diagnostic</font> test that that usually<font color="#E5E5E5"> makes them refer</font>

the patient<font color="#E5E5E5"> I guess the most of your</font> <font color="#CCCCCC">cases with a lot</font><font color="#E5E5E5"> of care</font><font color="#CCCCCC"> tompa see a lot</font> of staining<font color="#E5E5E5"> or the</font><font color="#CCCCCC"> Sjogren's patients</font> they typically<font color="#E5E5E5"> refer anyway because they</font> have the<font color="#E5E5E5"> feeling they cannot they</font><font color="#CCCCCC"> are</font> not not<font color="#E5E5E5"> able</font><font color="#CCCCCC"> to treat them and others</font>

sometimes<font color="#E5E5E5"> are</font><font color="#CCCCCC"> just are just patients</font> that complain a lot<font color="#CCCCCC"> and so I guess they</font> <font color="#E5E5E5">are they are not the easy patients they</font> <font color="#E5E5E5">are also referred so would people in</font> generally will people go direct to the <font color="#E5E5E5">ophthalmologist or would they go</font><font color="#CCCCCC"> to a GP</font>

first and then<font color="#CCCCCC"> gano and last movie</font> <font color="#CCCCCC">actually they would go to enough</font> opthamologist<font color="#E5E5E5"> most of them I would say</font> 99%<font color="#E5E5E5"> because the GPS normally don't like</font> <font color="#CCCCCC">to treat eyes</font><font color="#E5E5E5"> and they have no ideas of</font> ice<font color="#E5E5E5"> they</font><font color="#CCCCCC"> secrete</font><font color="#E5E5E5"> allergy they sometimes</font>

give antibiotics to children but<font color="#E5E5E5"> I think</font> in in in<font color="#E5E5E5"> adult complaining of typical</font> symptoms<font color="#E5E5E5"> after</font><font color="#CCCCCC"> I they they they</font> treat them<font color="#E5E5E5"> they would either tell them</font> to get<font color="#CCCCCC"> some artificial</font><font color="#E5E5E5"> tears in</font><font color="#CCCCCC"> their in</font> <font color="#CCCCCC">their pharmacy</font><font color="#E5E5E5"> but if this doesn't help</font>

<font color="#E5E5E5">go to a to see an ophthalmologist</font><font color="#CCCCCC"> okay</font> you mentioned private<font color="#E5E5E5"> practice is most</font> <font color="#CCCCCC">ophthalmologist in</font><font color="#E5E5E5"> Germany private or</font> again yeah<font color="#CCCCCC"> as me it's called</font><font color="#E5E5E5"> private</font> practice but they treat of course private patients but<font color="#CCCCCC"> also normally</font>

insured patients but<font color="#E5E5E5"> this we have a</font> system we have the<font color="#E5E5E5"> university system we</font> have a system<font color="#CCCCCC"> of city hospitals but we</font> also have a big system<font color="#E5E5E5"> of practices 16</font> patients<font color="#CCCCCC"> not</font><font color="#E5E5E5"> optimal of not optometrists</font> but ophthalmologists<font color="#E5E5E5"> seeing patients in</font>

practice<font color="#E5E5E5"> okay and so the</font> ophthalmologists when they see a patient would it be<font color="#E5E5E5"> normal for a patient</font><font color="#CCCCCC"> to have</font> <font color="#E5E5E5">already just tried self</font><font color="#CCCCCC"> treatment or</font> would they go see ophthalmologist<font color="#CCCCCC"> an</font> <font color="#CCCCCC">ophthalmologist</font><font color="#E5E5E5"> then tell them which</font>

drops to use I guess<font color="#E5E5E5"> most of the of the</font> patients have tried self treatment <font color="#CCCCCC">before they see an ophthalmologist and</font> if it didn't<font color="#E5E5E5"> work or if they have the</font> feeling<font color="#CCCCCC"> it's not gone after two or three</font> <font color="#CCCCCC">days I guess they want</font><font color="#E5E5E5"> to see enough the</font>

most<font color="#E5E5E5"> to find out whether it's dry or</font> something<font color="#E5E5E5"> else because it also could</font><font color="#CCCCCC"> be</font> something else<font color="#CCCCCC"> they don't know yes so</font> sometimes it's<font color="#CCCCCC"> allergy</font><font color="#E5E5E5"> sometimes it's</font> infection yeah so some<font color="#E5E5E5"> the patient</font> doesn't<font color="#E5E5E5"> know so when when artificial</font>

<font color="#CCCCCC">tears don't work</font> <font color="#E5E5E5">I guess they make an appointment with</font> <font color="#CCCCCC">the</font><font color="#E5E5E5"> but first with</font><font color="#CCCCCC"> a normal</font> ophthalmologist and only if the normal <font color="#E5E5E5">of the mullis's cannot help them or they</font> <font color="#E5E5E5">have the feeling it he doesn't</font><font color="#CCCCCC"> or she</font>

doesn't help them<font color="#E5E5E5"> then they come to see</font> <font color="#E5E5E5">me or to come to see their people and at</font> the<font color="#CCCCCC"> University and what would be the</font> normal<font color="#E5E5E5"> sort of treatment cascade and an</font> ophthalmologist<font color="#CCCCCC"> will put them throughout</font> <font color="#CCCCCC">I've seen the 2007 guidelines but it is</font>

just to understand<font color="#E5E5E5"> how this works in</font> practice<font color="#E5E5E5"> sort of what the proportion of</font> <font color="#E5E5E5">patients get the different types of</font> treatments the corticosteroids or<font color="#E5E5E5"> the</font> systemic tetracyclines etc<font color="#E5E5E5"> I have the</font> feeling that umbrella practice patients

mainly get artificial tears it mainly my<font color="#CCCCCC"> Bowman blended functions</font> <font color="#CCCCCC">overlooked they</font><font color="#E5E5E5"> are</font><font color="#CCCCCC"> not</font><font color="#E5E5E5"> they're not</font> instructed to do my<font color="#E5E5E5"> bomb in my bedroom</font> <font color="#E5E5E5">to</font><font color="#CCCCCC"> do lit hygiene most most</font><font color="#E5E5E5"> of them</font> outside<font color="#E5E5E5"> so I found I sometimes see quite</font>

easy cases<font color="#E5E5E5"> with a little bit of</font> meibomian gland dysfunction but under <font color="#CCCCCC">Teresa's with of course</font><font color="#E5E5E5"> artificial</font><font color="#CCCCCC"> tears</font> <font color="#CCCCCC">only so but outside not many things are</font> done<font color="#E5E5E5"> but also doxycycline is sometimes</font> prescribed but very rarely described a

