September 2007 Volume 3, Issue 3

Vision WithAttitude

M e d i c a l s I n t e r n a t i o n a l

Inside this issue:

LaunchingBiomedics 1 Day -Lebanon

2

Professionals’Corner

3

Business; Optical,One Day.Syria - CL Events

4

Ophthalmology. 5

STAAR; ICL Training 6

Dental 7

JORDAN’s Activities 8

SLT - EGYPT 9

SLT - U.A.E. 10

Refractive - SaudiArabia

11

A Team memberpoint of view

12

ISO FOR MEDICALS INTERNATIONAL (LEBANON)Dear Colleagues, Suppliers, Partners and Friends:

It is my great pleasure to report to all that, afterabout two years of work, Medicals InternationalSARL, our Lebanon Subsidiary, was awarded ISO9001:2000 International Management QualityStandard accredetation last week after goingthrough a tough audit by QMI (management sys-tems registration).

Working on a quality management system was acommitment that we undertook, knowing that tocontinue to grow and serve the interest of our cus-tomers and suppliers best, it was a must step. Wehave many new staff , growing number of clients,and a larger supplier base therefore it was impossi-ble to continue to count on individual innovationsolely; a proper quality management systembecame a need.

I am happy to report that thanks to the engagementof everyone in our Beirut team we succeeded ingoing through the audit for ISO and we proved thatour system was fully compliant with the audit. ISOis a first step in the way as we will have a continu-ous improvement program to ensure that we havethe most competitive and fit organization in theindustry.

Medicals International SARL is the first organiza-

tion in our industryto be awarded sucha prestigious accred-itation. Now, wewill move to applythose new methodsof management andwork on all of ourorganization and wewill be better struc-tured to grow. Ibelieve Egypt is next in our line up.Medicals is committed to excellence. We haveexpanded our training budgets to a much aggres-sive figures this year. We have much more peopleunder industry training or undertaking academicchallenges that will help them deliver better job toall. Parallel we are going through a full refurbishingof our locations. Cairo team moved recently to anew owned location. Dubai will be moving next toa much larger facility. Riyadh signed a new space,Syria soon, and the list is growing..

Thank you for your trust.. My message is a simpleassurance that we are quite wary that we need to bemuch more organized to service everyones interestbetter.

Your partner and friend,Walid G. BarakePresident and Founder.

Page 2

BIOMEDICS ONE DAY NOW IN LEBANON

Medicals International is pleased toannounce the launching of the Biomedics

One Day in Lebanon with a motto;A Fresh Way to Start Your Day.

"The Biomedics Contact Lens Family is amarket leader in 3 markets in our region;including Lebanon. Our valued contact

lens wearers and practitioners will surelyappreciate the introduction of the one day

modality to the Lebanese Market"announced Walid G. Barake, President &

Founder of the Medicals InternationalGroup, at the opening ceremony at theMetropolitan Palace Hotel in Beirut."Global Contact Lens Trends reflectgrowth of 11% in this segment of the

industry" Mr. Barake added. RitaChehwane, Sr. Sales & Marketing

Manager, Lebanon presented to the audi-ence a brief on the product and the spe-

cially designed marketing program that shedrafted for the Lebanese market that offers

our contact lens wearers a 20% in freegoods once they prescribe to our

Prestigious Card program.

The Biomedics Family of contact lenses isan FDA approved product (Federal Food& Drug Association in the USA) and is

accredited with CE mark. The BiomedicsContact Lens Family has been in the ArabWorld Market for over 13 years distributed

exclusively by Medicals International.

Rita Chehwane, B.Sc., MBA Sr. Sales & Marketing Manager

Lebanon

The newly designed pack &patient friendly blister.

THE ALL NEW BIOMEDICS 1DAY PRODUCT SPECIFICATIONS

Biomedics 1-Day

Material: Ocufilcon B; with visibility handling tint & UV inhibitor

Diameter: 14.2 mmCenter Thickness: 0.07 mmBase Curve: 8.7 mmWater Content: 52%Power Range: -10.00 to +6.00Packaging: 30 blisters per box

Volume 3, Issue 3 Page 3

HOW IS KERATOCONUS TREATED?The goal of treatment is to correct vision. Invery mild cases, this can be achieved with eye-glasses; however, the majority of those withKC require contact lenses to correct visionadequately. In severe cases, a corneal trans-plant may be necessary.In the earliest stages of KC , ordinary eye-glasses may be used to correct the mildmyopia and astigmatism . As the disease pro-gresses, additional thinning and bulging of thecornea creates a unique form of astigmatism.This astigmatism is not correctable with glass-es and often best managed with contact lenses.Many contact lens designs have been promot-ed to correct the distorted vision commonlyseen in KC. The lens type that is most fre-quently used is called a rigid gas permeablelens (RGP).RGP lenses (ROSE K lens) have a number offeatures that make them ideal for KC.Why Using Rose k Lens?In my experience for fitting contact lens Ifound the Rose K Lens is the best RGP lens

available in the market of Saudi Arabia,because the design of this contact lens whichhas a smaller posterior optical zone whichdecreases as the base curve of the lens steep-ens. This allows better clearance of the mid-peripheral cornea. The design also consists ofthree peripheral clearance systems, thus allow-ing different peripheral corneal-lens relation-ships. It is fitted from a trial set and the multi-ple parameters make fitting the Rose K lenseasy with reduced chair time and increasedpractice efficiency.It offers a choice of standard, flat and steepperipheral systems producing a range of dif-ferent edge lifts. With rose-k better visual acu-ity is reached and the clinical results haveshown an improvement in patient vision.Increased patient comfort is well experiencedby patients who have worn other KeratoconusRGP designs choose Rose K.Its simply more comfortable. The Lens isdesigned to produce good tear exchangeunderneath the lens, to keep overall thickness

minimal and to maximize the optic area forany base curve.All Rose K fitting sets are supplied in BostonES material without UV blocker. This is doneso that the practitioner can assess the best flu-orescein pattern. (Rx lenses that are suppliedin Boston ES with UV blocker, sometimesmakes it difficult to assess the true fluoresceinpattern).

I highly encourage all optometrist to abusepositively this type of contact lens. I will con-tinue using this excellent lens as I also looktowards excellence in patient care.

