Author Archives: Envision Magazine

Sowing the Seeds of Inspiration

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mod. Beau

Spectacle Eyeworks expands their vast and versatile eyewear collection by adding eight new styles, three of which have yet to be officially unveiled. 

Modern, clean chic with just the right amount of flavor make the appeal of these frames undeniable, and extremely wearable. Stainless steel fronts matched with temples constructed of innovative and indestructible TR-90 make each design super-lightweight, while the plastic temple tips allow for customizing adjustments. This perfect union of materials brings comfort into the equation, a rare find in fashion.

To make things more intriguing, love was called upon for the inspiration of these new additions. The inner temples are beautifully and artfully decorated with a quote from an old Persian teaching. On one temple, there is the English translation, “Plant no seeds, but the seeds of love in your heart.” Mehran Baghaie, operations director and chief designer at Spectacle Eyeworks says, “I was always moved by these words and I wanted to share them by bringing some love and peace into my work. Just another touch to make each of these models unique and purely Spectacle Eyeworks.”

Each new style is available in five smooth matte colors, including classic black and radiant red. All frames include a signature case, point-of-purchase display, and one-year warranty.

A Promising Future for Ophthalmics

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By Evra Taylor

Canada is a major contributor to pharmaceutical and biotechnology research and development (R&D), investing close to $92 million in 2011. According to Andrea Gilpin, director, corporate communications, Novartis Canada, this separates us from many of our counterparts worldwide. “There are over 100 clinical studies going on now in Canada. They encompass such areas as primary care, established medicines, and Phase III and Phase IV studies,” explains Gilpin. “This year, we’re investing in three main areas – protein-protein interaction, biologics, and drug delivery,” she says.

Of the $92 million, 76 per cent was allocated to clinical research and a portion was earmarked for pre-clinical research. In a major R&D initiative in Quebec, Novartis Pharmaceuticals Canada has become the latest pharmaceutical company to partner in the Explore program of the Québec Consortium for Drug Discovery (CQDM), which funds small, unconventional and highly innovative research projects that may have an impact on the drug discovery process. Projects funded by Explore must have the potential for a breakthrough discovery that could lead to an important change in the current drug discovery paradigm or conventional wisdom.

Novartis has invested $300,000 in the Explore program, joining several other pharmaceutical companies, including AstraZeneca, Eli Lilly Canada, Merck and Pfizer Canada.

Diane Gosselin, president and CEO of CQDM, states, “We’re trying to fund and impact biopharmaceutical research where the most crucial needs are. For example, an antibody for macular degeneration or other conditions at the back of the eye would be of great interest for pharma members. Drug delivery for these types of conditions – anything that can improve the efficiency of the drug for the back of the eye – is important to us.”

While ophthalmic-related projects are not part of this year’s Explore line-up, they form a significant part of Novartis Canada’s business. “Lucentis is considered to be a key business driver for us. It was one of our biggest products in Canada in 2012,” notes Gilpin.

The current indications for Lucentis in Canada are age-related macular degeneration (AMD), visual impairment due to diabetic macular edema (DME), and visual impairment due to macular edema secondary to retinal vein occlusion (RVO). The importance of treating AMD, which typically affects older adults, should not be underestimated in light of Canada’s aging population. Another indication being sought in Canada for Lucentis is pathological myopia, an extremely high amount of nearsightedness that causes an alteration of the shape or globe of the eye and may lead to profound vision loss.

In 2011, Alcon merged with Novartis, uniting the strengths of Alcon, CIBA VISION and Novartis. The newly formed Alcon business became the second-largest division of Novartis.

Alcon has filed Jetrea™ (ocriplasmin) with Health Canada for the treatment of the sight-threatening eye conditions vitreomacular traction and macular hole. In October 2012, Jetrea was approved in the U.S. for the treatment of patients with symptomatic vitreomacular adhesion (VMA) and in January 2013, ThromboGenics launched Jetrea in the U.S.

Other big players on the Canadian eyecare scene include Bausch + Lomb, whose widely used Lotemax™ (loteprednol) reduces inflammation resulting from cataract and other types of eye surgery, as well as a number of eye conditions.

Allergan Canada markets Restasis®, cyclosporine eye drops used to treat dry eye disease, which is currently considered to be the most prevalent ocular condition in North America.

Eye diseases can have a devastating impact on quality of life. Fortunately, new pharmaceutical products are continually being developed to help those affected.

The Accidental Designer: Cynthia Shapiro Comes into Her Own

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By Paddy Kamen

Cynthia Shapiro is a woman coming into her own power: personally and professionally. She’s been doing so all her life. A designer of frames and a highly successful businesswoman, Shapiro is multi-faceted and dynamic.

Shapiro’s mother was an artist, as is her brother, and although she has always seen herself as a creative person, it was several years before this side of her personality married the capable business woman in her.

The first step in her development was as the inside manager of Europa International, an eyewear distribution company founded by Cynthia and her husband, Alan Shapiro (now deceased). “Alan had a background in the optical industry so we took a chance on an offer of partnership to start our own distribution company,” she explains. “We never looked back.”

Shapiro might never have taken up designing, except for the fact that much of the design and production that used to be done in Europe shifted to China. “At that point, we knew what our customers wanted and I was confident that I could deliver it,” explains Shapiro, whose design aesthetic is inspired by architecture. “I love clean, straight shapes and my designs are somewhat minimal. I like things that last a long time and I look for colours that will go with everything so that the eyewear carries the customer from one season to the next.”

Europa has always created their own brands; they now have seven ophthalmic eyewear collections:Côte D’Azur, Scott Harris, Scott Harris Vintage, Michael Ryen, David Benjamin, db4k (for kids), Cinzia Ophthalmic and Adin Thomas. Shapiro heads a team of designers, with her main focus of late on Cinzia Ophthalmic. “We re-launched the collection at Vision Expo East last year. The new, more defined frames have been very well-received within the industry.”

