What Are the Risks and Disadvantages of Eyhance?
Posted , 20 users are following.
What are the risks and disadvantages of Eyhance? Looking into them as a possible lens choice in addition to Clareon
Monofocals.
2 likes, 183 replies
We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.
×
Notes on What Are the Risks and Disadvantages of Eyhance?
bob38868 Spring1951
Edited
I have not posted here for quite a while. I was frustrated with the interface (hard to find new posts in long threads) and the minder limitations on what can be shared but it had been almost 2 years with Eyhance Toric lenses in both eyes.
I was the "guinea pig" first Eyhance patient with a highly skilled local surgeon at a local highly aclaimed eye surgery center. We talked about Vivity originally however all of the study I did pointed to Eyhance being the safer approach to get low artifact eyesight with the benefit of a little more intermediate clear vision. I was lucky to have symetrical bow-tie shaped astigmatisim in both eyes that he thought he could likely total correct. The plan was to put my dominant right eye at plano and my left eye at .5 near sighted. The astigmatism was totally corrected and I ended up with .25 farsighted in the right eye and plano in the left. I had slight corner retinal tear out of my vision that needed spot welded with a green laser which was skillfully performed by a doctor I refer to as "nurse Ratched" as she was all business and no chit chat. The service included laser incision to help with toric alignment...and that is what they did with all patients. I got IV for both surgeries and only remember being asked to "look at the light". No complications at all and the thing that that stunned me after the first eye was done is that I had been watching old black and white TV shows in black and orange when I saw the difference between the new Eyhance eye and the left with the cataract. Also I got to see stars as pinpoints of light.
I ended up being able to read the office eye chart at a local Walmart eye doctor 3 months after 20/15 either eye and can completely function without glasses outside on partly cloudy to fully sunny days. I can read the dash and navigation map in my car any day however I can't read the map at night. I love my vision as I was near sighted with astigmatism to the point I needed progressive glasses which I always felt were a compromise. Glasses also limit peripheral vision so I have a wider panorama now. I can function mostly around the house without glasses however I have found I feel more comfortable in low light with + .75 glass lens German readers. When I work on electronics I put on a pair of 1.5 glasses to be able to see the circuit details and read components. I plan on getting some night time driving glasses that will bring the right eye to plano and the left eye .5 near sighted. I've already experimented with contacts and that combination is what I was hoping for with the surgery results. That combination gave me good night driving distance vision and I could read my navigation map.
In the process of setting up my sun room at the house for starting garden plants I built a photo controlled light switch using an accurate light sensor (+/- 5%) coupled to an Arduino feeding an opto-relay. I programmed it to switch the lights on when the light coming through the picture window dropped below 2000 lux. I had fun going to different locations of the house taking measurements and comparing the level where I could function best with no glasses. I found no problem down to 200 lux. Bright day noon outside the sun measured 65k lux. Daytime inside the house with lights off away from windows the house averaged around 5-20 lux.
I can read my iPhone mail and text messages indoors with lights on and it is really clear when outside during the day. The +.75 glasses make everything more comfortable and I can recognize neighbors at the end of the street with them on. I love the lenses and feel I made a good decision. My only sad part is the doctor missed the target we wanted however he said it could be +/- the target with all surgeries.
Night time going through the woods is not a problem with no glasses on after my eyes adjust...takes longer at 70. Total dark overcast nights are not as easy however I can do it if I have been out for at least 20 minutes. Clear moonlight nights are a piece of cake and fun again. No starbursts from lights however I do sometimes see a single ring around outside lawn LED lights at night. I can read my LED alarm clock at night 3ft from my pillow with clarity.
I also don't have perfect centerization in both eyes as the doctor told me at the original appointment that my angle kappa was to the point he would only do mono or Eyhance with my eyes.
I hope this helps others. I feel I made a good decision...even though I now identify as a guinea pig.
Spring1951 bob38868
Posted
Thanks for the detailed information. It is hard to find people with one to two years with any Monofocal so it is very valuable information. Eyhance Toric Lenses sound like the right choice for you. Appreciate the post!
karin08666 bob38868
Edited
Thank you so much bob38868 for posting this. I am trying to choose between Eyhance and Tecnis monofocals. My husband had monofocals put in 4 years ago, so I know what to expect from those. There are people who have posted on this forum with their outcomes days, weeks or a couple months after their Eyhance surgery, but I have only found one other person who posted about Eyhance a year or more after surgery.