prescribed I would say my<font color="#E5E5E5"> beliefs</font> hygiene is very<font color="#CCCCCC"> rarely discussed in some</font> severe<font color="#E5E5E5"> cases steroids are used but not</font> <font color="#E5E5E5">usually not frequently I would say I</font> think<font color="#E5E5E5"> the message still hasn't gotten to</font> everybody that drive has some

inflammatory<font color="#CCCCCC"> component and also</font><font color="#E5E5E5"> the</font> cycles for an a that is now available <font color="#CCCCCC">Europe is</font><font color="#E5E5E5"> not really prescribed outside</font> because it's<font color="#CCCCCC"> very</font><font color="#E5E5E5"> expensive and the</font> doctors outside<font color="#CCCCCC"> are afraid that</font><font color="#E5E5E5"> their</font> budget is too low<font color="#E5E5E5"> to prescribe</font><font color="#CCCCCC"> it</font><font color="#E5E5E5"> which</font>

is not<font color="#E5E5E5"> true in fact but they</font><font color="#CCCCCC"> are this is</font> <font color="#CCCCCC">their</font><font color="#E5E5E5"> their this is what they say they</font> cannot describe it because<font color="#CCCCCC"> they're low</font> budget<font color="#CCCCCC"> ok so</font><font color="#E5E5E5"> this is the case outside</font> <font color="#E5E5E5">there's not much done outside for dry</font> patients dry patients are not the

<font color="#CCCCCC">patients</font><font color="#E5E5E5"> the doctors really want to see</font> in their practice yeah<font color="#CCCCCC"> so my</font> understanding is<font color="#E5E5E5"> this correct</font><font color="#CCCCCC"> if the in</font> Germany that<font color="#CCCCCC"> if something is</font><font color="#E5E5E5"> available</font> OTC<font color="#CCCCCC"> it would never be prescribed and</font> reimbursed<font color="#E5E5E5"> it's not like that yeah</font>

that's correct<font color="#E5E5E5"> that's correct</font> <font color="#CCCCCC">ok yes yes yes</font><font color="#E5E5E5"> is correct</font><font color="#CCCCCC"> I mean there</font> are<font color="#E5E5E5"> some artificial tears that are but</font> they are medications<font color="#E5E5E5"> and they can be</font> prescribed<font color="#E5E5E5"> in certain in very very few</font> <font color="#E5E5E5">instances for example</font><font color="#CCCCCC"> sure</font><font color="#E5E5E5"> grand</font>

syndrome or in<font color="#CCCCCC"> patients is pemphigoid or</font> patients<font color="#E5E5E5"> with facial nerve paralysis</font><font color="#CCCCCC"> we</font> can prescribe certain artificial tears but they are are<font color="#E5E5E5"> not see not see</font> products they are medications<font color="#E5E5E5"> is that</font> based on just the route that<font color="#E5E5E5"> the company</font>

with<font color="#CCCCCC"> the Mauri</font><font color="#E5E5E5"> how</font><font color="#CCCCCC"> I</font><font color="#E5E5E5"> got so</font><font color="#CCCCCC"> didn't</font> particularly have an active ingredient <font color="#CCCCCC">no more no it's the more expensive</font><font color="#E5E5E5"> way</font> to to get something<font color="#CCCCCC"> approved</font><font color="#E5E5E5"> the</font> <font color="#CCCCCC">occasion way it's</font><font color="#E5E5E5"> very expensive I get</font> because<font color="#CCCCCC"> you have to do all the studies</font>

and<font color="#CCCCCC"> tests have</font><font color="#E5E5E5"> to get it approved like</font> like<font color="#CCCCCC"> a active</font><font color="#E5E5E5"> ingredient it's very</font> difficult<font color="#E5E5E5"> and most of the companies</font> nowadays don't<font color="#E5E5E5"> go this way no not if</font> they don't<font color="#E5E5E5"> have to yeah so what sort of</font> proportion of patients<font color="#E5E5E5"> that you see and</font>

do you<font color="#E5E5E5"> think would be eligible for those</font> prescription<font color="#E5E5E5"> and</font><font color="#CCCCCC"> medications like this</font> yes<font color="#E5E5E5"> I would say I would</font><font color="#CCCCCC"> say of the</font> patients<font color="#E5E5E5"> I see it will be</font><font color="#CCCCCC"> 80%</font><font color="#E5E5E5"> but of the</font> patients all the<font color="#CCCCCC"> dry patients will be</font> probably<font color="#E5E5E5"> 40% because the rest I</font><font color="#CCCCCC"> think is</font>

it's<font color="#CCCCCC"> ok with artificial just</font><font color="#E5E5E5"> only end a</font> <font color="#CCCCCC">little bit of lead heading</font><font color="#E5E5E5"> most of most</font> of the<font color="#E5E5E5"> milder eyes work like this and so</font> these prescription artificial tears<font color="#E5E5E5"> what</font> sort of monthly costs are they I<font color="#E5E5E5"> mean</font> there are<font color="#E5E5E5"> not many you can prescribe and</font>

only in those three instances<font color="#E5E5E5"> I told you</font> <font color="#E5E5E5">mine for sure grant syndrome</font><font color="#CCCCCC"> facial</font> paralysis and pemphigoid<font color="#CCCCCC"> I mean then</font> <font color="#E5E5E5">these are</font><font color="#CCCCCC"> not many many patients this is</font> a minority<font color="#CCCCCC"> of patients okay and so the</font> artificial<font color="#CCCCCC"> peels example I got</font><font color="#E5E5E5"> your</font>

peepee I probably got<font color="#E5E5E5"> your question</font> wrong <font color="#E5E5E5">sorry</font><font color="#CCCCCC"> I got the question wrong on on how</font> <font color="#CCCCCC">many patients</font><font color="#E5E5E5"> I have I can prescribe</font> some very<font color="#CCCCCC"> view those your patients yes</font> <font color="#CCCCCC">okay and for those particular patients</font>