Ghassan H. RadwanKingdom of Saudi Arabia

Optometrist National Guard Hospital King Abdulaziz Medical

City - Jeddah

EYE AND VISION DEVELOPMENT

The visual system is the most complex senso-ry system in the human body. However, it isthe least mature system at birth. Though theyhave the anatomical structures needed forsight, infants have not learned to use themyet. Much of their first weeks and months arespent learning to see. As children grow, morecomplex skills, like visual perception, develop.

At birth, babies are capable of seeing shapesby following lines where light and dark meet.They can see variations of light and dark andshades of gray. Newborns can only focusbetween 8?12 inches (20?30 cm), so much oftheir vision is blurred. Full term babies shouldbe able to see their mother's facial expressionswithin a week of birth.

Eye muscle coordination in a newborn is alsovery immature. Babies' eyes often turn in orout or do not work together, a conditioncalled strabismus. Babies initially learn tofocus their eyes by looking at faces. They thengradually move out to objects brought close tothem. Tracking and eye teaming skills beginto develop when infants start following mov-ing objects.

EXPECTED VISUAL PERFORMANCES:Birth to 6 weeks of age:" Stares at surrounding when awake " Momentarily holds gaze on bright light orbright object " Blinks at camera flash " Eyes and head move together " One eye may seem turned in at times 8 weeks to 24 weeks:" Eyes begin to move more widely with lesshead movement " Eyes begin to follow moving objects or peo-ple (8-12 weeks) " Watches parent's face when being talked to(10-12 weeks)

" Begins to watch own hands (12-16 weeks) " Eyes move in active inspection of surround-ings (18-20 weeks) " While sitting, looks at hands, food, bottle(18-24 weeks) " Now looking for, and watching more distantobjects (20-28 weeks) 30 weeks to 48 weeks:" May turn eyes inward while inspectinghands or toy (28-32 weeks) " Eyes more mobile and move with little headmovement (30-36 weeks) " Watches activities around him for longerperiods of time (30-36 weeks) " Looks for toys he drops (32-38 weeks) " Visually inspects toys he can hold (38-40weeks) " Creeps after favorite toy when seen (40-44weeks) " Sweeps eyes around room to see what's hap-pening (44-48 weeks) " Visually responds to smiles and voice ofothers (40-48 weeks) " More and more visual inspection of objectsand persons (46-52 weeks) 12 months to 18 months:" Now using both hands and visually steeringhand activity (12-14 months) " Visually interested in simple pictures (14-16months) " Often holds objects very close to eyes toinspect (14-18 months) " Points to objects or people using words"look" or "see" (14-18 months) " Looks for and identifies pictures in books(16-18 months) 24 months to 36 months:" Occasionally visually inspects without need-ing to touch (20-24 months) " Smiles, facial brightening when viewsfavorite objects and people (20-24 months) " Likes to watch movement of wheels, eggbeater, etc. (24-28 months)

" Watches own hand while scribbling (26-30months) " Visually explores and steers own walkingand climbing (30-36 months) " Watches and imitates other children (30-36months) " Can now begin to keep coloring on thepaper (34-38 months) " "Reads" pictures in books (34-38 months) 40 months to 48 months:" Brings head and eyes close to page of bookwhile inspecting (40-44 months) " Draws and names circle and cross on paper(40-44 months) " Can close eyes on request, and may be ableto wink one eye (46-50 months) 4 years to 5 years:" Uses eyes and hands together well and inincreasing skill " Moves and rolls eyes in an expressive way " Draws and names pictures " Colors within lines " Cuts and pastes quite well on simple pic-tures " Copies simple forms and some letters " Can place small objects in small openings " Passes all the tests described in ImportantObservation Parents Can Make " Visually alert and observant of surroundings " Tells about places, objects, or people seenelsewhere " Shows increasing visual interest in newobjects and place.

ref: *encyclopedia of children* Lea-test

Widad Is'haq, ODSenior Optometrist

Jeddah Eye HospitalLow Vision Practitioner

Ebsar Foundation

Page 4

COATING QUALITY FROM SEIKOThe competitive situation for opticians isincreasingly challenging. Many retailers take theeasy, but short sighted, option to offer lowprices. This creates the need to achieve high vol-umes to be profitable and creates the idea incustomer minds that spectacles have low value.

Forward looking opticians see the need to offeradded value products such as SEIKO. They dis-cuss the many benefits that SEIKO lenses haveto offer and this builds customer understandingof the real value of their purchase. It has beenshown all over the world that consumers will paymore for goods that will improve their lives.

Medicals International understands customermotivation and this is why they offer a widerange of high value, high benefit SEIKO lenses in

their markets. Some benefits such as clear lenscoatings or ultra-thin materials are relativelyeasy to demonstrate or explain to customers.Others such as progressive lens designs aremore complicated so it is important that retail-ers should prepare simple explanations to helpwearers understand the benefits that high tech-nology lenses offer. Medicals International canhelp you to understand and explain SEIKO lens-es and this will help you to raise the value of thelenses that you sell.

For more details please contact Elyse El-Choueifaty at echoueifaty@medicalsintl.com

David Nicoll International Sales

SEIKO Optical UK

SYRIA OFFICE STARTS ITS TUTORIAL PRESENTATIONS SERIES ENTITLED CONTACT LENSES

& OPTIMAL CARE SYSTEMS BY NICOLAS ARAMOUNI; SALES MANAGER

ONE DAY BUSINESS AND YOUR NET RETURN

As an optical retailer the challenges you are fac-ing today are of significance that it is becomingimportant to have a close look at what makessense for you to sell and what not!

Competition today is very different from what weconsidered our competitor “yesterday”.Competition in our Days include:

1- The emergence of large optical retail outletsand purchasing groups that have the financialpower to invest significantly in various means toreach a large customer base such as: better out-let positioning, larger retail space, advertising,advanced merchandising, etc…

2- The acquisition of large optical designers andmanufacturers of retail chains. Today you are

faced with a next door competitor that has amanufacturer cost. This is becoming of signifi-cant danger to your very existence since a largenumber of the brands that your retail are madeby those same groups.

3- In every country the number of retail outletsin general is expanding.

4- Refractive surgery is becoming a viable visu-al correction alternative to many patientsaround the globe.

5- Plus various other competitive factors.

Does this mean we should be scared and startlooking for alternative career opportunities? Ofcourse NOT!I believe what the above means is that we

should be wary that our profit centers havechanged and that we are faced with a newertype of competition that should be our tomor-row's foremost challenge to deal with.

