Episode 100 - Dr. Darryl Glover Interviews Harbir At Vision Expo East

Canada's number-one optometry podcast is celebrating its 100th episode. It’s quite a journey we’ve been on in The 20/20 Podcast! Harbir Sian welcomed several guests to his podcast, and they shared tons of insights into the eyecare industry. In this episode, Harbir celebrates the 100th episode of The 20/20 Podcast with Dr. Darryl Glover and friends live from the Vision Expo East. Harbir dives into his journey in the industry and accounts for the great experience he had in podcasting. Let’s journey back into memory lane and witness the growth Harbir shares in the eyecare industry.

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Dr. Darryl Glover Interviews Harbir At Vision Expo East

It is your favorite optometrist, Dr. Darryl Glover. I am excited because I get to hang out with this young man right here, Dr. Harbir Sian from The 20/20 Podcast. Canada's number-one optometry podcast is celebrating its 100th episode.

Thank you. I appreciate it. All thanks to you.

It is all you. You are a rockstar. Everyone in the eyecare industry knows your name, brand, and the value you create for the eyecare industry. That is why you have all these people here celebrating with you.

I am truly grateful. I got a lot of friends here joining us. Feel free to pop in and say hello if you guys want at any point, honestly. This is the 100th episode. I'm excited and proud. I get to celebrate it in the best possible way that I could, which is right here at Vision Expo East in New York. We are at the Vision Council booth with the man himself, Dr. Darryl Glover, and some other friends in attendance and sipping a little champagne. I can't ask for anything better.

I want to give a shout-out to the Vision Council because they have done an incredible job of putting on the Vision Expo. They do so much for eyecare in general. Thank you, Vision Council.

I wanted to say one real quick thing. My wife is going to read this at some point. I was trying to figure out what to do for my 100th episode. I was telling my wife a few weeks back. I was like, “What if I interview you for my 100th episode?” I thought it was a good idea. That is when I texted you, and you were like, “That was last minute.” I was like, “That is because I had another plan, and that got vetoed.” Here we are anyways. What are we going to do?

I want to walk through your journey of podcasting. Let's take it from day one, the first episode. Before you even got into the first episode, why did you want to start podcasting? What called you? What is your why?

The impetus for the show came years ago. I had my own eyewear brand. I was trying to launch that. I was connecting with many people in different industries. At the same time, on social media, I was connecting with eyecare people. Students, new grads, and people like that are asking me, “How do you think I can get to that level or escalate my business?” I was like, “I'm talking a successful people on one side over here who have these big businesses or athletes.” It is inspirational.

I want to share their message with the other people I'm talking to because I'm still on my journey. I like to share someone else's story. That is where it came from. I recorded 5 or 6 episodes before I ever announced I was going to do a podcast. I got 5 or 6 guests together, individually. I recorded 5 or 6 episodes to see if I felt like I was on something. I recorded this little trailer promo video. You might remember seeing that. I was like, “I like this.” I started doing it more. Initially, they were all in person in my clinic, and COVID happened. I went online and connected with you. Since you have given me that support, it has been amazing. The growth we have seen has been awesome.

It is bidirectional. I have learned so much from you. Every day, I grow with you. I'm excited to be here on this 100th episode. It is incredible why. You create value for the industry. That is why everyone is here to see you and celebrate with you because you are a rockstar in eyecare. Let's continue walking down this journey.

In the beginning, what were some of the challenges or gaps you ran into? When it comes to podcasting, it is still new. When you look at eyecare and healthcare, not a lot of people are doing that. I love to know what some of your challenges were. There are a lot of people out there that were like, “I want to start a podcast. I see Dr. Harbir Sian. I want to be the next 20/20 Podcast.” Have some gems on them.

The biggest thing I tell people is, in the beginning, I got too hung up on like, “I got to have a nice camera, nice microphone, and great lighting.” All of those things make a difference, but you don't need that stuff. I bought these cheap wireless microphones that plug into an iPhone for $30 on Amazon. I bought this light that was $50 or $70 off Amazon.

Within $100, I had what I needed. I recorded on my phone if I was doing a video. Otherwise, I did the audio. The biggest piece of advice I can give to anybody is to get started. There are going to be hurdles and stumble. You will stumble and all that, but once you get going, it is amazing how people see you actively doing something. They respect that enough that they want to support you.

The other little impetus to starting the podcast was a guy named Gary Vee. Everybody knows this guy. He used to say years ago, “Everybody should have a podcast.” He was like, “You are trying to call people up to get business from them or connect with them, and they are saying no. If you call them in and say, ‘I love to have you on my podcast,’ they will say yes.” I guarantee you it works. It has worked. You still got to be genuine, authentic, be good at what you do, and get good at it, eventually. That was it. Get started and do it.

I was trying to find clips that I could share on social media. I went back to Episode 50 something. That is far in, 40 to 50 episodes in. I was watching. I was like, “I can't believe I was timid.” It took me a while to get in comfortable with my own skin. A lesson I learned from a lot of colleagues is to be yourself. Whatever you are, geeky, nerdy, or super cool, just be you. I'm the geeky, nerdy guy. I lean into them.

When it comes to podcasts, it is like patient care. You got to be authentic, connect with the people or the person in front of you, and create value. That is what we do as podcasters. It is amazing. Let's continue walking down this journey. You have done 100 episodes. That is huge. Tell me about your top five episodes. Let's talk about that, starting with number five. Let me not do that because people are going to be haters out there.

Vision Expo East: When it comes to podcasts, it is like patient care. You've got to be authentic, connect with the people or the person in front of you, and create value.

There are a lot of nice people I have had on my show before. I don't want to upset anybody. I'm blessed to get to speak to the people that I do. If you told me several years ago before I started this show that I would get to sit down with you now in here doing this, or I got to chat with Adam, Wendy, or whoever on the show or special people, I would have said, “No.” Those people wouldn’t talk to me. It is like an optometrist with a clinic in Vancouver. They don't know who I am. It is crazy. We are not a superstar on a global scale, but it is still special within our industry.

We were walking in Times Square. We are a big crowd. All of a sudden, this young lady stops. I look at her beer, and he looks at me. She comes up and gives us a hug. She takes a picture with us. I was from the United States, and he was from Canada. You are a celebrity and superstar. To be recognized in Times Square in New York with all these people is a big deal.

I appreciate that, but only when there is a big vision conference happening in New York. If I come a month later, nobody is going to know who I am. Fair enough, that was special. Those little things that happen once in a while are funny. I got to go back to your question. There's one thing I did in 2022, and I called you when I had this idea. It was outside of my comfort zone. That was to do this series of episodes where I called out people in the industry. There are a lot of changes happening in the Canadian market. New entrants were coming in.

You called them out. You were real limply.

I was frustrated at that time. I called Darryl. I was like, “I want to do this thing.” I go on the show and say, “Specsavers, IRIS, and LensCrafters, I want you to come on the show and tell me where you think Canadian optometry is going and how you are going to make it a better profession in the future.” It was uncomfortable for me to go out. I felt like a nobody with a podcast, and they were going to be like, “Who is this dude coming on in public calling us out?” I did it. Thanks for the encouragement and a couple of colleagues I trust. They gave me feedback, and I did it. I got an amazing response. Everybody who I called out came on the show. Yuan was a wonderful person that gave me a lot of feedback on that series. Thank you very much.

You never asked me to be honest.

It is not over yet.

Come on over so you can be on a show.

Thank you very much for being here

It was a fantastic excuse.

What did you like about it the most?

You didn't throw any punches. You didn't hate things. You asked real questions. You were expecting a real answer. You asked the questions that we all ask. Whether you work for a corporate, a sole practitioner, are more interested in the medical aspects of optometry, or work in a clinic, you were there and you are genuine about it.

The hard thing was one was to put that call out. I even got some funny comments after. I put the thing out there before our provincial conference in Vancouver. When I went to the conference, I had somebody come by from one of these organizations. He was like, “People are not happy with you.” At first, I was scared, and I was like, “Good. That was the point.” They all came on the show and shared their story. That was a big turning point for me as a host to be comfortable asking the tough questions.

I love that you are able to bring people on a platform and give them a voice because, a lot of times, we don't know some of these organizations' stories. We go by what we hear, the rumor mill. You were able to bring all these organizations on your show to have an authentic conversation, and you have changed the eyecare industry. What else have you got for me? I know I told you the top five.

Vision Expo East: A lot of times, we don't know some of these organizations' stories. We go by what we hear—the rumor mill. Being able to bring all these organizations on for an authentic conversation changed the eyecare industry.

There were six episodes in that series. Dr. Hayley Wickenheiser, I always put this up near the top. I feel comfortable doing that because she is not in eyecare. She is the greatest women's ice hockey player in history and a multiple-time Olympic gold medalist champion. She's a big-time person in Canada. She was like Wayne Gretzky and Hayley Wickenheiser. In Canada, to be a superstar hockey player is a big deal.

She is now a medical doctor. She finished her hockey career. She still worked with the Toronto Maple Leafs in their head office. She went to medical school while she was doing that. She was now working as a medical doctor. She came on the show, and her number one message was all about grit, hard work, and mental toughness. I love that one a lot. It was special.

Give me another one. One more, and that is it.

It is tough.

That is why I'm glad I'm asking the questions.

I'm going to try to give something that comes right off the top of my head here. I like Steve Vargo. He came on the show, and this was one of the best episodes of the year. I recorded with him again. He got good insights. If I'm picking from my eyecare community, everybody who has come on has been incredible.

I agree with you 100%, but I want to put you on the spot a little bit. I want to put someone else on the spot a little bit. Wendy, come on over. I'm asking Harbir the questions. On the 100th episode, you had the opportunity to do a show with Dr. Sian. I love to get the guest's perspective on how he held the conversation, how he navigated the conversation, how he made you feel, and the value created after that show.

It is a lifelong friendship. We bonded virtually. We are meeting for the first time here in New York. It was a great opportunity for me to be on your show, but to hear his voice is calming and loving. You make people feel welcome. You love the industry. You love everybody. He wants collaboration and to bring us all together. I love what you represent. He is a style guy. The TED Talk is incredible. In a short period of time, you made such a mark on our industry. We became friends on your show. I follow and watch everything you do.

Thank you, Wendy. That is very kind.

Thank you for doing this with us, and congratulations.

I love that we were able to get that perspective because we talked about podcasting, but what do the audience and guests feel? You heard from the people. You are a rockstar. I want to circle back onto something that Wendy brought up, your TED Talk. How did that even take place? What was going through your head when you were on stage? Walk us through that experience because I feel like that is a part of your journey in podcasting.

It was an incredible experience. That is a bucket list item, the opportunity to give a TED Talk. I would never have expected it. It is funny how things come out of somewhere seemingly, but it is all the relationships you build over the years and connecting with people in an authentic way enough that leaves a bit of an impression that when an opportunity comes by, they think about you.

It is all the relationships you build over the years and connecting with people in an authentic way that leaves an impression so that when an opportunity comes along, they think about you.

They were doing a TEDx event in Vancouver. The organizer knew someone I knew, and that guy decided to throw my name in the hat. He was like, “You should talk to Harbir. He is passionate about eyecare.” At the time, I have this series of YouTube videos I've created called Chiasma. The optic chiasm is the junction where the two optic nerves meet. This is the geeky side.

It is the combination of two lines of thought. I brought together the two lines I thought were eyecare and philosophy. I made these videos where I’m walking in nature, and I'm talking about how important our eyes are. They saw those videos, and they said, “We like you to do something like this on stage.” I put that together. I was amped.

They were coming to Vancouver a couple of days before. People were flying in for this event to speak at it. I was one of the local speakers. A few days before the event, they have a rehearsal. You got to go and meet the organizers for the first time in person. I did a virtual thing before. They go, “Do your talk.” I was like, “What do you want?” They were like, “50%, 75%, and 100%, all in. Give me your talk.” I was like, “I'm not ready for that. I will give you as best as I can.” I did it.

There is one guy I had never spoken to before. He is sitting in the audience. He goes, “I don't get what you are trying to say. What is the point of your talk?” I was like, “I think I was clear that I'm passionate about eyes.” He was like, “No, you are flat here. This is not good. You got to change this.” I was blown away. I came back and rehearsed again a day later. He was like, “Go home and practice. Here are some notes.” I came back, and I did it with so much passion. Another person in the audience that I hadn't met before was like, “I don't know.” They even said to me, “It is too late to change the talk now.” I was like, “What? Do you want me to scrap the whole thing? Unbelievable.”

If you go to watch the TED Talk on YouTube, that is 95% of what I originally had. They gave me good advice like, “Change your tone a little bit. Slow it down here. What are you doing with your hands?” The content was almost exactly the same. Thankfully, it has gotten a lot of good feedback. I had let that feedback get to me two days before I was supposed to step on stage. Luckily, it didn't. I feel good about how it all turned out.

I was watching something on Instagram. It was this guy talking about, “Five minutes of the day can haunt you for the entire day in the next couple of days. We got to get out of the habit of letting that five minutes hold real estate in our brains.” You are a fantastic podcaster, the best out there. The TED Talk to me was next level. You do a lot of things. You are a podcaster and TED Talker and own two practices, corporate and private practice. What do you not do? With all these things that you have your hands in, how are you able to make it happen?

I appreciate the question, but the number one answer is that I have so much support and love at home. My wife is insanely supportive. I know that a lot of people don't get what I get at home as far as that. I have all sorts of crazy ideas in my head and all these little endeavors I want to do. She will always hear me out and rarely be like, “That is stupid.” She will, but she will hash it up. We have three beautiful baby girls that I like. I'm still here in New York. That is because my wife is flexible, accommodating, and supportive in a way that she knows these opportunities can pay off in the future in different ways. I have that.

I always run everything by her first. I'm like, “I'm going to do a podcast.” She was like, “What is that going to take?” I was like, “I'm going to go to New York for a conference.” She was like, “What is that going to take? What does that mean for our family? What does it mean for your time with the kids?” I’m setting all the priorities and doing all that.

I got support from my parents, my sister, and my cousins. I got support in the practice. I have my business partner who pulls so much weight that I'm able to come here and do this. I'm able to take time off to spend time at home with the family because I know that she can run things. I know a lot of people don't have it. What I'm doing and what I'm capable of is way further down on the list after all the people who are helping and propping me up. I'm standing on the shoulders of all these amazing people.

The supporting cast is heavy. I'm a firm believer like you. My wife is my secret sauce. Whatever I need, as long as she is there, she is going to make me great. My wife is my everything. She is my biggest hater and supporter. Imagine what those conversations sound and look like at home. I want to bring it to an end.

I want to read a quick text from my wife. She knows when I need a soft touch and a kick in the ass. She is not shy to use her tactics. I was tired and feeling jittery. I did two CE lectures. I was like, “I want to make sure these go well.” She texted me. She goes, “You will do great. You have done this many times. You did a TED Talk. F these guys.”

Don't you love it when your wife can keep it real and authentic?

She didn't mean F these guys, but she was trying to get me amped up like, “You got it.” I love that. That is the support I got. It is amazing.

You got a fantastic support system. You are shining. I’m looking at you. Your face is glowing. You are living your best life out here in these eyecare streets. I was going to ask you to wrap it up. We are in a profession where we get to help people with the most precious sense known to mankind, sight. You impact a lot of people, how eyecare professionals think, and how organizations create products and services. If you could give one piece of advice to all those people out there in eyecare land, what would it be?

The biggest thing that is top of mind for me is always thinking about the long-term outlook for our profession. We want to care for our patients, but if our profession is not growing, expanding its scope, strengthening, and elevating consistently, we are not going to be able to continue to provide the care that we want to provide and take care of. Like you said, the most precious sense that we have is our vision.

There are a lot of factors and disruptive forces that come in that sway the way we practice and how we think about our practice. It's constantly thinking about how we can make it better, and a big part of that is working together and being collaborative. In a place like this, the energy is always great. One of the things I said in my presentation is collaboration over competition.

I always have that mindset of working together. You will find amazing people like Darryl and all these nice people that have come and said thank you or said hello on the show. It all comes from collaboration and helping each other. People want to help each other. It is insane. Please lend a helping hand to somebody. Maybe even more importantly, if you need help, ask somebody for help. One of the best ways to connect and create a bond with somebody is to ask for help. They help you, and you create this lasting bond. Helping each other to elevate the profession is the last message I want to leave.

Congratulations. We got to toast to that. I'm excited and proud. I'm speechless. A hundred episodes are under your belt. It is fantastic. God is good.

Your superpower is that you empower other people.

That was Episode 100 of the show. I'm doing Episode 101 shortly after this. You want to look out for that one with my wonderful friend, Dr. Claudine Curry. It is going to be an amazing episode. Thank you, Dr. Glover. Before I wrap up, I should have done this before I did the little close out there, but I said it many times, but 100 episodes, all the connections I'm making, the people I'm meeting, the fact I'm here in New York, so much of it is thanks to you.

I'm not the only person to say this. Many people say this about you. No matter where I am. Think about Obie out in Africa. Different people in different countries, in different states, and Canada, people know you and love you. The number one thing I said is, “Your superpower is you empower other people.” I feel that you have empowered me. Thank you very much. See you in the next episode. That is enough smooching and bromance here.

My wife is going to get jealous. Peace.

Important Links

• Dr. Darryl Glover

• Dr. Hayley Wickenheiser – Past Episode

• Steve Vargo – Past Episode

• Chiasma

Episode 99 - Causes And Impact Of Burnout: Dr. Steve Vargo

Physician burnout—a topic that is top of mind for many medical professionals. Fatigue and loss of interest at work can lead to "depersonalization" with patients and a dramatic decrease in productivity overall.

In this episode, Dr. Steve Vargo discusses some of the causes of burnout and takes a broader view on how to resolve the issue. While activities such as exercise, yoga, and meditation do help, Dr. Vargo believes the longer-lasting resolution comes from HOW we provide patient care.

Connect with Dr. Steve Vargo:

Website - https://drstevevargo.com/

Instagram - https://www.instagram.com/dr.stevevargo/?hl=en

LinkedIn - https://www.linkedin.com/in/stevevargo

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Causes And Impact Of Burnout: Dr. Steve Vargo

This conversation is going to be a very important one. It's an important topic that's been front of mind for so many clinicians these days and that is about physician burnout. There's no better person to speak to about that than my friend Dr. Steve Vargo. Steve, if you don't know him already, is a Practice Management Consultant with IDOC. He is a multiple-time published author and a sought-after speaker and the host of his own podcast called the Eye Own a Business podcast. Thanks again, Steve, for joining me here on the show. I appreciate it.

Thanks for having me back and congratulations to you. As we were talking before, we got logged on here, almost 100 episodes. We are almost there. At Vision Expo, you are going to record the big 100.

Thank you very much. I was going to drop that little nugget here. This will be episode 99 that we are in here. If anything, 99 might be better than 100 because of Wayne Gretzky is the great one. Ninety-nine makes you the great one here, Steve. We will have a special little celebratory episode coming up next for the big 100. Thank you very much. Steve, why don't you give us a quick little intro if you wouldn't mind? Tell us a little bit about yourself for those who haven't met you or know too much about you.

I practiced for years in the Chicago area and I took a bit of an unusual but interesting path where I stopped practicing about a few years ago and I transitioned into the practice management side and joined a group at the time called Prima Eye Group. About a year into that, we were bought by a group called IDOC which I work with now. It's very rewarding in a different way. I'm not seeing patients anymore, but I get to work with a lot of different practice owners to guide and give them some of the support they need to operate a successful practice.

Your books have been very helpful to me. They are great. I got one of them right here. This one I love, Prescribing Change was a great book. I know you released it as an audiobook. Tell me a little bit about that so people know where we could find that.

I did go back at the request or I had the question come through enough times, “Do you have an audiobook?” I got tired of saying no. Even though I don't like the sound of my own voice, people always tell me I have got that FM radio voice. I put that together and thought, “Maybe I can record it myself because I auditioned a few people to do it.” When I heard it back, I just thought, “That is not the way I want it to sound.” It wasn't the way in my head that it sounds.

I recorded it. I haven't done that one yet. That's a project ahead, but I did one in a couple of my earlier books, Eye on Leadership, and the other one But I Don't Sell. How to sell without being salesy? How to have those conversations with patients? I did make audio versions of those. That one's still yet to come, but you can certainly get the Kindle or the paperback version.

It's cool to see that you are expanding into those different areas because audiobooks are huge. I don't listen to audiobooks as much as I used to, but for a couple of years that's all I did was audiobooks. Your books are great. I don't want to get too off track here because we got an important off-topic to talk about but the conversation about selling without selling is an uncomfortable place for optometrists especially.

For those who don't know, Steve was on the show last time, and the first conversation you and I had was about that stuff. It was talking about prescribing change and talking about how to sell and things. Please go back and read that. That was one of the top episodes. People liked it. There's a lot of value in that. Please go back and check that one out. Burnout, I'm hearing this term a lot these days and is it just me? Is it just now, all of a sudden, there's a lot of it or is it been around for a long time and we hadn't known what to call it? Why is it so prominent right now?

It has been around for a long time, but it's become something that's grown that's become more problematic, especially with healthcare professionals. I wish I could remember her name, but there's a doctor that does a lot of speaking on the issue. Listening to hear her speak was the first time that I heard the extent of it and I started doing my own research on it.

What I found is the impact it has, not just on the physician, and our mental well-being, our physical, and our emotional states, but also how it translates into the outcomes we get with patients. Even if we want to go down the road of practice management, ultimately, it can affect the financial health of the practice. Some quick stats, over 50% of US-based physicians claim to be experiencing burnout. Forty percent claim to have varying levels of depression and the suicide rate of physicians is twice that of the general population. That's staggering. We have to look at that and say something's not working here with the way the healthcare model is set up right now.

Causes Of Burnout: Over 50% of US-based physicians claim to be experiencing burnout. 40% have varying levels of depression, and the suicide rate of physicians is twice that of the general population.