<font color="#CCCCCC">how much is charged for</font><font color="#E5E5E5"> these tears this</font> is around<font color="#E5E5E5"> 20 I would say 20 euro a</font> bottle like the normal artificial tears <font color="#E5E5E5">they burn up less or more all right</font><font color="#CCCCCC"> okay</font> <font color="#CCCCCC">and can</font><font color="#E5E5E5"> they be bought over the counter</font> as well<font color="#E5E5E5"> yes you can and what you</font>

mentioned<font color="#E5E5E5"> that not many</font><font color="#CCCCCC"> people and get</font> the cyclosporine and what sort<font color="#E5E5E5"> of it is</font><font color="#CCCCCC"> that you think</font> <font color="#E5E5E5">with the general ophthalmology community</font> is that lack of<font color="#E5E5E5"> knowledge</font><font color="#CCCCCC"> and experience</font> of<font color="#E5E5E5"> the</font><font color="#CCCCCC"> more</font><font color="#E5E5E5"> mainly as you say a</font><font color="#CCCCCC"> fear</font>

about<font color="#E5E5E5"> price</font><font color="#CCCCCC"> I know actually</font><font color="#E5E5E5"> I think the</font> community outside knows that<font color="#E5E5E5"> there</font><font color="#CCCCCC"> is a</font> new medication<font color="#E5E5E5"> and that it might be</font> helpful<font color="#CCCCCC"> for their patients</font><font color="#E5E5E5"> because they</font> sometimes refer them to<font color="#E5E5E5"> me for</font> prescribing<font color="#CCCCCC"> an eye curve so they know</font>

it's on the market<font color="#CCCCCC"> and they know</font><font color="#E5E5E5"> it may</font> be helpful<font color="#E5E5E5"> but they say it's due to</font> explore it too<font color="#E5E5E5"> expensive</font><font color="#CCCCCC"> for them for</font> their<font color="#E5E5E5"> budget</font><font color="#CCCCCC"> I they cannot prescribe it</font> for the patient<font color="#E5E5E5"> okay so it comes out</font><font color="#CCCCCC"> of</font> <font color="#CCCCCC">the University budget yeah yeah no I</font>

<font color="#CCCCCC">mean</font><font color="#E5E5E5"> it's not a problem of budget it's</font> just an excuse<font color="#E5E5E5"> because they as soon in</font> Germany<font color="#CCCCCC"> it's the case when medication</font> <font color="#E5E5E5">doesn't have a product</font><font color="#CCCCCC"> no name product</font> more<font color="#E5E5E5"> less that can</font><font color="#CCCCCC"> suck can be</font> substituted<font color="#E5E5E5"> and you can prescribe the</font>

the official product<font color="#E5E5E5"> without</font><font color="#CCCCCC"> a problem</font> you know if there would be<font color="#E5E5E5"> like an eye</font> curve is no name now<font color="#E5E5E5"> which is much</font> <font color="#CCCCCC">cheaper you have to use the cheaper</font> product but but if there is<font color="#E5E5E5"> only the</font> original<font color="#E5E5E5"> product and no other</font>

possibility it's no problem<font color="#E5E5E5"> with the</font> budget<font color="#CCCCCC"> but the doctors don't seem and</font> don't want<font color="#E5E5E5"> to understand this</font><font color="#CCCCCC"> what's</font> <font color="#E5E5E5">your feeling</font><font color="#CCCCCC"> for</font><font color="#E5E5E5"> that the reason I mean</font> just what why<font color="#E5E5E5"> is drawing eyes such as an</font> interesting<font color="#E5E5E5"> area for them because</font><font color="#CCCCCC"> it</font>

takes<font color="#CCCCCC"> time the patients are complaining</font> <font color="#E5E5E5">all the time the patients are never</font> really happy<font color="#CCCCCC"> you can do I mean many many</font> things and still they come and complain <font color="#E5E5E5">so I think it's it's physical it's a</font> chronic<font color="#E5E5E5"> disease</font><font color="#CCCCCC"> they come</font><font color="#E5E5E5"> like every</font>

<font color="#E5E5E5">couple of weeks</font><font color="#CCCCCC"> yeah I think it's it's</font> it's<font color="#E5E5E5"> also psychologically very difficult</font> disease<font color="#E5E5E5"> for I mean for the</font><font color="#CCCCCC"> patient and</font> <font color="#E5E5E5">for</font><font color="#CCCCCC"> the doctor patient</font><font color="#E5E5E5"> wants to talk a</font> lot<font color="#E5E5E5"> and in private practice and in</font> <font color="#E5E5E5">Germany you</font><font color="#CCCCCC"> have</font><font color="#E5E5E5"> like five</font><font color="#CCCCCC"> minutes for</font><font color="#E5E5E5"> a</font>

<font color="#CCCCCC">patient for yes and I think it's</font><font color="#E5E5E5"> not a</font> just not possible yes<font color="#E5E5E5"> so this is also the reason</font><font color="#CCCCCC"> why they</font> are<font color="#CCCCCC"> not doing</font><font color="#E5E5E5"> that the normal test</font> you're doing<font color="#E5E5E5"> I mean they don't</font><font color="#CCCCCC"> use</font> fluorescein they don't do<font color="#CCCCCC"> Shermer</font>

testing they don't do they don't do<font color="#E5E5E5"> all</font> these<font color="#E5E5E5"> time-consuming procedures mm-hmm</font> <font color="#CCCCCC">that's programs with my next question</font> which is<font color="#E5E5E5"> how</font><font color="#CCCCCC"> many of</font><font color="#E5E5E5"> these patients who</font> come back time time again actually have signs as well as symptoms<font color="#E5E5E5"> most of most</font>

<font color="#E5E5E5">of them have both right okay but</font> <font color="#E5E5E5">sometimes it doesn't correlate but you</font> know about<font color="#E5E5E5"> this sometimes the symptoms</font> <font color="#E5E5E5">are much much more than the signs and</font> <font color="#CCCCCC">vice-versa so and sometimes it's</font> <font color="#E5E5E5">difficult to understand why the patient</font>

is complaining but<font color="#E5E5E5"> them yeah yeah</font> because<font color="#E5E5E5"> there's not much to see but</font> <font color="#CCCCCC">still</font><font color="#E5E5E5"> but still there seem to be</font> symptoms yes okay<font color="#E5E5E5"> and to your knowledge</font> and<font color="#E5E5E5"> when this relates to</font><font color="#CCCCCC"> lamb</font><font color="#E5E5E5"> alight and</font> <font color="#E5E5E5">except the</font><font color="#CCCCCC"> fact that it's a device and</font>

<font color="#CCCCCC">or</font><font color="#E5E5E5"> registered as a device and would that</font> preclude it from ever getting reimbursement<font color="#E5E5E5"> or is</font><font color="#CCCCCC"> that</font><font color="#E5E5E5"> is there</font> nothing<font color="#E5E5E5"> within Germany that would stop</font> <font color="#CCCCCC">it being reimbursed as a device or</font><font color="#E5E5E5"> how</font> was the reimbursement work if if they

wanted<font color="#E5E5E5"> to go for reimbursement yes I</font> mean intermediate<font color="#E5E5E5"> I think there is no</font> reimbursement for a<font color="#CCCCCC"> see product as far</font> <font color="#CCCCCC">as</font><font color="#E5E5E5"> I know I know in other countries</font> <font color="#CCCCCC">there</font><font color="#E5E5E5"> is like in Italy</font><font color="#CCCCCC"> in France</font><font color="#E5E5E5"> but I</font><font color="#CCCCCC"> I</font> <font color="#CCCCCC">don't</font><font color="#E5E5E5"> know any NEC product that is</font>