In my intervention today I want us to have a clos-er look on how the business of One Day can sig-nificantly improve our per patient profit marginwhilst offering a healthier alternative for anycontact lens wearers and will improve yourpatient retention. I want you kindly to consultwith your designated Medicals InternationalTerritory Manager on how this could be possibleand how we can work together in confrontingour mutual challenges.

from our editing team

Our first official presentation in Damascus-Syria took place at the Blue Tower Hotel on July27, where we had the pleasure to meet withmost of our customers in Damascus & sur-rounding region.

Mr. Walid Barake presented first, introducingour company profile & directing the attendanceto a valuable insight, towards sales startegies,which will enable them achieving better resultswhen implementing them. He then, presentedour Tri-Kolor features & benefits, where every-one was delighted to hear about.

Mr. Nicolas Aramouni our Sales Manager, pre-sented secondly, listing CLs' problems and howto better handling them!

Afterwards we shared with our dear guests, awonderful calm dinner, exchanging thoughtsand ideas about future projects.

Page 5Volume 3, Issue 3

7 YEARS, 3 OERTLI UNITS, 1 PARTNERSHIP BY AHMAD TABAGA, B.ENG.,SALES MANAGER

OPHTHALMOLOGYWe are privileged to be the provider of choice for Prof.Dr. Mohamad Al Saadany of Tanta University. Dr. AlSaadany was interviewed while delivering to him his3rd Oertli unit in 7 years.

Prof. Al Saadany, it was 7 years since you have beenintroduced to Medicals International, can you tell ushow did it start?

7 years ago MI was unknown to us, they had juststarted running their operation in Egypt. At that timewe were, as a group of ophthalmic surgeons, workingon constructing the 1st large Ear and Eye subspecial-ty hospital in the Delta of Egypt. Salah Malek who wasin charge of sales at the time was the first to visit us.Actually when he was introducing the company andhis products, we have been impressed by the qualityof his knowledge and his professional attitude. This iswhat made him gain our trust rapidly, amid the fact ofhim being new in the Egyptian market.

Is this what encouraged you to buy your first OertliCataRhex unit?Actually it was a very hard decision, at that time, tobuy a Phaco system that has little reference in Egypt.The trend was to buy one of the systems of the emi-nent American manufacturers.MI has helped us with a lot of information that havereflected their understanding of this recent technolo-gy, and we put their machine under trials for a whileand to be compared to other competing systems.And how was the evaluation?

Efficiency, stability and friendly use were the finalagreed judgment. Is this what made you do it again 5 years later whenyou bought your second one?

In those 5 years our CataRhex has given us manyproves that it deserves to be the only Phaco to use.When we did an extension in our surgical theatre inthe year after buying Oertli, we had a belief that weshould gather different technologies in our place andnot to rely on one technology provider. This was thereason to acquire a second system other than Oertli.In 5 years, we realized that the whole team favors theOertli. Amid the high surgical load, the Oertli provedto be very robust and its down time was negligible.Even when it broke down, the Medicals team wasalways ready to provide prompt and efficient service.With the back up unit and instruments strategy thatMedicals employs, they saved us from any work inter-ruptions.- With the Cool Phaco introduced in 2002, Oertli werethe pioneers this technology.- One of the bench marks that appreciate for Oertli,that we were able to upgrade our existing system tothe latest phaco technology in a very low cost, whereother phaco manufacturers offered the new technol-ogy only with the new models leaving their oldmachine users hesitated between buying new sys-tems to use the technology or live with the old tech-nology.- With the new SwissTech from Oertli, they were able

introduce ample advantages to continue with whatthey have been started with their CataRhex Model- With the second Oertli we have turned 100% of ourphaco surgeries to Oertli systems.This very interesting doctor, 2 machines are fillingyour needs, what about the 3rd one?

This unit is purchased by me for personal use, theportability of CataRhex is a unique advantage, it isonly 5.7 Kgm that can fit in any pilot case, when mycolleagues and friends invite me to help them withphaco surgeries, I take my oertli with me, I feel com-fort and efficiency when I use it.Also with the new SwissTech machine they intro-duced the new COMICS through 1.6mm incision,they results looks very promising.

DDooccttoorr,, hhooww ddoo yyoouu sseeee MMII??When MI tried to sell us the 1st phaco, they said thatthey aim to be our partner, after 7 years I'm con-vinced that this is the most accurate definition for ourrelation, it has been started to last for ever.

Best regards to MI team.

Mohamed el Saadany GhorabaProfessor of ophthalmology

Tanta university

THE NEW ASTRASCAN XL EXCIMER LASER FROM LASERSIGHT

(SAME PREVIOUS SHAPE, TOTALLY DIFFERENT LASER!)"Key element of medical equipments is keeping yourmachine performing properly as well as having thelatest update available from the supplier installed onyour system.”To be able to have this, it is mandatory that the sys-tem you have purchased would be able to be upgrad-ed by having minimal intervention or parts replacedreducing upgrade cost and time.Lately I have experienced upgrading the Excimerlaser system at the Canadian Eye centre (Hazmieh-Lebanon), from its old platform (200Hz, 50 Hz track-er, ..) to the latest generation software and hardwareavailable from LaserSight.

The new upgrade package came to life fromLaserSight for the AstraScan XL systems only, thisupgrade includes:1. 300 Hz running frequency which decreased lasersurgical time by around 45% (if the time optimiza-tion is enabled), or by 30% if time optimization is dis-abled.2. Electronic energy feedback system for the lasercavity output, this will increase dramatically the cav-ity life time and reduce the need of interventions onthe laser optics.3. The user interface just got better and more userfriendly facilitating patient data entry where thetechnician would enter the patient parameters fromone screen and immediately visually check the abla-tion profile, as well as, having automatic calibration

to accurately prepare the laser for patient surgeryand daily calibration procedures.4. As the laser frequency is set now to 300Hz, thesystem has to have a fast eye tracking system run-ning parallel at the same frequency 300Hz.5. the new software as well supports pupil registra-tion option, this will help locking the eye tracker tothe visual axis (instead of the pupil center) whenthere is big difference between both axis (or highvalue of angle Kappa).6. As well the new software will give the user theoption to choose automatically the centre of thetreatment as sent from the customizedablation/planning software (AstraPro), or set thismanually using the In_situ pupil registration or usingthe center of the pupil.