I didn't realize that the suicide rate is double that of the average person so the non-physician population. Over 50% say that they are suffering some burnout.

The highest suicide rate of any profession is among physicians.

I’d be interested to see because the term physician is broad and there are different forms of physicians within that. I wonder if there are some in there that are dramatically higher than others and what those might be. How about optometry? Do you feel like it's a common condition or common issue that we are dealing with?

Burnout, that's a great question. I apologize for not having it in front of me, but you can look that up. There is a breakdown of the different professions. Off the top of my head, I just can't remember what those are.

Is burnout an issue in optometry? Not suicide. That's a heavy topic that maybe is for another time.

I hear it a lot in my consultations with other doctors as well. I will give you a quick background on me. I did practice for years and we can go as the discussion moves on into what some of the hallmark signs of burnout, but I was experiencing some of that. I'm a sample size of one. I don't know when I was practicing what other people are experiencing until I started doing more consulting and working with other doctors.

It's always interesting because nobody ever reaches out to consulting, which is the full reason. It's always typically something that has to do with the business side or practice management. I need to lower my cost of goods. Can you help me hire an office manager or train somebody? It's those sorts of things. The more the conversation would develop and the more you get to know somebody, perhaps trust starts to develop a little bit more and people would start to open up about a lot of the more emotional problems that they are having. That burnout, that stress that they are experiencing started to come out and I thought, “This is much more prevalent than I ever thought it was.”

That was something else I was going to mention right off the top. One, it's spoken about a lot more now, but there are likely still so many more people who are maybe embarrassed to talk about it or for whatever reason don't want to talk about it, but they are experiencing it. Even those who are experiencing it and don't even realize that's what it is. You said over 50%. I bet you it's like quite a bit higher than that even.

For the person who perhaps is not sure, “Am I experiencing burnout or what I might be dealing with?” from your conversations, what have you learned? What were you able to tease out from those people who initially were like, “I need an office manager,” but then you realize that they were dealing with burnout or they came to that conclusion themselves? What are some of the signs of that?

If we look at the hallmark signs that research has found, and this is specific to physicians, this is one of the initial things we will typically experience when we are burned out. Let me also mention, to some degree, we are always going to feel some amount of stress and burnout. Everybody gets depressed once in a while. Everybody has days where they don't feel like going to work, but we need to decipher what is normal and where have we hit a point where we need to change something.

One of the initial hallmark signs of burnout is what they call depersonalization, which is probably the opposite of the reason that we got into healthcare. If you were in optometry school, if we could bring ourselves back to that time when we were maybe in optometry school and say, “Why are you here? What do you want to get out of this profession?”

You'd probably mentioned something about wanting to make a difference and make an impact in other people's lives, wanting to help people, not just their vision, but their quality of life. Depersonalization is when we lose that. When we stop seeing patients as human beings and start seeing them as appointment slots or transactions and then healthcare starts to become much more transactional as opposed to relational, we lose those connections.

Imagine going to work every day, and a lot of people feel this way. I started to feel this way. At some point, you look at your appointment sheet and you see a bunch of names on there. You start to lose that ability to make that connection with people, and we can dig more into this. Once you do that, it affects not only you but also affects the patient as well because I don't think you can be there. Be present, be reading, caring, empathetic, compassionate, and all those things that require that connection and the high quality of care and also the perception that the patient's going to have of you so it snowballs.

We want to get into that because there's a lot more. As you said, it snowballs from there. There's a lot more that will result from that lack of connection, that depersonalization. Before we get into that, maybe you could share some more of the signs, those hallmark signs of burnout. First, you mentioned this absence of human connection or this depersonalization. What would be another one?

One is the absence of a sense of accomplishment. We put ourselves in a position and again, these build on each other. If you are going to work every day and you are unable to connect, there's a ton of research showing that when we are able to connect with patients that the adherence to treatment goes up significantly, and they have done that by surveying patients.

Patients who rate their doctors as great readers. People who are very caring, empathetic, and listen to the patient that their adherence to treatment is upwards of 60% better than when there's not that connection with the physician. When there's that depersonalization, we are not building that connection. We are bouncing from room to room. Again, it's very transactional. If you look at it through the numbers I gave you, there's a greater chance that we are not getting the results and outcomes we want with patients.

It's frustrating when you are just talking to patients all day and they are nodding their heads but they are not going along with your treatment guidance. If a patient walks in your door with their glasses broken in half, there's a pretty good chance they are going to buy a pair of glasses, and that's something we are used to.

A lot of doctors now are trying to implement more advanced services and products into the patient experience. A lot of them at the same time spend a lot of time talking to patients, sometimes talking at patients and the patient doesn't go along with what they'd like the doctor to do. There's that lack of a sense of accomplishment where you are going to work. Now there's a personalization combined with this feeling that I'm not making a difference because my patients aren't agreeing to the dry eye therapy, myopia management. They are not buying into these products or services that could help them.

The last one would be emotional or physical exhaustion when you hit a point where you feel exhausted. What should be meaningful encounters with patients starts to become exhausting, then that would be another hallmark sign of burnout as well. To some degree, we are always going to have a bad day. If you are going to work every day and if that describes normal for you, then you have probably hit a point where you want to sit back and take stock of, “Am I experiencing a high level of consistent burnout? What do I need to change at this point?”

A hallmark sign of burnout is when what should be meaningful encounters with patients start to become exhausting.

I feel like that third one is probably the one that if you said, “What does burnout sound like?” it'd probably be something like what you mentioned there, that emotional or physical exhaustion where you are burnt out physically. There are other signs of that, even if you are not necessarily feeling that exhaustion, that depersonalization.

The absence of sense of accomplishment would be hard to deal with. It seems like it would become this negative cycle at that point and then you would start to feel more exhausted because you are not getting the results you'd like to get. If we could go back to that first one, how does that then affect other aspects of your work, your business, and things like that?

Maybe we flip this around to give the opposite scenario. Imagine a scenario where you were able to make that connection with patients and patients felt heard and understood. We have all been there. We have all had that experience with a patient. We can all think of at least one and hopefully more where we felt like we did understand the patient. We listened to the patient and felt understood.

There was that connection and the patient let you know that you made a difference in my life. I want you to imagine for a minute how you felt at that moment. You probably didn't feel exhausted. You probably didn't feel stressed or burned out. You had a tremendous sense of connection and accomplishment with that patient.

A lot of this is built around how we change the way we practice. I might be getting a little off-topic here, but a lot of times when we think of how we handle burnout or stress, we think of it in terms of what they call escapism. “I need to get away. I need to go on. I need to take more vacation days. Get away from patient care, exercise, or more meditation. I need to get away from it all.” Practice fewer days and see fewer patients.

Those things can't help. Especially the exercise, meditation, and all those things certainly can help, but what they found is the effects are typically moderate at best because it doesn't get into these other areas. You still have to come back from a vacation. This is what you are experiencing at work. It all filters into how the practice works.

It's a bit of a transition here, but again, if you are not able to make those connections with patients, you are not able to get the outcomes you want. What does that typically mean for the success of your practice? You are selling more glasses or you are selling fewer glasses. More people agreeing to advanced dry eye therapy or fewer. More parents signing up for myopia management or less. More referrals or fewer. If you are not getting that, you'd like to translate into negative outcomes for the financial health of the practice as well.

Causes Of Burnout: If you are not able to make those connections with patients, you are not able to get the outcomes you want.

When you put it that way, it does help frame that whole mental state that you are in. In my mind, as you were talking, I was starting to think about all these different things about neurotransmitters. You talk about dopamine when you are feeling good and all these kinds of things. You are probably getting a hit of all of that good stuff when those good things are happening. On the flip side, you are not getting those good interactions and you are not making that connection.

Adrenaline and bad things kick in.

All the bad chemicals that we don't want are likely floating around. I never thought to put that together. It's cool to look at it that way. I'm a nerd about that type of thing, but the other thing, if you don't mind me going a little bit off track here. They reminded me of something that I heard a while back about, somebody said to me like, “What makes you happy right now? Is it thinking about your past? Is it thinking about where you are right now or is it thinking about where you are going to be?”

My thought was, “What determines my happiness in the moment is likely where I am right now. I love having the show. I'm pretty happy right now. If I knew the next thing I was going to do after this was to go do something that I hate doing, it would affect my mood right now and affect my ability to connect with you, Steve.

If I'm sitting in this room with a patient and I hate this job and then I know the next thing I got to do is go see another patient, I'm likely going to be unhappy now. In fact, going on that vacation's not going to help because as the vacation comes to an end, I'm going to go back to that same job that I was trying to escape from. It all leads to that and it becomes a negative cycle.

You talked about escapism and perhaps meditation, we know that helps a lot. It's not the way to treat the root cause of this issue. How would we get to that root? I feel like a hard thing to answer, but ultimately, we want to help define the problem. We want to help people understand whether they are dealing with this or not, but then also how they can remedy this or potentially start to make it better.

I don't think there's one right path. I do think for a lot of physicians, it's time to rethink how they are practicing, and how they are providing patient care. We got into this through a lot of the changes in healthcare. I don't want to blame EHRs. The way we have to practice now is different and we don't have that time to sit down and interact with patients as much.

It's a balancing act for me too because one of the things that I consult with a lot of practices on is how we operate efficiently in a way. A lot of practices in this era that we are in especially with vision care plans will want advice on how I see more patients. A lot of discussions I have are around how we operate patient care in a way that's perhaps faster where you could see more patients but at the same time without compromising clinical care or the patient experience. It brings us back to sitting down and, maybe I will ask you this. If you had to pick a certain, how long do you think that on average a doctor spends with each patient in the exam room? I know that it varies.

Fifteen minutes.

That's exactly what I would say. Let's say fifteen minutes, and I know there are some that are quicker and some are longer. How do you spend that fifteen minutes? If you are walking in the exam room and you are taking it as a very transactional experience and doing a bunch of tests on people, it becomes very mundane and routine. You are bouncing from room to room, but you are not taking that time to understand. Have a conversation with the patient. Make eye contact.

Could we change how we practice? That could be through more delegation, it could be through more automation, or it could be through having a scribe. Getting to that point because I don't want the conversation to go, “We have to see more patients.” “Are you telling me I need to spend longer?” “No, not necessarily.” What I'd like to look at is if we take that fifteen minutes, how can we better use it? Do get that feeling back that we are making a difference. If you are my patient, I get to sit down and we can have a conversation here. At the end of that fifteen minutes when you are walking out of the room, you feel good about the experience and I feel good about the experience that I provided.

You used the word delegate in there a couple of times. That word's come up a lot over the last years or so with different guests that I have spoken to in the series of conversations about where's the future of our profession going and so on. When I would ask the heads of these organizations and people who have hundreds of clinics under their banners what they are doing, they tend to be at the forefront of the technology and stuff because they want to implement and make their business more efficient.

The term delegation came up a lot. They are saying, “The doctor's going to be doing less of these tasks. There's going to be technology taking care of these things.” Perhaps in a few cases, doctors may have a scribe. I feel like that's a lot of where our headaches or stress levels come from. I got to run these individual tests by myself. I don't have the time to sit and connect with the patient. If that's taken care of, that does open up a lot of time for the connection piece.

That's what you have to do. Open up time. Create time. I did a podcast with Dr. Selina McGee and we were talking about dry eye and in particular nutritional supplements. One of the questions I asked her was, “How do you find the time?” A lot of times, I will hear from a doctor, especially if they are trying to introduce maybe some specialty care specialty products, but it's not working.

A lot of times what they will say is, “I wish I had more time. It's a very busy practice and I'm spending a lot of time trying to keep up with the routine care with the testing and the things I need to do. With routine care, I don't have time to talk about dry eye therapy, nutritional supplements, myopia management, or whatever else it is.” I pose that question to her and her answer got me thinking again about that efficiency issue. How do we change the way that we structure that exam slot that we have or our individual time with the patient?

She mentioned a few things. She goes, “I have had to learn how to be succinct in communication and focus on what are the most important things that I need to talk about.” Deciding early, what direction do I want this exam to go? If it is a direction, I think this person would benefit from IPL, myopia management, or whatever it is that we start working in that direction, but also being succinct with communication.

She goes, “Very rarely am I communicating with the patient but not doing something else.” We were taught in school to sit down and do a long case history. It's me and you talking, and then we do a bunch of tests. In the end, we come up with our diagnosis and then we educate the patient, but could we do that while we are doing other things?

She points out that there's an art to it because you still want to make that eye contact. She says it's something she's worked on but she feels like she's moving, talking, and educating at the same time but also with a lot of delegation. She goes, “I know what I need to discuss in the exam room and where my value is at. There are other things that I might give them handouts or a video to watch. I put a lot of effort into training the staff so they can pick up the conversation when I'm done.”

Let's call it that fifteen minutes. She feels pretty good at the end of that fifteen minutes that she made a difference in the lives of her patients. That's a doctor who enjoys going to work. Now does she enjoy every day? Probably not. Does she have her days? Probably like everybody else. She's human. We are all human. However, when I listen to doctors who say, “I love my job,” almost always, 100 times out of 100, they have figured out a way to construct an exam where they have that time to have that connection with the patient.

Causes Of Burnout: When doctors say, “I love my job,” almost always they have figured out a way to construct an exam where they have that time to have that connection with the patient.

By the way, I'd listened to some of that and there was something about her getting rid of the patient history or something like that. Right at the beginning of the like not spending so much time on taking a big history.

That's the efficiency conversation. There's not one right way for every practice to do it, but it's good for the owners and for the managers to sit down and say, “What do we want this to look like for the patient?” They walk in the door to the minute they walk out and some of that discussion should involve, “What do we need to stop doing?”

That leads me to another question that I want to ask you, which is so important and personally feel from my experience that is very relevant to the feeling of burnout or unhappiness perhaps in the workplace. That is the culture that offices and the different staff have, whether it's your office manager, your optical staff, or the team that you have. You are going to see all these different practices and work with different doctors. How often do you see that work culture affecting the physician’s feelings and then the risk of burnout at the end of the day?

It's huge. I'm glad you brought that up because it's related. Even if you enjoy patient care but you don't enjoy the people you work with, it's going to be difficult to be happy at work. It is hard. It's one of the hardest things for a business owner or a manager to create a positive culture anyway. It's always worth fighting for. If we dig into the research, what the research has shown is that if you don't have good relationships with the people you work with, the risk of burnout skyrockets.

Even if you enjoy patient care, but you don't enjoy the people you work with, it's going to be difficult to be happy at work.

Another thing that you should probably look at is how much of this is on me and building the culture I want. I need to find the core values here and what we are all about. Do I need to rethink how I'm hiring? I know it's difficult to hire these days, but maybe it's not just about experience, but what kind of people, attitudes, attributes, and qualities we want to bring in here. Once we have defined what culture we have and does it require to do sometimes the hard decisions of letting somebody go who are not a good fit?

I don't know how many times I have heard this fear of letting somebody go because maybe it was a key position, but then saying afterward how happy everyone is that person isn't there anymore because they were not a good fit for the practices. Something else you want to look at as well is the culture and the people. Who are there every day that's going to play a major role in your own happiness with your job?

I know this from my personal experience as a business owner and as we have grown. When you have 1 or 2 staffing and are small, it's easy to manage and oversee that. When you get to 5 or 6, one bad apple can start to affect the overall feeling. When you start to get to 10 or 12, then it's hard because you may have a couple of bad apples and it's hard to know because some people are good at hiding it. It's weird people personalities.

Having a good structure and having people who have good responsibilities or understand their responsibilities of taking care of certain things will help you uncover when there are bad apples. It's important as I have learned to try to pick those out quickly. Nip things in the bud as early as you can even if it seems hard.

I have been through the process where I haven't done that early enough and I have seen the outcomes. We have done it quickly. In my opinion, multiple fold benefit. One is that you have gotten rid of the negativity that cores from the epicenter, and now that's gone. Staff will see that you are taking the initiative or doing the thing that needs no they know needs to be done and you care about how the other staffs feel at the office and it breeds a better culture overall.

As the business owner, if you are even the doctor working in that culture, it's going to help you feel better because everybody else is looking at you as somebody who's looking out for them. It's extremely valuable and very important. In fact, I was speaking with Dr. Carly Rose on the show. She was talking about that and how the hardest thing is letting people go.

She's like, “You'd love to be the leader who helps somebody flourish. You'd love to be the person that someone says, ‘He's the one who helped me take it to the next level as a leader. He was amazing.’” Sometimes you have to be the leader who's at the person's rock bottom and you have to be the rock bottom for that person. That is going to be valuable for their life as well. I never thought about how that is important as well. Taking totally off on a different tangent, but talking about staffing and HR and stuff has been a big topic these days. Give any thoughts you have on that little spiel that I gave there.

As a leader, it's your responsibility as well to look out for the potential for burnout among the people on your team. If you are not creating the right environment, if you are not intentional with that, this doesn't work. The focus of this talk has mostly been on the burnout of the physician, but from the patient's perspective, the only touchpoint, it's not that the doctor's the only touchpoint. There are a lot of touchpoints. If you are delivering that high-quality care, you are a good listener, the empathy and everything that goes into that, delivering that great patient experience, but your staff is burned out, what experience is that going to be for the patient?

As a leader, it's your responsibility as well to look out for the potential for burnout among the people on your team.

I will share a quick story with you about a chiropractor I used to go to. I have some lower back issues. I liked the chiropractor. I thought he was a nice guy. He was very thorough. I thought it was odd because every time I was in there, I didn't get that same experience from the staff. The staff could be very short, sometimes rude and they didn't deliver that same experience.

I knew one of the people who worked there as a girl I'd gone to high school with. We ran into each other one time it was the grocery store and we were making small talk. I said I like the doctor. When I mentioned that to her, she looked at me for a second and she indicated something to say, “What a jerk he was.” I said, “That's odd. I never got that when I went in there.” She goes, “No. He's not like that with the patients. He's like that with the staff.”

That explained to me the experience that I got from the staff. The staff seemed burned out and stressed out. He wasn't putting in the effort to create the culture that was going to lead to the staff feeling like they needed to feel. It's something that we have to do as leaders and as people who are building the culture in our office.

Make sure that we are intentional with building the culture that the staff is going to feel the same things that the doctor needs to feel. Once the staff starts to feel that sense of depersonalization or that sense that we are not making a difference, that sense of emotional exhaustion, then it's downhill. That's not going to play well with the patient's experience. At the end of this is the financial health of the practice.

That's obvious. When we are talking business-wise, that's always going to be the bottom line. That's an insightful story. I have worked in a clinic like that as an associate. As a young associate, the staff was going to talk to me more openly than they were going to talk to the business owner. When I was working, they would often be telling me, “He doesn't even say hi when he walks in the door. He goes straight to the back and does his thing. He doesn't even say bye when he leaves. He barely even talks to us.”

As a young associate, you get a little bit of free time. You go up to the front and you chit-chat. That’s the way I was. As great of a doctor as that person was, I still am friends with him and he's great, but at that time anyways, he hadn't made that connection with the staff. It has been a while since I graduated. I feel like back then, maybe you could get away with that, but right now post-COVID, that's going to be a lot harder for business owners to get away with not having a good culture and not giving their staff that attention that they deserve as you explained. That’s an insightful point there.

For those who are reading, if you are want to learn a little more about how to develop a cool culture, go back a couple episodes to the episode I did with Kevin Wilhelm from Marketing4ECPs because they are award-winning company in that regard, and he had some cool things to share. Shameless self-promoting on my own platform here. This is terrible. To get back to the actual conversation here about burnout, you have talked about it a couple times already in this conversation. Doctors say, “I don't have enough time.” There was an interesting thing that you shared with me. How much more time do we need to take to build that connection with our patients?

It turns out it's not much, and that's one of the biggest drawbacks. I do a presentation on this topic and I save this part for the end. I will point out that I bet a lot of you are feeling as we have been talking about this. You agree with what I'm saying that we should work toward developing that connection with patients. Do a better job of listening, being empathetic, and working harder to understand what's going on with the patient. The pushback on that will often be, “I don't have time. We are a very busy practice.”

I agree. That's why I'm stressed out and burned out, bouncing from one room to the next. That's my life at work. Here's the thing. When they went and surveyed patients who rated their doctors, they rated their doctors high on these different scales of being a good listener, being empathetic, some who they felt took the time to understand them. On average that doctor spent an additional 56 seconds with the patients a minute.

You could get that minute back somewhere else. We could do a little bit quicker refraction. Maybe there's maybe one less test we can do. We can learn to be more synced with our explanations of things. You could get that minute back, but is it possible that spending an additional minute with a patient could not only significantly impacts our own health in terms of less burnout and stress but also impact the outcomes that we are getting?

Remember when the patient feels heard and understood, their likelihood of adhering to treatment recommendations goes up significantly and all that is going to translate into higher revenues for the practice as well. It doesn't take much longer. If we could carve out that time. This is what I'm saying. If you want to go on more vacations, go on more vacations.

When the patient feels heard and understood, their likelihood of adhering to treatment recommendations goes up significantly.

If you are working 5 days a week and you want to cut down patient care to 3 days a week, put that on your list of goals and we will work toward that, but don't discount the process of how you spend your time with the patients. I have talked to doctors who have done that. There's a book out there. I have used a lot of research in my presentations. It's called Compassionomics.

That was a doctor. It was an MD that was by all definitions burned out. He turned things around by spending 1 minute or 2 at the beginning. He says, “I'm going to give them my full attention and we are going to have a conversation. I'm going to take that time to be more present.” To your point before, we are not worried about the last patient or what's in the next room. I'm going to be present with the patient, and that translated into enhanced relationships, deeper relationships with the patients he has. He says over the course of the next days to weeks, he started to feel his sense of burnout dropped significantly.

It's remarkable how much that could help that human connection. Obviously, with COVID, we have started to lose it quite a bit and that's part of the deal here. Taking the time to have that connection is important. It reminded me of two different things here. One is Darryl Glover. What does he say? Everyone's favorite optometrist. DG says that he does his two-minute drill in the beginning.

