ACTIONS
In its hydrated state, the EXTREME H2O DAILY (hioxifilcon A) soft contact lens, when placed on the cornea, acts as a refracting medium to focus light rays on the retina.

CAUTION
Due to the small number of patients enrolled in clinical investigation of lenses, all refractive powers, design configurations, or lens parameters available in the lens material were not evaluated in significant numbers. Consequently, when selecting an appropriate lens design and parameters, the eye care practitioner should consider all characteristics of the lens that can affect lens performance and ocular health, including oxygen permeability, wettability, central and peripheral thickness, and optic zone diameter. The potential impact of these factors on the patient’s ocular health must be carefully weighed against the patient’s need for refractive correction. Therefore, the continuing ocular health of the patient and lens performance on the eye should be carefully monitored by the prescribing eye care practitioner.

INDICATIONS
The EXTREME H2O DAILY (hioxifilcon A) spherical soft contact lens for daily wear is indicated for the correction of visual acuity in aphakic or not-aphakic persons with non-diseased eyes that are myopic or hyperopic. The lens may be worn by persons who exhibit astigmatism of 0.75 Diopters or less that does not interfere with visual acuity. Daily wear replacement schedules may vary from patient to patient and should be decided by the eye care practitioners in consultation with their patients. When prescribed for daily disposable use, no cleaning or disinfection is required. Lenses should be discarded upon removal

CONTRAINDICATIONS:
DO NOT USE the EXTREME H2O DAILY (hioxifilcon A) soft contact lenses when any of the following conditions are present:
• Acute or sub acute inflammation or infection of the anterior chamber of the eye.
• Any eye disease, injury, or abnormality that affects the cornea, conjunctive, or eyelids.
• Severe insufficiency of lacrimal secretion (dry eyes).
• Corneal hypoesthesia (reduced corneal sensitivity), if not-aphakic.
• Any systemic disease that may affect the eye or be exaggerated by wearing contact lenses.
• Allergic reactions of ocular surfaces or adnexa that may be induced or exaggerated by wearing contact lenses or use of contact lens solutions.
• Allergy to any ingredient, such as mercury or thimerosal, in solution which must be used to care for EXTREME H2O DAILY soft contact lenses.
• Any active corneal infection (bacterial, fungi, or viral).
• If eyes become red or irritated.
• Patients unable to follow lens care regimen or unable to obtain assistance to do so.

WARNINGS
Patients should be advised of the following warnings pertaining to contact lens wear:
PROBLEMS WITH CONTACT LENSES AND CONTACT LENS CARE PRODUCTS COULD RESULT IN SERIOUS INJURY TO THE EYE. It is essential that you
follow your eye care practitioner’s directions and all labeling instructions for proper use of your lenses and lens care products, including the lens case. EYE PROBLEMS, INCLUDING CORNEAL ULCERS, CAN DEVELOP RAPIDLY AND LEAD TO LOSS OF VISION; THEREFORE, IF YOU EXPERIENCE ANY DISCOMFORT, EXCESSIVE TEARING, VISION CHANGES, REDNESS OF THE EYE, IMMEDIATELY REMOVE YOUR LENSES AND PROMPTLY CONTACT YOUR EYE CARE PRACTITIONER.
Daily Wear lenses are not indicated for overnight wear, and patients should be instructed not to wear lenses while sleeping. Clinical studies have shown that the risk of serious adverse reactions is increased when these lenses are worn overnight.
Studies have shown that contact lens wearers who are smokers have a higher incidence of adverse reactions than nonsmokers.
If a patient experiences eye discomfort, excessive tearing, vision changes, or redness of the eye, the patient should be instructed to immediately remove lens and promptly contact his or her eye care practitioner.
ALL CONTACT LENS WEARERS MUST RETURN FOR PERIODIC CHECK-UP VISITS AS RECOMMENDED BY THEIR EYE CARE PRACTITIONER.

PRECAUTIONS
• Clinical studies have demonstrated that contact lenses manufactured from hioxifilcon A are safe and effective for their intended use. However, the clinical studies may not have included all design configurations or lens parameters that are presently available in this lens material.
Consequently, when selecting an appropriate lens design and parameters, the eye care practitioner should consider all characteristics of the lens that can affect lens performance and ocular health, including oxygen permeability, wettability, central and peripheral thickness, and optic zone diameter.
The potential impact of these factors on the patient’s ocular health should be carefully weighed against the patient’s need for refractive correction; therefore the continuing ocular health of the patient and lens performance on the eye should be carefully monitored by the prescribing eye care practitioner.
• Fluorescein, a yellow dye, should not be used while the lens is on the eye. The lens absorbs this dye and become discolored. Whenever Fluorescein is used in eyes, the eyes should be flushed with a sterile saline solution that is recommended for in eye use. Wait at least one hour before replacing the lens. Too early replacement may allow the lens to absorb residual Fluorescein irreversibly.
• Before leaving the eye care practitioner’s office, the patient should be able to promptly remove the lens or should have someone else available who can remove the lens for him or her.
• Eye care practitioners should instruct the patient to remove the lens immediately if the eye becomes red or irritated.