On the other hand the AstraPro (LaserSight customablation software) was upgraded as well to include 2activation modalities according to the user needs:either as per case or yearly licensing basis, the newsoftware is able to perform three types of treat-ments:

1. P surgeries, where the system do the calculationor planning of the surgery to compensate only forthe prolate shape of the cornea.2. The second type is the Q Surgeries one: in thistype of surgery the laser will adjust the Q value ofthe cornea to adjust for asphericty as well as to com-

pensate for the Prolate shape similar to the P proce-dures.3. Finally the last type of surgeries that we can dowith the AstraPro, are the Z Surgeries, this is suit-able for correcting irregular astigmatism as well asde-centered treatments where adjustment of Z axisis needed. Surely Z surgeries will be compensatingfor both Prolate and Asphericity.

As a final but essential stage of the upgrade, we hadto install new software for the AstraMax 3D topogra-phy station. The AstraMax new software will includethe Zernike coefficient table in addition to the fullanterior/posterior coverage of the cornea usingthree independent cameras available in the previ-ous software.The new software as well will include higher resolu-tion for better image/topography acquisition.

For more information about our new Excimer laserupgrade please do not hesitate to contact our repre-sentatives.

Michel KleibChief Engineer,

Product Development Manager

Page 6

STAAR CERTIFIED ICL ADVANCED PROCTORING COURSE:THUN, SWITZERLAND

Four product specialists from MedicalsInternational attended the Staar VisianICL/Toric ICL advanced proctoring course,which was held on July 1-5 in Thun,Switzerland. Mireille Gemayel (Dubai),Ahmed Tabaga (Egypt), Paul Khalil(KSA), and Youssef Alwan (KSA) wereamong 27 proctors who participated in thecourse. Seven trainers from Staar werepresent, with the participation of Dr. KjellGundersen (Norway) as a clinical advisorfor this course, which consisted of the fol-lowing topics:

1. Advanced pre-op examinations forICL/TICL2. ICL/TICL calculation 3. Advanced Surgical Procedure steps4. Complication avoidance and manage-ment5. Hands on experience: pre-op measure-ments using various methods6. Calculation workshop7. Case studies 8. Practice development9. User complaints handling and manage-ment10. Competitor analysis11. Meetings, conferences, and trainingprograms overview12. Clinical studies and key articlesoverview

After the course, a trip to Staar manufac-turing plant in Nidau was organized,where the step-by-step manufacturing ofthis highly advanced refractive implant(ICL/Toric ICL) was shown to the atten-dees.

This course highlights both companies'common goal in establishing a strongground for modern additive refractive sur-gery implementation in the region. It alsoemphasizes our commitment towards pro-viding a professional approach to ourvaluable ICL practitioners and potentialusers.

Youssef M. ALWAN, B.Sc., B.E.Sales Manager (Ophthalmic Surgicals),

& Clinical Application Specialist

Volume 3, Issue 3 Page 7

Five month ago I remember Walidtelling me, "If you want to take anydecision in your career, now it's thetime." Five month ago I took that deci-sion that really changed the flow'sdirection of my career, preferencesthat I was hanging to for the lastdecade now changed and I decidedto take a rational detour. Four monthpassed and I'm still experiencing atotal new rush.

In May 2007 our dental division sawthe light in Medicals InternationalKuwait and I was (and still) the personin charge. I had a plan and the execu-tion begun. I visited Lebanon manytimes and got the proper training withcolleagues and great Lebanese doc-tors. The first step was introducingmyself and the company to a totallynew segment of the medical industry;The Dentists. This was totally strangeto me since I never had done anysales' call before in my life. Of courseall kind of worries were invading mymind, but I was determined to turn mytasks successful. And actually thiswhat happened. I was able to create avery good connection with so manydoctors in Kuwait in a very short time,ending up making my first sales, thenthe next, and the next. Today we'redealing already with the most presti-gious clinics and hospitals in thecountry!

What made my life easier in that 5month period, other than the back upof everyone in my company, is a prod-uct that I really believe in "AstraDental Implants", moreover a productthat I love!

I believed that everyone (in need) isentitled to have the best implants inthe market. And I passed successful-ly this belief to our new customers.Why accept failures and you can getthe most effective implant surface inthe market? Why accept bone loss?Why accept screw loosening or frac-tures and we have the best implant-abutment connection known in theindustry? This is what Astra is about

Strengthen by this belief, I havedecided too to participate in theregions' events related to implantsdentistry, to get to know deeper and

deeper the cultures, the business, tolearn more and more about implantol-ogy to able to assist our customers inKuwait with the best service availableto them. My first one was in Aleppowhere I attended the ThridInternational Syrian GermanCongress of Implantology 2007.

A very nice event, well prepared andcoordinated, where I had the chanceto meet doctors from the region,exchanged ideas, experiences andtips! Four days of presentations andtrainings were undertaken. Many sub-jects tackling the sinus lift, the bonegraft, the problems with implants,advanced clinical applications ofimplants in oral and maxillofacial sur-geries, implants retained overden-tures, esthetic considerations in den-tal implants and so many other issuesof the day to day concern.

Distinguished doctors in the filed;from Germany, Syria, Jordan,Lebanon, France, Turkey participatedin the event and lectures, like Dr.Anas Damalkhi, Dr. Issam Khoury,Prof. Wolfgang Voigt, Dr. Rola Al-Habashneh, Dr. Moussa Marashdeh,Prof. Meikel Vesper and many othershad very interesting presentations.

What's next? The first InternationalImplantolgy Congress in Jordan is yetto come on 30th of October 2007 andwe will be there. My objective is totake advantage of our "real true long-lasting treasure" in this part of theworld, the knowledge; and pass itthrough and use it in my daily busi-ness practice to enhance the qualityof the service ending up in a moresatisfied doctor, consequently a betterserved patient.

Now that our dental division is grow-ing, building up the best customers inKuwait and the entire region, we willalways keep our dentists up to date ofall the events and new clinical andtechnical practices by constantlymaintaining a special corner for thedental industry in our newsletter.That's a promise.

At the end, I would like to thank every-one who believed in me (and still …since the we're only in the beginning)and backed me up, especially myvaluable customers in Kuwait whotrusted me with their most precious.

Best Regards,Bassam Khoury, MBABusiness Manager, DENTAL.

A WONDERFUL START OF OUR DENTAL DIVISION IN KUWAIT

Prof. Wolfgang Voigt from Germany lecturingabout Implants Fractures

Prof. Wolfgang and me in the last day of theevent

Receiving Appreciation Trophies and Souvenirsof the event in Sheraton Aleppo

Page 8

MEDICALS INTERNATIONAL, JORDAN ON THE MOVE...