He told me that before too and that's great. I know exactly what you are talking about.

That's cool and he's good at what he does. There's another doctor who I look up to and that's Dr. Kiran Ramesh in Toronto. She now does consulting on this. She like talks to people like me. She's in a position like yourself where she's going around talking to ODs. She's got her connect and direct. She's got this idea of like when you walk into the room, clear everything away, and you walk in with an open heart and compassion. Your number one job is to connect with that patient before you do anything else.

She sounds lovey-dovey or whatever, but she's like, “Once you have love for this patient in front of you, then everything else is easy.” I have been working on that. As silly as it might sound, as hokey as it might sound, sometimes you almost get goosebumps when you talk to a patient like, “I'm so happy to help you.” It's pretty cool. It's pretty special.

There's so much negativity in the profession. We had our national convention and we have these calm round table sessions where we get in a room with 10 to 15 doctors and we talk about a lot of different topics and issues. There was a handful of doctors in the room who were telling their own individual stories.

“I have done it for 20 or 30 years. I absolutely love it. I absolutely love going to work.” It's always 100 times out of 100 when I hear that, that is going to be built around the quality of the relationships they have with their patients. It has almost no factor on money because as I got to better understand their practice, some of these practices were very low revenue practices. Some were very high revenue practices.

I have heard this from doctors on both ends and in between that absolutely love going to work, but always built on the quality of the relationships that they have with their patients. That is where I would put the focus of my attention. The staffing thing is right up there. I have never met a doctor who said, “I'm having all kinds of problems with my staff,” and wasn't stressed out.

Putting some thought into how we are providing patient care, not necessarily getting away from it. I'm all 100% supportive. If you are working five days a week and you feel like, “I need to work three in my life,” that's fine. Let's work toward that goal, but putting an emphasis on how we are providing patient care in a way that makes you happy. Especially if you are a leader in the practice, the people that I surround myself with at work every day, are they adding to my happiness or are they subtracting from my happiness and making some changes, whether it's culture or personnel changes there?

All of that going back to something else you were saying earlier is being very intentional about all of it. Sometimes we fall into this. The routine of it all and you just keep going. The next thing you know, you are burnt out and you have poor staff relations or whatever it might be. Being very intentional about it, building that culture, and taking the time to have that connection with a patient. If you plan to stay in this profession, you are going to be doing this every day for the foreseeable future. You may as well enjoy it and then you go home. If you have a family, you go home to your family feeling good and bring that good energy back to them as well.

The way things are aligned right now in the healthcare profession, it's not set up for you to be happy. Does that sound bad? The way managed care is set up administratively and regulatory, all the things that we have to do now, if you are not intentional with it, there's a good chance that you are going to fall into that 50% plus that feels burned out.

Causes Of Burnout: The way things are aligned right now in the healthcare profession, it's not set up for you to be happy.

You made a great point. We do have control. Some things we don't have control over, but we have a lot more control than we think we do. How do we take control of our experience that we have when we go to work both with our patients with our staff? That's going to play into the experience that they have as well. Being intentional with it is something we have to do. The way things are set up right now if you weren't intentional, there's a good chance you are going to sooner or later fall into a place where you probably feel that sense of burnout starting to kick in.

It's unfortunate that the system is set up for not necessarily failure, but it's not set up for us to flourish and be happy. The way it's set up for whatever reason, for whoever has the impact on the system, eventually, it's evolved into what it is now. We have to take the control of it and do things to make it so that we can be happy in our own environment. Steve, to bring it all together, is there anything that we missed, any important things about burnout that you have learned, that you speak about that we should be sharing with the audience?

Experiment. Maybe set a goal over the next several months or maybe a year of what needs to look like for me to be happier going to work and experiment with that. Pull your staff together. A lot of times stress and burnout, we tend to fall into a sense of feeling like, “I need to do all this on my own.” Acknowledge it and maybe make it clear to your staff as well. I think they will appreciate that, “I want this to be a more rewarding and happier place for everybody.”

Let me hear your ideas. What are the things that we could change? What's stressing you out because there's a good chance maybe it's stressing all of us out. What are the things that we could start to change? We may not be able to impact everything, but again that is something that could help you, but it could also build the culture that you want as well and then keep tweaking it until you get to a point where you know you worked too hard and spent too much money. You took out too many loans to be unhappy.

Don't settle for that. I know that feeling. I enjoyed aspects of practicing, but there was a point where I had done it for a period of time. My path was odd because I did consulting. I'm not suggesting other people need to do something completely different, but I had to find my path. That took me into the business side of things which I had a greater passion for that, but that's not for everybody. What does that path look like for you even within clinical care? What are the things that you could change that start to restore some of that joy that you have for the profession? It's there. You have to find it.

The key thing is, in practice, changing the way eventually evolving and tweaking. Having the conversation, changing the way that we practice, and creating the environment that we want to have and the connections that we want to have at work will make us happy and then reduce the level of burnout.

The other thing if I could add is the profession of optometry, but so many other professions in this day and age allow us to do lots of different things that are related to our job like this. For example, a show, conference, teaching a class, or other stuff, or it could be totally different. I think of Dr. Danielle Richardson who's this yoga master and has her own clothing line, all this stuff that makes her super happy.

It's implementing those and making sure you have those types of creative outlets or any outlet that can help you stay passionate and keep the juices flowing. Personally, that's been super helpful for me. I love social media. I love this stuff. It's still relevant to work, but it allows me to like change my mindset a little bit. The clinical doesn't get super boring because I have switch gears to this and then I can go back to clinical and everything is still fun. That's my two cents on that as well.

It doesn't have to be work-related. I will say this too. There are so many opportunities out there that didn't exist when I graduated even within the industry to both balance the clinical aspect and the clinical care. There are a lot of opportunities now with consulting within the industry speaking. I found that I had a passion for speaking, consulting, working with other doctors, and writing. That's where the books came from. I love that.

There was a creative side of me that didn't get a chance to come out in the exam room. I found a lot of that, but are there things within the industry that you would like to do whether it's some consulting or some speaking? Do you have a unique talent or something unique area of expertise that you could build a brand around that? We both are doing a show. It’s things like that.

You made a good point. Outside of the profession, are there things that you could be doing that would bring more joy and reduce some of the burnout? Do you want to play in a rock band? Go dust off the guitar, and do what you want to do, but in my mind, I keep going back to the profession. The definition of insanity is doing the same thing over and expecting a different outcome.

Try something different and see if you feel better. The results will probably come pretty quickly like the doctor I mentioned before, he said, “Within weeks, I started to feel that sense of nice burnout starts to dissipate by changing a few things. Making a few simple adjustments to how I showed up for my patients.”

It can be that quick. It can. That's awesome. Thanks, Steve. I know you shared a few last thoughts there. Any final words you want to share related, whether it's to burnout or anything else? Maybe perhaps where can people find you and find your podcasts?

If you go to IDOC website, that's IDOC.net. You can find out more on the podcast there along with other things. The podcast is available on most podcast platforms. If it's audio, people probably couldn't see what you were doing before. You pointed to your eye. Eye Own a Business. See what we did there and then my own website. Do you want to know more about me? You can typically find me on social media or DrSteveVargo.com.

Thank you, Steve, for coming on to share your thoughts and your knowledge on this very important topic. Like I said earlier, it’s on the forefront of so many people's minds. Thank you to everybody who's tuned in to read this. As I mentioned before, if you found any value, please do share it. Take a screenshot, put up a link on LinkedIn, wherever it is, and let people know that we are having this conversation.

There's going to be a lot of information in here that's going to help the many of our colleagues who are suffering from burnout and help them get out of that rut so please do share it with them. Thanks again for tuning in to the show, Canada's number one optometry show. I will see you guys in the next 100th episode. Take care.

 Important Links

• IDOC

• Eye Own a Business

• Prescribing Change

• Eye on Leadership

• But I Don't Sell

• Steve Vargo - Past Episode

• Dr. Selina McGee - Past Episode on Eye Own A Business Podcast

• Dr. Carly Rose - Past Episode

• Marketing4ECPs

• Compassionomics

• DrSteveVargo.com

• https://www.Instagram.com/dr.stevevargo/?hl=en

• https://www.Linkedin.com/in/stevevargo

About Dr. Steve Vargo

Optometrist, consultant, author and speaker. In 2014, Steve joined Prima Eye Group (now IDOC) as Vice President of Optometric Consulting.

Episode 98 - Eye2Eye: The 3 Pillars of a Strong Company Culture

What does it take to develop a strong company culture? In this episode, Dr. Harbir Sian shares insights from a previous guest, Dr. Justin Manning, who outlined his three pillars to developing a successful culture at work: vision, empathy, accountability. Harbir elaborates on each of these points while adding in some of his own stories and personal experiences of implementing these pillars in his own workplace.

Let us know if you found this episode valuable. LIKE, SHARE, and SUBSCRIBE!

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Watch the episode here

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Eye2Eye: The 3 Pillars of a Strong Company Culture

This episode is going to be an episode of the Eye2Eye series. If you have been reading the show for a while, then you are probably familiar with Eye2Eye. Eye2Eye is a solo episode with this guy right here, sharing some thoughts and experiences that I have about certain things in the industry or within the profession, and often piggybacking off of some of the things that my amazing guests have shared with me over the years.

In this episode, I am piggybacking off of the last episode, which was with Kevin Wilhelm from POD Marketing/Marketing4ECPs. He talked about how to build a culture that will help you attract and retain top talent. As I was talking to him, I was thinking about an interview that I did with Dr. Justin Manning who talked to me about his three pillars of building a strong culture.

Dr. Justin Manning is a chief Member Experience Officer at PECAA. In this interview that I did with him while I was at Vision Expo, he shared his three pillars for building a strong culture. These are the things that he goes into different practices. He talks to the owners, managers, and staff, and he dives into what they can do to improve the culture that they have.

He's got a lot of firsthand experience. I resonated with a lot of the things that Justin was talking about, and it reminded me of a lot of things that are going on in my own offices and things that we are doing well and perhaps not doing well that we need to improve on. What are Dr. Justin Manning's three pillars for building a strong culture? 1) Vision. 2) Empathy, and 3) Accountability. We are going to dive into each one of those and explore what they each mean and how we can apply those in the real world in our modes of practice.

Number one is vision. A quick quote from Justin in this interview, he said, “Help your team connect the day-to-day role of their job with the bigger impact on the patients, the community, and society at large.” In essence, help them see the bigger picture. A lot of times, we go to work. We are stuck in the mundane activities that we have to do and forget the impact that they can have on our patients and community.

It's important to remind them. Justin said, “There's no such thing as over-emphasizing or oversharing your vision. That should be the first thing you do every day, the last thing you do every day, and make sure you relate everything that they are doing to your entire staff. All the managers, all the staff, everybody in the office, each job that they are doing, and how it relates to society at large, or at least your patients and how it's helping their patients’ lives. Help your patients see better and improve their quality of life.”

Take every little task that you do. Perhaps it's someone working in the lab, edging some lenses and reminding them when you get a chance, “Great job edging those lenses for this patient. You did a good job on this particularly tough prescription. It's going to help our patients see better and have a better quality of life. This is relating to our mission and our vision for the practice and the business at large,” and being sure to reiterate that on a daily basis.

This reminded me of a story that you may have heard a parable about the three brick layers. If you haven't heard it, I'm going to share it with you here now anyways. Essentially, there's somebody walking down the street and they see three people laying bricks building a building. The person walking down the street asked the first bricklayer, “What are you doing?” The bricklayer said, “I'm laying brick.” He moved on to the second person and asked him, “What are you doing?” He says, “I'm building a wall.” He moved on to the third person and asked the third person, “What are you doing?” He says, “I am building a place of worship.”

They are all doing the exact same job, but they all had three different perspectives on what they were doing. The third person had the biggest vision. He was building a church or place of worship. He knew the impact that was going to have on his community, his family, and even himself in the future. It’s having that larger vision for yourself, reminding yourself each day, what each time you go to work, how you are impacting more than the one person in front of you, perhaps your society or the larger impact you are having on that one person in front of you than simply providing a prescription or checking their eye health. As Justin said, remind your staff of that every single day.

Number one was the vision. Number two is empathy. I know this word gets thrown around quite a lot, but it cannot be overstated how important empathy is in our day-to-day personal lives and our work lives. The quote from Dr. Justin Manning that I want to share with you regarding empathy is the same way your patients want to know that you care about their well-being.

Your employees and staff team want to know that you care about them and their success more than anything. They want to feel understood at a human level. We all have bad days. We will spill our coffee or we all get stuck in traffic. Something happens, and our mood gets a little thrown off. We all get it. That, to me, is empathy, remembering that I have bad days. When somebody on my team has a bad day, I should be cutting them the same slack. I would cut myself when I say, “You spilled your coffee or you are in a bad mood. Let's move on from this. How do we make this better?” It’s understanding that everybody's coming in to work on their own and living their own lives with their baggage.

Recognizing those dynamics and being open to having those conversations with the team to see where they are coming from is vital to building that culture, to have that open culture where people feel comfortable and welcome at work. The way I like to say it is we talk to our patients, customers, and clients, and we try to give them the best possible experience because we know that they could go home and give us a Google review. We want everyone to give us a five-star Google Review. Imagine that your staff could give you a Google review every day. Imagine every interaction you had with every human being. Somebody could write there on the spot, give you a Google review, and a number would pop up above their head to give you an idea of how that interaction went.

How would you go into each one of those interactions differently? How would you behave differently? If you do that, not so much consciously, but in general, you have that understanding daily that you are going to try to give each person the best interaction and the most empathy that you can. How would you treat them differently, and how would that experience differ for your staff and your team that are engaging with you, and then how would they engage with themselves? If they know that the leadership in their company is providing this level of empathy, how much empathy would they then provide themselves?

From a doctor-patient standpoint, it's been well-documented how important empathy is and can be. Empathy helps to improve patient outcomes. It improves patients’ adherence to treatments and therapies. It reduces the potential for litigation and lawsuits. It can speed up patient recovery. There was a study that Justin shared with us during this show where patients who were dealing with common ailments like the cold or the flu didn't need medication or treatment.

Empathy helps improve patients’ adherence to treatments and therapies. It reduces the potential for litigation and lawsuits while speeding up patient recovery.

Patients whose doctors rated high in empathy recovered from those day-to-day illnesses faster than patients whose doctors rated lower in empathy. That is the magic of empathy, and that's the same type of magical effect you can have on your team and developing culture when you show a lot of empathy at work.

Out of the three pillars, we have covered two already. Number one is to have a clear vision that you reiterate day in and day out with your staff. Number two was to show empathy. Show empathy to your staff to help them feel seen and to help them feel welcome and to help them feel like they are human beings who can make mistakes and won't be judged too harshly on those mistakes. It helps them to build a more comfortable environment at work.

The third pillar to help build a strong culture is accountability. Part of accountability is providing feedback, providing praise, providing constructive criticism, and holding your staff and your team and yourself accountable to the goals and the tasks that you have assigned. Justin shared an interesting finding from the Harvard Business Review regarding accountability. He said, “The Harvard Business Review said that you should have four pieces of positive feedback for each piece of developmental or constructive feedback or criticism.” That's a lot if you think about it. The 4:1 ratio sounds like a lot, but that's not happening all at once.

You are not saying, “Here's 1, 2, 3, and 4 nice things. Now I got to give you a piece of constructive feedback.” It's knowing that you are always providing that constant feedback, and hopefully, it's mostly good feedback. We often neglect to provide that positive feedback. We assume everyone's doing their job good enough.

It's important to remind people that they are doing their job well because they don't want to forget that their task is important and critical to the success of the business. What's even more important Justin shared is those four pieces of praise should be linked back to number one, which was the vision. When somebody does a good job, you don't just say, “Good job.” You say, “Great job doing X, Y, and Z.” Be specific. That positive thing that you have done relates to our vision and the greater goal that we have to help our community. Relating that and bringing that together helps the staff and the team to understand their place in the bigger picture.

Company Culture: Remind your team if they are doing their job well. You don’t want them to forget that their tasks are important and critical to the success of the business.

It reminds me of, I make this joke, sharing this feedback. I do this as part of a lecture that I give. The lecture is called CEO Insight. I take people like Justin and other people who have come on the show, and I plagiarize them. I share their insights. I ask them first, and then I share their insights in this lecture. I like to share this one story. It reminds me of the movie Anchorman if you have seen that. I'm a big movie buff myself. There's a scene in Anchorman where Ron Burgundy said something nasty that he wasn't supposed to say. He read off the teleprompter, but he had no idea he did it.

To him, everything went well. The broadcast went amazing, and after the broadcast was done, he was just, “Great job, everybody. You over there, you are all on the floor. Great job.” He is walking off saying a good job to everybody and then taking off. Honestly, I have been caught doing that myself, walking out the door. Luckily not having sworn at anybody, but walking out the door and saying, “Good job, everyone. See you later,” and realizing that now I need to start to give and I have started to give more specific and constructive feedback to my staff on the good things that they have done that day.

If I forget to do it during the day before I leave, I will say, “Cindy, good job doing this. I witnessed you giving the patient this information or dealing with this difficult situation. I wanted to tell you that it was a great job, and it's helping us serve our patients better.” I’m making sure I'm giving each piece of positive feedback to as many of the team as I can each day.

When it comes to giving constructive criticism or developmental feedback, there are very important things to follow. The number one thing when giving constructive feedback is this. Let's say there's been a situation where the team member perhaps didn't deal with a situation the way they should have. The number one thing is to separate the person from the incident or the task that was done incorrectly.

Company Culture: When giving constructive criticism, separate the person from the incident or the task that was done incorrectly.

Instead of going to the person and saying, “You did this wrong,” it separates them and says, “Joe, this thing happened and it was done incorrectly.” Then ask Joe with empathy and understanding that he's coming from a different place than you are, “What is it that would have led to this happening? What was it that was going on that resulted in this happening?” Make sure those two are separate. The person and the task or the event that happened are separated so the person doesn't feel like they are being attacked. It was the thing that went wrong that's being investigated and you are working on it together.

Once you have determined what went wrong, talk about why it was wrong, how it should be done better, and how it could be corrected next time or avoided the next time. That was the key piece of feedback that Justin had given when giving constructive criticism or developmental feedback. It is to separate the person from the action.

Finally, when it comes to accountability, the only way to hold somebody accountable is to have specific goals and specific tasks and even further have some measurable metrics to say to determine whether a task was done up to standard or up to your requirements. You can give that positive feedback when you hit certain targets or goals.

You can give the praises when they are due and give the developmental feedback when you can have, and you have something to physically or visibly show the team member, “Here's where we fell short. Let's talk about why that happened and how we can do it better.” It is important to be transparent, to be very clear with the objectives, and clear as to why certain objectives were met and why they were not met so staff doesn’t feel like they are being kept in the dark and that you are perhaps judging them or evaluating them on criteria that they are not clear with.

Be transparent with your team. Be clear why certain objectives are met or not. Do not keep them in the dark or evaluate them on criteria they do not understand.

Be very clear about that. When I have spoken with other people, even Kevin Wilhelm in the last episode when we talked about building a culture, it's very important to be very clear about what's expected, how we are all going to get there together, and how the team is working towards all of that. Also, talking about when metrics were met and when they were not met.

Those were the three pillars of building a strong culture. Thanks to our friend, Dr. Justin Manning. 1) Having a clear vision. 2) Showing empathy, and 3) Having accountability at all levels from the top to the bottom, being accountable, and being open to discussing that level of accountability with everybody. Those are all very important, vital, and critical to developing a strong culture in your business.

From my perspective, I will always like to share that for me, I'm always a work in progress. Some days we hit all three of these bang on, and it's magical, and most days we are working on one or the other, or even 2 out of the 3 potentially. The number one thing that I like to come in and lead with is empathy, and I try my hardest to do that every single day, and then also be clear on accountability. I would say the one thing that I'm probably weakest at is sharing our vision for the goal of the practice and where we want to go and how we want to help our community. That's something that we are working on.

To add my two cents, this is something that Justin did talk about as well. Sitting down with the team or staff regularly is vital. I haven't done that enough over the years. We have started to do that a lot more, and instantly, I have seen how impactful that can be. A lot of the people I speak to have a great culture and great structure in their business. They are regular, and regular usually means weekly meetings. We are at a twice-a-month cadence now, but we are trying to get more regular. The more frequently you meet, the more quickly little issues will come up and can get sorted and dealt with, and they don't linger and start to eat away at the culture.

Company Culture: The more frequently you meet with your team, the more quickly little issues will come up and can get sorted. You can stop them from lingering and eating way at the culture.

Having a good culture also means recruiting good people, bringing in good people, training them well, developing that, and nurturing those good and talented people. That's something that I'm not going to talk about so much in this one. I want you to go back to read the episode with Kevin because he talks all about that. POD Marketing, the company that he's the Founder of, won a national award for a company that was admired for the strong culture that they have in their corporate culture. If you look at what they do and the way they showcase it, they advertise it. In the same way that I would use social media to advertise to patients how great my clinic is, they use social media to advertise to potential employees how amazing the culture is at their office.

I encourage you to go check them out. Go read that episode. If you want to rewind even further, you can go back and find the episode with Justin, which was part of a collaborative episode I did with 3 or 4 different guests when I was at Vision Expo. You will find that insightful as well. As always, thank you so much for reading. I hope you found this valuable. If you did, please take a screenshot, send a link to a friend, and let people know that we are sharing this information here on the show. Thanks, as always, for reading, Canada's number one optometry show. I will see you in the next episode.

 Important Links

• Kevin Wilhelm – Previous Episode

• Dr. Justin Manning – Previous Episode

Episode 97 - How To Attract And Retain TOP TALENT - Kevin Wilhelm, Marketing4ECPs

In our post-pandemic world, the most common concerns among business owners tend to center around staffing. How do we hire, train, and retain great staff? In this episode, Kevin Wilhelm, the founder and President of Pod Marketing/Marketing4ECPs, shares how he built an award-winning corporate culture that his employees celebrate. They have an annual awards event at the company every year! One lesson in attracting high-quality talent for your business is telling your story to the right person at the right time. Business owners should create unique things that attract top talents into their business instead of doing what everyone does because they’re putting themselves in the middle of a commodity. Learn more by tuning in to this episode today.