Business savvy is a gift that Shapiro has in spades. As just one example, she pioneered a product that is now taken for granted in the optical marketplace: fashionable readers. “I could see the demographic trend toward people needing readers and realized that there was nothing attractive on the market, let alone good quality at a reasonable price.”

Shapiro’s answer to this need was innovative: she saw the link between fashionable readers and matching accessories and so created Cinzia Designs. Just as there is an outfit for every occasion, just so there is a scarf, necklace, watch, handbag and attractive reader case for every woman with Cinzia readers.

At first, optical professionals turned a cold shoulder to the Cinzia concept. “They didn’t want readers at that time,” Shapiro allows. Undaunted, she sold the collection to fashion boutiques. Designers from around the world were eager to contribute their accessories to the Cinzia collections. “This has been very creative work and quite rewarding on many levels,” says Shapiro.

Optical grade readers and sunglasses for both men and women are available within the flagship Cinzia and Trendies collections. While Cinzia tends to be more conservative, with pieces designed to appeal for many years to come, Trendies offers light-hearted and playful pieces in line with the most current colour trends and fashions.

Cinzia and the other Europa brands are distributed in Canada by Rob Soloway of Cenoco/Central Optical Company. “Rob has been in the optical laboratory business for many years and he reviews every frame from an optical perspective,” says Shapiro. “He has made many changes to our designs over the years, and we love working with him and his family.”

The majority of Cinzia readers and sunglasses allow for easy replacement of their lenses with prescription product.

Since her husband’s passing three years ago, Shapiro has taken up the challenge of meeting life in a new way. “Alan said I should pour myself into our business and I’ve done that. After a hiatus to deal with his loss, I came out of my shell and put more energy into Cinzia Designs. I’m enjoying international travel with my staff. Our son stepped up to the plate after Alan’s passing and has taken to the business with great alacrity. His presence has made my life so much warmer and I am fortunate to get to see another side of him.”

Dividing her time between the Europa International headquarters nearChicago, and the design center and showroom in Scottsdale, AZ, Cynthia Shapiro continues to create a life of meaning centered around her family and business. The accomplished businesswoman and fashion designer is someone to watch, for she marries business acumen with the creative side of life. When asked what she does for fun, outside of business, she quickly responds: “Business is my fun. My heart and soul belong to the optical business.”

Incompatible Solutions?

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By Shirley Ha, BSc. (Hons), O.D.

Wearing contact lenses increases the risk of complications such as corneal infiltrative events (CIEs). Over the last few years, a growing number of reports show an increase in a newly classified, non-infectious CIE called contact lens-associated infiltrative keratitis (CLAIK). It is especially prevalent in patients using certain silicone hydrogel (SiHy) lens and multi-purpose solution (MPS) combinations[i],[ii],[iii].

Anecdotal cases from private practitioners are also on the rise, with two Minnesotaoptometrists recently claiming to have linked more than 35 cases of CLAIK to one leading contact lens solution.[iv]

Yet, according to Dr. Robin Chalmers and her team at the Indiana University School of Optometry, the incidence of CIEs was over three per cent per year in their retrospective chart reviews of 3,549 multiple-brand SCL wearers.[v],[vi] This is in agreement with Carnt et al., who also found a similar overall CIE incidence rate of 3.1 per cent with their 558 participants.[vii]

Additionally, 166 subjects, using more than 45 lens solution combinations in another retrospective, multicentre, case-control study showed no significant increase in CIE risk with any single contact lens brand, lens care product or combinations.[viii]

The relationship between “sterile” infiltrates and the use of SiHy-MPS combinations was first observed in 2007 when researchers identified fluorescein staining concomitant with infiltrates as a sign of cell cytotoxicity.[ix] Others suggested the corneal staining was not associated with infiltrates but rather related to the MPS preservatives binding to the fluorescein dye (PATH) and was transient and non-cytotoxic.[x]

Furthermore, new research is emerging to indicate that sodium fluorescein can enter and stain living or early apoptotic cells and solution-induced corneal staining (SICS) may not be an appropriate evaluation of solution toxicity anymore.[xi]

Some proposed that infiltrates come from the direct, physical insult associated with having a SiHy lens in the eye. The higher modulus SiHy material on the cornea, lids and adnexa triggers an antigenic or foreign body response to release inflammatory mediators that cause CLAIK, giant papillary conjunctivitis (GPC), corneal neovascularization, and mucin ball production.[xii] Also, SiHy fits are usually tighter than conventional hydrogels to prevent “fluting” or excessive edge lift. The poorer tear exchange, along with the absence of the blinking process on the back surface of the lens, allows debris, deposits and microbial biofilm, including released endotoxins, to build up and become additional stimuli for an immunological response.[xiii] The hypothetical pathophysiology may explain why some studies paradoxically show a two-fold greater risk for CIEs with silicone hydrogels than with conventional hydrogels.5

Other identifiable risk factors for CLAIK include, but are not limited to, exceeding the recommended wearing schedule and poor compliance, such as lack of hand washing, failing to rub and rinse contact lenses, case contamination, topping up solution, inadequate case hygiene, and not replacing cases at least once a month.[xiv]

Typically, patients with CLAIK will present with bilateral, small, diffuse, epithelial or sub-epithelial, grey, granular infiltrates in the central or entire cornea. They are different from the unilateral, single, round, sub-epithelial or anterior stromal, grey-white, mid-peripheral to peripheral infiltrates seen in infiltrative keratitis (IK) and in contact lens peripheral ulcers (CLPU) or the multiple, small-diffuse round white infiltrates seen 2-3 mm from the limbus in contact lens-associated red eye (CLARE).1 The eyes can be white to moderately injected with no corneal oedema and there is no overlying NaFl staining. Patient symptoms can range from none to acute burning, redness and photophobia, with some reporting prior milder episodes of hyperaemia that disappear when they give their eyes a break from contact lens wear.1