ROSE K PRESENTATION FOR OPTIC CENTREIn the pursuit of improving the local level of our services, in a wayto deliver to the patient a better vision with the best alternativevisual correction, Medicals International Jordan represented byAlaa’ Meqdadi, territory manager CL, gave a presentation on theRose K lenses to 18 optometrists –divided on three group– fromAl-Ganem Group, better known as Optics Centre . The presenta-tion started with a review on the keratoconus, its definition, relat-ed symptoms, and continued with the specs and features differ-entiating the Rose K lens from other rigid lenses available interms of materials used and lens design. After that, a detailedreview of the fitting process used for the keratoconus patientswas reviewed, followed by many cases as a live fitting. ACertificate was distributed for each of the attendants.

Medicals International - Jordan has always beenseeking to implement modern techniques inrefractive surgery other than the most commontraditional correction techniques, like PRK andLASIK. In this concern, several meetings were held duringthis year, where presentations, training courses,and proctored surgeries were done successfully.

1) Epi-LASIK, which has the same goal as PRKwith much less pain and faster healing time. It isdone using a mechanical separator to push to theside the epithelium bed at the level of the laminadensa in the basement layer, to expose the treat-ed area, and then it will be pulled back manuallywhen the laser procedure has finished (instead ofwashing it out like in PRK). 2) ICL/TICL, Implantable Contact lenses and ToricImplantable Contact Lenses:The procedure involves an easy and short sur-gery, where a thin foldable lens is implanted prop-erly in the sulcus, between the crystalline lens andthe iris, to correct high Myopia, Hyperopia, andMyopic Astigmatism, or in critical eyes, whereother procedures are risky to perform (thincorneas, forme-fruste keratoconus, etc..). 3) INTACS Corneal Implants (Rings), a therapeu-tic procedure dedicated for Keratoconus treat-ment, by flattening the cornea using two PMMArings implanted at 70% depth in the stroma, after

manual (or now laser-induced) dissection of twoappropriate corneal tunnels starting from a tiny 2-mm radial incision. These rings will delay the dis-ease progression and restore a good part of thepatient's visual acuity.

So here below are some of our activities:

Epi Lasik for Al Hussein Medical Center in May,2007 where live surgeries for about 20 eyes wereperformed after a briefing from Eng. Salah Malekour Vice president.Results: 18 over 20 of the flaps were performedonly 2 of them were not perfect.Post-Op less pain and faster recovery were seenSaid Dr. Ayman Mdanat, Head of the OphthalmicDepartment at the hospital, and Dr. SamiDaassan, Head of the Refractive Unit.

ICL/TICL1) Didactic course at the Jordan University hospi-tal, in early 2007.2) Briefing at the King Abdullah hospital, in early2007, followed by surgeries

Intacs: 1) Didactic course at The Jordan University hospi-tal, in early 2007 followed by surgeries. 2) Briefing at The Eye Specialty hospital inJanuary, 2007 .3) Didactic course at King Abdullah hospital, in

early 2007 followed by surgeries 4) Didactic course at Al Hussein Medical Center inApril, 2007 followed by surgeries.

Also I was invited in August 2007, by the Iraqiministry of health through Dr. Fares El Bakri, awell known Iraqi doctor, for three days work in IrbilNorth of Iraq. Actitivities were the following: 1) One day presentations in Razghani hospital onIntacs, ICL and Oertli Phaco machine for around30 attendees.2) Two days cataract surgeries (around 15 surger-ies) on the Oertli SwissTech Phaco machine. Thefirst day was in the Republic Teaching hospital,and the second day in Irbil New Vision Eye Center(a private center), where beside the usual tech-niques, we tried the unique Radio FrequencyCapsulorhexis and the CO-MICS (coaxial microincision surgery) at 1.6mm incision! Surgerieswent very well, and it was performed by Dr. Bakri.

The attendees were very satisfied and showedvery high interest since these techniques weretotally new for them.

Sincerely yours

Georges AratimosSales ManagerJordan Office

OPHTHALMOLOGY - JORDAN & IRAQ

Alaa’ in the middle of the picture

Page 9Volume 3, Issue 3

EPI-LASIK INTRODUCTION TO BAHRAIN

Medicals International congratulates Dr.Haifa Mahmoud for the introduction of theEpi-LASIK highly advanced refractive pro-cedure to Bahrain. Dr. Haifa has done morethan 50 successful Epi-LASIK procedureson her recently acquired EpiVision system(made by Gebauer, Germany - www.epivi-sion.eu), to her prestigious and highlysophisticated center, Dr. Haifa Eye Center,who is the only center offering this kind ofpractice in Bahrain. Dr. Haifa is extremelyhappy about her EpiVision system, which isthe most advanced worldwide. She hasmoved all her PRK procedures, and manyof her LASIK procedures to Epi-LASIK.She said that the system is very easy to useand gives her a peace of mind and herpatients extreme satisfaction after the pro-cedure, since it has the advantages of bothLASIK and PRK in terms of safety and

quick recovery. We congratulate Dr. Haifafor her always being up-to-date with the lat-est technologies and we wish her more andmore success and prosperity

Youssef M. ALWAN, B.Sc., B.E.Sales Manager, Ophthalmic Line (KSA)

& Clinical Application Specialist

EGYPTIAN SLT SYMPOSIUM SPOTLIGHTS EARLY GLAUCOMA

TREATMENT

I use SLT in the early stages ofglaucoma, when treatment ismost effective."Mr. Ejaz Ansari, MaidstoneHospital,Kent, UK

The July 2007 Cairo SLT Symposium pro-vided an excellent opportunity for glauco-ma experts to congregate and share theirSLT knowledge and experience. Specialguest Ejaz Ansari from the Eye, Ear andMouth Unit (EEMU) of MaidstoneHospital, Kent, UK was invited to presenthis long-term experience with the treat-ment.

Mr. Ansari, who has been performing SLTfor five years, emphasized the importanceof the Early Manifest Glaucoma TreatmentStudy (EMGTS), which demonstrated thatearly glaucoma treatment helps to preservethe vision of patients with glaucoma. "SLTcan be applied in the early stages of glauco-ma to improve the long-term prognosis ofpatients," he said. "I use SLT in the earlystages of glaucoma, when treatment is mosteffective."