Connect with Kevin: https://www.linkedin.com/in/connect-with-kevin

Thanks for listening to The 20/20 Podcast. Be sure to comment and share!

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How To Attract And Retain TOP TALENT - Kevin Wilhelm, Marketing4ECPs

Thank you again for joining me on another episode. Thank you for all the support. As always, I'm going to ask a quick request right off the top. If you get any value out of this episode, and you absolutely will, I can guarantee it. If you have gotten any value out of previous episodes, please share it. Send a link to your friend, leave a review, leave a comment, put a link up on LinkedIn, Instagram, or wherever, and take a screenshot.

Let everybody know that you're tuned into this conversation with me and my amazing guest, Mr. Kevin Wilhelm from POD Marketing and Marketing4ECPs. Kevin is the Founder and President of POD Marketing, but of course, we see the Marketing4ECPs side of it a little more. He's a published author of an Amazon bestseller.

More recently, POD Marketing won an award for Best Corporate Culture. That's what we're going to be talking about in this conversation. How to develop a great corporate culture and how to attract and retain top talent? Kevin is a master at that. We're going to dive deep into that. Kevin, thank you so much for joining me on the show.

As always, absolutely.

I gave a quick rundown of who you are. Tell us a little bit more about who you are and what you do.

I'm a family man. I have three beautiful kids and a beautiful wife. We live in Calgary. I've been running POD Marketing for ten years. It’s not quite a startup, but it feels that way every day, the way that we move. I enjoy building teams. I enjoy being part of what other people are creating. I also love the industry that we're in, which is the eye care industry, and helping it move to the next level. I love what I do.

That's awesome to hear. We don't hear that enough that you love what you do. A lot of times I'll be talking to somebody and they're just like, "Yeah, it's fine." It always makes me sad. If you're not watching, you should go to YouTube and watch the video. I want to comment on this quickly. You're sitting in this nice office space with lots of windows. I could see some bottles in the background. It got this Mad Men feel to where you are. The next time we have to record this in person, I'll probably slip up and slur my words as much as when I'm sober sitting here.

Let's dive into this. Corporate culture or company culture is more of a hot topic now. It’s more relevant than it ever has been. With all of the difficulties people are having with staffing and hiring, spending more time developing that culture and building a workspace where people are happy to be is more important than ever.

I want to lay this up for you. If you could take us step by step. Let's say you're in a place where there's not much of a corporate culture. It’s not necessarily a negative place, but there's not much to speak of. What are the steps for developing that culture? What have you guys done? Before we even go into that, I mentioned right off the top that you recently won an award. Tell me about that award and what that was about.

We're proud of this. We're based in Calgary. We felt like we're Calgary's best-kept secret because our clients are all over Canada and the United States. From a local perspective, marketers don't know about us because they don't see us winning big clients that are local brands, and even support independent optometry.

We believe we have a great company to work for, and we'll get into why. One of our objectives, as we continue to grow, is we want to attract and then retain the best talent that we can find. With all the work we put into our culture, one of our objectives was to start marketing ourselves. Get out there and start becoming a known entity in the city so that we start attracting great grads from university and great marketers from other agencies and companies, and bring them here.

One of those things was we wanted to look for some recognition. We were named one of the Most Admired Corporate Cultures in Canada by Waterstone Capital based out of Toronto. It is a very prestigious award. We're very proud of it. It's a pretty intense interview process. It took months with many people applying for that. It goes from a vision and perspective. It talks about employee treatment. It talks about financial performance as well. Is there an opportunity for growth? It's not about perks. It's about the programs and policies in place for employees to make sure that they're engaged, motivated, and fulfilled.

Pod Marketing is named one of the Most Admired Corporate Cultures in Canada by Waterstone Capital, based in Toronto.

Congratulations. From what I've experienced, speaking to different people throughout the company, it's legit. People always seem to be happy and excited when I talk to them. That's cool. It makes you the perfect person to speak on this topic. Once again, going back to my question, how do we start? What do we look at? What are the steps?

The first thing is to identify what your culture is. I'm going to equate it to other advice that I give from a marketing perspective which is, "Why do patients choose your practice?" What are you doing intentionally to remove yourself from the commodity of price and convenience? If you are only chosen on price and convenience, it's a tough business model. Somebody more inexpensive and more convenient will win those patients.

The same goes for employees. Convenience is, "Are you close to my house? Are you allowing me to work from home? What's the flexibility?" Price is, "How much are you paying me?" The first thing is to identify what you are intentionally doing and what can you provide to employees or team members that will attract them to want to work for you. Of course, there's a whole other part of it, which is retention.

The first one is the identification of, "What is my culture today?" I define culture as traditions plus norms and values. Those three areas all have a place. Traditions are, "What are the celebrations we do? What are the meeting pulses? What are the holiday parties?" It‘s those kinds of traditions that people look forward to like how you celebrate birthdays or what have you.

Norms are, "How are we greeted in the morning? How do we treat one another? What is the software stack?" Those things matter based on, "Am I using an antiquated patient management software that's frustrating? Is it high-tech and cool or different? Are they bringing in new equipment and new systems to advance my learning?" That's part of the culture.

Values are the most important which are core values. Most corporate cultures will win or lose on the creation, implementation, and compliance of corporate values. You can get those three things and identify them. If you don't feel you have them, then I would first start there. What are your traditions? What are those norms? Of course, focusing on the core values that need to be the pillar of any great corporate culture.

Top Talent: Focus on the core values that must be the pillar of any great corporate culture.

That's super helpful. We've talked about business and things like that. The number one thing in most cases is to have a look and do a little introspection. Understand where you're at and what is your standing in all of these categories. Breaking culture down into those three things, traditions, norms, and values is helpful.

Thank you for defining them because that way, you can go back to your workspace and look at those different pillars. Once you've taken a look and you are able to say, "I don't even know what my culture is" or "I don't have a defined core value," maybe we start there. We don't have defined core values. What do we do next?

This is the exercise that I would do. I would get in a staff meeting, have your staff come together, and start to write out on Post-it Notes or pieces of paper what your current values are today. What they believe them to be. It’s not aspirational and not what we want to be, but who are we today, and what do we value about one another? Everybody writes as many as they can.

We then put them on a big boardroom table, you put them in the middle, and you start grouping them and see the patterns that start existing. Once you start seeing the patterns, you might have 7, 8, or 9, then you want to focus on the ones that represent who we are and what makes up the DNA of our company today.

We did this exercise years ago. We started to notice a lot of optimism and an optimistic outlook. There was a lot about the positivity side. We combined those and positivity became one of them. You start to see these patterns, and then you identify and you articulate, "That's what this value is." As the owner, CEO, or whatever position you hold in your company, it is your job to articulate 2 to 3 sentences about what that value means to the organization and you as the leader.

One of our core values is integrity. In marketing, everybody has had a bad experience at some point with a marketing company. It's important that we have integrity. The way that I structured it is we're all human beings and we're going to make mistakes. When that happens, are you putting your hand up and saying, "That was my mistake?" That’s accountability.

Are you also holding your head up and saying, "I'm okay. I've made that mistake, but I'm bringing a plan to not let it happen again. I'm holding my accountability. Do I hold to the commitments that I make? Can my team trust me? When I say I'm going to get this thing delivered on time, do I hold my words?" We define that value.

I sit down with every new employee personally and I walk them through each value that we have. I walk them through the definition of what it means, and then I share examples. I highlight when Ashley showed integrity as an example of a workspace so the new employee could understand and see it in action.

Furthermore, when we do staff meetings, we take the first 10 to 15 minutes to highlight examples of people demonstrating these core values. Throughout the month, there's an ability for them to nominate up here. They get one nomination a month. They say, "Ashley demonstrated this example." We put it in a box or, in our case, we email it in. I will pick the top ones and read them aloud. We recognize people for living our core values. We don't go more than 30 days without highlighting them, speaking about them, and recognizing them. They're truly ingrained in our organization from top to bottom.

Do you make it mandatory that everybody should put one of those in or is it voluntary? Do you get months where nobody nominates the person or there's always something?

We probably have over 50 nominations per value. I then take hours to whittle that down to pick the stories that are impactful. I also want to spread out the recognition a little bit to people that haven't been on. At the end of the year, we have an award ceremony. It's one of our traditions. In the office, we do the potties. It's POD Marketing, so we call it the potties. Our trophy is a glass toilet because it's a potty. We give a potty away for each of our core values who has had the most nominations in a year, and then an overall core value award winner. They maintain that for a year.

Monthly, you ask the staff to put in these nominations, and they voluntarily put in lots of nominations. They're nominating their colleagues, highlighting the big stuff, and celebrating the good stuff that they're doing. You keep track of all of that and you give out awards at the end of the year. That's so cool. I'm going to try to start doing that.

Our team is not nearly as big as yours, but I like that idea. I think that's very cool. You mentioned that you spend time individually with each person. You've told me that before and I found that incredible. How valuable do you think that is? It’s a rhetorical question here, but for someone like myself who is a business owner and own a clinic with 8 or 10 staff, do you recommend that I sit down with each one to check in on how they're doing? How valuable do you think that would be?

It grossly has an underestimated value. We do hire lots. Right now, we're over 120 full-time employees. We have grown dramatically in the last few years. We end up having an onboarding week. We bring everybody in. They know the hiring dates throughout the year. We're on average about 6 to 8 people a month. They come together as a cohort, and then they go through a week of training. They're meeting different departments. They're understanding the verticals. They're getting training in eye care specifically. They understand the story.

The very last meeting of the week is the Friday 3:00 time slot. I come in and I deliver a culture presentation. I have a full slide deck. I talk about our traditions, norms, values, purpose, and vision. I talk about performance against culture, and how you can have high performers and high culture. That's what we're looking for. There are people that are high performers but have low culture. I explicitly explain to them, "If you are somebody who's a high performer but low culture, you will not be in this organization.” There is no room. We have to take you up.

Be careful of this. It doesn't mean you're a bad person. It means that the culture may not fit you. An example is the way that we grow and the way that we move in digital marketing is changing so fast. We have to be dynamic. We have to think on our feet and be willing to change at a drop of a hat. Working for me, you have to be even faster. If you're somebody who fights change, you might be the nicest person in the world, but you're not going to be the right fit culturally because you have to lean into change. It might just be the wrong fit, which is fine, but we can't have you in this organization. We have to find those people that fit the culture.

Top Talent: The way that we grow and the way that we move in digital marketing are changing so fast. We have to be dynamic. We must think on our feet and be willing to change at a drop of a hat. Working for Kevin Wilhelm, you have to be even faster.

I spend time with them at the end of that meeting, and then I do a 60-day check-in. I'm asking them, "How has the support been? How has the training been? How has your onboarding been? Do you have the materials and the resources that you need?" They meet with different people. They meet with our Vice President of Operations 30 days in.

Other than that, across the board, every team member has a one-on-one every week. It's a minimum of 30 minutes. That is what can make a massive difference in the organization. It’s having that time. People value time with their boss or their manager more than anything else. Many business owners or managers say, "I don't even know what to talk to them about. What am I going to say every week?"

Ultimately, it's five minutes of person-to-person connection, "How are you?" Genuinely care about them as a person. Make sure you're checking that way, and then, "What's on your list? How can I support you?" They should come with what they need. Let's think of an optician. It might be, "I'm struggling with this brand. I don't love the brand. I'm not selling this brand. I don't believe in the brand."

We can have an honest conversation about, "I'm struggling with Becky and I have a personal conflict. I would love to have some advice on how to deal with Becky." Whatever that is, you're there for them. One-on-one time is important. At every one-on-one, we’re delivering feedback. Ideally, it's positive, but it might be something you notice they could do a little bit better.

Let's say you're having an issue with people showing up on time. In this case, we'll say Jennifer. "Jennifer, I've noticed that you're showing up on time every day for the last few weeks. I appreciate it. We're having a little trouble with everybody, but I wanted to pass along and say that I've noticed that you are, and I appreciate that." She will leave that meeting feeling fulfilled, validated, noticed, and present. She will be far more engaged. She brings that positivity into her workspace moving forward.

Now, let's go with Jason. "Jason, I've noticed that you're showing up a little bit late for the last couple of weeks. You're a big part of our team. I want to make sure I can support you. Is there something going on that I can help you with?" That feedback can immediately correct and go, "I can be better. That'd be great if we could do that." That little feedback checks it, as opposed to letting resentment build up.

Jason impacts everybody by being late and nothing happens to Jason. That's where culture gets away from us. When there is accountability, we're not recognizing the great behaviors. We're not dealing with undesirable behaviors at the moment, it seems like everyone can do what they want. That's where culture starts separating. It's not about the perks and it’s nice, but it's about the accountability and what's happening within the 9:00 to 5:00 or the 8:00 to 4:00 or that kind of system.

I can imagine that that's extremely powerful, the fact that you're able to take the time and sit down with everybody. Aiming this towards ECPs and someone like myself, I'm seeing patients most days when I'm in the office. I got to find time to sit down and chat with the staff in-between patients or lunch. Do you think the same 30-minute structure every week is the only way to do it? Do you feel like there's some flexibility around that?

As the owner, who would your direct reports be? Probably your office manager. You might have a senior head optician. They may need that 30 minutes. You might have 1 or 2 people that you are giving that dedicated time. They're the ones that then manage everybody else. They should be having a 15-minute check-in once a week.

It should be quick. It could be in the back, a walk around, or right before their shift. It's like, "On Wednesday if you're starting at 10:00, let's meet at 9:45. I want to do a quick check-in. If you have nothing on your agenda, great. I just want to make sure that you know that I have this time dedicated to you every week." It cascades down.

As the owner, you don't need to meet with everybody every week. Your direct reports, you're giving them that time. That way, it allows them to save the issues they might be having for that meeting as well. That also reduces the amount of one-off, "This isn't working. I don't like this." They can save it and have a list for that meeting, making it productive, and efficient for you. I would say, every direct report should have a check-in set aside every week for whatever you can make work. Maybe 15 minutes to 30 minutes. The employees will feel incredibly valued to know that they have space with somebody to have an open discussion.

Speaking for myself, I know that I need to get those check-ins and I don't do it often enough. Knowing from your perspective how powerful it has been for you, it's going to become a much bigger priority moving forward. You've taken a look at your traditions, norms, and values. You're starting to hash them out a little bit, develop a bit of a culture, and see what kind of culture you need. How do you use that?

The biggest issue facing most business owners these days is attracting and retaining top talent. The way the industries have been and the things that people are dealing with. Let's go to attracting. How do you start to attract high-quality talent to your business? Whether it's an optometry clinic or someone like yourself?

Let's go to marketing 101, which is telling your story to the right person at the right time. When we ask practice owners, "What makes you different and unique?" We hear so often, "We do the same thing as everyone else." "Why do I want to go there? What's the magnet? What’s pulling me there?" From an employee's perspective, "Why should I work there?"

If you are trying to be like everybody else, you will be right in the middle of a commodity. It's not all about money. I don't think you should have to overpay. Overpaying is a tax. It's a business tax of being perhaps an unremarkable employer. You can create other things that can attract them. We know people care about flexibility. I understand you need people to show up. What does flexibility look like within the job? Knowing there are boundaries, “I need you here from this time to here this time,” but what could flexibility look like?

People want autonomy. They want to know they own their role within boundaries. Speaking to those things in a job ad matters. The reputation of your practice matters. People want to work somewhere they are proud of. Think about your "About Us" page as both attracting patients and employees. It is typically the second most visited page on your website. Go onto your analytics. If you're a client of ours, talk to your clients and ask them where it ranks, and how many people are viewing the "About Us" page. It's much higher than most people think.

Customers and employees want to know who you are before they decide to commit to you, whether it's an hour or whether it's their career. Think about if you were on stage in front of 100 optometrists, 100 associates, and 100 opticians, and you have two minutes to give a pitch as to why they should come work for you. Knowing there are seven other people who are going to be on stage next. What are those two minutes? What's that elevator pitch?

If you don't have anything, great, then I would be working on finding out what employees care about. Is it paid? What are the paid time-off policies? What are the employee discounts? What about friends and family discounts? Are there snacks? There’s value in putting free snacks on their half-an-hour break. They don't have to go out and spend money, but they'll get granola bars and healthy snacks. It immediately raises satisfaction. It could be something like a Costco run a couple of times a month. The satisfaction goes through the roof.

Team builders. Once a month or once a quarter, we do something as a team. We go out and do axe throwing and kart racing, or go out and get our dogs together. Those are the traditions and norms. Those are the things that bring us together. If you're doing these things and talk about them on the "About Us" page, when you write a job ad, it's factual instead of emotional. You're dealing with an emotional person who's trying to make an investment in themselves.

What is your "About Us” page saying? What is your job ad saying? You can create video content and show a day-in-the-life interview. Have some of your employees on camera getting a testimonial about working there. That way, when they click on that page and they see the "Why work with us?" They can watch stories of potential colleagues talking about why they love it. "We get treated fairly. They appreciate us. I feel valued. I feel heard." Anyone who's looking for a job probably doesn't feel those things. Just by hearing someone say that, they go, "That's where I want to work."

Our employees, the ones that come to us will always say, "I've been on your YouTube channel. I'm on your Instagram." We promote our culture through those things. They're making decisions based on the content we're putting out and they're choosing to apply. It's a huge factor to tell your story and be intentional about what you're putting out in the world.

Have great referral programs for staff. Reward your staff. We do $500 if they stay past three months. People are a little bit more apt to recommend somebody to have them come in. Some of your best employees are the ones that were referred to you by existing employees because they share values. Friends share values. If you're value-aligned and that great employee makes a recommendation, they're probably value-aligned. You're pulling more people in that are already value-aligned.

It makes it so much better. There are high rewards for people to go out and find employees who work well. If you build a place where nobody wants to leave, it's so much easier to attract. When the spot opens up, there's a line of friends of your employees that want to work there. They're almost begging to do it, so you're not needing job boards. You have them lined up.

Usually, it's a referral program to bring in new patients, but you have a referral program for hiring. If somebody at your office or somebody who already works there refers somebody who gets hired and sticks around for at least three months, the person who referred them gets a reward. That's awesome. There are so many good points in there. I don't think I'm going to be able to go back and touch on each of them, but if you're tuning in, you'll probably want to rewind it.

The snack thing is something that I can tell you from my personal experience has been beneficial and powerful. It's a few hundred bucks a month or whatever the number is. It has more than 10X the value as far as how happy it makes the staff and the doctors. It's partly about the food because they want to be able to eat the food and drinks. It's also about you going out of your way to supply me with these goodies. It's the care and the intangible value that it brings as well.

These are amazing stuff that you guys are doing. I never thought about advertising the workplace. Interviewing the staff and putting that content out for potential staff or doctors to see. That's the stuff they want to know about. The "About Us" page being one of the most viewed makes a lot of sense. Would it make sense for an optometry clinic to have a "Why work with us" page? Is that something we can have hidden and we can share the link with prospective staff who are looking to work with us?

It's up to where the practice is. If you're growing your hiring and that's an issue, I would have it there. One thing I'll say is if prospective patients see this content. How much you value employees and how much you treat them and care about them, that only makes them want to work with you more as well. There's a huge benefit of knowing that you take care of your staff and it's a great place.

You know there's continuity and there's appreciation like, "As a patient, I have a choice where I go. I want to go somewhere that treats the people that are helping me and they treat them well." Advertising and promoting the workplace and what it's like has so many other ancillary benefits. Don't be shy about talking about the benefits of why someone should come and work for you.

Think about Google. Google's entire reputation is they're an engineering company, but its entire reputation skyrocketed when people found out how it treated employees. It all of a sudden became this amazingly cool business. All it was is a search engine. People's reputations or brand value skyrocketed because they get snacks on their slides and they get haircuts. All of a sudden, people are like, "I love Google." It's increasing their brand loyalty because of how they treat their employees.

It makes a lot of sense. I go to the About page almost immediately as well because I want to see the faces of the people, who they are, and read about them, and whatever business it may be that's usually service-related that I'm going to go to. If on the "About Us" page, the staff are bragging about why they love working there, I would feel a lot more likely to go see that place or to use their services.

You've encompassed in there both attracting and retaining. Any other things that you might want to touch on as far as building that culture? I love what you said in there about the tax. That's a cool point. Paying a higher wage is a tax on your lack of culture or the fact that you're not a remarkable business. Spend the money on becoming a remarkable business and maybe you won't have to pay your new or potential incoming staff as much. That won't be something that you have to pay. That's a cool point, too.

There's a basic hygiene of making sure people are paid fairly for what they do. In some cases, we are so desperate for somebody that we pay so much more to get them. It has a way to fracture the culture as well. Have pay bands that you're comfortable with, and then create a great experience that attracts people that are within those bands.

In this conversation of attracting talent for an optometry clinic, there are various levels of that or there are different categories of talent that we're trying to attract. It could be front-end staff, an optician, or a doctor. I'm sure there's a lot of overlap in the approach, but there will be also some differences. Lately, there has been a lot of talk about there being a shortage of doctors and high demand for doctors. Some of it is due to new corporations entering the market. Some of it is whatever the natural progression of the way the industry is going.

Either way, the result is that there are larger entities, FYidoctors, Specsavers, and the like that have lots of money that are giving incentives to doctors and new grads, particularly those coming out of school. "Come work for us for a few years. We'll cover your debt. We'll give you a big signing bonus." You've seen a lot of optometry practices. I don't want you to necessarily overstep or be too uncomfortable with the answer here, but do you have any suggestions for a smaller clinic like mine for example? How do you think we might go about attracting those doctors instead of them going to FYi and getting a big $50,000 bonus or something like that?