Fortunately, CLAIK can be treated without any long-term consequences. Because of its self-limiting nature, immediate lens cessation is a good place to start. Treatment can range from simple monitoring to prescribing topical ocular steroids, such as Lotemax or Pred Forte, or a combination antibiotic/steroid preparation, such as Tobradex, to decrease the microbial load. Once the signs and symptoms are resolved completely, wait at least eight days to see if the infiltrates reappear; if they do not, consider changing the lens care solution to another MPS or hydrogen peroxide system before loosening the fit or refitting to another SiHy or conventional hydrogel. Finish off with a discussion of lens hygiene and compliance or better yet, switch to a daily disposable lens without solution.1 

While it has been suggested that CLAIK may be associated with certain SiHy-MPS combinations, the non-consensus in clinical data make this debatable. Regardless of whether it is a growing problem or not, CLAIK is still a concern for the patient and the practitioner, especially if there are vision, ocular health and safety risks. Until we get definitive evidence that certain combinations of SiHy material and MPS cause CLAIK, it remains incumbent on the research community and lens product companies, in the interests of accurate diagnosis and appropriate risk management by eyecare professionals, to continue to investigate other aetiologies for CLAIK that might have been overlooked.

[i] SHOVLIN J, EIDEN S.B., et al. “Infiltrative keratitis in daily lens wearers: do you see what I see?” Contact Lens Spectrum. vol. 26, suppl, April 2011

[ii] SACCO A. “Contact Lens-Associated Infiltrative Keratitis and Multipurpose Solutions”. Contact Lens Spectrum. April 2011

[iii] KISLAN T.P., HOM M.M. “Corneal infiltrates with multipurpose solutions and contact lens combinations”. Investigative Ophthalmology & Visual Science vol. 51, suppl, May 2010, E-Abstract 3424

[iv] “Clinicians link contact lens-associated infiltrative keratitis to contact lens solution”, Ocular Surgery News,August 30, 2012.

[v] SZCZOTKA-FLYNN, Loretta B, CHALMERS, Robin. “Corneal Infiltrates: Managing Risks With Soft Lens Wear”, Contact Lens Spectrum. vol. 27, January 2012, p. 12-13

[vi] CHALMERS, R.L., MITCHELL, G.L., et al. “Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) Study”. Investigative Ophthalmology & Visual Science, vol. 52, no 9, August 2011, p. 6690-6

[vii] CARNT, N.A., EVANS, V.E., et al. “Contact lens-related adverse events and the silicone hydrogel lenses and daily wear care system “used”, Archives of Ophthalmology, vol. 127, no 12, December 2009, p. 1616-23

[viii] CHALMERS, R.L., McNALLY, J., et al. “Multi-center case control study of the role of lens materials and care products on the development of corneal infiltrates”, Optometry & Vision Science, vol. 89, no 3, March 2012, p. 316-25

[ix] CARNT, N., JALBERT, I., et al. “Solution toxicity in soft contact lens daily wear is associated with corneal inflammation”. Optometry Vision Science, vol. 84, no 4, April 2007, p. 309-15.

[x] KARPECKI, D. “The Science behind the Stain”. Contact Lens Spectrum, supp. October 2011

[xi] BAKKAR, May M. An investigation of solution-induced corneal staining using an in vitro model, A thesis submitted for the degree of Doctor of Philosophy (PhD) in the Faculty if Life Sciences, University of Manchester, UK, 2012, 244 p.

[xii] EFRON, N. “Contact lens induced changes in the anterior eye as observed in vivo with the confocal microscope”, Progress in Retinal & Eye Research, vol. 24, no 4, July 2007, p. 398-436

[xiii] OZKAN, J., MANDATHARA, P., et al. “Risk factors for corneal inflammatory and mechanical events with extended wear silicone hydrogel contact lenses”, Optometry & Vision Science, vol. 87, no 11, November 2010, p. 847-53

[xiv] SZCZOTKA-FLYNN, L., LASS, J.H., et al. “Risk factors for corneal infiltrative events during continuous wear of silicone hydrogel contact lenses”, Investigative Ophthalmology & Visual Science, vol 51, no 11, November 2010, p. 5421-30

Ophthalmic Equipment Takes a Giant Leap: Who Benefits?

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By Paddy Kamen

We’re seeing a renaissance in the ability of new ophthalmic equipment to diagnose and refract. Does this mean a bigger investment for practitioners? And how do end users benefit?

When something such as our ability to observe disease within the eye takes a giant leap forward, I think we can rightly say we have a paradigm shift on our hands. Such is the case with optical coherence tomography (OCT), a new technology that began as a research tool and leapt into optical practices a mere six years ago.

Tools for refraction have also taken giant strides forward with the commercialization of wavefront aberrometry. We cover this development later in this story, but first: OCT – what is exactly is it?

The word ‘tomography’ means imaging and is used in medicine to connote taking pictures of the interior of the body. OCT takes high-resolution, cross-sectional images of biological systems by measuring reflected light; it has been used to study the human eye since 1993.

Dr. Ralph Chou, professor emeritus at the University of Waterloo’s School of Optometry, says, “OCT looks through interference effects at the reflection of light off the various structures within the retina or cornea, and can resolve on the level of micrometres, so we’re looking at individual cells. It represents a quantum leap in what we are able to detect because we can actually see where changes have occurred in the living eye, without inconveniencing patients. We can now watch, monitor and see whether a treatment is working or not.”

Are OCTs becoming the new standard of practice? Chou says that while the cost of the equipment is prohibitive for many, “You must, at a minimum, be able to interpret OCT images. It is becoming the standard of practice and the level of care we have to understand and deliver. Even if you don’t have an OCT machine, you need to understand it so you can counsel the patient accordingly.”

Richard Maharaj notes that OCT is already becoming the new standard south of the border, especially in ophthalmic practice. The clinical director at eyeLABS optometry and dry eye clinic in Brampton,Ontario says, “Not many in optometry practices have OCT equipment yet, but sales are on the rise. In Ontario, where our scope of practice has changed, a lot of my colleagues are looking to purchase.”