"For my patients already on topical treat-ment, I use SLT to reduce drug prescriptionand to improve pressure control," Ansariexplained. "For my new glaucoma patients,I use SLT to delay the need for a prescrip-tion. For me, SLT is a safe, effective andversatile treatment."

After a practical and precise description oftreatment modalities, Ansari explained theimportance of communication withpatients. "I systematically present the differ-ent options to my new glaucoma patients -SLT and medication. I explain the advan-tages and disadvantages of both alterna-tives; then, I give them time to make theirown decision."

After Ansari's presentation, AhmedMostafa Abdel-Rahman, MD, FRCSEd,Assistant professor, at the Cairo Universityprovided attendees with an overview ofpapers from the recent World GlaucomaCongress in Singapore. He also shared hisown recent experience with SLT."I use SLT to stop or to avoid anti-glauco-ma drugs, to reduce the number of anti-

glaucoma drugs or to avoid surgery," hesaid. "The preliminary results encourageme to propose SLT to the majority of myglaucoma patients. I have treated 22 eyes of14 patients, (11 Females, 3 males, mean age46.5 years) with a mean preoperative IOP at22 mmHg and mean preoperative medica-tions of 1.09. One month after treatment,the mean IOP is 17.1 mmHg (22.2% IOPreduction) and the number of medicationshas reduced to 0.5."

To conclude, Abdel-Rahman outlined theresults of the EMGTS study, which showedthat the risk of glaucoma progressiondecreases by 50 percent with every 3 mmHg of pressure reduction.

Philippe MauryMarketing Manager Greater Europe

Ellex 82 Gilbert Street, Adelaide SA, 5000

AustraliaTel + 33 626 332 266

pmaury@ellex.comwww.ellex.com

Page 10

GLAUCOMA FILTRATION VIA SELECTIVE LASER TRABECULOPLASTY

SLT appears to be a safe and effective proce-dure for patients who have high intraocularpressure despite being on multiple pressurelowering medications.Glaucoma is a series of diseases that if leftuntreated can cause damage to the optic nerveresulting in gradual visual loss and blindness,damage to the optic nerve due to glaucoma iscaused by an elevated IOP, AH fills the AC andprovides nourishment to the tissue, the AH alsoprovides pressure to help maintain the shape ofthe eye, the increase in pressure cause the opticnerve damage, resulting in nerve cell death andvision loss.OAG is a progressive eye disease, the mostcommon type of glaucoma, occurs when thereis either a sustained increase in fluid produc-tion or decrease in fluid drainage, with thisimbalance in fluid flow, there is an increase inthe IOP, which in turn reduces blood flow tothe sensitive tissue of the optic nerve, over time,as the optic nerve fibers are destroyed, periph-eral vision lost.OAG treatment concentrates on lowering thepressure inside the eye to prevent damage to theoptic nerve, the most common treatments forglaucoma have been the use of medication inthe form of eye drops, pills and laser treat-ments, laser treatment and some medicationsallow for faster drainage, while other medica-tion reduce the production of AH, if thesemethods fail to decrease fluid pressure, SLT,ALT, or surgery may be required to create anew drainage channel.Material and methods:22 eyes of 12 patients were treated by SLT; allpatients had POAG with IOP at upper levelcontrol by medical therapy (maximum), theirages ranged between 30 to 70 years.All patients have done for them procedure. VF,IOP, gonioscopy, funduscopy for evaluation ofoptic disc.

SLT perform in the office and only takes 15minutes, prior to the procedure, eye drops willbe given for anesthesia and to prepare the eyefor treatment, the laser application are madethrough slit lamp microscope, the laser pulseduration is fixed at 3 nanoseconds, the spot sizeis fixed at 400 μm, which cover the entire mesh-work from Schwalk's line to ciliary body band,sixty confluent application over 180° or 120 per360°, the power is adjustable from 0.3 to2 mJ,using as a tissue end point for the energy set-ting, a tiny air bubble, with fly pigment or everyslight blanching of the meshwork can be seenin 0.6 to 1.2 mJ range.SLT use ND YAG laser to create channelswithin the trabecular meshwork of the eye to

allow better drainage of AH, the laser energy(532 nm wavelengths) targets melanocytes inthe trabecular meshwork without damagingsurrounding non pigment cells.

Results:" The IOP checked one hour, the following day,one week, 1 month, 2 months, 3 months, 6months, and a year after laser treatment, mini-mum follow up 3 months." The average patient age was 52 years (from 30to 75 years), the disease had been discoveredsince longtime (5 to 20 years) before laser treat-ment." The average total energy was 0.6 to 1.2 mJ,delivered 120 spot for 360°." Preoperative IOP was 25 - 6 mm Hge" Postoperative IOP; one hour post laser a tran-sient increase to 29 - 7 mm Hge occurred in allpatients." Post operative IOP one day post laserdecrease to 22 - 5 mm Hge." Postoperative IOP one week post laserdecrease to 20 - 5 mm Hge." Postoperative IOP one month post laserdecrease to 20 - 6 mm Hge." Postoperative IOP 3 month post laserdecrease to 20 - 6 mm Hge." Postoperative IOP 6 month post laserdecrease to 20 - 6 mm Hge." All patients have been stop medical treatmentsecond day post laser therapy" 2 Eyes need medical therapy 4 months postlaser, where done for them repeat SLT.

Discussion:SLT consider as a secondary therapy to be usedonly when patients can't get optimal control ofIOP on medication, the procedure could rivalor even supplant IOP lowering medications asprimary therapy for glaucoma.SLT has become as an intermediate stepbetween medications and glaucoma filtrationsurgery. SLT is new laser treatment for OAG.uses short pulses of low energy laser light totarget melanin containing cells in the trabecularmeshwork of tiny channels, the objective of thesurgery is to help fluids drain out of the eye,reducing IOP that can damage to the opticnerve and lost of vision.The frequency doubled 532 nm, Nd: YAG laserwas found to be an appropriate wavelength forinjuring the pigmented cells while sparing thenon pigment cells and the surrounding struc-ture, a 3 nanoseconds laser pulse with a large400 μm beam diameter, the short pulse dura-tion is below the thermal relaxation time of thetissue and therefore no thermal damage occurs,so SLT target the pigmented cells and not cause

any collateral thermal injury.Since SLT offers the chance of significant IOPreduction without the thermal injury to theangle structures and are important to validatethe role proposed for SLT in the treatment ofOAGSince medication and eye drops can causeundesirable side effects or simply fail to controlglaucoma, and because patients frequently failto take their medications, so SLT may be a bet-ter alternative, in which occur biologicalresponse that increase AH drainage andreduces IOP. It May reduce the need for life-long use of expensive eye drops and other med-ications.Argon laser Trabeculoplasty (ALT) resultspaced burns made in the trabecular mesh-work, and scarring of the trabecular meshwork,which may limit its success and the ability toretreat the eye while SLT targets pigment cellsin the trabecular meshwork, which dose nothave the associated damage to other tissues andadverse scarring effects.So SLT may be repeated many times, SLT hasalso been found to be effective when ALT andother forms of treatment have failed.