reimbursed<font color="#E5E5E5"> right okay now it's</font> interesting<font color="#E5E5E5"> and alarming and in terms of</font> the level of unmet need of the patients that you<font color="#CCCCCC"> see have you got a feel for how</font> many<font color="#CCCCCC"> asking you've treated them are</font> still<font color="#E5E5E5"> unhappy with the outcome</font><font color="#CCCCCC"> I think</font>

it's improved a lot since we have<font color="#E5E5E5"> cycles</font> <font color="#CCCCCC">Brian I really I have to</font><font color="#E5E5E5"> have to say</font> <font color="#E5E5E5">that or it still it I think it improved</font> since the time<font color="#CCCCCC"> we're</font><font color="#E5E5E5"> using</font><font color="#CCCCCC"> anything</font> Nitori treatment<font color="#CCCCCC"> I have the</font><font color="#E5E5E5"> feeling that</font> <font color="#E5E5E5">there</font><font color="#CCCCCC"> are really some patients that are</font>

happy or<font color="#CCCCCC"> are</font><font color="#E5E5E5"> happier after</font><font color="#CCCCCC"> treatment</font> <font color="#E5E5E5">there are very few like moderate to</font> <font color="#E5E5E5">severe</font><font color="#CCCCCC"> dr patients that are happy only</font> with artificial<font color="#E5E5E5"> tears yeah oh and other</font> any other limitations on the current treatments because<font color="#E5E5E5"> I know with some</font><font color="#CCCCCC"> of</font>

<font color="#E5E5E5">the well with a cyclosporine</font><font color="#CCCCCC"> they take a</font> <font color="#E5E5E5">while to</font><font color="#CCCCCC"> work and can sting</font><font color="#E5E5E5"> deathly yes</font> yes<font color="#CCCCCC"> and is</font><font color="#E5E5E5"> that the main problem</font><font color="#CCCCCC"> with</font> them<font color="#CCCCCC"> to getting getting people to</font><font color="#E5E5E5"> take</font> them for long enough<font color="#E5E5E5"> yeah not</font> indefinitely<font color="#CCCCCC"> I mean you really need a</font>

need to tell your patient those two things you just<font color="#CCCCCC"> said they work</font><font color="#E5E5E5"> only</font> after<font color="#CCCCCC"> six to eight weeks and in the</font> beginning you<font color="#E5E5E5"> only have disadvantage</font><font color="#CCCCCC"> you</font> don't have an<font color="#CCCCCC"> advantage they may sting</font> they may burn and everything but you

have<font color="#E5E5E5"> to keep on</font><font color="#CCCCCC"> taking them</font><font color="#E5E5E5"> because</font> <font color="#CCCCCC">after six</font><font color="#E5E5E5"> to eight weeks you may have an</font> improvement<font color="#E5E5E5"> and also the</font><font color="#CCCCCC"> improvement is</font> not rapid<font color="#E5E5E5"> I mean there</font><font color="#CCCCCC"> is slow</font> improvement over weeks<font color="#CCCCCC"> and months this</font> <font color="#CCCCCC">is my</font><font color="#E5E5E5"> experience with us with</font><font color="#CCCCCC"> the</font>

medication now over the two years we had it what what's your<font color="#E5E5E5"> feel for the types</font> <font color="#E5E5E5">of</font><font color="#CCCCCC"> compliances</font><font color="#E5E5E5"> in what what</font><font color="#CCCCCC"> percentage</font> of people<font color="#CCCCCC"> when they've been</font><font color="#E5E5E5"> told that</font> that's<font color="#E5E5E5"> how it works</font><font color="#CCCCCC"> we'll actually</font><font color="#E5E5E5"> use</font> <font color="#CCCCCC">it for as</font><font color="#E5E5E5"> long as they</font><font color="#CCCCCC"> should I would</font>

say my patients are<font color="#CCCCCC"> very good they are</font> <font color="#E5E5E5">like 80 to 90 percent</font><font color="#CCCCCC"> but I also see</font> patients<font color="#E5E5E5"> from my colleagues in the</font> hospital<font color="#E5E5E5"> and I think when they're not</font> <font color="#E5E5E5">getting the message that it's about the</font> <font color="#CCCCCC">burning</font><font color="#E5E5E5"> and about the stinging and about</font>

the they have to use it and<font color="#E5E5E5"> there's no</font> <font color="#E5E5E5">other choice at the</font><font color="#CCCCCC"> moment there's no</font> other<font color="#CCCCCC"> long-lasting treatment</font> <font color="#E5E5E5">anti-inflammatory if you don't tell them</font> the story and<font color="#E5E5E5"> if you don't give them all</font> the instructions<font color="#E5E5E5"> I think with it</font><font color="#CCCCCC"> they're</font>

about<font color="#CCCCCC"> fifty percent</font><font color="#E5E5E5"> of patients that</font> that<font color="#E5E5E5"> discontinue right okay because one</font> <font color="#CCCCCC">of the</font><font color="#E5E5E5"> topics of conversation with</font> <font color="#E5E5E5">lamella is whether or not the use of</font> their<font color="#CCCCCC"> eyedrops as well would the</font><font color="#E5E5E5"> answer</font> yet but it's whether<font color="#E5E5E5"> or not it would</font>

mitigate<font color="#CCCCCC"> the some of the stinging</font><font color="#E5E5E5"> and</font> burning and at me only make make patients more compliant and stick the the course<font color="#E5E5E5"> long</font> enough to actually<font color="#CCCCCC"> have an effect of the</font> anti-inflammatory<font color="#CCCCCC"> ok Cecelia if we just</font>

move on<font color="#CCCCCC"> to</font><font color="#E5E5E5"> the target product profile</font><font color="#CCCCCC"> as</font> lamellae area<font color="#CCCCCC"> I would have mentioned</font> <font color="#E5E5E5">that it's going to be well it is</font><font color="#CCCCCC"> C</font> marked and I mean the ingredients are phospholipid so what<font color="#E5E5E5"> lamella has done it</font> that if you've<font color="#E5E5E5"> had a chance to</font><font color="#CCCCCC"> actually</font>

look at<font color="#E5E5E5"> their website they've</font><font color="#CCCCCC"> their</font> whole company<font color="#CCCCCC"> is based on a</font><font color="#E5E5E5"> technology</font> where they've managed<font color="#CCCCCC"> to</font><font color="#E5E5E5"> completely</font> mimic the<font color="#E5E5E5"> structure of alveolar lamella</font> bodies so they're<font color="#CCCCCC"> looking at them in</font> cystic fibrosis and<font color="#E5E5E5"> radiotherapy induced</font>

dry mouth<font color="#E5E5E5"> and also dry eye</font> <font color="#E5E5E5">so within dry eye the mechanism is</font> described as purely biophysical that because if these<font color="#E5E5E5"> lamella zones have got</font> such a low surface tension they will spread out<font color="#CCCCCC"> and supplement</font><font color="#E5E5E5"> the</font><font color="#CCCCCC"> Tso</font><font color="#E5E5E5"> and</font>

