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Kevin Buehler, Division Head, Alcon, discusses merger with Novartis

You joined Alcon in 1984 and rose steadily through the organization before becoming chief executive officer in 2009 at the age of 52. Is that type of long service and internal promotion a hallmark of Alcon culture?

In my first year with the company Alcon sales reached USD 300 million. In 2010 we passed USD 7 billion. It has been a privilege to watch from a front row seat as technology has delivered across all our businesses.

When you think about what we do to help patients preserve or even regain their vision – or the benefits we provide to surgeons and doctors – I can’t think of another business I would rather be in.

In terms of tenure, I am certainly not unique at Alcon. It isn’t unusual to be in a meeting where the majority of people have been with the company 15 or 20 or even 25 years.

Kevin Buehler

Kevin Buehler, Division Head, Alcon

As market leader, Alcon has been a driving force in transforming ophthalmic surgery

Absolutely – we have seen surgical procedures evolve in all our areas. Cataract surgery, of course, which is by far our biggest surgical business but also back-of-the-eye surgery for retinal disorders, as well as correction of refractive error, or LASIK.

We provide the entire basket of products used by surgeons, from lens removal equipment to replacement intraocular lenses, attachments and accessories that go onto the machines and viscoelastic products allowing surgeons to work effectively and safely in the small space of the eye.

The beauty here is that Alcon works hand-in-hand with new doctors, or doctors who are learning to use new technologies. This emphasis on education helps us develop strong and lasting relationships.

For cataract surgery, the preferred lens extraction method is known as phacoemulsification. Ultrasound waves break up the clouded natural lens that is removed with suction through an incision only a few millimeters in size. Today more than 90% of cataract extraction procedures in developed countries use phacoemulsification.

The incision can be so small because replacement intraocular lenses, made from acrylic materials, are folded in half for insertion and then unfolded inside the eye. Our AcrySof intraocular lenses are the most frequently implanted intraocular lenses in the world: more than 40 million lenses have been implanted to date.

The original intraocular lenses were “monofocal.” That means the correction normally was for distance vision and people would wear reading glasses for near vision. The next step is to what we call our advanced technology intraocular lenses – “multifocal” lenses such as our AcrySof ReSTOR lens. In clinical trials, ReSTOR has provided quality distance vision, as well as better acuities at near and intermediate distances, without glasses for a majority of patients. We also have created an AcrySof Toric lens that does the correction for astigmatism.

Traditionally, the eye care field has been divided into separate populations of surgeons who did either cataracts or refractive surgery. Patients aren’t interested in going to one group of doctors or the other – they are looking for the best available outcome.

So in the next two decades, I believe we are going to see surgeons who will become expert in using all of the technologies – becoming a one-stop source for the correction of any refractive error. Today you are already see early adopters who will use a AcrySof ReSTOR intraocular lens to get a patient back to 20/20 vision. Then, if they encounter some residual error, they may use a laser to touch up and get the patient’s vision to the original target they were trying to hit.

How will Alcon work together with the Novartis Institutes for BioMedical Research (NIBR) to strengthen drug discovery?

In ophthalmology, you often see rapid conversion and adoption of new products – that reflects the high level of unmet medical need for treatments against glaucoma, “wet” age-related macular degeneration and other eye diseases.

I believe working with NIBR will bring us access to many new molecules – an opportunity to get more shots on goal for eye projects – and leverage the division’s existing capabilities in preclinical and clinical development.

I’m excited by NIBR’s pathway strategy and the potential of these core signaling pathways to have an impact in ophthalmology. For example, inflammation is important systemically but inflammation pathways are very important inside the eye. And because the eye is self-contained, a closed system, it is sometimes possible to take a more direct approach in drug delivery, compared to medicines with systemic exposure.

What are the biggest advantages and benefits of being part of Novartis?

First, I want to emphasize that Nestle was very supportive of the long-term interests of Alcon, up to and including the last two years when a change in ownership appeared increasingly likely. Alcon did more business development transactions while the Novartis-Nestle deal was pending than in the previous five years. Nestle could have taken the position that we should have waited – but that was never the case.

On the other hand, everybody has to recognize the huge benefits associated with having a strategic owner like Novartis. Healthcare is not going to get easier over the next 10 years – it is going to become more challenging. Remaining a stand-alone specialty healthcare entity like Alcon is going to be more difficult. So being part of the larger healthcare structure of Novartis will be very insulating, and beneficial.

At the same time, Novartis has many capabilities that Alcon can leverage. I spoke earlier about collaboration in drug discovery. I believe that Novartis is much better at market access and reimbursement than Alcon, another benefit for us. And we can put more energy around our commercial efforts in emerging markets, because that obviously is a priority for Novartis as well.

The biggest challenge I see for Alcon within this beneficial strategic relationship with Novartis is not to lose what has made Alcon successful. We have to find the right balance, allowing us to remain tightly focused around the eye. And we have to continue to take advantage of growth opportunities in the nimble format of a specialty company that has worked so well – while leveraging all the good things offered by Novartis, without getting lost.