Wavefront aberrometers also represent quite a jump in assessing vision. Ralph Chou explains: “Aberrometers project beams of light through the pupil. They don’t just measure at the very centre of the pupil but at a number of different points. Depending on the instrument, it can measure several thousand or more points within the pupil. The instrument has its own computerized system to analyze the findings and see which aberrations are dominant and which are not.”

Chou says that aberrometers are becoming more common because they have so many different uses.

Wayne Stobie, director of marketing for Innova, agrees with Chou and adds that aberrometers were originally designed to measure the eye for the most effective refractive surgery. Subsequently, they have been used for premium cataract surgery, and more recently, for wavefront-guided refractions for spectacles and contact lenses.

Maharaj takes a ‘devil’s advocate’ point of view on the subject of the relationship between measuring equipment and lenses: “The vendors who provide the equipment have also, in many cases, developed lenses to correct the aberrations they have just identified. So they’ve created their own market, which is very clever. At the same time, I have put patients through wavefront refraction and they have been astounded with the resulting quality of their vision. It definitely makes a difference to some patients. I wonder if we should recommend this all the time or just for patients with higher aberrations?”

Mayur Desai, owner of Toronto-based Downtown Eyecare Associates, purchased the Zeiss iProfiler® in 2009. Why did he make this investment? “I wanted to offer the best technology to help us provide comprehensive, hospital-grade diagnostic testing for the patient during the course of the eye exam,” he explains. “I was also aware that patients were having trouble getting access to the best testing within the traditional healthcare model. Typically they can wait up to three months for appropriate testing in Ontario.”

Desai gives the Zeiss i.Scription® Rx as an option to all his clients, informing them that it would be the best lens choice within a range of options. “What makes the lenses unique is that the optical aberration measurements give the lens an accuracy of 1/100 of a diopter. They are the most highly customized lenses available,” he explains.

Desai adds that people who have trouble reading in low-light conditions and have problems driving at night are perfect candidates for this technology. “This is because the aberrations become more problematic when the pupil is dilated. The system corrects for these types of imperfections.”

Since he initially purchased his aberrometer four years ago, Desai sees more of his colleagues investing in similar equipment, in addition to OCTs (which he also has). “They clearly want to raise the level of care in their practices,” he notes.

Ralph Chou weighs in on the benefits to the end-user obtained from the use of wavefront aberrometry: “There’s no doubt in my mind that new lens products designed from aberrometer readings will give patients the best possible correction that technology can deliver. The question is, will the patient put out the money for them?”

*****

In the rest of this article, we survey various new equipment options available to eyecare professionals (ECPs).  We cover a wide range of equipment, including several OCT machines and aberrometers, plus edgers, surfacers, and even an iPad application for office use.

Innova has provided ongoing equipment consultancy and support to Canadian eyecare professionals since 1986. Their engineers work with clinicians, helping them integrate technology into their practices. Wayne Stobie, Innova’s director of marketing, is particularly excited about the new systems from Nidek.

“OCT is quickly becoming the standard of care in practices acrossCanada,” notes Stobie. “In only six years we’ve seen huge developments in the quality and quantity of OCT technology, and the instruments are now affordable for every office. Our Nidek RS-3000L boasts next-generation SD-OCT design functions, including dizzying measurement speed (53,000 Hz), 6+1 layer segmentation, and 50 X HD macula scans. In addition, the RS-3000L has intuitive reporting, incorporating normative databases to ensure that treatment decisions can be made with confidence.”

Innova also offers the OPD-Scan III, a unique, advanced vision-assessment system that combines topography, wavefront, autorefraction, keratometry and pupillometry. As a stand-alone unit, or when combined with a Nidek refraction system, the OPD-Scan III optimizes efficiencies and helps to provide excellent eyecare while growing the practice’s optical revenue through increased directed dispensing. Stobie explains: “Nidek products work and speak together to walk clinicians through the whole refraction process, whether they are measuring for corrective laser surgery (Nidek makes a laser), cataract surgery or for eyeglasses or contact lenses.”

Essilor offers new tools to help eyecare professionals measure wrap, vertex, pantoscopic angle and eye rotation centre, with the ultimate aim of creating a superior visual experience for clients. The Essilor Visioffice® is for professionals who want to showcase their skills, while providing products that are better adapted to each consumer.

Visioffice performs and records up to 20 measurements, including the real 3D position of the unique eye rotation centre for each eye. The system recommends the best lens solution for every prescription, while also giving the client personalized, interactive demonstrations of the effects of different lens options. The system also takes photos of the clients in different frames, so that they can compare them from an aesthetic viewpoint. Visioffice is designed specifically for the high-end Varilux lens specialist. The newly introduced Swing3 is a similar measuring device geared to the entry-level market.

Continuous interaction between Essilor’s lens development and software application teams ensures that the new lenses and measuring instruments that make those lenses come to life are developed in tandem, explains Michel Cloutier, national director of instruments for EssilorCanada.

Also look for Essilor’s soon-to-be-announced entry into examination equipment. “We are building a variety of products, starting with auto-refractors, and training the presentation team,” notes Cloutier.

Visionix is a Luneau company in the same family as Briot and Weco. Visionix founder, Marc Abitbol, pioneered the first wavefront product for industry applications in 1997 and the first full refraction line based on wavefront in 2009. Joel Kozlowski, North American director for Visionix, says the L80 ARK Topo/Wave+ provides a 1,500-point measurement in 10-12 seconds. The single measurement gives daytime and nighttime refraction, in addition to corneal topography data, and full ocular aberration data. Based on the ‘gold standard’ Hartmann-Shack sensor, the L80 is fully automated, adds Kozlowski. “The limitations of traditional measurement devices no longer need to constrain us. With the L80, you get a much more accurate measurement, and it is priced significantly lower than the competition.”