Thank you for all the details, it has answered a lot of my questions. If I go with Eyhance my doctor is targeting for -.25 in the left eye and -.50 in the right eye, which sounds close to what you were hoping for. Nothing is ever a guarantee and my outcome may be different than yours, but it is always good to get as much knowledge and learn of other people’s outcomes as you can when making this big of a decision.
I tried progressive glasses years ago and could never get them to work for me; I guess my brain could just never figure it out. With Eyhance having a gradual increase in “power” levels I wonder if I would have the same problems with Eyhance. An excellent question for my surgeon perhaps.
Thanks again for sharing your experience with Eyhance. It was very helpful.
karbonbee bob38868
Posted
Wow. What an excellent outcome and thank you for the detailed report. Extremely helpful. I'm going for Eyhance in both eyes in a couple of weeks time, and reading your results has given me confidence in my own selection.
Spring1951
Posted
i think I read the same study. I just wonder how much sharper it would be for intermediate. Thanks.
Spring1951
Posted
My health plan only stocks a very few types of Monofocals.
karbonbee Spring1951
Posted
To blue light filter or not, the debate continues... Spring1951, I was just looking through results with regards to the blue light filtering, in particular with regards to AMD, and am seeing mixed results also. It's pretty much a fifty-fifty split, though what RonAKA says makes perfect sense. Here's some excerpts from a study that was funded by Alcon in 2019, so it's supporting the blue light filter (uses a lot of "coulds"), but which still has some really interesting information. It's long, but it's well laid out and easy to go through. It covers a number of topics, and what it had to say about circadian rhythms surprised me, and the information about the difference in night driving with a BLF IOL as opposed to wearing with blue light filtering was interesting also. Just replace the underscores in the link at the bottom with periods when you copy and paste it to read the whole article (this way it doesn't trigger a hold by the moderators).
.
"Blue light–filtering (BLF) IOLs were designed to filter short-wave light in addition to ultraviolet light and mimic the natural crystalline lens. Current studies indicate that BLF IOLs may provide protection from blue light–induced retinal damage and slow the development and progression of age-related macular degeneration. Additionally, BLF IOLs have been shown to improve chromatic contrast, reduce photostress recovery time, reduce glare disability and discomfort, and generally improve visual performance under glare conditions. Although a number of concerns have been raised about the relative risks versus the benefits of BLF IOLs, recent studies reported no adverse effects on visual function or contrast under photopic conditions, no long-term effects on color vision, and no detrimental effects on circadian rhythms with BLF IOLs. Based on the current understanding of the field, evidence suggests that BLF IOLs would be returning the eye to a more natural state compared with non-BLF lenses."
.
"Humans are not the only species that appear to be strongly influenced by blue light. There are aquatic animals and terrestrial species, such as prairie dogs and squirrels, that have evolved yellow intraocular lenses that act as blue light filters, as described by Walls and Judd and reviewed by Hammond.3,4 These filters are adaptations that developed in ecological niches where visual function could be impaired owing to bright sunlight and where damage could occur as a result of continuous exposure to highly actinic short-wave light."
.
"Humans have evolved specific mechanisms for producing intraocular blue light filters. The macular pigments (meso-zeaxanthin and dietary lutein and zeaxanthin) are naturally occurring intraocular filters found in the inner layers of the macula that absorb wavelengths between ~400 and 520 nm, with an absorption peak at 460 nm.5–7 These pigments can be found in very high proportion (over a log unit optical density) in and around the fovea (central 10°–12°), effectively screening central cones and rods of the retina.8 Empirical studies have found that this screening yields numerous beneficial effects to vision. For example, there are multiple double-blinded randomized controlled trials (reviewed by Mares) showing that supplementing lutein and zeaxanthin leads to improved visual function under glare conditions when compared with placebo."
.
