Revealing the “Silent Thief”

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

Glaucoma affects nearly 65 million people worldwide. Sometimes called the “silent thief,” it often causes irreversible damage before one experiences any symptoms. As a result, nearly half of those suffering with the disease are unaware of it. Although glaucoma has been identifiable for centuries, its cause is unknown in most cases. Currently, there is no cure for the disease, making it one of the leading causes of blindness around the world.

Glaucoma damages the optic nerve, the part of the eye that carries the images we see from the retina to the brain. There are many different kinds of glaucoma and a variety of treatment options for each. In the healthy eye, a clear liquid known as aqueous humor circulates inside the front portion of the eye. In order to maintain a constant healthy eye pressure, the eye continually produces a small amount of aqueous humor. An equal amount of this fluid flows out of the eye through a microscopic drain called the trabecular meshwork in the drainage angle. In glaucoma, the aqueous humor does not flow through the drainage angle correctly. As a result, fluid pressure in the eye increases. This extra force puts pressure on the optic nerve in the back of the eye, causing damage to the nerve fibres and peripheral visual field loss.

EyeOnHealth2Glaucoma comes in various forms. It is generally divided into three classes: open angle glaucoma, narrow angle glaucoma, and secondary glaucoma. Open angle glaucomas occur when the access to the drainage angle is open. While it is important to note that not all people with elevated intraocular pressures will develop glaucoma, it is well-established that elevated intraocular pressures are a risk factor for glaucoma development. A form of open angle glaucoma without elevated intraocular pressures is known as low-tension or normal-tension glaucoma. This form may be associated with poor blood flow to the optic nerve. Narrow angle glaucoma can occur when access to the drainage angle is blocked by adjacent structures inside the eye. This type of glaucoma can result in an acutely elevated eye pressure, which is a painful event known as acute angle closure. Often, a laser procedure called a peripheral iridotomy is necessary to prevent this acute event from occurring in at-risk eyes. Lastly, secondary glaucomas can result from a variety of intraocular or systemic diseases, from diabetes to retinal detachments to intraocular inflammation or uveitis.

There are various treatment options for glaucoma. The mainstay of glaucoma management today includes eye drops that serve to either reduce the amount of fluid produced by the eye or aid in fluid drainage through the pathways that already exist in the eye. In some instances, laser therapy can be utilized to help remodel the trabecular meshwork and facilitate improved outflow. The goal of glaucoma management is to reduce the intraocular pressure, thereby reducing the stress on the optic nerve and preventing visual field loss. It is important to note that once injury to the nerve fibres has occurred, it is impossible to reverse it.

As a last resort, ophthalmologists may turn to surgical options to lower the eye pressure. Trabeculectomy is a surgery in which the eye’s natural drainage system is bypassed by creating a natural filter through the eye wall. Other surgical approaches involve utilizing a glaucoma drainage device that can shunt fluid from inside the eye to a reservoir that is implanted under the conjunctiva.

In recent years, ophthalmologists have pioneered new forms of surgical interventions and implants that may improve outflow through minimally invasive means. The proliferation of MIGS, or minimally invasive glaucoma surgeries, aims to lower intraocular pressures through less aggressive surgical interventions like those mentioned above. While varied, these forms of surgery often attempt to manipulate the eye’s natural drainage system, as opposed to creating a bypass, to achieve results. Time will tell if these new surgical modalities will be effective in minimizing the progression of vision loss from glaucoma in the long term.

It is important to note that glaucoma usually presents with no symptoms in its early stages. Visual field loss from glaucoma is often peripheral, so even patients with advanced glaucoma may not be aware that their optic nerves have been damaged. Proper treatment can often delay or slow further vision loss that might result. It is particularly important for certain individuals to be evaluated for glaucoma. This includes those over the age of 60, the relatives of people with glaucoma, people of African descent and anyone with elevated eye pressure. While optic nerve damage is currently irreversible and there is no cure for glaucoma, vision loss can usually be prevented if the disease is detected in its early stages.

While Thinking Globally, Ronor Acts Locally

By Paddy Kamen

Robert Charbonneau and his company, Ronor International Inc., are not shy when it comes to participating in world markets. The 100 per cent Canadian-controlled firm expanded into China in 2006 as one of the first ventures allowed to operate as a wholly owned foreign investment under new central government regulations.