Number one is identifying and understanding why would an associate be attracted to work in independent practice. What could you offer them that they aren't offered there? For sure, there is a level of autonomy that they're going to get. At FYi, those places probably have some strict policies and a lot more corporate policies, and a lot more administrative tasks that they have to do that take them out of the general eye care, which is why they got into it.

It might be about helping more people. It could be autonomy in the job. I've seen a practice that does profit sharing. They take X and the rest is shared amongst others. There's a little bit more of an ownership or a WestJet model over that one. A lot of it is just how you treat them. I'm not saying anything about the chains. This is just in general. When it comes to managing people, treat them how they want to be treated. Do not treat them how you want to be treated. Treat them like adults. Show them the respect that they deserve knowing that they have a profession and they've invested in this. They're looking to grow their career.

When managing people, do not treat them how you want them to treat you. Treat them how they want you to treat them. Treat them like adults.

One other thing you can offer them is an exit buy-in option. There are the right shifts. Maybe you're giving up some of your shifts and ideal times for them because that's what you can offer them. They can play a role in the marketing per se or the HR policies. They can stretch their limits more than they would be, which potentially the chain.

Think about what are all the things that we have to offer that the conglomerate chains can't because of the policy process, what have you. Lean into those and you'll find the associates that want what you have. That's the key. You're marketing what you can offer. You'll find the people that share those values. It's hard to fight against signing bonuses, so what could you do? That's the question. Is it more paid time off? Is it offering them sabbaticals? Is it offering them more flexibility than what they can get elsewhere? Flexibility matters a lot right now. What type of flexibility can you provide that isn't available anywhere else?

You've been on the show before, and I don't remember if at that time I did this thing where I asked you the two questions at the end. It has been a while. I think you came in the early days of COVID. It's been long enough. I'll ask you the same questions again. First of all, where can people connect with you? Where can people connect with Marketing4ECPs if they want to learn more, or POD Marketing if they want to see more about the culture that you've built? Where should they go?

I'm everywhere. LinkedIn, my name's right there. Search me up on LinkedIn and connect. That's a great way. If you want to email me, it's Kevin@4ECPs.com. I will return emails, so feel free to email me directly, whether it's marketing or anything to do with what we shared here. I'm happy to share.

I forgot to say earlier, but I'll mention this now. This conversation with Kevin originally was supposed to be on marketing because we're going to be doing a series of marketing. I'm calling it the Marketing Corner as a little series of show episodes with different people from Marketing4ECPs, people who have expertise in different areas, whether it's brand building or social media.

We're going to do 4 or 5 of these throughout the year. We were originally going to be talking about the ABCs of marketing. Instead, we figured culture-building was probably a more relevant topic and a more pressing topic to talk about. Stay tuned for actual marketing-related conversations coming up very soon. We got those interviews lined up and going to be released over the next months or so slowly. Stay tuned for those conversations.

Usually, when I'm having these types of more in-depth conversations, these are the two questions I like to ask every guest. If you could step into a time machine and go back to a point in your life that was a difficult time. You're welcome to share that time if you like what happened, if not, at the very least, what advice would you give to yourself at that difficult time?

It would be probably my early to mid-20s. I had children which were early in my career. From trying to live the lifestyle that you need to live as a young parent and trying to provide, that was a tough time. The advice is to keep pushing. That's why I say that to a lot of people at this stage in life. The 20s are when you build a foundation. The 30s is when you start realizing that potential. The 40s is when you get to enjoy some of that. The 20s are supposed to be hard. You're supposed to put in the work. You're supposed to make some sacrifices and build the foundation for the rest of your life. I would say you're doing it right if you're in a similar situation.

Top Talent: The twenties are when you build a foundation. The thirties is when you start realizing that potential. The forties is when you get to enjoy some of that. The twenties are supposed to be hard.

The final question is in everything that you've done and all the success that's coming your way, how much of it would you say is due to luck, and how much is due to hard work?

I would say that you can only capitalize on luck if you've done the work to be ready for it. I will never downplay the value of hard work. It is the most important. When luck presents itself, you also have to be willing to lean into it and recognize it. It’s far more the hard work than the luck but I'm here in this part of the world and there's a lot of luck that went into that. You got to use what you get. I appreciate and I'm grateful for the luck that I have received in this world. I show that through hard work.

Any final words on culture or anything else you want to share before we wrap up?

If you're tuning in to this and investing time into trying to better yourself, you're already ten steps ahead of where you need to be. Keep investing in yourself and the profession. You have such a great show. You bring on amazing guests. A big kudos to everybody who's investing their own time to try to better themselves. That's the way to win. Great job.

If you're investing time into trying to better yourself, you're already ten steps ahead of where you need to be. Keep investing in yourself and the profession.

Thank you, Kevin. I appreciate it. You're one of those great guests. Thanks for sharing all your insights. Everybody, stay tuned because there are going to be a lot more marketing-related concepts and discussions coming up. They're going to be extremely beneficial, not just for business owners but for anybody who's trying to get themselves out there more and take advantage of the platforms that are available to us.

Stay tuned for that. Thanks again, Kevin. I appreciate all your insights. Thank you, everybody, who's been tuning in. Make sure you leave a review, leave a comment, hit like, and share it with some friends. I will be back again on Canada's number one optometry show in the next episode very soon. Take care.

Important Links

• POD Marketing

• Marketing4ECPs

• FYidoctors

• Specsavers

• LinkedIn - Kevin Wilhelm

• Kevin@4ECPs.com

About Kevin Wilhelm

Kevin Wilhelm is the President of Marketing4ECPs, a digital agency that specializes in supporting independent eye care professionals with their branding, lead generation, and online presence. He is a published author, speaker, and even has an online course on udemy.com. He loves to share his knowledge and experiences with other entrepreneurs when it comes to building and marketing companies.

Episode 96 - Practicing At Your Highest Level With Dr. Mark Eltis

At your highest level, practicing means always looking for new knowledge, making connections between seemingly unrelated topics, and pushing the boundaries of what is possible. In this episode, Dr. Mark Eltis discusses practicing at your highest level. Dr. Eltis is an exclusive expert in the field of dry eye and glaucoma, and we'll be discussing how these two topics are linked. While previous conversations have covered dry eye, Dr. Eltis sheds new light on the topic and provides insights into its relationship with glaucoma. This episode is not only relevant for students who are studying optometry but also for optometrists who want to improve their knowledge and skills for board and fellowship. Apart from his expertise in the field, Dr. Eltis has also built a high-end practice in the Toronto area. He shares tips and tricks on how he accomplished this and offers advice to optometrists who are looking to build a similar practice. Join us as we delve into the world of dry eye and glaucoma with Dr. Mark Eltis and learn how to practice at your highest level.

Connect with Dr. Mark Eltis: Website | LinkedIn | Facebook | Instagram

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Watch the episode here

Listen to the podcast here

Practicing At Your Highest Level With Dr. Mark Eltis

As always, I am humbled and so grateful for all the support everybody who's been sharing, liking, commenting, reviewing and all of that stuff. It's been incredible. Thank you for all of that. In return, I'm always trying to bring as much value as I can to the show by bringing on incredible guests like Dr. Mark Eltis, whom I have here with me. I'm sure if you spend any amount of time on social media or if you attend any CE lectures, especially related to glaucoma, dry eye or the type of stuff we're going to talk about, you've seen Mark multiple times. You know that he's an amazing, highly trained, highly educated person.

To give you a quick rundown of who he is before we get started so you know the caliber of guests that we're dealing with, Mark is the newly appointed President of the College of Optometrists of Ontario. What an accomplishment. Congratulations on that. As a quick disclaimer, he's not speaking in that capacity in this episode.

He is also a newly appointed Canadian Ambassador for the American Board of Optometry. He is himself a fellow and a diplomate of the American Board of Optometry. He is also a member of a very prestigious group called the Optometric Glaucoma Society, a very exclusive group of only a handful of optometrists in Canada and over 150 optometrists across the world who have this certain level of training and expertise in glaucoma. It's incredible to have somebody like this on the show. It's been a long time coming, Mark. We've been talking about this for a while. Thank you so much for coming on. I appreciate it.

It's my pleasure. We had so much fun when we met in person as well. I'm looking forward. I don’t know if you're going to be at BCDO in 2023 but I hope to see you again.

I'm always there. Every year I go. Even if I'm not speaking or attending too many lectures, I always try to attend because I show support for our association. Also, it's one of the more fun events for me to network and reconnect with local friends. I'm glad to hear you'll be there. That's awesome. To set the agenda for our audience, we're going to want to talk about dry eye because that's one of your big specialties. You do a lot of talking on that.

Dry eye is, to some degree, a topic that's been exhausted in a lot of ways. Myself being guilty of that too. I talk about it a lot. We're going to also talk about glaucoma. You are one of these high-level exclusive experts in the field but we're also going to tie dry eye to glaucoma. I know you've done some work on that space.

For the students out there who are studying or even optometrists who are looking to become more highly trained in the fellowship and the board certification, we're going to talk about some of that too. One of the things I want to pick your brain about is you've helped to build this high-end practice out in the Toronto area.

I want to learn from you a little bit about how you've done that and what tips and tricks you have for ODs looking to build that type of practice. That's a lot of stuff. Let's start with dry eye and I'm going to defer to you a little bit. I don't have too many specific nitty-gritty questions. I want to start with what's exciting in dry eye. What are you doing that you feel like you want to help people?

If I were to make a comment about dry eye, especially for young optometrists and people trying to get into it from a practice even management standpoint, you don't need a lot of fancy stuff. Let's put it this way. Fancy stuff does not make you a dry eye expert. Like everything else, it's about the education of the doctor and the training. I still say sometimes that I started lecturing on dry eye in 2009 or right before I was in LA. I was giving a lecture and it’s still on youtube. I called it Keeping a Lid on it: The Underdiagnosis and Management of Blepharitis. At the time, everybody was like, “What are you talking about?”

I remember graduating in 2003 and people were like, “Dry eye is connected to the mucus membrane,” or this kind of thing. We understand the connection with inflammation. I remember speaking on it and people are like, “Why are you even talking about this? This isn't a sexy topic. This is boring.” Sure enough, at that time and shortly thereafter, people were making the connection between inflammation and dry eye.

At the time, it was funny. It wasn't even a given. It's one of those things that they say in life. First, people deny it or ridicule it. Once it's accepted, they're like, “It’s connected. What are you talking about? We're at that stage.” My point is that while it's amazing to buy all the high-tech toys and I believe in them, the toys don't make you a dry eye expert.

I tell people, “Think about going to the dentist. Do you know any of the equipment they're using or the differentiation between a certain drill or scaling tool? You don't.” Ultimately, these things are going to even out. Everyone's going to have an IPL or whatever it may be. What's going to make the difference? It's back to the basics, which is how you treat your patients, how they feel in your chair, what you know and what are your levels of expertise when it comes to these issues.

With the technology, you can be the first and it's great to be the first or one of the fewer or to be groundbreaking. There's always better technology but I don't think that makes the difference between a good doctor and a bad doctor necessarily. I’ve worked in offices in the past where I had very little technology, either for dry eye or glaucoma and I still made it work. I don't want people to think that if you don't have that stuff, you can't be an authority in the field.

Having technology in the medical field is groundbreaking. But that doesn’t mean that if you don’t have the stuff, you can’t be an authority in the field.

That's a great point to start with. I’ve started talking about dry eye much later than you. One of the important pieces of advice I got from a mentor at that time because I was like, “What do I buy? Which meibographer? Which IPL,” was, “Do you have a slit lamp? Do you have fluorescein?” “Yes.” “Good. You're good to go.”

That's extremely important. A lot of people get bogged down in trying to buy all the technology. Thank you. From an expert standpoint, that's very important. Let's say that you've been doing that for a while and are looking to upgrade. We're not talking necessarily about brands but what types of things should one have to think about elevating their practice in the dry eye space?

Everything works in concert. IPL will help in most cases, for instance. However, you need to take an individualized approach. That's the other aspect maybe, which I was starting to talk about but didn't zero in on. You need to assess all levels. Let's say a mechanized expression, not to name particular brands, you need something that does that. Maybe they're afraid for whatever reason of certain techniques. There's low-level life therapy or something else that can be used which fits a patient's needs and also, their comfort level.

Not everybody's a candidate, for instance, for certain techniques but they are for others or even something more basic. I still start with expression, debridement and some microblepharoexfoliation. For me, that’s the starting point where I get to assess things and see it manually and see what's happening and how the patient responds to things touching their eye, being close and how they respond to certain things.

If you hook them up to them and you start something very elaborate and they're not even okay with you getting close to their eye, we have a problem. That's where I'm at. You can take it up to the next level. That trust builds, especially if you're going to do something which has even some mild side effects. You may not have that level of trust yet and that could break apart the situation.

I remember I watched an old lecture I used to give on dry eye. Even when we were using tea tree oil more commonly, I don't use it as much anymore for Ocrevus treatments and others. I don't start with the tea tree oil because it can be a little bit more aggressive. People can be like, “I don't want to do the cleaning because it burns.” Sometimes even though you want to go and throw everything but the kitchen sink at them, you may want to start a more stepwise approach to build that trust and confidence and get the buy-in from the patient.

I’ve had those patients where we're like, “We're going to do radio frequency and extraction on you,” and the patient's like, “I can't have anything near my eyes.” Some patients will tell us up front, “I’m bad with anything around my eyes but I'm going to try to tough it out.” You see them squirming and laying in the chair. It's funny. I give them a lot of credit for going through it. This stuff with dry eye, not to take anything away from you Mark and your expertise in it but we hear it a lot. There are lots of discussions around the dry eye. Am I right? You wrote an article or something about the connection between dry eye and glaucoma. There’s an overlap there. Tell me a little bit about that.

It's my two loves, dry eye and glaucoma. The connection is that, first of all, you know everybody has dry eye pretty much. It's an epidemic on its own. I see it in five-year-olds. I'm sure you do. That's not new probably to anybody who's focused on the field. What we neglect to think about is with glaucoma, why do people go blind? Is it that we don't have treatments? For the most part, we do have treatments. It's patient nonadherence, let's say. People are not taking their medications or not coming back for follow-ups. Why? It's not that glaucoma is necessarily painful if we're talking about POG or NTG. It's that the treatment can be uncomfortable like burning, stinging or ocular surface disease.

That's part of the dry eye world. If you improve their dry eye symptoms, you're more likely to have a patient who's going to take their medication. You can do multiple things like non-preserved medication but also treating their ocular surface. The dry eye blepharitis and meibomian gland dysfunction will probably make them take their glaucoma medication more consistently. My main point is if someone has glaucoma and they more than likely have dry eye, treat the dry eye because that's probably your best bet to prevent vision loss. They're going to become more compliant with their medication.

Glaucoma: If someone has glaucoma and they more than likely have dry eye, treat the dry eye because that's probably your best bet to prevent vision loss. They're going to become more compliant with their medication.

It's funny how you said it. A lot of times in the beginning, people would be like, “No, that doesn’t make any sense.” Later, when it all comes to it, they’re like, “Of course, that makes sense.” It seems so obvious. I don't do a whole lot of glaucoma. I'm going to be very upfront here but one of the biggest complaints that patients have is that the drop sting or their eyes get red. What's happening on the ocular surface that we can perhaps help to minimize?

Supporting the ocular surface with dry eye treatments and things makes a lot of sense. It seems almost too obvious to even talk about but it's not. It's still something that needs to be brought to light. What's the response that you've been getting? What do you recommend to ODs to start to do a bit more?

It's nothing complicated. You're taking a glaucoma patient or suspect because I see a lot of suspects. I tell my patients, “Ninety percent of you who are being monitored for glaucoma are never going to have it.” The problem is if you're in that 10% or we can argue about the exact percentage but if you're in that small percentage, you can lose vision. Unfortunately, I’ve seen a handful of patients who were in that category who weren't followed at my office but were seen by other places. Some of it's the patients not following up as much as they should have but sometimes it's also doctors being a little more blasé about following up 3 to 6 months if needed.

90% of you who are being monitored for glaucoma are never going to have it. The problem is if you're in that 10%, you can lose vision.

Sometimes I tell patients, “I know it can be costly and annoying but if you're in that category of the patient that's going to have more rapidly progressing glaucoma, you have an issue.” This is another misconception about glaucoma. It's a slow-moving disease. It is, except in times when it's not. It's hard to tell. You can say, “Higher myopes have a risk or certain patient demographics,” but we can't be 100% sure. I leave it to the patient.

I'm not one of those people that pulls the trigger on treatment very quickly. I talk about it with a patient. That connects to my earlier point about dry eye. If you want to be a glaucoma-focused optometrist, patient education and the relationship with your patient are probably paramount because you need to explain to them, “It's usually a slow-moving disease. I don't think you have it but one can never be 100% sure. Even with all the technology, OCT, HRT, corneal hysteresis, all that stuff and the most advanced visual field machine, there's still that level of uncertainty.”

“How do we mitigate that risk? I can see you more often and we can discuss the risk and benefits of putting you on treatment, which is lifetime or observing very closely.” I compare it sometimes to the stock market where I say, “If you watch it for 1 day or 2, you're not getting a sense of what's happening. More readings over time tell you what's happening.” It's like the Berkshire Hathaway CEO says, Warren Buffett, “Stocks all over the place in the long-term is where you see the reality of what was happening.”

That's the same thing in glaucoma where I can do an OCT two days in a row and one can look like in the red zone and the other one can look perfectly normal. Which one is true? Probably the 3rd one or the 4th or the 5th. If we do them in sequence and we don't wait six months, then we're going to panic if all of a sudden they were perfect in testing one. At testing two, it's like you've lost all this RNFL, supposedly. You're like, “We got to treat it.” No, we should have watched it more carefully to get more data points.

If there's ever any voice of reason in the world of the crazy stock market, it's him. It makes sense that you have to look at the big picture but also, to get that big picture, you got to have people keep coming back. You got to get those multiple data points. Without that, you can't choose the right course of action. What would you suggest for somebody similar to what I was saying about dry eyes somebody who's looking to maybe do a bit more glaucoma? I don't do any or very little other than monitor certain things. We have the technology. I don't spend as much time seeing the patients who have those conditions. What would you say to me to get me more into it? What should I be doing to be helping those patients who have glaucoma to treat it more in my office?

The first thing I'd say is you don't need to have all the fanciest equipment but it's great if you do. I’ve been using OCT and HRT, not in my clinic necessarily but for a time I was sending out to another clinic where they were doing the testing where I didn't have the equipment. Glaucoma's not like something like a retinal detachment.

Generally speaking, you don't need the result on the same day. If it takes a couple of weeks to get the OCT or a month, it's probably not a big issue. If it is, you probably shouldn't be holding onto it anyway. The thing is so people understand the back-to-the-basics. I was taking a lot of courses at Berkeley on this. They were emphasizing a more back-to-basics approach with the photos and looking at the optic nerve.

Don Hood at Columbia is the opposite approach where with an OCT, you can pretty much tell glaucoma without looking at anything else, maybe the visual field but that's it. I tend to not adhere to one school of thought exclusively. I'm like, “Look at the images and yes, have the technology to help you.” The research shows that if you're a glaucoma specialist ophthalmologist, you can do just as well with imaging, 3D photos, stereoscopic photos and visual field as you can do with OCT. Certainly, myself included, are not that good. I would benefit from the OCT and all the other fancy tools.

What I would say is to use everything that you have. You don't have to be a hero. You don't have to diagnose it off a photo. If you're not sure about the OCT, there's nothing wrong with sending it out to a specialist to get an opinion. A lot of the time, I’ll tell you that I still get an opinion before putting on a borderline case on medication. If we're going to initiate lifetime treatment, I don't mind having that second opinion.

This is the thing that people don't get. When you go into a lecture and everybody's so sure about what glaucoma is and isn't, you're probably not in the best lecture circuit. When I’ve gone to Optometric Glaucoma Society meetings and you get experts from Harvard and Johns Hopkins, they tell you that they weren't sure or they show you where they made a mistake or they explain, “I thought this person didn't have glaucoma for 5 or 10 years. Looking back, it was obvious that they did.”

The thing is that it's a very difficult disease to diagnose. You may not be right at first. The issue is that it's okay. As long as you're monitoring close enough, it won't make an impact on the patient's vision. If you're too arrogant about knowing when it is and isn't or you're not doing enough testing, that can be the issue. Once the vision loss is there, then it becomes too late. Early on, if there are a few drops in the points on the OCT or some peripheral visual field defect, the patient's life isn't going to change. What will change is if you miss the big stuff.

The take-home message I feel like is simply getting the data points and monitoring the patients closely if you feel like there is a risk of developing glaucoma or progressing. That's the number one most back-to-basics thing. It's funny you mentioned the photographs. When I was doing one of my clinical rotations at an ophthalmology practice in Florida, one of the ophthalmologists was older even at that time. I'm sure at that time, he was in his 60s or 70s so he'd been practicing in the old days before a lot of these technologies had come around. He would look at a photo and a nerve and say, “I see this.”

He would look at it for ten seconds whereas we, as the students, would be blinding the patients in the slit lamp for ten minutes trying to see all the details that he was seeing and was able to pick up things that we were only able to compile after visual field, OCT photos, all the stuff together. It's cool and special to see the way that the brain works of somebody who's got that experience.

Let's talk about boards your board certification and a diplomate of the American Board of Optometry. That's different than me taking the board's exam to become an optometrist. You do a lot to talk to a lot of students and you help them get through that whole thing. You talked about the board process, like the KMK board process. Being an ambassador for the American Board of Optometry, you're also helping people go through that process. How do you become a diplomate? How do you do all these things?

Let's start with the student side of the conversation then we'll work our way to optometrists people who already graduate and working who want to elevate their training. From the student perspective, I'd love to have a section here where I could share this with students about, “Here's what you could do. Here's what Dr. Eltis has to share with you to prepare for boards.” You're talking about the psychology of it.

That's important because there's such a psychological aspect to it beyond just understanding the information. I’ll leave it to you before I give away the punchline here. Tell us what you'd like to share with students and what can we impart to upcoming optometrists here to make sure they're well prepared.