"The greatest source of both high-energy ultraviolet (UV) radiation and blue light is natural sunlight; artificial sources of UV radiation include welding and UV lamps, whereas artificial sources of blue light include electronic devices (eg, computers) and some indoor lights.2,10 Blue light–filtering (BLF) intraocular lenses (IOL) were designed to filter short-wave light and, like many IOLs, to selectively reduce the transmission of UV radiation. Most of UV radiation is blocked by the native lens (UV-B, 280–315 nm and UV-A, 315–400 nm) or absorbed by the cornea (<295 nm).2 However, recent data indicate that clinically significant amounts of UV-B radiation reach the retina of individuals until about the age of 30 years;11 IOLs without significant UV absorbance could quickly lead to significant retinal damage.12 BLF IOLs were different than typical UV-filtering IOLs because of the addition of short-wave light filtering to their absorbance profile. Therefore, the resulting light transmission of a BLF lens resembled that of a healthy natural crystalline lens.13–15 The basic premise of the BLF lens was that replacing an opacified natural lens with a non-BLF UV-filtering IOL (which would have been more similar to the lens of a human infant than a healthy older adult) created an unnatural condition. The large increase in blue light transmission with a non-BLF UV-filtering IOL in an older eye (eg, an eye with short-wave photosensitizers like the lipofuscin fluorophore diretinoid–pyridinium–ethanolamine [A2E], a byproduct of light-induced release of all-trans-retinal16) may place older patients at unnecessary risk. The basic hypothesis behind the BLF lens was that returning the eye to a more natural state would represent better clinical practice."
.
"Damage initiated by excessive light exposure is also implicated in numerous other ocular conditions, such as age-related cataract and macular degeneration (AMD).17 Blue light appears to be especially damaging to the retina owing to the existence of photosensitizers in that wave-band (eg, A2E); hence, its ability to cause photochemical (not just thermal) damage. In healthy adults, visible light passes through the crystalline lens and macular pigments of the inner retina, both of which have the capability to absorb blue light.1 The crystalline lens accumulates oxidative damage with age, causing it to become yellow and absorb higher amounts of UV and visible short-wave light, thus providing increased protection from blue light.18 In an in vitro study, blue light has been linked to oxidative damage mediated by photoexcitation of the visual chromophore retinal.19 Another in vitro study reported that A2E-laden retinal pigment epithelial cells had significantly less damage when exposed to light through a BLF lens compared with a UV-blocking lens."
.
Read more...
(wwwncbinlmnihgov/pmc/articles/PMC6901063/)
Spring1951
Edited
Thanks for the article. I had read up a lot on the subject when I first was diagnosed with AMD and decided to use blue light glasses when on the compter etc. There is no proof that it helps but with AMD you do anything you can that might possibly help just in case it does help!
I had to make a decision on what lens to pick, Eyhance Versus Clareon. My doctor yesterday said she preferred Eyhance but both are good. I just wrote her and selected Clareon for several reason relating to AMD. I like the idea of the blue light filter also. I can't figure out if it is in the natural lens why all the IOLS don't have it?
karbonbee Spring1951
Posted
That is good that you made a decision. Ultimately it's what makes you feel the most confident and comfortable. I bought a pair of the blue light glasses myself for computer work, post surgery -- so can't test them til after that, but they weren't expensive so not a loss. Some people didn't find that they helped, but quite a few did. Many people found that their eyes didn't tire as much. I also bought myself a pair of glasses with plain glass in them. I figured that it wouldn't hurt to have a "shield" in front of my eyes while I adjusted. Some extra protection from moving objects and dust would be helpful especially while I'm healing. My surgeon thought it was a good idea also. I searched through glasses on Amazon and chose a relatively inexpensive, but well made pair that I could use for progressive lenses down the road if need be.
.
I also got myself a pair of polarized sunglasses that fit over top of the glasses. I did not know such things existed before, lol. I got a pair with a light tint so I could use them inside if need be, since I'm already sensitive to light, and apparently will be even more so initially after surgery. Bonus though is that the pair I got fit over top of my current prescription glasses, so I've been wearing them around outside. Even though the tint is lighter, they definitely cut glare outside. My current glasses are supposed to have UV protection, but I'm still bothered by strong light outside. I also gathered a selection of preservative-free lubricating drops -- my eyes are a bit dry to begin with and apparently the surgery makes them even drier while they're healing. Many people found a big difference in their vision and overall healing after they started using the drops in addition to the prescribed ones. My surgeon suggested that I start using the drops prior to the surgery so the eye would be in better condition when he did the replacement. I've really noticed a big difference myself since starting to use them.
.
Good luck!