they've got no<font color="#CCCCCC"> other ingredients of them</font> say<font color="#E5E5E5"> light so no</font><font color="#CCCCCC"> alcohol no preservatives</font> they're completely<font color="#E5E5E5"> nursing</font> non-irritating<font color="#E5E5E5"> and</font><font color="#CCCCCC"> they like lipizzans</font> <font color="#CCCCCC">yes it isn't another word</font><font color="#E5E5E5"> for</font><font color="#CCCCCC"> it</font><font color="#E5E5E5"> the</font> <font color="#E5E5E5">possum or yes</font><font color="#CCCCCC"> completely yeah</font><font color="#E5E5E5"> okay yes</font>

there's a multilamellar<font color="#E5E5E5"> okay okay so</font> it's not<font color="#E5E5E5"> a core inside with the medic</font> with the medication inside but<font color="#CCCCCC"> they're</font> they<font color="#E5E5E5"> are made out of lamella of the</font> medication<font color="#E5E5E5"> it's yes so it's</font> phospholipids soy derive phospholipids

and<font color="#CCCCCC"> and so if they are them there's</font> there's some vesicles that<font color="#E5E5E5"> have met got</font> mulching or lamb or<font color="#E5E5E5"> lamellas on them yes</font> <font color="#E5E5E5">okay so I mean in the</font><font color="#CCCCCC"> future the company</font> <font color="#E5E5E5">is talking about developing combinations</font> with<font color="#CCCCCC"> api's and that might get</font>

<font color="#CCCCCC">incorporated</font><font color="#E5E5E5"> into the body of the</font> liposome<font color="#E5E5E5"> so that's one thing they're</font> going<font color="#E5E5E5"> to do but at the moment it's</font> purely biophysical it's<font color="#E5E5E5"> replacing the</font> lipid film if this was available<font color="#CCCCCC"> I mean</font> <font color="#CCCCCC">it's it's undergoing clinical trials at</font>

the moment we're in<font color="#E5E5E5"> the treatment</font> cascade would you see it<font color="#E5E5E5"> alec mentioned at the</font> beginning<font color="#CCCCCC"> just because of the cost of</font> <font color="#E5E5E5">goods</font><font color="#CCCCCC"> to some of the lipids and the</font> technology<font color="#E5E5E5"> involved in</font><font color="#CCCCCC"> making them it</font>

<font color="#E5E5E5">won't be a very it</font><font color="#CCCCCC"> won't be priced at</font> the price<font color="#CCCCCC"> of a normal artificial tear it</font> will be absolutely<font color="#E5E5E5"> significantly higher</font> okay where would you see<font color="#E5E5E5"> this being tried in</font> the treatment<font color="#E5E5E5"> cascade</font><font color="#CCCCCC"> okay can I ask</font><font color="#E5E5E5"> you</font>

something how long does it stay<font color="#CCCCCC"> on</font><font color="#E5E5E5"> the</font> ocular surface<font color="#E5E5E5"> are there any any numbers</font> prevent<font color="#E5E5E5"> I mean does</font><font color="#CCCCCC"> it stay like do you</font> only need to use<font color="#E5E5E5"> it like twice daily</font> <font color="#E5E5E5">because it stays for long or how does it</font> how does<font color="#CCCCCC"> it work so it's only got very</font>

almost anecdotal evidence here<font color="#CCCCCC"> and what</font> <font color="#E5E5E5">they the clinical trial is that the</font> people<font color="#E5E5E5"> can the patients can dose as</font> often as they like<font color="#CCCCCC"> and then recording</font> how many times they don't it<font color="#E5E5E5"> is going to</font> go towards the recommendations<font color="#E5E5E5"> but</font>

they've<font color="#E5E5E5"> got some preliminary data by</font> <font color="#CCCCCC">loading</font><font color="#E5E5E5"> the vesicles with something with</font> a low pH<font color="#CCCCCC"> and then seeing how you insert</font> a<font color="#E5E5E5"> residency time off at least four hours</font> <font color="#E5E5E5">yes yes so that</font><font color="#CCCCCC"> valid very very</font> preliminary<font color="#E5E5E5"> data just based on one</font>

experiment but you know the clinical <font color="#CCCCCC">trial is</font><font color="#E5E5E5"> going to inform you in use how</font> many<font color="#CCCCCC"> times a day people</font><font color="#E5E5E5"> can use it but</font> there'll be<font color="#E5E5E5"> no limitation because</font> <font color="#E5E5E5">there's</font><font color="#CCCCCC"> absolutely no side effects</font> <font color="#CCCCCC">whatsoever okay okay I mean</font><font color="#E5E5E5"> I would use</font>

it as<font color="#CCCCCC"> a I know you don't</font><font color="#E5E5E5"> want to hear</font> the word but<font color="#CCCCCC"> I would as</font><font color="#E5E5E5"> a better artist</font> <font color="#CCCCCC">here</font><font color="#E5E5E5"> at the moment</font><font color="#CCCCCC"> I would use it as a</font> <font color="#CCCCCC">long lasting substitution for</font><font color="#E5E5E5"> artificial</font> tears<font color="#E5E5E5"> that but that's not a typical</font> artificial turfs that says<font color="#CCCCCC"> substitutes a</font>

little bit of yeah<font color="#E5E5E5"> of the water but</font><font color="#CCCCCC"> also</font> substitutes lipid yes thank you well one of the<font color="#CCCCCC"> other mechanisms of action</font><font color="#E5E5E5"> of</font> these<font color="#E5E5E5"> lamella zones and this has come</font> <font color="#CCCCCC">from</font><font color="#E5E5E5"> the</font><font color="#CCCCCC"> Cystic Fibrosis and the</font> xerostomia<font color="#CCCCCC"> work is that</font><font color="#E5E5E5"> on the website</font>

<font color="#E5E5E5">actually under the dry mouth there's a</font> video<font color="#E5E5E5"> of the</font><font color="#CCCCCC"> lamella zones absolutely</font> imploding into this thick mucus from <font color="#CCCCCC">a radiotherapy patient</font><font color="#E5E5E5"> and</font><font color="#CCCCCC"> it instantly</font> <font color="#E5E5E5">then liquefied and runs so a child</font><font color="#CCCCCC"> I've</font> got planned<font color="#E5E5E5"> for next year is filamentary</font>

keratitis<font color="#E5E5E5"> is that something that you</font> could see a good potential<font color="#CCCCCC"> ending how</font> <font color="#CCCCCC">many patients</font><font color="#E5E5E5"> do you see with</font> filamentary keratitis is it right there <font color="#CCCCCC">is</font><font color="#E5E5E5"> there I mean</font><font color="#CCCCCC"> it it's</font><font color="#E5E5E5"> it's mostly in</font> patients with severe severe dry