Charbonneau, Ronor’s founder and president, demonstrated his commitment to expansion by moving his family to Hong Kong, where they lived for almost three years. It was a fascinating business experience as well as a tremendous cultural immersion for the whole family. “It was a very positive experience for my son, who was eight at the time, and my daughter, who was ten. She is now fluent in Mandarin, which is a key global language,” says Charbonneau. “And we all learned what it means to be members of a visible minority group.”

Working through 11 levels of government to establish a factory in Foshan City, Guangdong province was, “relatively easy,” notes Charbonneau. “China is a place where you can accomplish great things if you know how. But if you don’t know the rules, speak the language and understand their protocols, things can move at a snail’s pace. The learning curve was much more difficult than anticipated and the project took a long time to get off the ground.”

But Charbonneau succeeded and the factory is now in its fifth year of production, employing more than 200 people who manufacture Ronor-designed lens cleaning products and cases. “It was surprisingly easy to find a reliable and dedicated workforce,” notes Charbonneau. “They are not particularly loyal to their employers but the vast majority work hard and do an excellent job. One of the most difficult things was to establish a good supplier base.”

While it was frightening at the time, the world-wide economic slowdown in 2008-09 actually helped Ronor to succeed, as Charbonneau explains: “The Chinese economy experienced only a quick purge of the weakest manufacturers, which was, in fact, a good thing. Business rebounded rapidly and there were fewer companies to share the same volume. Economic slowdowns force organizations to review their habits and procurement practices, so this turned out to be an opportunity to meet new customers. Suddenly, thinking outside of the box became urgent and new opportunities were created.

“While the whole venture of setting up in China was, in retrospect, riskier and more difficult than expected, one of the rewards is that we are now, as far as we know, the only Canadian and possibly the only North American-based cleaning lens products and cases company that is 100 per cent vertically integrated.”

Over the past year a rapid and sustained rate of inflation in China has caused a surge in export prices. “Thanks to a strong Canadian dollar relative to the U.S. currency, most of these increases have not yet been reflected in the Canadian marketplace but this can’t continue forever,” notes Charbonneau.

Going global for Ronor also means distributing their accessory products in more than 15 countries, including the U.S.– their biggest customer outside Canada. Most major American retailers, including Luxottica Retail, Costco, US Vision, and Kaiser Permanente, are customers, as are U.S.-based importers like Altair, New York Eye and Nouveau.

Canadian retailers are fortunate in being the first to benefit from distribution of Ronor’s fashion frames, reading glasses and sunglasses. Since going into the frame business in 2000, Ronor has continuously expanded that side of the business and aligned with some of the top names in the industry, including Eschenbach Optik GmbH of Nuremberg, Germany. In fact, the two companies will soon be announcing a five-year renewal of their exclusive contract.

“We are glad that our excellent performance has allowed us to forge such a strong relationship with this first-class German company,” says Charbonneau. “Eschenbach is known for their great design and superior quality and has won numerous international design awards. For at least the next five years, the love affair between Canadian opticians and the Humphrey’s, Brendel and Marc O’Polo brands, among others, will continue to be delivered through Ronor. Dealing with the best in the frame industry helps Ronor become one of the best distributors here at home.”

Humphrey’s is Ronor’s number one collection and the company sells more units of that brand per capita than are sold in any other country among the nine subsidiaries outside of Germany.

The other brands Ronor represents include New York Eye/Hart Specialties and house brands Nordic, King Size and 4U&I. The ‘Boutique Wholesale’ subsidiary Voila Vision Inc. distributes French designer frames Azzaro, Thierry Mugler, Smalto and licensed brands IKKS, and X-One.

Eighteen full-time sales reps bring the Ronor focus on service and customer satisfaction home to more than 3,500 accounts across Canada. “The caliber of our salespeople, most of whom have been with us for over 10 years, makes me confident that each and every contact point with our customers will be satisfying for them. We want every ECP to feel at ease trying all of our products and services because we stand behind them 100 per cent,” says Charbonneau.