And from Weco, the E6 edger is the fastest retail edger today and therefore the most productive, according to Sebastian Pena-Feldmann, product manager at Luneau Technology. “Due to the smallest edging wheels in the market, the bevel edging is perfect, even on high curved lenses. And the SD technology for complex shapes is absolutely innovative and cannot be found in this capacity anywhere else in the market. While capable of the most complex types of jobs, the easy-to-use interface offers confidence and skill for the edging optician.”

Topcon presents an innovative and stylish operating experience in the new KR-1 Auto Kerato-Refractometer and the new CT-1P non-contact tonometer with built-in pachymeter. With a history of dedicated service to eyecare professionals since 1963, Topcon positions itself as the leading distributor of ophthalmic equipment and supplies inCanada. These devices prove the point. More compact than previous models, they feature fully automated operation with an easy-to-use colour touch panel, which replaces the traditional type control lever. The adjustable control panel can be positioned in any direction. These machines are designed for flexible layout and incredible space savings, especially if they are combined. They can be installed in many different positions in the examination room: side-by-side, 90-degrees, or even face-to-face.

Peripheral ocular pathologies may go undetected but for Optos®’ patented ultra-wide field digital scanning laser technology. The newest addition to the Optos family of retinal imaging devices, Daytona provides simultaneous, non-contact central pole-to-periphery views of up to 82 per cent or 200 degrees of the retina, displayed in one single capture, compared to 45 degrees achieved with conventional methods. This desktop model offers multiple wavelength imaging, including options for colour, red-free and autofluorescence with green laser light.

The Optos 200Tx™ device was designed specifically for ophthalmologists and vitreoretinal specialists. It offers multiple-wavelength imaging, including options for colour, red-free, fluorescein angiography and autofluorescence with green laser light. With its advanced features like eye steering and ResMax® central pole resolution enhancement, it helps practitioners discover more evidence of disease and guide their treatment decisions.

All images are available immediately and stored electronically for future comparison or telehealth applications, and are compatible with image management and electronic health records (EHR) systems.

CobaltDS is the name to remember for surfacing systems from Coburn Technologies. The new system is based on considerable research and development. What sets the Cobalt apart? “There are several critical differences between the new Cobalt system and other high-volume digital surfacing systems,” explains Curt Brey, vice-president of marketing and business development. “The Cobalt uses a new cold mist cutting technology, which combines the benefits of a dry cut generator with those of a wet cutting process. It therefore eliminates the need for a large, high-maintenance water reclamation system, yet it produces a surface finish that may be the best in the industry.” 

The Cobalt leaves the final polished lens virtually haze-free without the need to apply hard coating for optical clarity and produces better-cut and polished free-form lens results. Brey adds that the Cobalt is ideal for ECPs who are looking to bring their lens surfacing needs in-house, and for existing lens processing labs. “This system is fast enough to support a production environment, but small enough to accommodate limited space, with a lower cost of entry than comparable systems.”

Optical practices with substantial clientele over the age of 45 can serve those clients better by offering Eschenbach Optik low vision aids. Eschenbach makes it easy to ascertain and fill a patient’s needs with their EasyVision and Low Vision Programs. As Canadian National Sales Manager Ryan Heeney points out, “Our diagnostic dispensing system finds an appropriate solution quickly, determining what device is appropriate and what level of magnification is needed. The system allows for successful patient outcomes, whether the solutions are intended to complement surgical or therapeutic treatments or in cases where the use of magnification is all that is available to help the patient accomplish their visual goals and activities of daily living.”

Eschenbach Optik has a proud history of innovation. “We have introduced a number of firsts to the marketplace, from the incorporation of diffractive lenses in magnifiers, to the creation of a patented cera-tec® hard lens coating, to the introduction of progressive readers. Our products are distinguished from the competition due to their high quality, as they are made inGermany according to ISO9001 standards. In addition, our EasyVision and Low Vision Programs are differentiated from others in the market due to the ongoing consultative support that is included with the programs.

Nikon is leading the way with the use of Apple’s iPad as a clinical device. The Nikon Imagine-i application (app) is an interactive demonstrator application and an exciting presentation platform. “With the iPad being so portable, lightweight and easy to use, it just makes sense for practitioners to use them in the office or store,” saysAngela Marsellos, director of marketing and communications. The app demonstrates the quality of Nikon products and helps eyecare professionals explain the advancement in lens technologies and show benefits in an engaging way.

“This app is for any practice that wants to set themselves apart by being able to really show patients the quality behind the products they offer. Cutting-edge, highly graphical and interactive, the Nikon app allows eyecare professionals to engage with their patients, and gives patients the information they need to make a more informed decision,” adds Marsellos.

The Nikon Imagine-i application is available as a free download on iTunes, but a password is needed to access the professional simulation tool. The password is available for purchase only through Nikon Optical Canada. Eyecare professionals will want to contact their Nikon representative to inquire about purchasing the password.

Also look to Nikon for a measurement device as an iPad-based solution, expected to be released later this year.

Western Eyecare Instruments (WECI) distributes diagnostic and other leading-edge instruments for eyecare professionals from all three disciplines. Recent products include the PLM 6100. “This is the latest auto-lensometer on the market,” says President David Black. “It makes reading the three main types of lenses easy and efficient, and is priced to accommodate even the tightest of budgets.”

The PLC 7000 is WECI’s most popular LCD flat screen auto-projector. It is more cost-effective and versatile than its predecessors, say Black, who is also happy to be selling the Potec auto-refractor keratometer. “This is fast, easy to use, and will print out the objective prescription. The patient simply focuses and the instrument does the rest. Among other things, it will refract over IOLs, read contact lenses, PD and take pictures of the anterior of the eye.”

The challenges for ECPs when considering what equipment to buy, and when, are considerable. There is no doubt a ‘salivation’ factor when presented with so many options that will save time and create better patient/client outcomes. How to choose? That is the subject for another article!