Eye care practitioners should carefully instruct patients about the following care regimen and safety precautions:
• DO NOT use if the sterile blister package is opened or damaged. Always confirm the lens parameters printed on the multi-pack and on the individual lens  package match the patient’s prescription. If there is a mismatch, the patient should not use the product.
• If the lens sticks (stops moving) on the eye, follow the recommended directions in Care for A Sticking (Non-Moving) Lens. The lens should move freely on the eye for the continued health of the eye. If non-movement of the lens continues, the patient should be instructed to IMMEDIATELY consult his or her eye care practitioner.
• Always wash and rinse hands before handling lens. Do not get cosmetics, lotions, soaps, creams, deodorants, or sprays in the eyes or on the lens. It is best to put on lenses before putting on makeup. Water-based cosmetics are less likely to damage lenses than oil-based.
• Do not touch contact lenses with the fingers or hands if the hands are not free of foreign materials, as microscopic scratches of the lens may occur, causing distorted vision and/or injury to the eye.
• Carefully follow the handling, insertion, removal, cleaning, disinfection, storing, and wearing instructions in the patient instructions for the EXTREME H2O DAILY (hioxifilcon A) soft contact lens and those prescribed by the eye care practitioner.
• Never wear lenses beyond the period recommended by the eye care practitioner.
• If aerosol products such as hair spray are used while wearing lenses, exercise caution and keep eyes closed until the spray has settled.
• Always handle lenses carefully and avoid dropping them.
• Avoid all harmful or irritating vapors and fumes while wearing lenses.
• Ask the eye care practitioner about wearing lenses during sporting activities.
• Inform your doctor (health care practitioner) about being a contact lens wearer.
• Never use tweezers or other tools to remove lenses from the lens container unless specifically indicated for that use. Pour the lens into the hand.
• Do not touch the lens with fingernails.
• Never rinse the lenses in tap water. Tap water contains many impurities that can contaminate or damage the lenses and may lead to eye infection or injury.
• When lenses are worn for daily disposable wear, the patient should be informed that no cleaning or disinfection is needed. Patients should always dispose of lenses when removed and have spare lenses or spectacles available. Lenses prescribed on a daily-disposable wearing schedule should always be discarded when removed at the end of the wearing day.
• Always contact the eye care practitioner before using any medicine or medications in the eyes.
• Always inform the employer of being a contact lens wearer. Some jobs may require use of eye protection equipment or may require that the patient not wear contact lenses.
• As with any contact lens, follow-up visits are necessary to assure the continuing health of the patient’s eyes. The patient should be instructed as to a recommended follow-up schedule.

ADVERSE REACTIONS
The patient should be informed that the following problems may occur:
• Eyes stinging, burning, itching (irritation), or other eye pain.
• Comfort is less than when the lens was first placed in the eye.
• Feeling that something is in the eye such as a foreign body or scratched area.
• Excessive watering (tearing) of the eye.
• Unusual eye secretions.
• Redness of the eyes.
• Reduced sharpness of vision (poor visual acuity).
• Blurred vision, rainbows, or halos around objects.
• Sensitivity to light (photophobia).
• Dry eyes.

If the patient notices any of the above, he or she should be instructed to:
• IMMEDIATELY REMOVE LENS.
• If the discomfort or problem stops, then look closely at the lens. If the lens is in any way damaged, DO NOT PUT THE LENS BACK ON YOUR EYE. Place the lens in the storage case and contact your eye care practitioner. If the lens has dirt, an eyelash, or other foreign body on it, or the problem stops and the lens appears undamaged, the patient should thoroughly clean, rinse, and disinfect the lens then reinsert it.
• After reinsertion, if the problem continues, the patient should IMMEDIATELY REMOVE THE LENS AND CONSULT THE EYE CARE
PRACTITIONER.
• When any of the above problems occur, a serious condition such as infection, corneal ulcer, neovascularization, or iritis may be present. The patient should be instructed to KEEP LENS OFF THE EYE AND SEEK IMMEDIATE PROFESSIONAL IDENTIFICATION of the problem and prompt treatment to avoid serious eye damage.