In terms of academics, if you study for long enough and there are wonderful programs out there like you mentioned KMK, you can get the training in terms of the information that's going to be on the board exam. What students don't focus on or people don't talk about is the psychological aspect. That can be the silly things.

The theme of our conversation is glaucoma and dry eye like, “That makes sense. Why doesn’t anybody talk about that?” It's the simple things like do you have the clothing you're going to wear for your board exams? Do you have whatever equipment you need? Do you know how to get to the place you're going to be to? I guess in 2023, it'd be in Charlotte for the NBOs. Do you know how to get there? Did you arrive one day before and get to that place so you know how to arrive?

The reason I mentioned these things is that they seem like, “That's pretty easy and simple.” As a former examiner for national boards in Canada and the US, I’ve seen how students can get derailed if they're not in the right frame of mind when they enter the exam room. It doesn't take much. Anything that flusters you or gets you out of that zone can be an issue when you're talking about a practical examination.

Students can get derailed if they're not in the right frame of mind when they enter the exam room. It doesn't take much. Anything that flusters you or gets you out of that zone can be an issue when you're talking about a practical examination.

What you need to do is get everything in order, everything from what you're going to eat the night before and not studying or staying up late or getting into some panic or getting into an argument with somebody that day off. These are all things that will make a huge difference when you're taking your actual exam.

The second thing I would say, even putting the practical aside or for anything that requires this level of thinking and preparation for months, is you were going to get confused or the fog of war on how well you're doing. I’ve seen a lot of students give up halfway through even a written examination. They've told me so or in a practical exam, losing their focus and being demoralized, going from one station to another because they think they did disastrously and it's over. Most of the time, that’s not true.

It's weird because I’ve had that feeling too as a student where I think that things have gone badly and in the end, they didn't. Your mind will start playing tricks on you. I liken it to the fog of war where you don't know what the enemy is doing. You feel like it's hopeless but yet you don't know you're potentially advancing or things are going much better than you think.

It's in the confusion, chaos and emotional challenges that these situations present, your mind will not give you information as it truly is in the world. We all have that when we're angry or we have some life crisis. We're not perceiving information the way it truly is. We're perceiving it through the filter of our experience.

When confusion, chaos, and emotional challenges are present, your mind will not give you information as it truly is in the world.

That's my first message to students. You have to not give up. You have to keep fighting no matter what happens or what happened or what you think has happened, ignore it and proceed like nothing has happened and you're in the moment. Otherwise, in most of these situations, you’ll regret it because you were still in the game and you think you're not.

That's a huge piece of advice. I forgot to mention that you are formerly an examiner for the Canadian and American Board exams. Your input here is invaluable coming from that perspective. In theory, it's easier said than done. It’s like, “Wash your mind of that. Let's move on.” That mindset is very important to have. Having the memory of a goldfish is very important to have in so many aspects of life like in business education or wherever. Any practical tips for a student in that situation? You're in part three doing the practical side and came out of one room and you're like, “I think I messed that up.” How would you suggest to somebody to wash your mind off that and move on to the next?

The easiest way to do it is to say, “It doesn't matter if you failed the previous section. It doesn't matter what you do in this one. You might as well do well. Practice for the next time you're going to take it.” You're probably going to do a lot better because there's less on the line. The only thing you shouldn't do is say, “Forget it. It doesn't matter.” Even if you say, “I failed the previous section or whatever it is. I’ve got too many things wrong in the written part or I screwed up retinoscopy,” who cares? Do this. Practice for the next time you take it then.

I guarantee you, most of the time, you did fine in the previous section. If you want, I’ll share my absolute best tip. This is something which the rules change every year. It depends on which board exam you take. Even in school, it's never a good idea to redo a section in a practical exam. Even teaching at Waterloo or all these board examinations, I’ve never seen anything good come out of someone redoing a section if they allow you to do It.

The reason why is that you get points for the process. You are thinking about it methodically. When you redo it, you're focused on what you missed but you end up not doing all the other stuff correctly. The timing. You're forgetting that now you have less time so you're more under the gun. In all the time I’ve taught and I’ve been teaching academia for many years, I’ve never seen anything good come out of redoing a practical. I'm seeing it at that particular moment. In that same examination period, if you've got five minutes left, you're like, “I did this poorly. I'm going to redo it.”

You probably did fine. I’ve never seen someone redo it with a need to redo it. When it's disastrous, people run out of time and that's another concept of controlling the clock. You need to watch the clock. That's something where lecturing these things. I'm constantly watching the clock. Sometimes I’ll throw in a story and I’m like, “I’ve got less time to finish everything else. I need to know how I'm going to bring myself to that 50 minutes or 1 hour.” It's the same thing in examinations where you need to understand where you are relative to where you need to end. The last thing you want is to run out of time.

The last thing you want is to run out of time.

I feel like the time component is a deliberate thing in a lot of cases where they're deliberately putting in a bit of a time crunch to force you to think a little more quickly. Going back to your thing about redoing, it's important to trust that you prepared yourself and trust your process of thinking enough that going back is not going to help you any more than doing it the first time over. That's a key piece of advice. It's so easy to second-guess yourself in those situations.

It's been years since I’ve been in that position but going over it the second time would not help me. Go through it once. Trust that you've prepared yourself well enough. If it didn't work out, then you get a chance to do it again at another time. That's great advice. Thank you for sharing that. Let's move on to the optometrist who wants to elevate their training. Fellowship or a diplomate of the American Board of Optometry. Tell me a little bit about that process. What would you share with somebody who's looking to go into that area of specialty?

I remember even after a few years of practice before I started teaching, I got a little bored. The truth was I was doing the same thing every day. I had my little interests but I didn't know more than what I was taught in school. The thing is people sometimes think, “I don't want to do all that. It's going to be a lot of work.” I’ll be honest. It’s not that the average optometrist or patient is going to say, “They're a this or that or have this title.” No one will recognize that unless they're doing research into what it means. Your career is going to change things.

When I started my first paper on blepharitis, I was like, “I didn't know anything about this.” I didn't know about the research. Every time I write a paper, I find out how little I knew about a specific topic. The truth is that in a field such as ours, there's not enough time in one's lifetime to know about BV or low vision, glaucoma or dry eye. There are too many things. As much as you can dive into it, what interests you, you can focus on, for instance, a fellowship in the American Academy of Optometry.

That’s a nice place to start because you can write papers towards your fellowship and you’re focusing on things that you care about and that you’re interested in like case reports. You’re going to fall in love again with what you were interested in and dive deeper into it. A lot of the time, doctors ask me, “How do you sell the glaucoma testing or dry eye stuff?” I'm not selling. I believe in it. I'm confident in what the patient needs. I explain it to the patient. No selling is required.

If the patient doesn't want it, that's fine. I know the next patient will want it or the patient after that. I'm not the type of doctor who pushes. The only time I will even give a rebuttal is when it's a matter of making sure the patient understands the risks of not doing whatever I suggested. Once I'm clear that they've understood it, I don't try to push. I don't feel it's getting anywhere and that's what's needed. Certainly, even if you look at it from a business standpoint, I don't believe in that. I don't want to cheapen the process of seeing a doctor by me pushing anything. I explain what they need or what I think would be good for them or options.

Sometimes I tell them, “You don't have to do the glaucoma testing now. You have a family history but no other risk factors. You have a bit of mild dry eye these days. Everyone does. This is what we can do. If you don't want to do that, that's okay. I want you to have an awareness so that when you're having the symptoms, you're like, ‘Dr. Eltis told me this is an issue. I can revisit it and take it to the next level.’”

That's the way to go. I'm connecting that to the additional qualifications because you can respond when patients push back on something and say, “Glaucoma usually is high pressure. I don't have high pressure.” You can learn from doing research that about half of glaucoma patients have high pressure and NTG, Normal Tension Glaucoma, is a big deal, especially in certain populations. In the Japanese population, 90% of glaucoma patients never have a pressure above the statistical norm. If you understand those things, you can articulate why you're doing certain things and you can protect your patients from vision loss.

Glaucoma: If you understand important research about NTG, you can articulate why you're doing certain things, and you can protect your patients from vision loss.

That's a great correlation or segue to make there. I appreciate that. As you were saying that, I was like, “This is going to be perfect.” We're going to start talking about how you talk in practice but having those qualifications can often help you make a bit more of an impression on the patient. How about outside of patient care? What about other aspects?

Talk about doing research or writing papers. There's a certain type of person who's going to be interested in that. I'm not one of those people but what would you say to that person? Maybe they have a bit of an inclination for writing articles or doing research themselves. How can they get started or dive further into that?

If you see a case that interests you, keep it aside and then the research comes after. You can see a case. You don't have to have done something monumental. The truth was that a lot of the cases I used were simple cases that you see in practice like a primary open and glaucoma case, blepharitis or common things. Contact lens microbial keratitis. I talked about corneal ulcers. They're like, “This is cool.”

After you've recorded the case, then you go into the research. You have to go to PubMed, read articles, select them and then write a paper, which is not the easiest thing. It's like when my students at Waterloo complain about having to write a paper for their course. What I tell them is, “You're never going to learn as much. When you listen to a presentation, you absorb 5%, 10% of it or maybe 15%. When you are writing a paper, you will never forget that stuff because you keep going through it. You're reading the article that you have to put into your paper.”

I have to think of how it relates to everything you've researched in your case. When I'm going to a lecture about something I’ve already written a paper on, that is a lecture that is so easy to give because I know it inside out. When I'm preparing a lecture because it's needed on a topic and I’ve never written about it or talked about it in great detail or thought about it, it's a lot harder. You always feel like, “I hope they don't ask me about this.” I'd say, “That's a great question. I'm not sure.” My latest paper, which took me years to write, is about the long-term outcomes and recent advances in refractive surgery.

I’ve written a two-part piece and it's in the Canadian Journal of Optometry. It's because everybody keeps asking me at parties or anywhere I go, “What do you think about LASIK or the long-term outcome?” I was like, “This is a great question. I need to do my research on it.” Yes, it takes a long time but I feel excited and so confident to talk about that. If you're thinking about it, even elevating your career, like on being online or having a presence is important. Also, differentiate yourself from other doctors.

Having speaking engagements and writing is how patients find you. Even other professionals. You see it in law and accounting. They're publishing papers or articles because that's how people find you online and it sets you apart. People get to know you. They feel they understand what you're about or they sense a higher level of qualifications by reading these things or watching you speak. A TV interview or these things will also elevate you in the eyes of patients. Rightly or wrongly, I'm not saying that everybody that has written something and has made an appearance on whatever media is more qualified. I'm simply saying that that is a way to differentiate yourself from the average practitioner.

Glaucoma: There is always a way to differentiate yourself from the average practitioner.

I can imagine how much work that must be, the research, writing the article and all of that, the journal, although I was thinking maybe ChatGPT might be able to speed things up a little bit. Write an article that makes me look like a specialist in corneal refractive surgery.

You always get those doctors. I see it all the time. It's hurtful because you go through all these things and they say, “We're triple board certified. You're not even board certified.” It's not because you passed the licensing examination. That's not board certified.

I passed three parts of the board exam.

It's true. A lot of the public may not know or understand the difference but some people do. I say this as a dinosaur. In the end, there is a big difference between filming yourself on Tiktok or Instagram because you read a snippet from someone else's article and being in front of 1,000 people speaking about a topic and answering questions live. I will tell you that especially in social media, a lot of certain personalities will get a speaking gig because they do have a large following. It is a big difference to speak live in front of a huge audience and answering questions in real-time than it is being in front of a screen scripting your response or taking 50 takes of it.

That was not on the list of topics for us to discuss but that's a big one. I have a lot of respect for our colleagues in our profession or other professions who are out there on social media and building their presence. I'm doing that myself so I understand what goes into it but you're right. It's not a fine line. There's a pretty clear dividing line between social media content and online content versus being an expert and speaking in front of other people who are experts or well-educated and informed on that topic so they can ask you questions that will be hard to answer in a lot of cases. I’ve been in that position too.

Going back to what you said, I'm like, “I'm not sure I’ll have to look into that.” It's not a comfortable place to be. It takes guts to put yourself in that position. I’m not trying to pump my tires here but knowing how many times you've put yourself on those stages, there's a difference. I'd like to make sure that our colleagues know that too. I respect that when you educate yourself to this level and go out there to teach other people who are already educated in this area. That's a whole different ballgame. Good for you and thanks for doing it.

One other thing I wanted to talk about, which you already teased for us, was the practice, specifically high-end practice. Some people might take that the wrong way. We are talking about high-end in a couple of different ways or high-level practice. Let's talk about what that maybe means on the clinical side to have a high-end practice and what it means on the retail side. I'm trying to build up the higher end of the retail side of my practice. We have these mid-level mainstream frames and brands and stuff. We're slowly trying to work our way up to having a bit more of a boutique and high-end practice. I'd love to hear your take on that. Let's start with that because that's the side that I'm most concerned about. I'm being selfish here. Tell me your thoughts on that and we'll go from there.

It all comes down to the same thing. At the risk of being a broken record, if you've ever flown first class or you've gone to a nice boutique, even if you haven't bought anything, you go into Louis Vuitton or something like this, what is the difference? What is being offered? It's customer service. I’ll even split it into two parts. Those who know me know I like Disney. What's the difference when you go to Disney? Why is their customer service so world-renowned? Is it that they're offering you gold when you walk in and Dom Perignon on arrival? No. It's two things.

I’ll start with Disney because it's the motivation of the staff. People who work for Disney love Disney. If you can get even a little bit of that for your staff, you're already a step ahead. They are happy to be there. You travel a lot too. I'm sure you've hit I don't know which airline, let's say the equivalent of Star Lines Gold or whatever that is. When you walk into that lounge, what is different? What's different between that and the pizza shop at the airport? The difference is the greeting, the serenity and the little things that can be helped. If you ask the person of the attendant, “Is this flight delayed or not,” they can look it up for you. That smile. They're generally in a good mood, hopefully.

It depends on which airport but certainly, the level of care is higher than at the food court in the airport, the chaos that you have there and the level of, “I'm doing this as a job,” as opposed to, “We're treating you like a VIP.” It doesn't cost much more. You need the caliber of an employee but it doesn't cost much more even as the doctor to treat your patients as a VIP. I'm not talking about offering them incredibly expensive things but it's your time, care and attentiveness.

I went to the dentist before. I had a wisdom tooth extracted. The funny part about this was this doctor thought I couldn't tell he was somewhere else and didn't care about me. He was answering my questions. It wasn't that he wasn't giving me the answer but I could tell from their tone and the eye contact or lack thereof that they were thinking about what they will watch on Netflix that night. I'm touching on different elements. It may not be as structured as you would've hoped but it's about caring for the person serving you and being invested in the outcome.

Glaucoma: Being a doctor is about caring for the person serving you and being invested in the outcome.

It's about the perception that they are offering you their full attention and time, that they care as much about what's going to happen with that pair of glasses as you do. The truth is that if you're talking about accessories, for instance, a dry eye mask or a drop, when I first started selling drops, there were six times the price of something you can find in the pharmacy. I thought people were going to come back, complain and ask for refunds all the time. It's only happened a couple of times out of thousands of sales. Why? It’s because they perceived the value in the product. I’ve explained it. You can't do high-end sales like low-end. You can't be like, “Here's a drop. It is $60. Buy it.” That's not going to work.

If they don't find that you've invested the time in explaining their dry eye and situation, why this is the right drop for them? Opening it up and showing them how to use it. This takes a little bit of time. It can be staff as well but it's that extra investment of time. You can't have five-minute exams at no charge in a high-end area or somewhere where they're going to invest that time, energy and effort. You can't combine those two elements but why do you want to go into that space? It's because that's how you're going to differentiate your practice.

Starbucks does not want to be Tim Hortons. It never tries to. Everyone knows the coffee is $7 as opposed to $1 but they're willing to pay that to say, “I want the no cup, no coffee, no sugar, no anything, latte.” For whatever value they place on that, that's what you're offering in that practice. I have a lot of patients coming in for 2nd, 3rd and sometimes 10th opinions and they say, “I'm scared to get my pressure checked. I don't want anything close to my eye. What can you do for me?”

I understand from my regulatory body experience because people are going to say that in the comments. The standard of care is the glaucoma tonometry visual field. If a patient declines that level of care, you can do what they are comfortable with. Document properly and take into account all the regulatory stuff but give them that tailored service. If a patient walks in and says, “No, you have to have the air puff test. You're not a patient at this office.”

Aside from that being problematic in many respects, you're not giving them that tailored experience and not being sympathetic. I’ve seen surgeons too. I had a patient come back and say, “Thank you so much for sending me to that specific surgeon because he understood my specific anxiety and concerns and addressed it to the best that it could be addressed.” I'm not saying tell them, “Don't worry, surgery isn't going to hurt,” or this thing when it's not true. I'm saying, “We can put you under general anesthetic if you are too anxious to have the cataract surgery otherwise,” or this kind of thing.

As far as when we're talking about building a high-end practice and leveling up, in your opinion, the number one thing perhaps many people are missing is the service aspect of it, providing that high level of service. That creates the impression of higher quality and everything else beyond that. I’ve heard different offices will do different things like have a concierge or greeter. Do you think that's important? Do you have something like that at the practice that you're at?

It depends on what you consider concierge but I answer my emails. I make it available to patients after hours. Frankly, it saves you a lot of grief. You don't want them to have a complication or have an issue and then connect it to you. If you look at the research and lectures, why do patients complain about doctors or sue doctors? It's a perceived lack of interest or care on the part of the doctor. That's number one. Not dilating this thing is another major issue but it's a perception that the doctor didn't care about me or the outcome.

For instance, I had a flash and floater on the last patient on a Friday. I explained to them. I said, “I'm doing everything I can to prevent this from being an issue. We looked at the back of your eye and there's nothing there. However, there's always that chance early in a retinal tear. It can be missed with all the technology, dilation, opt dose and whatever else you have. If you think something's changing, go to emergency right away or message me right away. If I don't answer, go to emergency.”

The thing is if the patient has a retinal detachment and they go to emergency, they're not going to say, “That doctor didn't care about me. They didn't even think about this could happen. They missed it.” No matter what the doctor at emergency says or no matter what happens after that, they say, “I was warned about this.” It comes back to one of the things I constantly say to students.

It's better to explain first than apologize later. There's a complete difference between you saying, “It's going to be hard to adapt to that minus nine,” from a patient coming back and saying, “It's a little tough. I’ve worn it for a couple of days and I'm still not adapting.” You say, “It's tough with a minus nine.” It's a different experience for the patient.

On that note, as far as adaptation and prescribing, having that conversation with patients ahead of time is extremely valuable because they know that it's going to take time. A separate little clinical tip that I’ve found super helpful over the years is trial framing is huge. I started never trial framing and doing it sometimes. Over the last few years, I trial frame most people's prescriptions, sometimes for the actual function of making sure that they're comfortable. People with a lot of sills and stuff like that will make some minor adjustments through there.

A lot of times, it's the perception of giving that patient that extra step and level of care saying, “Here's what your new glasses are going to look like. I want to make sure that you like this before we prescribe it for you.” Even if it's a minus 150 and they're going to be fine, that goes a long way. Doing those little things throughout every part of that patient journey is what's going to elevate that level of care.

The thing is that some doctors do a quick exam and they like seeing patients having a short interaction. I love that longer interaction. If I'm seeing a patient every 45 minutes, it's going to be a different experience. You can offer more services but also discuss them and there's going to be buy-in to whatever they may need. You can mention dry eye and other services that you provide. That's another way to differentiate yourself. The revenue will come because they're buying into those treatments. It's not like you can simply have a staff member at the front.

I remember going to a dermatologist. I was there for a while. Everybody that walked out the receptionist said, “The doctor recommends this cream, lotion and shampoo for you.” It’s the script. Everybody that walked out got the same pitch. That doesn't work as well as you individualize treatment and care when you say, “No, I'm suggesting this dry eye treatment or procedures for you or this glaucoma test because,” and that's a different thing. There's staff, which is excellent. We have some to explain specific side effects or specific procedures to an extent but the doctor also needs to invest their time and energy into the patient to make the patient buy into additional care.

A lot of times, doctors have that pushback. When I talk to them about implementing dry eye or myopia management by having more of these conversations, the pushback is, "I don't have enough time in the exam room.” It does take more time. I would be lying to be like, “No, it's not going to take you any more time to have this extra conversation on top of what you're already doing.” It does take more time. It started by taking honestly 10 or 15 minutes sometimes to have a long conversation about all the things related to the dry eye that I wanted to tell the patient initially.

I streamline it down to maybe five minutes. If I want to have a good in-depth conversation about dry eye, I have images and all these things that I have set. The same with myopia management. I’ve streamlined it down to a few minutes of conversation with a parent. If it's going to go beyond that, we know what to do next. What's your feedback or suggestion to those doctors who are like, “I don't have the time during my eye exam to add this aspect?”

First, I'd say it's okay not to do dry eye or glaucoma stuff. You can send it to someone else. You can have an associate who does that stuff. That's okay. No one says you have to. As long as the patient's getting the ultimate treatment they need or you're making the referral, that's perfectly fine. Inter-optometric referrals are something we don't do enough as a profession. I know all my BV. I tell patients right away I don't dabble in BV. If you've got something beyond the most basic BV issue, I'm sending it out.

Same with low vision. I don't do neurorehabilitation. I don't waste a patient's time and I know what I know well. I don't want to dabble because I don't want to be that guy where I'm not going to do the right thing. Another expert will say, “He should have done this or that.” I don't want to get into that situation. The other thing I’ll say is for young practitioners, having someone in your practice who does a lot of social media helps. A lot of patients say even at that time that they're not ready to plunge into the dry eye treatment or you have to structure it for a different schedule, whatever procedure or technique you're going to do.