Looking at Cataracts

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By Netan Choudhry, M.D, FRCSC
and Jennifer George

Cataracts are a routine complication of aging and gradually begin to cause vision impairment. The condition is one of the leading causes of vision loss in adults aged 55 and older – in fact, over 2.5 million Canadians currently suffer from cataracts and this number is expected to double to five million by 2031.

The lens of a healthy eye is circular and biconvex, bulging outward like the surface of a magnifying glass. It is also transparent, allowing light rays to pass through it. This transparency is integral to the proper function of the lens. Similar to the lens of a camera, the passage of light through the lens determines the clarity of one’s vision. In a healthy eye, light can travel through the transparent lens to the retina, where it is converted into neural signals delivered to the brain. These signals become the images one sees. In patients with cataracts, however, a clouding of the eye’s lens occurs, resulting in blurred and out-of-focus vision. For the retina to capture a sharp image, the lens must be clear; having a cataract could be likened to seeing the world through a window covered in petroleum jelly.

Made primarily of water and protein, the lens has two main functions; it focuses light onto the retina, and it adjusts the eye’s focus, determining how clearly one sees objects both near and far away. As people age, some of the constituent proteins begin to gather, resulting in a clouded area within the lens. This clouding is called a cataract and it may grow over time, covering more of the lens and making it more difficult to see. Most age-related cataracts result from such protein gathering. While referred to as age-related, one can experience cataracts as early as one’s 40s, although they are more commonly experienced after age 50. During middle age, cataracts are usually less obstructive than in patients over 60, when most cataract-induced vision loss occurs.

The risk for developing cataracts increases with age, but many other factors also contribute to this condition. Diseases such as diabetes increase the risk of developing cataracts by up to 60 per cent. The high blood sugar levels that result from diabetes can cause the lens of the eye to swell, interrupting the focus of light. Ultimately, the lens will become clouded, blocking light and resulting in impaired vision. Oxygen-free radicals are naturally occurring molecules in the body and activities that result in their overproduction, such as smoking and excessive alcohol intake, along with ultraviolet radiation, harm nearly every type of cell in the body, including those located in the eye.

Several symptoms can indicate early-stage cataracts. Cloudy or blurred vision is one of the most common. Other symptoms include increased glare, double vision (in one eye) and poor night vision. Though cataracts can severely impair vision, treatment has greatly advanced in the last decade. In fact, cataract surgery has become routine in Canada, with more than 250,000 procedures performed annually. It is also one of the most successful surgeries, with over 95 per cent of patients reporting improved vision afterwards.

Not all cataracts require surgery. The symptoms of early cataracts can be treated with anti-glare lenses, brighter lighting and even new eyeglasses. However, surgery is often necessary if cataracts impede the treatment of other eye diseases, such as age-related macular degeneration.

There are a number of advances in the intraocular lenses used in cataract surgery, many of which involve correcting astigmatism, while offering both reading and distance correction. With the myriad treatment options and technological advancements available, the days of permanent vision loss due to cataracts have fortunately become a distant memory.

Transitions Academy Ignites Passion and Creates Fun

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By Paddy Kamen

Large photo – Grammy winning singer/songwriter Darius Rucker
Left inset – From left to right: Marie-Josée Mercier, vice-president of sales and operations, Lunetterie New Look, France Reimnitz, vice-president of marketing and merchandising, Lunetterie New Look
Right inset – Rachel Hill-Campbell, owner, Personal Optical

Fun, passion and incredible learning opportunities prevailed at the 17th annual Transitions Academy event at the Rosen Shingle Creek in Orlando, FLA this past January. Who had fun? I dare say everyone who attended the Darius Rucker concert. The former frontman for Hootie and the Blowfish performed his new-style country music at the closing event. Why Rucker? Because he is a celebrity ambassador for Transitions® lenses!

I imagine that all lovers of good cuisine had fun meeting Food Network® celebrity chef and long-time Transitions lens wearer, Robert Irvine, at the Transitions Academy.Irvine, host of Restaurant Impossible, is another 2013 celebrity ambassador for Transitions lenses. Chef Irvine made a special guest appearance during the North American marketing session, and joined Sherianne James, director, North America marketing, on stage.

Additional celebrity ambassadors for Transitions lenses in the coming year will include baseball legend Cal Ripken, Jr. and National Geographic reporters Annie Griffiths and Andrew Evans. All ambassadors were chosen after Transitions Optical conducted research into consumers’ interests and identified four top passions – music, sports, travel and food – giving them direction for 2013. 

The passion at Transitions Academy came through, not only in the enthusiasm these ambassadors have for Transitions lenses and healthy sight, but also in the incredible learning opportunities created in a series of FranklinCovey workshops. The “Working at the Speed of Trust” session provided tips for identifying and addressing “trust gaps” within a business and creating a more positive working environment. The “Five Choices to Extraordinary Productivity” session inspired employees to make more selective choices about where to invest their time, attention and energy. A third workshop, “Seven Habits of Highly Effective People,” provided attendees with tools to help maximize performance and reach career goals, both individually and as a team.

St. Catharines,Ontariooptician, Rachel Hill-Campbell, owner of Personal Optical, thoroughly enjoyed attending the Speed of Trust workshop. “I love the fact that the Transitions Academy gives us a choice of educational opportunities that help us strategically plan for further business success. Building trust with employees, suppliers and customers is key to my business and I got a lot out of the workshop.”

Hill-Campbell has been to five of the Transitions Academy events. “The Academy is wonderful every year, and I’m always excited to see how they will amaze us.”

And amaze her they did, for Transitions Optical selected Hill-Campbell as the winner of the 2012 Transitions Canadian Eyecare Professional of the Year award. Hill-Campbell was recognized for her outstanding efforts to promote eye health and the benefits of Transitions lenses in front of more than 1,100 optical professionals from North andSouth America.