<font color="#E5E5E5">Sjogren's</font><font color="#CCCCCC"> syndrome patients maybe</font> <font color="#E5E5E5">patients after a bone marrow transplant</font> severe dry patients but they are really <font color="#E5E5E5">suffering and for them there is no real</font> good treatment at this point I mean<font color="#CCCCCC"> also</font> <font color="#E5E5E5">cyclosporine helps but never brings them</font>

balance of zero<font color="#E5E5E5"> care autocracy never</font> <font color="#CCCCCC">it's just so so bad yeah all</font><font color="#E5E5E5"> right okay</font> <font color="#CCCCCC">um and in</font><font color="#E5E5E5"> terms of</font><font color="#CCCCCC"> Sjogren's are they</font> treated and just as<font color="#CCCCCC"> as a very severe dry</font> <font color="#E5E5E5">eye patient or do they</font><font color="#CCCCCC"> have a</font><font color="#E5E5E5"> different</font> <font color="#E5E5E5">type of treatment pathway because of the</font>

<font color="#E5E5E5">autoimmune component</font> I guess when when the doctor outsides <font color="#E5E5E5">realizes this is a patient with</font><font color="#CCCCCC"> circling</font> syndrome the patient if from the beginning<font color="#CCCCCC"> treated more aggressively I</font> mean<font color="#E5E5E5"> I think he doesn't go through ten</font>

<font color="#CCCCCC">different artists</font><font color="#E5E5E5"> as</font><font color="#CCCCCC"> peers first</font><font color="#E5E5E5"> because</font> from the<font color="#CCCCCC"> beginning the doctor knows he</font> has some autoimmune<font color="#E5E5E5"> disease the patient</font> <font color="#E5E5E5">has the autoimmune disease he has to</font> treat<font color="#CCCCCC"> Andy with</font><font color="#E5E5E5"> anti-inflammatory</font> treatment<font color="#E5E5E5"> and he has to do</font><font color="#CCCCCC"> more</font><font color="#E5E5E5"> than the</font>

normal and also the<font color="#CCCCCC"> patient has to rely</font> <font color="#E5E5E5">for you have to have to consider this as</font> well and send him<font color="#CCCCCC"> to the dentist to</font><font color="#E5E5E5"> the</font> rheumatologist answers like this<font color="#CCCCCC"> so I</font> guess the patient has a<font color="#E5E5E5"> different path</font> <font color="#CCCCCC">than a</font><font color="#E5E5E5"> normal</font><font color="#CCCCCC"> dry patient but from from</font>

a standpoint dry<font color="#E5E5E5"> eye</font><font color="#CCCCCC"> it's treated like a</font> severe dry some<font color="#E5E5E5"> patients you you</font> additionally give like pilocarpine orally and other things you wouldn't<font color="#E5E5E5"> do</font> that in a<font color="#E5E5E5"> normal dry patient but</font> otherwise<font color="#CCCCCC"> they're treated like normal dr</font>

<font color="#E5E5E5">severe dry patient okay</font> in Germany you tend to<font color="#E5E5E5"> use anything</font> off-label<font color="#CCCCCC"> I mean in Japan there's the</font> however<font color="#CCCCCC"> you pronounce it</font><font color="#E5E5E5"> chuckle</font><font color="#CCCCCC"> I'm as</font> <font color="#E5E5E5">a</font><font color="#CCCCCC"> columnist prop is that something</font> that's used in Germany<font color="#E5E5E5"> no I mean I'm not</font>

<font color="#CCCCCC">using</font><font color="#E5E5E5"> it I know that some of</font><font color="#CCCCCC"> my</font> colleagues are<font color="#CCCCCC"> using it but in</font><font color="#E5E5E5"> being</font> <font color="#CCCCCC">very you know rare cases in in in there</font> instances<font color="#E5E5E5"> where the psycho spawn is not</font> they cannot use<font color="#E5E5E5"> it or it's the patient</font> cannot<font color="#E5E5E5"> tolerate it so yes some are using</font>

<font color="#CCCCCC">it but</font><font color="#E5E5E5"> I guess it's very rare and what</font> you<font color="#E5E5E5"> have would you have a feel</font><font color="#CCCCCC"> for</font> whether or<font color="#E5E5E5"> not it's more effective than</font> the<font color="#E5E5E5"> slightest</font><font color="#CCCCCC"> foreign it's just a lack</font> of availability of<font color="#E5E5E5"> an approved product</font> is the reason or what<font color="#E5E5E5"> what would your</font>

feel for<font color="#E5E5E5"> it be I guess in</font><font color="#CCCCCC"> some patients</font> <font color="#CCCCCC">that cannot use</font><font color="#E5E5E5"> cyclosporine because it</font> burns too much or it's not effective<font color="#CCCCCC"> I</font> think it's worth to try<font color="#CCCCCC"> tech rolling</font> <font color="#E5E5E5">mousse I mean also</font><font color="#CCCCCC"> it's from the same</font> group of<font color="#CCCCCC"> medications it can maybe be</font>

tolerated better or may work<font color="#CCCCCC"> differently</font> a little<font color="#CCCCCC"> bit differently and I think</font> it's worth trying<font color="#E5E5E5"> but but I I guess they</font> work very<font color="#E5E5E5"> very similar both of them no I</font> don't<font color="#E5E5E5"> out but I don't</font><font color="#CCCCCC"> really</font><font color="#E5E5E5"> have</font> <font color="#E5E5E5">experience I know from some publications</font>

<font color="#E5E5E5">that it seems to work but there has</font> never been a study<font color="#E5E5E5"> comparing</font> cyclosporine<font color="#CCCCCC"> tacrolimus</font> <font color="#E5E5E5">okay I don't really know okay so</font><font color="#CCCCCC"> for</font> myself<font color="#CCCCCC"> pay point of view and</font><font color="#E5E5E5"> you</font> mentioned that<font color="#E5E5E5"> the the</font><font color="#CCCCCC"> medical tiers are</font>

about 20 euros<font color="#E5E5E5"> a bottle is it is</font><font color="#CCCCCC"> that</font><font color="#E5E5E5"> a</font> bottle<font color="#CCCCCC"> that will last</font><font color="#E5E5E5"> proximately a</font> month<font color="#E5E5E5"> it depends</font><font color="#CCCCCC"> I mean when you just</font> <font color="#CCCCCC">need</font><font color="#E5E5E5"> it twice or three times daily it</font> lasts three<font color="#CCCCCC"> months if if it's if it can</font> be taken<font color="#CCCCCC"> for three months I mean</font><font color="#E5E5E5"> this</font>

and some bottles are not not good for <font color="#E5E5E5">three months but if but if you have to</font> take it our<font color="#CCCCCC"> Lee it may be only good</font><font color="#E5E5E5"> for</font> a week or<font color="#CCCCCC"> ten days</font><font color="#E5E5E5"> do you have it</font> you have any sense of what the maximum tolerated<font color="#E5E5E5"> monthly so I know it will vary</font>

between patients here and but what the sort<font color="#E5E5E5"> of that's what</font> your feel for the maximum people would tolerate if they have an<font color="#E5E5E5"> effective</font> product<font color="#CCCCCC"> how much they pay for something</font> <font color="#E5E5E5">for an effective</font><font color="#CCCCCC"> product from per month</font>