FITTING PROCEDURE (SPHERICAL)
Patient Selection
The practitioner should first assess the patient’s needs and characteristics necessary to fit with EXTREME H2O DAILY lenses. A through pre-fitting examination should be conducted to ensure the patient is a suitable candidate for soft contact lens wear.
Pre-fitting Examination
A pre-fitting examination is necessary to:
• Determine if the patient is a suitable candidate in terms of motivation, physical state, and willingness to comply with instructions concerning wear time and hygiene;
• Carefully evaluate the lids, lashes, conjunctival areas as well as the anterior segment of the eye for suitability for contact lens wear;
• Take ocular measurements for initial contact lens parameter selection; and
• Collect and record baseline clinical information to which post-fitting examination results can be compared.
A pre-fitting examination should include a case history, a spherocylindrical refraction, keratometric readings, tear assessment, and biomicroscopy of the anterior segment.
Initial Power Determination
The initial power selection should be as close as possible to the patient’s prescription after taking into account spherical equivalent and vertex calculations, if necessary.  Remember to compensate for vertex distance if the refraction is greater than ± 4.00D.
Base Curve Selection
A well-fitted lens provides good movement, centration, and comfort. This can be achieved for the majority of patients with the 8.6 mm base curve. However, corneal curvature measurements should be performed to establish the patient’s baseline ocular status.
Place a lens on each of the patient’s eyes and allow a 15 minute period of adjustment and equilibration.
Characteristics of a Well-Fitted Lens: A properly fitted lens will center and completely cover the cornea in all fields of gaze, allow sufficient lens movement to provide tear exchange under the lens during a blink in primary or upgaze, move freely when manipulated with the index finger on the lower lid nudging upward, and return to its properly centered position when released.
Characteristics of a Tight (Steep) Lens: A tight or steep fit may provide insufficient or no lens movement during a blink in primary or upgaze, resist movement if nudged upward with the index finger and/or cause fluctuating vision between blinks. If the contact lens is deemed to be steep fitting, do not dispense to the patient. A flatter lens (larger base curve) should be evaluated if available.
Characteristics of a Loose (Flat) Lens: A loose or flat fit may exhibit reduced comfort, decentration, excessive movement during the blink or in primary upgaze, and/or edge standoff. If the contact lens is deemed to be flat fitting, do not dispense to the patient. A steeper lens (smaller base curve) should be evaluated if available.
Final Lens Power Determination
After the lens fit is successful, a spherical over-refraction should be performed to determine the proper lens power to be dispensed.
Example: 

Diagnostic lens: -3.00D
Over-refraction: -0.25D
Final lens power: -3.25D

FOLLOW-UP EXAMINATIONS
• Within one week of lens dispensing
• After three weeks of lens wear
• After seven weeks of lens wear
• After each six-month period of lens wear.
At the follow-up examinations, the patient should report good subjective quality of vision. Adaptation to vision with EXTREME H2O DAILY (hioxifilcon A) soft contact lenses should occur almost immediately and should definitely be reported within the first (1 week) follow-up visit. At these follow-up visits the practitioner should:
• Check distances and near acuity with lenses in place.
• Over-refract to verify lens prescription.
• Observe the position of the lens on the cornea. The lens should be centered and move on upward gaze and with a blink.
• Evert the lids to examine the tarsal conjunctiva and check for incidence of giant papillary conjunctivitis.
• Remove the lens. Check corneal curvature. There should be no substantial changes in either meridian.
• Perform a slit-lamp examination with and without Fluorescein. Check for corneal edema, corneal abrasion, vascularization, corneal infiltrates, and perilimbal injection. Reinsert the lens only after all residual Fluorescein has dissipated from the eye.
• Clean the lens with a surfactant cleaner, and examine for deposits, foreign bodies or physical imperfections of the lens surface.

LENS HANDLING
Wash and rinse hands thoroughly, making certain all soap residues have been rinsed away before drying with a lint-free towel. It is suggested to wet the lens while in the eye using lubricating and rewetting drops before removal of the lens. Care should be used not to pinch the lens when removing it from the eye. Pinching the lens can reduce the life of the lens.
Always start with the right lens first in order to avoid mixing the lenses. In removing the lenses, try to avoid touching the inside (concave) surface of the lens. It is possible, though not likely, that the lens might be inside out; therefore, check the lens by placing it on the index finger and examine its profile. If the edges of the lens tend to point outward, the lens is inside out. After removing the lens from its container assure that it is clean, clear and wet.

LENS CARE DIRECTIONS
Eye care practitioners should review with the patient that cleaning or disinfection is not needed with disposable lenses. Patients should always dispose of the lenses when they are removed and have replacement lenses or spectacles available. Eye care practitioners may recommend a lubricating/rewetting solution which can be used to wet (lubricate) lenses while they are being worn to make them more comfortable. Note: Some solutions may have more than one function, which will be indicated on the label.
Read the label on the solution bottle, and follow instructions.
• Care for a sticking (non-moving) lens:
If the lens sticks (cannot be removed), the patient should be instructed to apply 3 to 4 drops of the recommended lubricating or rewetting solution directly to the eye and wait until the lens begins to move freely on the eye before removing it. If non-movement of the lens continues after 15 minutes, the patient should IMMEDIATELY consult the eye care practitioner.

RECOMMENDED WEARING SCHEDULE
Wearing schedule should be determined by the eye care practitioner. Close professional supervision is recommended to ensure safe and successful contact lens wear. If the patient complains of discomfort, decreased vision, ocular injection or corneal edema, the lens should be removed and the patient scheduled for examination. The problem may be relieved by putting the patient on a different wearing schedule or possibly by refitting the lenses. Patients tend to over-wear the lenses initially. It is important not to exceed the initial wearing schedule. Regular check-ups, as determined by the eye care practitioner, are also extremely important. The maximum suggested wearing schedule for EXTREME H2O DAILY (hioxifilcon A) soft contact lenses is as follows.

SUGGESTED WEARING SCHEDULE