“Rachel greatly believes in her profession. She has a flair and a strong ability to use grassroots techniques to build trust with everyone in her community,” said Christine Underhill, business manager, Transitions Optical, Canada. “She continually challenges herself to inspire everyone around her to think about what they can do to improve their vision and how Transitions lenses can help.”

Winning the award was a thrill for Hill-Campbell, an optician’s daughter with strong roots in the profession and the eyecare community in the Niagara region, where she was raised. In an interview with Envision: seeing beyond magazine, Hill-Campbell said: “My father, Hans Hill, previously worked for Sears Optical and I was privileged to meet many local eyecare professionals while growing up. It was wonderful for me to “come of age”, so to speak, as an equal at this event with so many colleagues from my career in attendance.”

Lunetterie New Look was also honoured as the first-ever Transitions Retailer of the Year inCanada. France Reimnitz, vice president of marketing and merchandising, accepted the award on behalf of the New Look team.

“We have a long history of doing everything we can to provide the best possible experience for our patients, and a big part of that has meant offering the entire family of Transitions lens products,” said Reimnitz.

“With their inspiring education tactics and incredible passion for the Transitions family of products, New Look was very deserving of the Transitions Retailer of the Year title,” said Underhill. “We congratulate them for their success in 2012, thank them for serving as a strong Transitions partner and for their contributions in providing valuable eye health education.” 

And so another fun-filled and passionate Transitions Academy has left indelible memories and inspired action in the hearts and minds of all attendees. This invitation-only event takes place annually. How do you get an invitation? Talk to your Transitions representative!

Canadians Turning to Online Investing

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By JoAnne Sommers


Canadians now use the Internet for everything from booking vacations to searching for new romantic partners. So it’s not surprising that growing numbers of us are researching and managing our investments online.

A recent TD Direct Investing Poll found that 41 per cent of respondents use the Internet to research their investment options; 22 per cent expressed comfort with managing their investments online and another 13 per cent said they invest online more frequently than they did five years ago.

The growth in popularity of “do it yourself” (DIY) investing has a lot to do with convenience, as well as flexibility and control.

“You can log on 24/7 and never need to make an appointment,” explains Robert Nuyten, a Toronto-based BMO InvestorLine consultant. “And online brokerages offer a variety of tools to help you manage your account with confidence.”

Online brokerage accounts can hold a wide variety of investments. BMO’s list includes mutual funds and exchange-traded funds (ETFs), guaranteed investment certificates (GICs) and bonds. Investors can also purchase individual stocks through such accounts.

Probably the most compelling benefit of the DIY approach is significantly lower commissions. “The average cost of a single online trade ranges from $9.95 to $29,” Nuyten notes. “By comparison, if you use a full-service broker it’s in the $100 to $200 range.”

It pays to shop around before selecting a trading site. There’s a wide range of online brokers to choose from and they compete intensely by offering special rates and deals, such as free trades for a specified period of time. Compare features, pricing and promotions carefully. You can also get recommendations from friends, family and co-workers, and visit investing blogs and financial discussion forums to find the broker that’s best suited to your needs.

Once you’ve chosen a broker, think about the purpose of your online trading activities. “What do you want to accomplish?” asks Nuyten. “Dabbling in the market is very different than building an investment portfolio. Your intentions will determine the type of account that’s best for you.”

To help you decide, there are advanced tools and features available on the direct brokers’ websites. You can also discuss the matter with a representative at your local bank branch.

DIY investing is not for everyone. Independence generally means limited or no access to financial service professionals when you have questions about risk or the suitability of certain investments. You’re also on your own when it comes to dealing with the emotional roller coaster of price swings and questions about whether to sell a holding that has appreciated or hold on to it in hopes of increasing your gains.

Online trading also involves a lot of work. Although all trading sites offer tools and huge amounts of research information, you need considerable self-discipline to work through all of it. So be honest with yourself – is this really for you?

If it is, then go for it. And good luck!

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Resources:

  • The Internet has loads of basic explanatory information for people who are new to DIY investing. Start with GetSmarterAboutMoney.ca, a non-profit site that provides good, basic information.
  • The investor education centre, Globeinvestor, at www.theglobeandmail.com is worth a visit.
  • Investopedia (www.investopedia.com) is another website worth checking out; it’s like an online encyclopedia.

A GPS for Investing

Online investors have traditionally been on their own when it comes to making decisions, but for those who want personalized advice and validation for their choices, BMO InvestorLine recently introduced adviceDirect. The fee-based service, which is unique inCanada, provides continuous portfolio monitoring and notifications and advises investors when their portfolios require attention related to asset allocation, level of diversification and poorly rated equities. It also lets you know if the portfolio has more risk than your investor profile allows.  

“The launch of adviceDirect represents a new way to invest and helps take the guesswork out of investing decisions by offering investors personalized advice so they can stay in charge of their portfolio,” says Robert Nuyten, a Toronto-based BMO InvestorLine consultant. “In many ways, it is like having a co-pilot to help you manage. Not only do we alert you, but we provide recommendations and advice about where to correct issues so your portfolio is aligned with your investment objectives.”

adviceDirect isn’t for casual investors: the minimum account size is $100,000, for which you get 30 free trades, and the cost is 1 per cent of the account value annually. For accounts between $500,000 and $1 million, the fee is 0.75 per cent and over $1 million it is 0.5 per cent.

The new service is very popular with BMO InvestorLine clients, Nuyten says. “Our feedback was that some self-directed clients wanted something between full service and complete independence. There was nothing in between those two extremes before and adviceDirect fills that void.”

More information is available online at www.bmo.com/advicedirect.

Your Future is in the Cards

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By James Ahola

Some years ago I worked at a car wash in Toronto. It was located in the parking garage of a downtown skyscraper and our client list included many of Canada’s elite – sports stars, powerful lawyers, famous architects and big business owners. They weren’t all stars but I quickly learned that every customer was to be treated like royalty. 