<font color="#E5E5E5">yes</font><font color="#CCCCCC"> to</font><font color="#E5E5E5"> difficult</font> I would say<font color="#E5E5E5"> fifty three hundred zero</font><font color="#CCCCCC"> I</font> mean<font color="#CCCCCC"> it depends because all of these</font> many of<font color="#E5E5E5"> these</font><font color="#CCCCCC"> patients are like old</font> ladies with a small income or smaller <font color="#CCCCCC">how to say yeah pension</font>

<font color="#E5E5E5">yeah pension so for them fifty euro is</font> really a lot<font color="#CCCCCC"> of money so I would say</font> like between<font color="#CCCCCC"> fifteen hundred</font> <font color="#E5E5E5">you're</font><font color="#CCCCCC"> on</font><font color="#E5E5E5"> okay and for you to</font><font color="#CCCCCC"> prescribe</font> this<font color="#E5E5E5"> and you bet I'm just this isn't the</font> sort<font color="#CCCCCC"> of costing that they have in mind</font>

<font color="#E5E5E5">just saying coming over some say</font><font color="#CCCCCC"> for</font> example if this was thirty to forty euros a month from<font color="#E5E5E5"> a lot and what sort</font> <font color="#E5E5E5">of clinical data would you need</font><font color="#CCCCCC"> to see</font> in<font color="#E5E5E5"> order to and start prescribing this</font> and we would it be based on what you

read about<font color="#E5E5E5"> the clinical data or is the</font> treatment pathway<font color="#CCCCCC"> much more empirical as</font> in we<font color="#E5E5E5"> try this first if</font><font color="#CCCCCC"> that doesn't</font> work<font color="#E5E5E5"> we try this I mean but this</font><font color="#CCCCCC"> is this</font> that this<font color="#E5E5E5"> means that it would be it</font> medication I can prescribe<font color="#E5E5E5"> and there's a</font>

<font color="#E5E5E5">CD product I</font><font color="#CCCCCC"> will never be</font><font color="#E5E5E5"> able to</font> prescribe it<font color="#CCCCCC"> I know</font><font color="#E5E5E5"> I can only recommend</font> <font color="#E5E5E5">it as a CD product</font><font color="#CCCCCC"> okay yes and I would</font> <font color="#E5E5E5">recommend it if</font><font color="#CCCCCC"> I'm unconvinced that</font><font color="#E5E5E5"> it</font> <font color="#E5E5E5">is superior to normal artificial</font><font color="#CCCCCC"> appear</font> <font color="#CCCCCC">mmm-hmm because then that</font><font color="#E5E5E5"> the</font>

<font color="#CCCCCC">double/double money per month</font><font color="#E5E5E5"> seems</font> seems to be okay it has to be I guess that has to be better<font color="#E5E5E5"> than a normal</font> artificial<font color="#CCCCCC"> tear</font><font color="#E5E5E5"> concerning our surface</font> concerning symptoms<font color="#E5E5E5"> yes</font><font color="#CCCCCC"> and these are</font> all<font color="#E5E5E5"> things</font><font color="#CCCCCC"> that</font><font color="#E5E5E5"> are measuring</font><font color="#CCCCCC"> and things</font>

<font color="#CCCCCC">easily</font><font color="#E5E5E5"> multi</font><font color="#CCCCCC"> ism</font> the study that<font color="#E5E5E5"> is ongoing at the moment</font> they're measuring OSD<font color="#CCCCCC"> IVAs</font><font color="#E5E5E5"> okay</font> <font color="#CCCCCC">non-invasive tear breakup time is a</font> <font color="#E5E5E5">kilometer</font><font color="#CCCCCC"> II in theory arbitrary</font> osmolarity and<font color="#E5E5E5"> corneal and conjunctival</font>

staining but<font color="#CCCCCC"> I</font><font color="#E5E5E5"> don't mean</font><font color="#CCCCCC"> to</font><font color="#E5E5E5"> me with no</font> experience<font color="#E5E5E5"> in this particular field it</font> happens<font color="#E5E5E5"> if I may ask</font> <font color="#CCCCCC">I really</font><font color="#E5E5E5"> recruit like</font><font color="#CCCCCC"> it's moderate to</font> severe dry patients or which kind of<font color="#CCCCCC"> we</font> <font color="#CCCCCC">just haven't looked for precision</font>

planetary assisted patients with knit but less than<font color="#CCCCCC"> 10 seconds</font> <font color="#E5E5E5">derma test less than 10 millimeters in</font> five minutes<font color="#E5E5E5"> and</font><font color="#CCCCCC"> patients symptoms score</font> of greater than<font color="#E5E5E5"> fourteen point five</font> using them at once this<font color="#E5E5E5"> is</font><font color="#CCCCCC"> all kind of</font>

dry yeah oh is it<font color="#CCCCCC"> right thank you yeah</font> because osteo verse 14 is smile dry and<font color="#E5E5E5"> also</font><font color="#CCCCCC"> a</font> <font color="#CCCCCC">Tiffin breakup time of nine and then the</font> <font color="#E5E5E5">Sherman of nine is</font><font color="#CCCCCC"> miles</font><font color="#E5E5E5"> dry so I reckon</font> I would<font color="#E5E5E5"> quite my dry</font><font color="#CCCCCC"> okay so</font><font color="#E5E5E5"> they</font><font color="#CCCCCC"> is</font>

<font color="#E5E5E5">very experienced everybody in face then</font> <font color="#E5E5E5">they probably check in the beginning in</font> the analysis for whom it works best<font color="#E5E5E5"> yeah</font> <font color="#E5E5E5">okay</font> and<font color="#CCCCCC"> Alan</font><font color="#E5E5E5"> also in terms of the product</font> profile<font color="#E5E5E5"> verify currently working on</font>

<font color="#E5E5E5">different formats and formulations but</font> the current formulations<font color="#E5E5E5"> of use for the</font> clinical trial at the moment when<font color="#E5E5E5"> it's</font> reconstituted<font color="#E5E5E5"> and it's stable well for</font> the refrigeration during distribution<font color="#CCCCCC"> it</font> has<font color="#CCCCCC"> to be refrigerated during</font>