Spring1951 karbonbee
Edited
That is a good idea about using eye drops, lubricant preservative free, prior to surgery and I am going to do that. also. I have clear safety glasses that I sometimes wear and the nurse I talked to said could be a good thing to wear while healing.
I have blue light glasses and can't tell if they help but somehow like to wear them on the computer? It is possible that my eyes are tiring less which is why I may like to wear them but can't prove it??
I have seen those glasses that fit over eye glasses and I think a great idea. I never wear glasses so I have never bought them. Yes, I walk around blind but somehow it doesn't bother me!!
Thanks again for bringing up the lubricant drops and info. you have gotten on them from others. I had forgotten about them and think that it is wise to use them pre and post surgery.
billy111 karbonbee
Edited
Yes, lubricating drops are very important. Make sure they are preservative free. You can get them in a multidose bottle. I used Alcon Hydration PF. They are not cheap but are worth it. It is also good to use those drops prior to getting eyes refracted for cataract surgery as they can give a more accurate refraction. And yes, cataract surgery can make the eye or worsen eyes already dry.
karbonbee billy111
Posted
I've tried a couple of them. The surgeon wanted me to start using them a month before surgery, so it's been three weeks now and I've noticed quite a difference. The clinic specified preservative-free, so the ones I got were as such. I got Refresh Plus (works great, but I hate all of the little plastic dispensers), HydraSense Advanced for dry eyes and their Ultra gel for overnight, Oasis Tears Plus, and most recently TheraTears. So far, the Refresh and TheraTears are winning for me. I thought that both of the HydraSense were doing a pretty good job, but then I got an irritating dry spot under the lid of one eye after vacuuming the basement ceilings and they didn't do much for it, but the Refresh eradicated it immediately, as did the TheraTears, the next time it happened. Refresh, HydraSense and TheraTears are all reasonably priced. The Oasis Tears Plus that I had read such great reviews about because it's main ingredient is glycerin, was pretty pricey (hard to find in Canada), and it's performance has been very underwhelming. Highly disappointed with it. People complained about the special dispenser of the bottle HydraSense uses, but I didn't have any problems with it at all. I much prefer a bottle to those little disposable individual treatments that the Refresh and Oasis come in. The TheraTears isn't listed as preservative free, but apparently it is.
RonAKA karbonbee
Posted
I think the most effective active ingredient in the dry eye drops is sodium hyaluronate. The amount in the various brands seems to vary. I don't think there is any at all in the Systane Ultra. The HydraSense Advanced Dry Eye drops I use, have 0.15%. The HyLo drops that my wife prefers have 0.10%. At Costco the HydraSense is about $24 for three bottles, and a bit less on sale. The HyLo is what I would call a ridiculous price at about $38 for one (same sized) bottle. There is a gel version of the HyLo that does have more sodium hyaluronate, but is even more expensive. Despite my sell job, my wife still prefers the 0.1% HyLo drops. They keep it behind the counter at the Costco pharmacy, due I expect to the small size package and the high cost - easy to steal!
karbonbee RonAKA
Edited
That's what is in the HydraSense, and it was my early on favourite, but after multiple treatments over a day and a half, it did nothing for that very dry spot under my eyelid -- turns out I have a blocked duct there. I wasn't big initially on the Refresh Plus, which contains Carboxymethylcellulose Sodium (0.5%), but after one treatment, that dry spot disappeared, so I'm now a fan. Just checked the TheraTears which cost $13.19 CAD for a 15ml bottle, with free shipping via Amazon, and it has the same main ingredients as the Refresh, and is made in Switzerland. Refresh just says EU, and I couldn't find the country of manufacturing for the HydraSense, though the main company, Bayer, is located in Mississauga (Ontario). Though I don't know if that matters much any more.
RonAKA karbonbee
Edited
Interesting. A CBC article today prompted me to do some research on the HydraSense Advanced for Dry Eyes drops. Apparently there have been some eye infections in the US that have been blamed on contaminated eye drops for dry eyes. My only conclusion from the article is that one should should avoid eye drops made in India. The specific bacteria which is resistant to treatment is rare in the US, but common in India.
.
CBC How U.S. officials solved the mystery of eyedrops infecting dozens with drug-resistant bacteria
.