Repeat SLT provides long term reduction ofIOP in glaucoma and allows patients to usefewer medications, to achieve good control ofIOP, the repeat rate was better than that seenwith ALT, so SLT lowered IOP and maintainthe reduction over months or even years.SLT repeated applications may lower IOP ineyes where the IOP has drifted back up to pre-treatment levels without altering the structureintegrity of the out flow system.Since transient IOP spikes may occur in somepatients a topical antiglaucoma may be givenbefore and after the laser therapy until the IOPfalls back to pretreatments levels or lower.

Conclusion:SLT is effective and safe as primary treatmentfor patients with ocular hypertension andOAG, SLT may provide a meaningful IOPreduction in eyes non responsive to ALT, thetime course for IOP reduction following SLThas been variable, but a signification response isseen at postoperative day one, most patientswill have to return for follow up visits torecheck that treated eye.There are no incidences of allergy or systemicside effects with SLT, complication are minimalbut may include inflammation, transitory IOPspike, and conjunctivitis or eye pain.Vision loss from glaucoma is permanent butcan be prevented with early detection and treat-ment, glaucoma management is a lifelongprocess that requires frequent monitoring andconstant treatment, since there is no way todetermine if glaucoma is under control basedon how persons feels or their vision, personswith glaucoma should be examined every threemonths for the rest of their lives.

Dr. Abdul Razzak Al-Samarrai MD, FCES, FICS, HDO, MRC OphSenior Consultant Ophthalmologist Ibn Al Haithem Specialty MedicalCenter, U.A.E.

LASIK SUCCESS IN SOUTH SAUDI ARABIA WITH THE ASTRASCAN LASER

Laser refractive eye surgery constitutes a majorpart of modern refractive surgery today. LASIK(Laser-Assisted in Situ Keratomileusis) is still themostly performed refractive surgery, where thepatient gets excellent results through a quick pro-cedure, where his cornea is accurately remodeledafter vaporizing part of his stromal tissue throughthe use of the Excimer laser, after creating a stro-mal flap, which will be re-positioned back after-wards. We are very proud to announce that Dr. Saad Al-Mousa, one of the most prominent eye surgeons inSouth KSA, has performed more than 1,200 suc-cessful LASIK pa-tients with the AstraScan excimerlaser - LaserSight Technologies Inc. (USA), the firstof its kind in Saudi Arabia. "Dr. Saad Al-Mousa EyeCenter" (Abha, KSA) pro-vides a comprehensiveophthalmic surgery practice where Dr. Saad per-forms most modern eye surgeries(Phacoemulsification and other intra-ocular sur-geries, LASIK and other laser procedures, PhakicIOLs, etc…). Dr. Saad is very happy from the performance andthe outcomes of his laser and he has added a fewcomments that we have included below:1) Safety and efficacy: "This laser is a peace ofmind" as per Dr. Saad; "we never worried about anyovercorrection, or any possible unpredictableresults. Everything is within our hands and thelaser nomogram is so predictable that we only hada handful of redos or enhancements (about 6-7eyes only out of more than a 2400 eyes) whichwere all manageable and led to 20/20 final out-comes". The AstraScan laser has a beautiful supergaussian flying spot of 0.6 mm running at 200 Hz,at a very low and highly stable energy shot-to-shot(< 1mJ/pulse). It has a fluence feedback systemmaintaining a fluence of 0.89 mJ/cm2, and a ver-tical ablation of 0.25 microns per shot, henceallowing for smooth corneal contouring with highaccuracy. 2) Reliability: "The LaserSight laser is very reliable;we have done a lot of hard cases (mixed astigma-tism, hyperopic astigmatism, high myopic astigma-tism) and the results were so accurate and stable"Dr. Saad added. "In addition, we have done a largenumber of cases per day, sometimes more than

20 patients, and the laser still performs robustly,without interruption. It also has a highly reliableeye tracker, which works seamlessly with the laser,on about 99% of the cases". It is a video-basedactive/passive eye tracker, and it has 3-point infra-red lighting system which allows excellent cover-age of the eye from all angles. The AstraScan laser has a small laser cavity with alow energy profile, and only six optics in the laserpath, allowing for higher reliability and less prob-lems than most common lasers. 4) Ease of use: "Our laser is so practical and con-venient" said Dr. Saad, "having a small overall size,a smart and highly intuitive software, and easycontrols, which make our life easy. My assistantenters the patient data through the touch-screen(or keyboard) and follows me throughout the LASIKprocedure with all data showing on one screen infront of her: patient data, laser progress, alongwith the live video re-cording showing the eye-tracked patient's eye being operated". TheAstraScan laser has a small footprint, a comfort-able swivel patient bed controlled by a X-Y-Z move-ment joystick. It has coaxial and oblique patientlighting options, and a very intuitive software fordata entry and management, and for laser calibra-tion and alignment pro-cedures (for both laserassistants and service engineers).5) Patient satisfaction: Dr. Saad is extremely happyfrom his patients' feedback. "It is a blessing to seehow happy my patients are after LASIK" he added,and he showed me several times the flowers andchocolate boxes he got from many of them thank-ing him for "changing their lives" after the LASIKprocedure. The AstraScan laser provides immedi-ate post-op results due to its low energy and mini-mal stromal abla-tion. It is a very quiet laser aswell; the patient does not hear any of the "shotgun"sounds heard in other lasers so he will remainpeacefully focused on the aiming beam. In addi-tion, I'd like to mention that the laser unit has avery nice and friendly look with nice moderncurves, unlike many of the other lasers in the mar-ket which look like heavy manufacturing machin-ery. It has also a swivel patient bed on which thepatient can sit first at 90 degrees, and then thebed will be lowered and aligned under the laser