One faithful client came in at least twice a week with his late-model Buick Riviera. It had beautiful long lines, was in mint condition and obviously was a personal treasure to the owner.  One rainy day the client came in with his vehicle – one I had washed just two days before. I thought to myself, “Who gets their car cleaned on a rainy day?” Something in my demeanour betrayed me because he said, “What’s the matter? I just like to have a clean car.”

I smiled and washed the car. Then he left and that was the last time I ever saw him. His reason for not returning had nothing to do with product, price or service; it was because I made him feel disrespected.

Conversely, my friend Josée had a powerfully positive experience. She found herself with a small problem while attending an important business meeting outside the country. Unfortunately, due to extenuating circumstances, she didn’t have a good pair of dress shoes to wear. It was a small matter in the big scheme of things but if you’ve ever had a wardrobe problem, you know how big small things can seem – and Josée needed to be at the top of her game. She mentioned her problem to a workmate and was overheard by Marco, an employee of the company that was helping to put on the meeting. Marco politely interrupted Josée and said he knew of a place nearby where his wife loved to shop for shoes. He offered to take Josée there since the owners didn’t speak her language. My friend agreed. During a break in her schedule Marco took Josée to the shop where she found a perfect pair of shoes for the occasion and returned to the meeting without missing a thing. Marco came to Josée’s assistance several more times in the following days, finding a lost purse, repairing broken jewelry, and assisting with other small but important details. He went out of his way to personally see to her needs, none of which were his official responsibility. In a foreign country where Josée was at a disadvantage, Marco was her knight in shining armor. 

One thing is certain: if Josée ever returns to that area and needs the services of Marco’s company, competitors would have a very hard time winning her business. Others might be able to compete on product, price and services. But no one can compete with the fact that Marco made Josée feel like a queen.

Gaining new business is a combination of price, product and services, and, like in a game of cards, these kings, queens and aces are needed to survive. But to gain repeat business, all the power lies in the trump cards: in other words, how you make your customer feel. Once in play, trump cards change the game dramatically. With bad experiences and negative feelings, the trump cards are against you and you’ll be fighting an uphill battle. With good experiences and positive customer feelings, the cards are in your favour, and you become an unstoppable force.

Mastering Financial Literacy

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By JoAnne Sommers

What is your level of financial literacy? Perhaps not as high as it should be, judging by the results of a recent Angus Reid Public Opinion survey and financial literacy quiz of Canadian entrepreneurs.

The online survey of 500 small business owners across the country, conducted on behalf of Intuit Canada*, posed questions such as, “what is the role of the balance sheet?” and “how can short-term cash flow be improved?” The results indicated that the vast majority of participants face a serious financial literacy skills gap, said Jeff Cates, managing director of Intuit Canada.

“A large number of small business owners (83 per cent) scored either basic or below basic on the quiz (i.e., six correct answers or fewer out of 10),” he noted.

Intuit, a provider of financial and tax management software, suggests a likely root cause of the poor showing: while about half of the small business owners surveyed realized that they needed to spend time on financial management, only 11 per cent of them had sought professional help and resources.

“Starting a small business is one of the most empowering journeys one can take, but it’s also marked by an unrelenting series of obstacles – from understanding tax requirements to juggling inventory to managing payroll,” said Cates. “In order to succeed, small business owners must have the financial literacy skills needed to navigate these obstacles. Unfortunately, the majority do not.”

He pointed to recent Statistics Canada numbers showing that while 85 per cent of small businesses survive their first year, only 51 per cent are still alive after five years.

In addition to starting a business on a sound financial footing, Cates calls the ability to understand and manage everyday financial realities and challenges, “the key to long-term success [and] essential to reversing this trend.”

The survey results are very sobering, said Dan Kelly, president and CEO of the 109,000-member Canadian Federation of Independent Business (CFIB).

“Thousands of Canadians go into business each year, not because they are financial gurus, but because of other talents or opportunities. Many quickly learn of the massive demands on their time and attention – particularly in dealing with red tape, taxation and finance. While many entrepreneurs have terrific business instincts, they can become even more successful if they take the time to improve their financial literacy.”

Fortunately, there appears to be a willingness on the part of many entrepreneurs to do so. The Intuit study revealed that fully 88 per cent of respondents want to build their skills; another 42 per cent want to spend more time with an accountant, 24 per cent would like to attend information sessions with other small business owners, and 22 per cent want online tutorials to improve their skills.

Thanks to the efforts of government, banks, industry associations and non-profit organizations, there is a wide range of tools, resources and support designed to boost financial literacy among small business owners. Last fall, the Financial Consumer Agency of Canada, a federal government body mandated to protect and educate consumers – including small-business owners – about financial services, launched a free financial toolkit. Appropriately named “Your Financial Toolkit”, it includes videos, tools, case studies and 11 modules that can be completed in workshop settings on issues that include credit and debt management, income tax and financial planning.

Canada’s banks have experts available to work with small business clients and provide advice, either one-on-one or through business planning seminars, training opportunities, coaching podcasts, publications and seminars dealing with subjects ranging from efficient business management, business planning and funding sources to recovery of accounts receivable.

Scotiabank, for example, offers specialized programs and products that are designed to help small business owners get started on the right foot. In addition to its products and services, the site features advice-laden blogs and videos on a wide range of financial management issues. Scotiabank also offers new small-business customers its Running Start for businesses planning guide, as well as a complimentary copy of Intuit’s Easy Start accounting system.

BMO Bank of Montreal’s SmartSteps for Business is a new online tool that provides entrepreneurs with a customized plan to make their banking more efficient, while taking care of financial needs that go beyond their businesses.

And RBC Royal Bank of Canadaoffers what it calls ‘Definitive Guides’ for personal financial management for business owners. The current package includes guides on succession planning, growing and streamlining your business, as well as personal financial management.

Ultimately, it’s up to small business owners to take advantage of such services. Owners can’t be experts in everything but they can strengthen their businesses significantly by availing themselves of the skills and knowledge of those who are.

*The firms had operated for at least one year and employed up to 100 staff.