That's where you can say, “I post a lot of my techniques online.” This is where you can look and direct them to the information or your articles. This is where all that stuff makes a difference. It's one thing to direct them to some show about dry eye or other doctors. It's another thing for them to see what you've been doing, what you are passionate about and how you implement it in your office. It makes them feel more comfortable. It's not on your time. The internet is 24 hours a day at their convenience.

Leveraging social media and other online platforms is huge. It has to be done. I do an eCommerce digital branding lecture and that's one of the most important take-home messages. I'm up at whatever time in the morning and get the kids ready, take them to school, go to work, commute home, then it's dinnertime, bedtime for the kids. Next thing you know, it’s 9:00 PM and I'm sitting on a couch.

Am I going to call somebody and be like, “Can you explain this procedure to me?” No, I'm going to go online. If I’m going to buy something, I go online. This is the case for so many people. If you're not presenting at least the basics of what you do on a good website and social media, you're missing a massive opportunity with a good chunk of the population. It’s very important.

My social media is tailored more for patients. I think about my fellow practitioners and it's for fun. When I say it's for patients, it's more for existing patients if they want to see what I'm up to, what I'm doing and what's new. Someone's not going to look at your Instagram or TikTok and be like, “I want this person as my doctor.” They're probably not in the same jurisdiction. They're halfway around the world. I don't think that's so effective. I do think a patient of yours whom you've mentioned a technique or your passion about this particular topic or myopia management and that's what you're into, can look and say, “I get it. I see. It's for this and that.”

A lot of their questions are answered in their time. They can do their research and compare it to other doctors as well and they can see a difference. We've all seen those web pages where there is generic writing about conditions. It falls flat to me. I can't say from a patient perspective but you're like, “I can tell this is from a generic response.”

Social media adds that personal touch. It's a piece of the puzzle. Sometimes it is but often it's not going to be the one thing that draws a person in. Let's say they got the same information from the website. There are 3 wonderful websites for 3 nice-looking clinics. They all offer the three same techniques. My next step is, “Let's see what their social media account looks like.” That's how I function and I know I'm not alone. I can go there and get the personal feeling behind the scenes.

If your social media is very generic looking or it has been put together by some media company or whatever social media that you've outsourced, then I'm going to weigh that out with, “Here I see the doctors are making videos of themselves and talking and telling me more about what they do,” versus the generic looking, very nicely polished feed. I'm likely to go with that one where I’ve gotten to see what the doctors are about. It's a nice little piece of that puzzle, for sure. Mark, in every episode, I end with two questions. Before we get into those questions, I want to ask you. How can people get in touch with you? Where can they find you?

Speaking of social media, I try to be active. Everything from LinkedIn to Instagram and Facebook. That's where I post stuff at practice. If you look me up online, look up my name. You can find me. Just google.

Remember, most people are reading and not watching. It's the same question that I ask every guest at the end of every episode. Number one is if we could step in the time machine and we could go back to a time in your life that was difficult, you're more than welcome to share that moment if you'd like to. More importantly, what advice would you give to younger Mark at that time?

I’ll make it very clinically relevant. When I was in school, my biggest regret as an optometry student was not asking enough questions. When I was in the clinic and the clinician tried to show me something, I felt like I needed to be like, “Yes, I see it,” when I didn't see anything. I felt like my grade was going to be affected and I'm not going to pass and I'm going to fail and my life is going to be over. The truth is looking back, it didn't matter. I should have taken that clinical time saying, “No, I don't see it. Can you show me again? I don't understand this concept.” That would've propelled me forward.

Glaucoma: One of the biggest regrets an optometry student can have is not asking enough questions.

I did a lot of my learning by doing my fellowship and diplomate. That was another learning experience for me. Even during boards, you learn new stuff, doing the preparatory stuff but I wish I would've in clinic asked more questions and allowed myself, even if it's a mean supervisor and say, “How come you don't know this? You should know this by now.” Who cares? What is the worst they were going to do?

I remember the worst grade I got in clinic one day was something that wasn't my fault. The supervisors took it out on me and gave me a 5 out of 10. What does it matter? I could have asked more questions on other days and gotten so much further ahead in my education by not being afraid of them saying, “You don't know that? I'm going to give you a 5 out of 10.” Is that 90 on a day where you didn't learn anything? In your 1st year in practice, you have taken a 7 on that day with the information rather than a 9 because that 9s not going to do anything for you.

I was very guilty of that. I'd never asked questions. A lot of times, it leaves you in a tougher spot down the road. That's great advice for students and even for optometrists. If you're at a lecture and CE, don't be afraid to look silly. There's no such thing as a dumb question. Almost always, honestly, if you have a question, somebody else has it too. Instead of being afraid and making yourself look silly, look at it the other way. You're helping someone else by asking that question. It's a different way to look at it.

As a presenter, we're so excited. We're waiting for people to ask questions. There isn't any such thing as a dumb question. It's usually the people who ask questions in the gotcha moment that don't know what they're talking about. It's the people who are honestly asking questions. It's usually an excellent question. As a presenter, it energizes us that to get questions and we love it.

As a presenter, it feels good to help answer and clarify something for somebody in the audience. I’ve never had a question where I was like, “Come on. I talked about this for an hour.” I never feel that way. It's always like, “I'm happy to. Please.” The fact that somebody's going to leave here knowing a little bit more than when they came in makes you as a presenter feel so good from a couple of different perspectives.

You're being so altruistic by asking this question. You're helping someone else in the audience. You're helping the presenter feel good. You're a superstar instead of coming out thinking that maybe you're dumb or something for asking the question. Student, new grad or veteran OD, it's important to ask those questions. The second of the two questions is, with everything that you've accomplished, Mark, to this point and everything you're doing, how much of it would you say is due to luck and how much is due to hard work?

That is an exceptional question. I was thinking about that. What everyone needs to realize and this is not optometry related is that they sometimes will see social media. I post all my accomplishments. I don't post all the rejections but that's normal. I will say this. I’ve been practicing for many years. I'm a dinosaur. In my professional career, you cannot imagine the number of rejections or perceived injustices in the sense like, “I deserve that and someone unqualified got it or someone got it because of a connection.”

That's happened to me more times than I can even remember. The thing is it can seem after a while that it's hopeless or you're never going to make it. The thing is that in the end, if you keep at it and I'm talking about many years, I'm not talking about 1 or 2 years, eventually, you'll be rewarded. We were talking about some of the things I’ve been proud to achieve or that's happened to me. That's not a last year’s situation. That's a 20-year situation.

What I want people to understand, especially students and anybody reading this is it's not that some people have it all figured out and they get one achievement after another or one offer after another. Pushing through that rejection, those times of total humiliation and complete unfairness are going to get you ahead of life.

Some people have it all figured out, and they get one achievement after another or one offer after another. But pushing through that rejection, those times of total humiliation and complete unfairness are going to get you ahead of life.

That's incredible to share. Thank you for sharing that. It's a shame we don't share enough of that on social media. I suppose that's not the right platform to share. Although some people do it to get a bit of pity and get a lot of likes for that reason too. There's a whole different thing there. Social media generally is a highlight reel. People get caught up in watching Mark become the President of the College of Optometrists, the ambassador for this thing, as well as part of this elite society for glaucoma. They say, “Everything's working out for this guy.” No, it's the years of work that you've put in and then you start to get lucky.

The answers I’ve heard or I like to think for myself is the harder you work, the luckier you get and the more opportunities you create for yourself. A lot of times, I’ve heard people say to me, “You're always in the right place at the right time.” That's offensive because I'm like, “You don't know how many wrong places I’ve been in to end up in the right place this time.” It's all part of the process for sure. Thank you for sharing that. Any other final words of wisdom you'd like to share before we wrap up?

I wish I could share all the failures and rejections. Social media, which I love, has an excellent part but also has a negative side. You always have to understand that, yes, there's luck, which you touched on. I’ve usually been lucky when I’ve done the preparation and they say luck is when preparation meets opportunity. I have my regrets and I’ve done stupid things. Things haven't worked out or there have been people who will try to backstab you or ruin your career and all these things.

I’ll say this, which is another point on the same theme. If people aren't attacking you in some way, trashing you or speaking poorly about you, you're doing nothing right. They may be correct that you did something wrong. You have to be open to that criticism. I'm simply saying for most of us who are thinking about what we’re doing and are not like, “I'm doing everything right,” and who have that introspection, the reality is people will be jealous.

Not everybody who's liking your post is celebrating you or people who are watching your story. Half of those people never say anything positive. I know they're not watching it because they love me. The thing is you have to understand that when you are in a position or you're going places, people are going to try to bring you down. That's the nature of the world and you have to accept it. Know that there's nothing you can do about it and keep moving forward. If there is criticism even from an enemy or someone negative, you can consider it and judge it by its validity or lack thereof and then move forward.

Wonderful advice from a very experienced optometrist from the clinical perspective, research perspective and all of those. If you are pushing boundaries, you're going to probably make people uncomfortable. You'll likely get some of that “hate.” How you move forward is all going to be about how you deal with that. Thanks for sharing that, Mark. Thank you for taking the time. I appreciate it. You had incredible amounts of insight to share. No matter whether somebody's reading, if they're a student, a new grad, a veteran OD or something else and they're in the research side of things, they're going to find value in this whole conversation. Thank you for that. I appreciate it. It's been great to finally do this.

My pleasure. It was wonderful to speak with you again. Honestly, from a selfish standpoint, I can't wait to see you at BCDO and party again because you're way cooler than I am. You elevate me with your presence.

That's very kind of you. My wife would laugh at you for saying that but thank you. That's awesome. Thanks again, Mark. I can't wait to see you there, for sure. Thank you, everybody, who's reading this episode of the show, Canada's number one optometry show. I appreciate all the support. There's so much value. Whatever part you found valuable, please take a screenshot, throw it up on Instagram or share the link on LinkedIn or share it with a friend through a text message. Let everybody know that Mark was here and talking about all these great things. Stay tuned for the next episode coming very soon.

Important Links

• Dr. Mark Eltis

• Optometric Glaucoma Society

• Keeping a Lid on it: The Underdiagnosis and Management of Blepharitis – YouTube

• LinkedIn – Dr. Mark Eltis

• Instagram – Dr. Mark Eltis

• Facebook – Dr. Mark Eltis

About Dr. Mark Eltis

With twenty years in practice and 14 years in academia, Dr. Eltis has presented and published internationally and has been sought as an expert for national television and print. He is the current president of the College of Optometrists of Ontario (provincial regulatory body) and the Canadian Ambassador for the American Board of Optometry.

Dr. Eltis is a member of the Optometric Glaucoma Society (OGS) and a ACOE team chair for residency site evaluations. He has been a consultant for academic institutions overseas, law firms, and a subject matter expert for competency evaluations.

Dr. Eltis has also been a previous examiner for NBEO and the Canadian board examinations. He is a Fellow of the American Academy of Optometry and a Diplomate of the American Board of Optometry. Dr. Eltis has practiced in New York, California, and Toronto.

Episode 95 - The Future Of Canadian Optometry - Dr. Stanley Woo, Director Of The Waterloo School Of Optometry

Dr. Stanley Woo is the Director of the Waterloo School of Optometry and Vision Science. In his role, he is an avid advocate for the advancement and growth of optometry. In this episode, Dr. Woo shares his views on the future of optometry in Canada from the point of view of a person responsible for the education of future optometrists. Dr. Stanley Woo also shares the role of Waterloo School in several disruptions in the industry. We cover all the relevant topics to what is changing in the landscape of Canadian optometry. Tune in to this episode to find out more.

Check out these links:

Seeing Beyond 2020 Campaign: https://uwaterloo.ca/seeing-beyond-2020/

Canadian College of Specialties in Optometry: https://ccso-ccso.ca/en/

Thanks for listening!

Be sure to rate, review, and provide feedback to help us improve the podcast!

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The Future Of Canadian Optometry - Dr. Stanley Woo, Director Of The Waterloo School Of Optometry

I'm honored to have Dr. Stanley Woo on the show. He is the Director of the School of Optometry and Vision Science at the University of Waterloo. That is the only English-speaking optometry school in Canada. They have a large presence in the industry and the profession of optometry here in Canada. I'm honored to have you here, Dr. Woo. Thank you for joining me.

Thank you very much for the opportunity. It is certainly a pleasure to be here. I appreciate all the great work that you are doing to promote awareness and education through your show. It is an honor to be here. Thank you so much.

Dr. Woo, before we jump into it, I love for you to give us a little bit of self-intro. What is your position at the University of Waterloo?

As Director of the School of Optometry Vision Science, we lead the school mission, vision, values, and certainly the multiple missions that we have there, our talented faculty, staff, and students. We have a big presence in delivering patient care. We are also responsible for clinical education and training for the contemporary practice of optometry. Last but not least, being able to do innovative research from self to society to be able to encompass new techniques, technologies, and research that we can translate into practice to improve health outcomes. It covers the gamut, and I'm fortunate to be the spokesperson for all the great people back home.

You are a great spokesperson. I want to quickly throw this in there before we jump into it, but I have heard you speak multiple times. You come to BC for the conference every year to share what is happening and what is new at Waterloo and remind everybody that this is the preeminent institute in Canada, especially on the research side.

It is always fun to hear you talk because you are always entertaining and charismatic on stage. It is part of the reason why I was excited to have you on. I knew you would be a good guest from that side of things. We will dig a little bit more into that stuff toward the end of the show. The research side is interesting to me. That is a side that perhaps we don't think about enough and how important that is to our profession. We will get into that.

To set the stage, one of the reasons I was so excited to have you on is the future of Canadian optometry. I have had multiple conversations now with guests and talk about the future of Canadian optometry. What is the future of the profession? What does the presence of certain entities in the profession mean? What does the education look like? What does the training for students coming out of school look like? What do we expect the future to look like for our profession? Is it bright or dim? Is it positive? Is it negative?

What better person to have this conversation with than the Director of the University here in Canada who is leading the educational programs for the new graduates? I wanted to dig into this conversation with you, Dr. Woo. There are seven previous episodes and this is the eighth in this vein here of the future of Canadian optometry. The first question I've asked every guest is, in your opinion, what is the current state of optometry in Canada?

That’s an excellent question and a challenging one. There is no simple answer. We are at a bit of a crossroads in Canada. Optometry is a profession. We are well-positioned to assume a primary care role to address the growing eye and vision care needs of an aging population. By the same token, we often fall outside of the priorities for health systems. Remuneration has lagged significantly behind the level of education, skill, and training that we are able to bring into play. Those challenges put us in a position where there is a great opportunity, but there are challenges to be better recognized within the system, and how we can help to improve access while also being appropriately remunerated.

I would agree on that crossroads. There are good and bad in there. We have to look at how we are always going to progress. In your opinion, how do you see us improving the remuneration and recognition within the healthcare system?

One of the pivotal areas is to be able to raise awareness and public education of both potential patients and communities, but also with the government to highlight that there is a public health crisis in vision care. It is often taken for granted at the margins. Yet we do recognize it with various organizations. The evidence is there to point out that it is something that needs to be urgently addressed.

Raise awareness, so public education of potential patients and communities, also with the government highlights the public health crisis in vision care.

In 2019, the World Health Organization pushed out its first vision report ever. It highlighted over 2.2 billion people with vision loss, almost half of which could be preventable. We might think that the World Health Organization is only addressing issues that are abroad where there might be less well-developed infrastructure. In point of fact is that a lot of the challenges they’ve identified also face us right here at home.

We recognize that there are a tremendous number of Canadians who are at risk of vision loss. Not everybody recognizes the ability or the need to get comprehensive eye examinations to address it. The economic impact is projected to be about $56 billion by 2015 as far as the annual cost of vision loss, and it is at about $33 billion now.

There is an urgent need to raise awareness to drive the recognition that it is a challenge that could and should be addressed. We need to be thoughtful and strategic in how we organize ourselves and be able to meet this challenge both as individual optometrists in our own communities and also through our provincial associations, colleges, and the national association.

One of the things that makes it somewhat optimistic is that there is a little bit greater awareness. There is a Private Member Bill by MP Judy Sgro for C-284, calling for a national vision care strategy. There is a growing awareness that we often take our sight for granted, but those who have been touched by vision loss and if you live long enough, everybody will have some experience with impaired vision. It is important to recognize that early diagnosis, intervention, and management treatments are critical to maximizing everybody's independence, quality of life, and the like.

One of the questions that come up quite a lot is the scope of practice and whether or not it is important for us to continue pushing to grow or expand that scope of practice. I think I know your answer to this, but where do you sit as far as expanding the scope of practice? How do we go about doing that?

The scope of practice is something that every health profession continues to expand and drive. We always want to be able to incorporate new technology and treatments, and accelerate that translation into practice so we can take the best possible care of our patients. The scope of practice isn't something that should be limited or constrained. It should be something that we promote and accelerate to leverage the rapid pace of technology and treatments available.

Waterloo School Of Optometry: Every health profession should continue to expand and drive the scope of practice. We always want to incorporate new technology and treatments and accelerate that translation into practice so we can take the best possible care of our patients.

The other challenge is we recognize that North America has the most well-developed optometry profession and programs in both education and research. We lead the way as far as being able to be primary eye-care providers and address particular medical eye-care needs. It is a challenging problem. We have an aging population and medical eye diseases like age-related macular degeneration, glaucoma, and diabetic retinopathy. These are all things that optometry is well-positioned to be able to incorporate and adapt to.

Some of the scopes of practice are a bit frustrating because technologies like lasers for glaucoma have been around for decades. They have been successfully deployed by optometrists in Oklahoma for over twenty years successfully and safely with improved access to patients to get better care and better outcomes. It is challenging that it has taken so long to do what seems to be self-evidently beneficial to the public, the health system, and the individual patients in remote communities that may not have access to care.

The scope of practice is critical. It is important to recognize that the school has a responsibility to be able to deliver that contemporary education, and to enable all of our graduates to practice at the highest level of scope available. Also, to support those in the profession with continuing professional development to be able to have access to education skills and training so they can deploy that into their communities.

We’re working together closely with the associations for their advocacy efforts with the colleges, with their duty to protect the public, and with the school providing the educational foundation. Having that collaboration among all three entities enables us to put together the evidence. It also enables us to demonstrate, particularly to the government, that it is imperative that optometrists are recognized for their full capabilities to help meet that growing demand, helps relieves stress on the health system, and look after folks in the community where they reside or are closer to home.

That is one of the more common frustrations, myself included. It has been a while since I graduated. Even with newer grads who are studying, whether it is in Canada or in the States, they’re coming back home and realizing that a good chunk of the medical training they have is not valuable or applicable. Our scope of practice is fairly narrow compared to the level of education. What do you think has been the main obstacle over the past couple of decades or however long it has been since we have been trained to a certain level but not able to practice to the same level?

First off is that we want to be able to educate to the highest level. Hopefully, that creates a passion, desire, and sense of initiative where new grads will want to press to say, “Why can't we do what we have been trained to do? Why can't we do the most that we can to support our patients and our community?” With that grassroots effort, the hope is that can help coordinate with provincial associations like the Alberta Association of Optometrists.

They have been effective in being able to build the case. They are a large province. They have a very wide geographic distribution. They have a strong case for improving rural access to medical eye care. They have assembled the evidence, the education, the research, and the impact. It is a question of being able to say, “At what stage does this have to be implemented? What is the hold-up?” The frustration comes down to a balance of awareness of reviewing the evidence, and not being afraid to institute change.

Health systems and lots of systems are resistant to change. Oftentimes, that disruption of the status quo can cause challenges. In this case, it might be a little bit upsetting to some. If we put patients first and recognize what their best interest is to get accessible medical eye-care, optometrists are well positioned.

Waterloo School Of Optometry: Optometrists are well positioned if we put patients first and recognize their best interest is to get accessible medical eye care.

We are in many more communities. There are many more of us than other eye-care providers. The opportunity to look after folks closer to home would be a benefit to those individuals in those communities, not having to travel as great a distance, getting more convenient care, and with the doctor that has already been looking after them. It is a natural extension to be able to promote it. The challenge is to get that first province like Alberta to be able to say, “It is overdue. The time is now to help make this happen.”

Kudos to our colleagues in Alberta for leading the way and paving that path a little bit. We look to them to see the progression they have made in serving their patients in different ways to prescribe and treat diseases that we are not able to in BC. I know other provinces are not yet, but we will hopefully continue moving forward. I was chatting with our mutual friend, Dr. Richard Maharaj, and he gave me a quote from you that I was hoping you might expand on which is, “Education before legislation.” Is that what you are talking about here or is there more to that?

It is a common mantra. I spent over two decades down in the US. I spent most of my academic career down there. I had been involved with the American Optometric Association, our state association in Texas, and this was a common refrain. When I was at the University of Houston, the College of Optometry there, we worked with the Texas Optometric Association.

The notion was if the criticism from folks who are reticent or concerned is there is no sufficient education for optometrists to be able to deliver this care safely and effectively, we then have to address that. We have to provide that foundation and make sure that we educate before legislation or before those changes are enacted to promote the opportunity. It does make good sense to make sure that the educational foundation is sound and that folks are prepared and able to deliver competent care.

Education before legislation resides within the school. We deliver the content first to our students but also to the profession. We have an advanced procedures course that we have incorporated. We have learned from our colleagues down in Oklahoma who have been doing this for over two decades. We have adapted it for the Canadian context.

Our healthcare systems are different. Some of the values are different. It is an opportunity to be able to provide that education. As associations go to their various legislatures, they can reassure those members that we have addressed the safety concerns and efficacy concerns. It is an important change that can help to improve the system.

Provide education so as associations go to their various legislatures, they can reassure those members that we have addressed the safety and efficacy concerns. It's an important change that can help to improve the system.

The other thing to consider is that education before legislation also reflects on educating the public and government officials. We have been fortunate to have MPs and NPPs come to visit the school. Their perception of what optometry is, where we are, where we have been, and where we have been going is a bit limited or narrow. Being able to come and visit the school, see the facilities and imaging technology, and see how we use lasers for YAG capsulotomies and SLT. It all of a sudden makes sense. They go, “You use that bio microscope every day. You put an energy source on there and you are still using the same technique. That isn't as big a reach.”