In any case I have not found where HydraSense is made. I suspect it is on the product insert, but don't have one to read. In the process I discovered that HydraSense make two more products that have double the amount of sodium hyaluronate at 0.3%; Ultra Gel Drops, and Ultra Night Gel drops. I don't often have dry eye issues during the day, but I suspect I may have issues during the night...
karbonbee RonAKA
Posted
Yes, I'd seen the article about the drug-resistant bacteria in eye drops made in India -- thanks for reminding me. I just pulled out the insert from my boxes for HydraSense and other than the location of the office, there was no information about where they actually manufacture their eye drops. I went to their website, and nothing there. Did a general search, and nothing there either. So I just sent them an email asking where their plant is. I quoted the problems with eye drops made in India as a good reason why this information should be included on the product information.
.
I have the HydraSense Advanced for Dry Eyes, and their Ultra Gel for Dry Eyes. I didn't see the night time ones though. Reviews on Amazon were saying that the gel ones didn't look very gel-like, and looked to be the same consistency as the regular ones, but they are indeed thicker. A drop had fallen onto a jar of mine and when it dried, and it was quite opaque. So that inspired me to do a little comparison test, and the gel version was very much more opaque than the regular one, which dried thinner and almost clear. I was putting the gel ones in before sleep as I do wake up with my eyelids kinda stuck, and read reports of that being even worse after the surgery, but even those didn't fix the dry spot I had. My eyes in general though don't seem as dry when I wake from using them.
RonAKA karbonbee
Edited
Amazon, if you can trust them, says the HydraSense products are made in Germany which makes sense as I believe Bayer is a German company. And I see my wife's HyLo is made in Germany as well. I think I will give the Ultra Night Gel drops a try. I have had issues with my left near eye only being blurry when I first wake up in the morning. I use a CPAP and I can't easily read the screen when I get up. It clears up in 20 minutes or so. This is the eye that the Lasik surgeon thinks that I have keratoconus in. I'm wondering if I am suffering from this night time dry eye thing...
karbonbee RonAKA
Edited
I just doubled check, and saw that. The product insert says "Manufacturer: Bayer Inc., Mississauga, On". They have offices there and Calgary in Canada according to their website. I looked Bayer up and they are still a German company with subsidiaries in many other countries. However, I read that their aspirin is made in China, and they've recently added more plants there, so... I will wait to see if they respond to my query. They also bought out Monsanto in 2018, which would make sense for them to have a headquarter in Alberta.
.
"The German drugmaker last week opened the first phase of the 1.4 billion yuan ($213 million) plant in Majinpu in the Yunan province of China. At 111,534 square meters (1,200,542 square feet), it is Bayer's second largest over-the-counter products manufacturing site in the Asia-Pacific, the company said in a statement. Dihon started the plant in 2013 and Bayer took it over after its buyout of the Chinese company in 2014 in a deal that brokerage M.M. Warburg estimated at about €500 million ($680 million).
The first phase of construction has secured GMP approval for part of the TCM production line, Bayer said. But additional work is ongoing that will allow the company to start manufacturing Bayer's key TCM product, Dan E Fu Kang, which is marketed as a gynecological medicine for women's health indications including dysmenorrhea, a Bayer spokesperson said Wednesday."
.
I found their overnight gel drops on Amazon, so I will give them a try.
karbonbee RonAKA
Edited
Heard back from HydraSense. Not very reassuring, nor informative. Highly disappointing though.
.
Hello,
Thank you for contacting Bayer Medical Information for information regarding hydraSense® eye drops.
Please be advised that Bayer has manufacturing sites globally. In addition, ingredients are sourced from many different suppliers. Unfortunately, we are unable to provide you with the specific country that products are manufactured in.
We apologize for the inconvenience and trust this information addressed your request.
karbonbee RonAKA
Posted
Heard back from them, posted the reply, but it's waiting to be moderated. Basically, they either don't know, or don't care to share the information.
karin08666 Spring1951
Edited
Spring1951, if I remember from some of your posts you are having your surgery tomorrow. Just wanted to wish you well and for a great outcome. You have done a lot of research and came to a decision as to what would work best for you, and that makes it a good decision. It is a tough decision for all of us and research helps us make a good one. Take care and let us know how everything turns out for you.