<font color="#E5E5E5">distribution and sales but then at room</font> temperature it<font color="#CCCCCC"> is stable for</font><font color="#E5E5E5"> six months</font> and<font color="#CCCCCC"> then one</font><font color="#E5E5E5"> month</font><font color="#CCCCCC"> after opening</font><font color="#E5E5E5"> would</font> you see that<font color="#CCCCCC"> if it was the</font><font color="#E5E5E5"> effective</font> <font color="#E5E5E5">problem product would you see that need</font> for refrigeration<font color="#E5E5E5"> during distribution</font>

<font color="#CCCCCC">and sales as a major problem or disperse</font> <font color="#CCCCCC">of minor inconvenience I think it's a</font> <font color="#CCCCCC">minor</font><font color="#E5E5E5"> inconvenience</font><font color="#CCCCCC"> actually I've just</font> <font color="#E5E5E5">been worked out</font><font color="#CCCCCC"> I'm just been talking to</font> <font color="#CCCCCC">Alf to a</font><font color="#E5E5E5"> local</font><font color="#CCCCCC"> pharmacy</font><font color="#E5E5E5"> next to them to</font> the hospital<font color="#E5E5E5"> because</font><font color="#CCCCCC"> we have a product</font>

<font color="#E5E5E5">probably have to freeze for</font><font color="#CCCCCC"> there is</font> more distribution<font color="#CCCCCC"> and they</font> said at the moment freezing<font color="#E5E5E5"> it's</font><font color="#CCCCCC"> a real</font> problem<font color="#E5E5E5"> but to have</font><font color="#CCCCCC"> something in</font><font color="#E5E5E5"> the</font> fridge is<font color="#CCCCCC"> not a problem for them so I</font> guess it's<font color="#E5E5E5"> not a problem for the</font>

<font color="#CCCCCC">pharmacies to</font><font color="#E5E5E5"> have it in the fridge</font><font color="#CCCCCC"> and</font> keep it in<font color="#E5E5E5"> the fridge before</font><font color="#CCCCCC"> saving</font> hours and even<font color="#E5E5E5"> monitor the temperature</font> you know every day and so I<font color="#E5E5E5"> I have the</font> feeling that refrigerator<font color="#E5E5E5"> the fridge is</font> <font color="#CCCCCC">not a problem</font>

the freezer might be problem fridge not is and in terms of<font color="#E5E5E5"> anything else in the</font> product<font color="#E5E5E5"> programming book if it</font><font color="#CCCCCC"> has to be</font> <font color="#E5E5E5">put in the eye for</font><font color="#CCCCCC"> three to four times</font><font color="#E5E5E5"> a</font> day would that<font color="#E5E5E5"> be acceptable or is that</font> <font color="#E5E5E5">still on the high side for people to</font>

comply<font color="#E5E5E5"> no it's it's acceptable I mean I</font> have many patients<font color="#CCCCCC"> who use artificial</font> tears every hour<font color="#CCCCCC"> and when every</font><font color="#E5E5E5"> half</font> <font color="#E5E5E5">hour</font><font color="#CCCCCC"> as</font><font color="#E5E5E5"> patients so I mean if you have</font> <font color="#CCCCCC">to use something only three four times a</font> day

that's luxury for them really<font color="#CCCCCC"> oh good</font> and in which<font color="#E5E5E5"> case I</font><font color="#CCCCCC"> think I've come to</font> <font color="#E5E5E5">the end of my questions that</font><font color="#CCCCCC"> has been</font> really useful<font color="#CCCCCC"> and there's a bit about</font> absolutely no<font color="#E5E5E5"> reimbursement for</font><font color="#CCCCCC"> cmart</font> <font color="#E5E5E5">though</font><font color="#CCCCCC"> that's that's</font><font color="#E5E5E5"> something the</font>

client updates<font color="#E5E5E5"> you</font><font color="#CCCCCC"> have a bit of a shock</font> about<font color="#E5E5E5"> I think anybody saw so many men</font> and yes I spoke to Professor<font color="#E5E5E5"> dealing</font> good idea yes yes and<font color="#E5E5E5"> he didn't tell you</font> that and<font color="#CCCCCC"> he let you well he he said he</font><font color="#E5E5E5"> wasn't</font>

in um I can't<font color="#E5E5E5"> remember what he said</font> actually<font color="#E5E5E5"> whether I mean you he said he</font> thought<font color="#CCCCCC"> it would</font><font color="#E5E5E5"> be a real</font><font color="#CCCCCC"> problem but</font> <font color="#E5E5E5">wasn't sure whether or not there was an</font> absolute know how like okay maybe<font color="#E5E5E5"> this</font> <font color="#CCCCCC">is my my</font><font color="#E5E5E5"> it's 99.9%</font><font color="#CCCCCC"> maybe there is a</font>

<font color="#E5E5E5">little bit of a detour you can take to</font> get<font color="#E5E5E5"> a CT product to reimburse but I</font> think it's not not the<font color="#CCCCCC"> usual way</font> <font color="#E5E5E5">definitely not the usual yes oh no no</font> nothing<font color="#E5E5E5"> very exceptional like this yeah</font> I<font color="#E5E5E5"> like the product yes yes</font><font color="#CCCCCC"> if that was</font>

his feeling<font color="#E5E5E5"> as well that they're going</font> <font color="#E5E5E5">to come into problems with this yeah</font> okay well I<font color="#E5E5E5"> think that is the</font><font color="#CCCCCC"> end</font><font color="#E5E5E5"> and</font> thanks ever so much for<font color="#CCCCCC"> that</font> if I do think of<font color="#E5E5E5"> anything or if the</font> client<font color="#CCCCCC"> once I've written up my notes</font>

the client has any<font color="#E5E5E5"> additional questions</font> is it<font color="#CCCCCC"> alright just to drop</font><font color="#E5E5E5"> you an email</font> <font color="#E5E5E5">with</font><font color="#CCCCCC"> the</font><font color="#E5E5E5"> gray no problem at all</font> look Rory adopted<font color="#CCCCCC"> yes in which case</font> thank you<font color="#E5E5E5"> very much isolate</font><font color="#CCCCCC"> this front</font> <font color="#CCCCCC">apply it by email I</font><font color="#E5E5E5"> will hand you</font><font color="#CCCCCC"> over</font>

to<font color="#CCCCCC"> our team secretary</font><font color="#E5E5E5"> Ellie who arranges</font> payment so she will send you a form but that's that's wonderful rather<font color="#CCCCCC"> grow my deep end things thank you</font> if I have a client<font color="#E5E5E5"> bye-bye</font><font color="#CCCCCC"> okay</font><font color="#E5E5E5"> take</font> more<font color="#CCCCCC"> for avenches has left the</font>

conference <font color="#E5E5E5">you</font>



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