Where is Ronor headed? True to form, there will be expansion both at home and abroad. “Here in Canada we will be growing by leaps and bounds with a mix of acquisitions and structural improvements aimed at making us the best service provider ever to Canadian ECPs,” notes Charbonneau. “A company like Ronor, with units outside Canada and customers worldwide, is best poised to deliver added value through our commitment to ‘think globally, act locally’.”

Robert Charbonneau, who has made the local and global growth of Ronor his life’s work, is expecting to hand over the reins of his company to a younger team within the next few years. “Ronor is the story of my life,” he says. “And before long I will enjoy watching it continue to grow while lying on a beach somewhere beautiful and sunny.”

No doubt Charbonneau will be thinking globally when he considers which beaches to visit between September and May. Come the Canadian summer, he’ll have plenty of ‘local’ beaches to choose from in La Belle Province and elsewhere in Canada. Don’t forget the sunscreen — and sunglasses from Ronor!

Can You Talk Technology?

Can You Talk Technology?
By Brian P. Dunleavy

Optical shop owner Steven Levy believes he has an advantage when it comes to understanding lens technology. His three-location business inToronto—LF Optical and LF Warehouse – began as an eyeglass-processing laboratory.

“The LF in the name originally meant ‘Lenses First,” he explains.

Even so, it hasn’t been easy for Levy and his staff of seven opticians to stay up-to-date on the latest in spectacle lens design. “Think about how it is when you buy a TV now,” notes Levy, who is not an optical practitioner but has been in the business for more than 20 years. “Three months later, if you walk up to the counter in the store with the same TV, the clerk laughs at you. It’s almost the same way with lens technology.”

Indeed, the past decade has seen a baffling array of technical enhancements in eyeglass lenses, from free-form progressives to digital single-vision. Keeping current can be a full-time job and it doesn’t help that lenses often take a backseat in optical shops to high-fashion frames, or that optometrists have taken an increasing interest in ocular biology and disease.

“Your garden-variety optometrist has not kept up well with new lens technology,” says Dr. B. Ralph Chou, MSc, OD, FAAO, an associate professor in the School of Optometry at the University of Waterloo and a practicing optometrist for more than 30 years.

Adds Madelaine Petrin, RO, an optician and professor in the opticianry program at Toronto’s Seneca College, “Our graduates know the latest lens technologies. For how long? That depends on where they work.”

Educators like Petrin and Chou feel strongly that eyecare practitioners – be they opticians in optical shops or optometrists with optical retail businesses in their practices – must improve their working knowledge of optics technology to ensure they offer their patients and customers the best eyeglass products available. According to Dr. Chou, studies have found that 50 to 60 per cent of optometrists’ income is derived from eyeglass sales, so they, “need to know how to hang glass because that’s where the money is.”

“Without a doubt, patients are more concerned about the ‘label’ on their frames than the actual lenses they house – or at least they are when they enter our clinics,” adds Dr. Alan R. Boyco, OD, owner of Image Optometry, a 14-location chain of optometry clinics in B.C. “But we’ve learned over the years that while a designer frame will elicit a lot of compliments for the patient, a ‘designer’ lens will generate a lot of new patients for our clinics.”

So how can eyecare practitioners stay informed on new lens technology? Continuing education meetings and courses for both opticians and optometrists are an excellent source of information on eyeglass lens designs. Both Boyco and Levy suggest having those who attend such programs share what they’ve learned with their colleagues in the optical shop or optometry practice through in-office workshops. Similarly, sending shop or practice representatives to local, regional or national conferences can help. Lens manufacturers are usually well represented at such events and more than willing to share information on their products. Once again, attendees can come back with knowledge to share with colleagues. Finally, lens-processing laboratories are also excellent sources of information on lens designs; lab personnel have hands-on knowledge of how new designs affect optics.

Above all, it doesn’t matter how you learn, just that you learn. It can make a difference in how your patients see, and whether they come back to you in the future.

“I want to offer our clients the best products available,” Levy says. “If they leave wearing nice frames, friends will ask, ‘Hey, where did you get those?’ If they leave wearing lenses with good optics, they will see better and tell their friends and family how knowledgeable our staff is. It is just good business.”