I just heard I am going for my surgery on Saturday. Was totally caught off guard with that, but fortunately I had made my final decision on which lens I wanted, so that was good. I had been considering Eyhance, but after reading a lot of posts on here and doing some research, decided going for the Tecnis monofocal was the best choice for me.
Spring1951 karin08666
Edited
Thanks very much for the good wishes for surgery on Thursday! I have done a lot of work on this and have some answers but still wish I knew more. I was getting uncertain last nig about my Monofocal choice but reviewed some of the reasons why I chose Clareon and now feel more certain about the choice.
I will be going with the blue light filter despite thinking I might want the clear one. My doctor informed me that they stock Clareon blue-light filter Monofocals but would have to order the clear Clareon which would take a week. She assured me that both are equally good and has had a lot of feedback from patients with both. One of her patients has a clear one in one eye and one with a blue light filter in the other and can't tell the difference!
It is hard when they change the surgery date but I guess sometimes they have to do that! I am surprised you went with Technis Monofocal as I thought you were going with Eyhance. Both are excellent, however. I am sure you made the right choice given your research. Best of luck on Saturday!
RonAKA karbonbee
Edited
I did some more poking around trying to find out what country HydraSense is made in. Not much luck. It seems they have gone out of their way to be evasive on it.
.
In any case while looking I found this article which may be of interest. It is written by a Toronto Optometrist, and does have an extensive list of references, so it seems he put some effort into it. It claims to not be bias, but I noted a subtle push of the HyLo product...
.
DR. MIKE NG, OD COMPARING PRESERVATIVE-FREE EYE DROP PRODUCTS IN CANADA & LOOKING BEYOND March 4, 2020
.
His claim is that the HyLo Hyaluronic acid (HA) is of the long chain variety compared to short chain in the HydraSense product, and that the long chain is better. My conclusion on a quick review was that a higher % of short chain HA was better than a lower % of long chain. There is also a statement that the HyLo product was the only one approved for use after eye surgery.
.
In another article I read, the conclusion was that one should use a more standard liquid eye drop for dry eyes during the day and the more viscous gel type at bedtime. I suspect part of the reason for this is that the gel type can cause blurry vision for some time after putting them in. Just before bedtime that would not be an issue.
.
My HydraSense Gel Ultra Night drops are supposed to arrive tomorrow from Amazon. I will try it by using the HydraSense Advanced in the morning and the gel drops at bedtime to see if that helps my first thing in the day blurry vision.
karbonbee RonAKA
Posted
Interesting article. I've never heard of Hylo drops. I read a number of articles about the best ones to use, but the results were all over the place, so I then went over to Amazon and read reviews by people using them. I chose a couple to try out from there. Lots of articles supporting Refresh and Systane, though reviews in general on Amazon weren't that great on Systane -- people were quite underwhelmed by their results. Everyone's eyes really are different though, based upon reviews from users. I posted my response from HydraSense above regarding where it's manufactured, but it's being moderated. I haven't checked the forum, but if no one has done it yet, you should start a discussion on dry eyes/lubricating drops.
RonAKA karbonbee
Edited
Interesting. I am not sure that response really complies with the source country laws in the US or Canada. I would expect they should have a country on each container as to where it was at minimum bottled.
RonAKA karbonbee
Edited
I got my HydroSense Gel Ultra Night time drops today. The package insert just says:
.
Manufacturer: Bayer Inc. Mississauga Ontario
.
Not conclusive that it is really made there, or packaged there, or whatever....
.
I tried them and while the liquid does not look much more viscous in the bottle, and it comes out of the bottle with the same required very firm squeeze, it is clearly different in the eye. There is no issue telling if you missed with the drop or not. Vision becomes very blurry with a single drop hit! I would not want to try doing an eye test in the 15 minutes or so after the drop goes in. It does clear up though. Will be interesting to see if it helps my vision first thing in the morning, if I put one drop in at bedtime.
karbonbee karin08666
Posted
Good luck to you also, Karin on your surgery on Saturday!
karbonbee RonAKA
Posted
I got mine also. A bit of a difference I'd say, but it doesn't seem to be no more than just the standard Refresh Plus drops.
.
Bayer's response to me said, "Please be advised that Bayer has manufacturing sites globally. In addition, ingredients are sourced from many different suppliers. Unfortunately, we are unable to provide you with the specific country that products are manufactured in.". I'm going to reply that that is not very reassuring to their customers.