output, unlike the surgery-type patient beds wherethe patient has to sleep on it directly. All these fea-tures give the patient the feeling that he is not inan operation room but rather in a outpatient clinicso he will be more relaxed. 6) Ease of Serviceability: Dr. Saad is very satisfiedfrom his laser's low rate of breakdown and fromour quick response in answering his servicerequests, other than the regular monthly check-ups on it. To note here, the AstraScan has a simpleoptical and electronic system with a small German-made laser cavity. Our highly profes-sional engi-neers have mastered the maintenance and servic-ing of these types of lasers after installing a goodnumber of them throughout the Middle East since2002. Moreover, the maintenance costs of thislaser are minimal along with a very eco-nomic gasmixture consumption. LaserSight's AstraScan has proven to be a highlyeffective modern laser with excel-lent results andaccurate outcomes, and has over the years gotdoctors and patients satisfaction, along with allthe surrounding people (nurses, technicians,…)due to its easier operation, user-friendliness, andlower maintenance frequency and cost. Medicals International is proud to be the chosenpartner of the Dr. Saad Al-Mousa Eye Center inAbha, and we wish Dr. Saad more and more suc-cess and prosperity in his career.

Youssef M. ALWAN, B.Sc., B.E.Sales Manager, Ophthalmic Line (KSA)

& Clinical Application Specialist

CLINICALLY AND FINANCIALLYOnce more, Ellex Medical - Australia, bridges the gapwith a stunning innovation "The Integre Duo".Ellex realized a gap, both clinically and financially inthe photo-coagulator market space. It has been longestablished that that various wavelengths are essen-tial to be able to optimize the patient's clinical out-comes. Yet, the use of some of those withered away asthe industry has failed to make corresponding lasers

robust and reliable enough.Various colors have different absorption rates and penetrations through theRetinal layers. Today, the industry offers either the general purpose solid-state, robust and affordable green wavelength or the complex multi-wave atan exorbitant tag price.The later, allows green, red and yellow wavelengths. Knowing that there isvery little pathologies that can be treated with the yellow and not with thegreen, Ellex brought to life the Integre Duo.The Integre Duo is the first solid-state photo-coagulator to deliver clinicallyproven red and green wavelengths. This advanced laser system makes it pos-sible to instantly select either a red or green wavelength during retina treat-ments, which maximizes treatment options and ensures effective patientresults. For common procedures like retinal photo-coagulation, laser trabecu-loplasty and iridotomy, the green wavelength provides the standard care. Thered wavelength produces less scatter for better transmission through acloudy cornea or lens, provides deeper penetration for effective treatment of

choroidal vessels, and enables the physician to treat in the presence of hem-orrhage. This is because of its moderate absorption by melanin in the retinalpigment epithelium, low absorption by hemoglobin and negligible absorptionby macular xanthophyl (minimizes risk of inner retinal damage during macu-lar photo-coagulation near the fovea).The system's unique single diode pump dual cavity design is less complexthan standard multi-wavelength cavity designs, using less optical compo-nents for improved temperature control and reduced risk of misalignment.This translates to more stable energy output at various pulse duration set-tings and bargain-basement cost.Further to having the most advanced laser cavity, the Integre Duo is fully inte-grated. The success witnessed with the yet to be challenged integratedphoto-coagulator design concept will be further extended with the IntegreDuo. The comfortable working distance, the true spot optical system as wellas the optimized retinal slit lamp will bring both the patient and the doctorexperience to new unrivaled standards.After being first to seal the YAG Q switch, the first to introduce the Super Qoptical Q switching modality, the first to integrate a green laser into its slitlamp, the Duo comes at no surprise. With the new balance between the qual-ity, versatility, and the price that the Duo presents, we are confident that wewill end up with more clinics producing more happy patients.

Salah G.MalekVice President Ophthalmology

Medicals International

ELLEX BRIDGES THE GAP

Volume 3, Issue 3 Page 11

"No" is a powerful word used by children, parents, educators, and business associates. Howone relates to it is shaped in early childhood, where many of us learned only the literal dic-tionary definition of the word. In adulthood, many of us still fear the word, and sometimesunhealthy or unstable relationships can be damaged or destroyed when a "no" is heard fromsomeone close to us.

According to some salespersons, the word "no" is an act or instance of refusing or denyingsomething. For instance, a customer's refusal to purchase products or services from a salesper-son is generally expressed via the word "no". For some others, they hear the word "no" differ-ently, they hear it to mean that the customer will be glad for the salesperson to return at amore convenient time or pleased to be shown another, more necessary product. When some-one says "no" they can be simply asking you to modify your proposal or change some detailsin your offer. When you get turned down by a customer, it doesn't necessarily mean that thecustomer did not like the products you are selling, or that he is not interested in buying. Thatis why it is important for the salespersons to be able to read between lines and detect any hid-den messages sent by customers.

The salesperson's attitude toward the word "no" and his/her ability not to focus on the "neg-ative" are traits that can make the difference between closing a deal and leaving with noth-ing in hand; "deal and no deal". And this is what the sales business mainly about; if you asa salesperson are not able to try different approaches and adjust your self and your offer witheach costumer you deal with, then you will have a problem that may costs you a lot. It isessential in our job to be flexible and to keep in mind that persistence pays off.

Wishing you "no"- free answers.

Khalid Al JarrahJr. Territory Manager

Amman-Jordan

HHeeaadd OOffffiiccee,,Mansourieh, LebanonTel. 961-4-530 630Fax: 961-4-409 365Email: info@medicalsintl.comWebsite: www.medicalsintl.com

P.O. Box: 272Mansourieh - El Meten,Lebanon

DON'T TAKE "NO" FOR AN ANSWER

We Think of The Patient First

BCLA 2007

The annual British Contact Lens Association (BCLA) meeting is one of the world’s largestdedicated events related to the anterior segment of the eye and contact lens industry, attract-ing more than 1000 visitors from the UK and overseas. This year, the BCLA ClinicalConference and Exhibition was held from May 31st till June 3rd, 2007 in Manchester, UK.

Four of Medicals International’s Contact Lens Sales Managers, Nicolas Aramouni, JosephNachawaty, Rita Chehwane, and Mireille Gemayel attended this meeting benefiting fromthe continuing education and training courses provided during this meeting. Medicals teamwould like to thank Coopervision for their usual support in the registration for this event.