The dangers and the things we manufacture in our minds about what that could mean and how it might be a threat division demystifies the whole thing. Education before legislation has two arms. One is for the profession and students. The other is for government officials so that they understand that this is realistic, credible, defensible, and ultimately to the benefit of patients.

Speaking of the education of students, these are two-pronged questions here. One is what types of disruption do you feel you have seen or should we expect to see coming in the profession? Two is regarding the education of students. How would you think Waterloo is addressing potential disruptions in the industry?

One of the things that are both exciting and a little anxiety-laden is technology. The pace of technological development and how that impacts the way we practice is growing by leaps and bounds. If we embrace that and help to shape it in a way that helps us do our jobs more efficiently and effectively, it can show great promise and potential. On the other hand, if we are resistant and we think we can delay or postpone it, it creates anxiety about, “What is our role? How can we adapt?”

One example is tele-optometry. Within telehealth and telemedicine, optometry is developing the technology that is at the cusp of being able to deliver comprehensive remote eye examinations. On the one hand, that could be a good thing. On the other, it might be disruptive and may even be challenging. From a positive standpoint, the notion is that it could be leveraged to help deliver access to care for rural and remote communities, in particular the indigenous communities, first nations, Inuit, and Métis.

It is not a panacea and a cure-all. Folks recognize that we have a big geographic distribution in Canada, and the weather is challenging sometimes. If tele-optometry technology can help us to improve year-round access and assist in the management of chronic eye diseases like glaucoma, that would be a benefit. The flip side is that tele-optometry is not limited to those areas. It also can provide convenient care. Whether it is extended hours or shorter wait times because it is a new modality, not everybody is comfortable with it. For those who do, it offers an alternative.

Being able to reconcile where we want to be, what we want to do, and how we want to incorporate as a profession to benefit our patients is one example of a disruption that we are navigating now. To address that for our students, we need to make an investment in infrastructure. We are fortunate to have a tele-optometry lane that we have deployed so we can start to understand how that works.

Our faculty team and graduate students are looking at that and trying to get a better handle on how it works, what the limitations are, and how we might help support policymaking and guidance to make sure that it is used effectively to maintain the standards of care. The other technology that is quite disruptive is AI. We get to the extremes where we have Skynet and Terminator. That is more sensationalized.

I view AI as something that can be harnessed for clinical decision support. I don't see it as a replacement. There is an important role to play for optometrists in the doctor-patient relationship to be able to cast, educate and guide patients through their journey as they seek healthcare, whether it is eye and vision care or beyond. There is a trusted relationship there and a connection. While there may be some who are happy with everything being remote, there will always be an opportunity for AI to support the work that we do.

Waterloo School Of Optometry: Optometrists have a role to play in the doctor-patient relationship to counsel, educate, and guide patients through their journey as they seek healthcare, whether it's eye vision care or beyond.

The challenge is we have to help shape how that unfolds. We need to be able to look under the hood and make sure that we understand how those algorithms are designed and built. Make sure that it is trustable and explainable, and helps to support the work that we need to do, particularly in a primary care setting.

With ophthalmic imaging, optometrists have OCT, fundus cameras, and technology for ophthalmic imaging. It is important that we recognize and harness that resource to work collectively to help shape how AI is developed. As you can imagine, we are the ones who see folks before they develop eye disease. If you are going to develop predictive models, it is not the end stage of identification. It is the things that are further upstream.

That enables us to create the infrastructure with the school as a potential resource and partner to now aggregate that information all across and address things like de-identification, privacy, and cybersecurity. We can create a public good to help support the next level and next generation of innovation. Those are two examples of some of the disruptions, and the role that we are trying to position the school as a national resource to support students, the profession, and the public.

Those are probably the two types of technology and disruption at the forefront of most people's minds. You mentioned that you felt like tele-optometry was on the cusp. I have spoken to some people who feel it is beyond that. It is here and ready. Would you disagree?

On the cusp, I referenced the middle of the normal distribution. There are early adopters who have already been implementing and doing it and doing a good job. There are still some gray areas from a regulatory standpoint and an efficacy standpoint. That is again a charge to the two schools, both us and Montreal, to develop the research protocols to find the evidence to support the efficacy and the effectiveness, and be able to look at it from both the patient experience and outcome lens and from a provider experience.

One of the things we need to explore is the pain points for folks to adopt technology like tele-optometry. Rather than simply leaving it in the gray area, it would be helpful to better understand when does it work well? When is it limited? How do we address the various patient pathways so that we can make sure that patients are looked after regardless of the technology or tool that we use to implement it?

With the AI thing, the whole Skynet thing is half a joke. I also think about the movie iRobot. I don't know if you remember seeing that one. Eventually, the machines take over. A real fear for many ODs is that machines will take over our jobs, but not necessarily control our world. Maybe one day, but I'm a bit of a conspiracy theorist. There is a fear that AI and virtual technology will bump the OD out of the exam room entirely. Do you think that is a concern?

It is always a concern. As technology gets better, and patience and the public choose their own pathway for how they want to seek and receive care, we have to be able to respond to that. It is incumbent upon us to demonstrate our value to our patients, the public, and the government about why it is important to have an optometrist to still be in the role to interpret that data and override the AI when it is incorrect. Recognize that there is a person behind all of the data that is gathered, and there is still a human component to what is required in being able to deliver the art and practice of optometry.

It is a potential threat. We have seen disruption in all sorts of industries, including manufacturing and the automotive industry. We are not immune and I recognize there is that challenge. I see that as our opportunity to harness that technology and make sure that we use it to be even better than we already are, and to recognize how it can make us more efficient and effective and deliver better care.

I prefer to see the glass half full. We can benefit from it. We shouldn't fear it. If we adapt and we incorporate it into what we do and demonstrate the evidence to support our value and what we can deliver, I'm confident that we can be even more effective. There are lots of folks who need care and who are unaware that they need care. This can help us be able to help address that challenge.

It comes up enough times during these conversations about the future of optometry in Canada. There are certain groups that are more vocal about this particular point. Particularly in Canada, there are not enough optometrists to meet the need of the general public. Do you agree that there is a shortage of optometrists and not enough optometrists in Canada?

My answers are more nuanced because I don't think it is an either-or. The way I would reframe that question is based on where the need is. Let me start first with where I believe there is a shortage. That is with the number of primary eye-care providers addressing the medical eye-care needs of an aging population.

In that regard, there are for sure not enough optometrists and ophthalmologists to be able to meet the needs. Everybody has declared that. We need to make sure that the optometrists that are graduating and the ones that are practicing are recognized, and that there are opportunities for them to be able to meet that need largely in rural and sometimes more remote communities. They need to have folks out there who are able to address those things most of the time to be able to deliver good care, and help improve and relieve the burden on the system. That would be one facet. We need more highly qualified optometrists ready to deliver contemporary eye-care.

On the flip side, if you go to any big urban center or city, there are lots of optometrists there. In that sense, in both locations, there is plenty of supply. If they limit their scope to more traditional refractive needs, whether that is glasses or contacts, arguably, you have a saturation point where there are sufficient options and choices where you wouldn't necessarily need to grow that segment of the industry.

This has been faced in the States as well, as they look at the increasing supply of optometrists and what the needs are. The take-home message would be that in Canada, in particular, medical eye care needs to outstrip the supply of optometrists and ophthalmologists. We need to continue to attract, recruit, and retain optometrists who are prepared to deliver full-scope contemporary optometry.

Your feeling is that it is more of a geographic imbalance. It is a poorly distributed supply of optometrists. We tend to gather into those metropolitan centers, and the rural areas and get less supply. Do you feel like that is primarily the shortage? There are certain areas that don't have enough primary eye-care providers. It is not that there is a global shortage of optometrists.

In Canada, it is a combination. It is easy to point to rural access to geographic distribution as one area of need. We need more practitioners out in those rural communities. Within the cities and major urban centers, there are still waiting times and demands for medical eye-care access. There is an opportunity for folks to carve out a different niche. The other aspect is growth within the services that are provided.

The depth and breadth of optometry continue to expand. You mentioned Dr. Richard Maharaj earlier. Dry eye, myopia control, medical eye-care management, vision therapy, low vision rehabilitation, there are a lot more that we can do now than we could 30 years ago. In that sense, there is a need for more folks, practitioners, and optometrists to be able to deliver that next level of care. There are folks who are happy to spend more time in those more specialized areas to help meet that growing demand.

The notion overall is if I had to say, “Do we have enough optometrists in Canada?” My short answer would be no. With the cautionary tale that we don't necessarily need everybody doing the same thing. What we need to recognize is we need a better distribution. There are more specialized areas in that there is growing demand, whether it is medical eye care or those others that I mentioned. That could be an opportunity for growth and improved access.

We are in a good state for all of Canada. There are only two schools of optometry here, ourselves and in Montreal, which is a French-speaking school. We recognize that we have a lot of Canadians who are interested in optometry school. Unfortunately, we don't have enough seats for all of the qualified Canadians who are talented and capable enough. They have to go down to the States, other areas, or jurisdictions to be able to get that training and return. There is clearly demand as far as the number of students. There is an opportunity for us to help to address that.

It is a perfect segue because the next part of that question and conversation often is that certain people are more vocal about this than others, but there is a need for more schools. Do you agree with that?

We had strategic planning exercise a number of years ago. One of the priorities that did emerge was to recognize that there are insufficient seats for the number of qualified Canadians who are interested in optometry school and practicing in the profession. One of the things we had proposed that was a bit different than perhaps what has been done previously is that rather than trying to start up a new school from scratch, it would be to work with the School of Optometry here at Waterloo. We already have the expertise and accreditation. We partner with another institution with the infrastructure to deliver health professions education. We work collaboratively in a joint program where we would have a satellite campus of the School of Optometry Waterloo at another location, ideally in a rural location.

The mantra is you recruit from the north for the north. You make it more accessible to folks who might not want to come to Waterloo or go to a big city. It makes it more comfortable, familiar, and closer to home, and leveraging technology. Through COVID, we have learned a lot about hybrid education. We are more comfortable with technology. We can achieve the same learning outcomes and use them to our advantage where it is appropriate and intentional.

Instead of somebody trying to create a school from scratch, which has happened, to my knowledge. I grew up in Waterloo. Every decade somebody decides they want to start a school, but the limitations are threefold. One is you have to have local optometry support. Those docs locally are the ones who are oftentimes that is going to the clinical preceptors to help support the clinical education training. They have to recognize that there is both a greater good and a need because it has been proven that in optometry schools, people end up connecting and settling down. They may start to gravitate and create an oversupply in that region.

Optometrists have to recognize, “We have a shortage. We want that. We want to recruit more folks from those communities, and it is okay if they stay.” Local OD support is one aspect. The second aspect is government. The government has to recognize that there is a need and a workforce shortage to meet healthcare priorities like medical eye care and to be willing to make the investment. Tuition and grant have continued to be flat or regress over the years. This is in every province is my understanding.

With tuition and grant insufficient to match the cost of delivering clinical education and training, there has to be a willingness to make that investment. If you can set tuition and grant, and you can get local OD support, the next part is to make sure you have an accredited program that has the quality that the public deserves and needs to meet that demand. This is where the School of Optometry at Waterloo could be a valuable partner because we have that know-how, accreditation, experience, and expertise. By lending that to a partner and working together collaboratively to co-design what the curriculum could look like, both the didactic, the laboratory, and the clinical education training, we could create that infrastructure in that partnership.

There are those three components. You have to have local support from the optometrist and the government, the economics make sense, and a guarantor for the accreditation and quality of the education that is being delivered. We don't need more folks practicing at different levels. What we need are more graduates practicing to the full scope of optometry with a fire in their belly to go and make that happen so that they can do what they are trained to do.

The last piece there is the accreditation and quality of training. It is certainly something that has been part of the discussion over the past years that I have been having these conversations. There have been rumblings in other countries perhaps to try "to meet the need." There needs to be a change in the level of training. The equivalent would be the nurse practitioner next to the MD, some equivalent in the OD space. That way, more people can have that need met. Is that going to be a possibility or maybe not ever? Is that anywhere on the horizon for Canada? How would we avoid that if you think that is a negative move in the wrong direction?

It is an interesting challenge because, on the one hand, we want to promote access. On the other hand, we already have a public that is not always aware of what eye care is and what is important about it. For example, children oftentimes have coverage for a comprehensive eye examination, but kids are resilient. Not every kid gets an eye exam even though they're eligible and it is covered.

It is fantastic that benefit is available, but the fact is that folks don't take their kids in whether it is awareness, education, or other access problems like transportation. It is a complex question. The challenge is if the public is already struggling with the value of getting an eye exam and then understanding the difference between screenings and comprehensive eye examinations, the last thing we need to do is to cannibalize the profession where you have different levels in different tiers.

Some optometrists do one thing that's not primary care, and others do a different level without it being clear to the public. Advanced practice type stuff specialization is different, but the core is primary eye care. We have to have a common fundamental foundation because that is the entry point. That is why it is primary care. Folks need to know that when they go see an optometrist, they are going to get this level of care. Not maybe this, that, or something lower. They need to understand this is the place to get a comprehensive eye examination for early diagnosis, prevention, treatment, and wellness, all the way through the diagnosis, management, and treatment of disease.

There is a struggle there. When you allow these different levels, it makes it more confusing in a situation that is already challenging. I would go the other direction and want to work with the government, public health, and those kinds of agencies to champion and get a comprehensive eye examination. It is essential to be able to see clearly and comfortably, particularly the children who aren't necessarily going to complain. They are going to adapt. If they can't see clearly, they will work around it.

I know many folks who come, and they have seen it for the first time. They go, “I had no idea my kid couldn't see the board or couldn't see this or that.” It is a shame because there is no reason why they couldn't. Sometimes they are affluent and professional, but it is not top of mind. I push back against this notion of watering down or allowing different aspects because if we are committed to being able to do it and willing to make the investment, we can elevate the expectation and that access without compromising the quality of care. That is what Canadians expect and deserve. That is why we all support each other with the health system. That is the commitment that we make as a profession.

Our offices are in fairly busy metropolitan areas. Even I have felt, as an owner of two offices, the difficulty in recruiting ODs. I’m not sure if there is a shortage or if it is one of those COVID-related things where people want to work less. Whatever the case is, there does seem to be a demand for ODs these days. With that, there are certain entities within the industry that are offering incentives to recruit ODs. Some large entities have more power to do that. They will give loans, pay larger salaries, or signing bonuses.

You are the head of this institution that is grooming these graduates and students to come out into the world of the profession. From that perspective, do you feel like these incentives are a good thing? The students are coming out of school like, “I can pay off my debt like this. I'm going to jump into the profession a lot faster?” Do you think it is somehow clouding their judgment a little bit in the way they are practicing? On one end here, you are trying to train them to the highest level, but perhaps they are taking jobs that are not in line with that because they are just going for the money.

Student debt is a concern whether you go to a Canadian school or a US school. It limits options and opportunities. It delays plans, whether buying a house, starting a family, or becoming a pathway for ownership or partnership in practice. First and foremost, we need to recognize the pressure on new graduates, in particular. Understandably, it will help to shape the choices they make.

I appreciate that there is an important vehicle to be able to help offset some of that student debt. There are some virtuous ways to be able to do that. There were programs where you can incentivize folks to practice in areas that are underserved. There are programs like that in the States. You get one-year loan forgiveness for one year of service to an underserved community. That is a win-win. That would be something that would be helpful for the government, in particular, to be able to help incentivize new grads to practice in communities that don't have as regular or effective access. That would be a pause. I don't want to mislabel relief of student debt as a bad thing only.

To your point, does it unduly influence students and new grads in a pathway that may not necessarily be best in the long term? I have a tremendous amount of respect for all optometrists and optometry graduates. They are smart and capable, but they need to be encouraged to ask the right questions, seek out the right resources, and not fall into the trap that many of us do where we think we are smart and we don't need to get help.

Whether that is accountants, lawyers, or the like, coming out with student debt, you are trying to save money. You think, “Maybe I could do this on my own.” My advice there would be if it sounds too good to be true, maybe it is too good to be true. Get professional advice to help you make those determinations. Ask the questions and see what the fine print means. Make sure it matches both your short-term needs and long-term desires for the profession. New grads are in it for the rest of their life and they are professional careers.

If it sounds too good to be true, it is too good to be true. But get professional advice to help you make those determinations to ask the questions, see what the fine print means, and ultimately ensure that it matches both your short-term needs and your long-term desires for the profession.

The challenge is you don't want to sacrifice, no matter how painful, that short term is to not make your future opportunities quite as promising. It is tough. It is a big sacrifice that we are asking folks to make. We all make it when we graduate. We have to make those trade-offs. I don't think we begrudge anybody for those choices.

At the end of the day, it is about making an informed choice, an objective and not necessarily emotional one, and being able to make an informed one based on all the evidence and the answers to all the questions that are most critical to have addressed. The most important thing is, how do you want to practice? What does that look like? Is that going to be sustainable for you in the future?

One of the key takeaways from that is making sure you ask the right questions at every step of the way, whether it is of other optometrists or from other professionals who will be involved financially or whatever interaction it might be. That is always important. I always feel like a lot of our colleagues, new grads, or whoever it might be could be a little myopic with seeing what is right in front of you and not seeing what the long-term impact is on your own career or the profession as a whole.

If the majority of our colleagues choose a certain path, it is going to lead to the public and the government seeing, “A lot of optometrists seem to practice like this. Maybe we don't need to expand the scope. Maybe we need to keep it to just this.” If more of us are looking at how we are going to grow the profession and the scope of practice by doing those more specialized types of things, then the public, the government, and everybody else will see, “It looks like optometrists do a lot of different things. Maybe we do need to give them what they are looking for.”

That is a much broader view that I'm hoping that more of us will have so our profession does continue to thrive. I assume you agree with that to some degree, but trying to do that in the most politically correct way without calling out too many people and without demeaning or making anyone feel bad. It is important we try to see things from a larger perspective.

Being able to see the big picture and our role in it is important. It is not necessarily the default. I get that you got pressures that you have to address. The other groups that I would give a shout-out to help with that broader perspective for new grads, in particular, are their provincial associations. They understand what the different challenges are, what the current state is, and what the tools and resources are to make that transition from student into practice. They are ready, willing, and able to help support new grads in being able to be successful. They are an important resource.

The other would be college. The college can help provide guidance on what the right responsibilities and duties are in each jurisdiction for each optometrist. Being aware of what you can and can't do, no matter what other folks are telling you. It is important to know what your rights are, but also your responsibilities because you don't want to inadvertently abdicate some of that. At the end of the day, you still have to be able to answer for the professional standards to which we all subscribe. I would encourage folks to be able to look to those two organizations in each province because they do help provide that context or that big picture, and to be able to see where things land.

The last point there is to emphasize we want folks graduating where they are hungry to do everything they are trained to do. We want them to go, “I am frustrated. I don't understand why I can't do an SLT to help my patient with glaucoma. It makes sense. I'm confident, capable, and ready to do it,” and be able to be that agent for change. We want new grads to be the ones who are going out there saying, “How come this can't get done? What can I do to help? How do I make sure that I can educate before legislation and make sure that my patients, who deserve the best possible care from me, can get it?”

I want to talk about the Seeing Beyond 2020 campaign, but do you have any other thoughts on the future of Canadian optometry? Where do you think we are going, and how can we do our part to make sure the profession thrives in the future?

It is wonderful to be able to look forward. I love the tagline at the top, The Future of Canadian Optometry. I'm optimistic. There are lots of things to dig to be able to do with that entry. One of the things we haven't talked about in-depth, but is worth expanding on, is the depth and breadth of optometry.

There is an increasingly critical mass in specializations. While we are not able to designate that for various reasons and different jurisdictions, largely because of marketing and advertising, there is a growing awareness that you can limit your practice to specific areas and do it well. You spend additional time and training. You see more complex patients in that space. It is beneficial for both our colleagues who may be doing primary care, and not low vision rehabilitation as a specialty. To do that takes time, energy, and expertise. That can be cultivated and developed. The patient benefited by not being limited to what we think is the limit of what we are able to do, but rather working collaboratively together.

Waterloo School Of Optometry: There's a growing awareness that you can limit your practice to specific areas, and do it very well, that you spend additional time and training that you see more and more complex patients in that space.

There is a group called the Canadian College of Specialties in Optometry, spearheaded by Alberta. They are working closely with Forac, which is the national association of the regulatory bodies of all the provincial colleges, to be able to recognize that there is some benefit to the public to know who might be in those different areas who might have had the additional training, education, and credentialing. Recognizing that it is not all about school and education. There is a great deal of clinical wisdom and experience that is brought there as well.

The CCSO is working on trying to create that framework and a pathway for the Canadian context, being able to help support both the regulators and the profession in having a reasonable, attainable, credible, and defensible path, and being able to recognize specialties and they are doing some good work. In full disclosure, I'm one of the directors there. I'm interested in being able to engage with the profession to help address any pain points or concerns, and help promote that credentialing as a benefit to the public and the profession. We start to understand who might be able to do those kinds of things in a way that would maintain the standard and quality that we expect.

The last episode I did on this topic, the Future of Canadian Optometry, was with Dr. Maharaj. He mentioned that. Being one of those ODs, he has spent time specializing. One of the pain points he was talking about was the fact that you can't call yourself a specialist in any particular area even though you have done all the training and specialized beyond what the majority of the profession is.

This is a great initiative to hopefully eventually provide that ability for us to say, “Yes, I'm specialized in this area.” I encourage specialization. It is important. Before I say the next thing, if you can't find the website, Google it, Canadian College of Specialties in Optometry. It will show up right away. Google filled that in for me. I started typing Canadian College of Specialties, and it came up. It is coming up. The website is CCSO-CCSO.ca. That will take you to the homepage there.

This is another example of education before legislation. There are two provincial colleges that are able to make the change and say, “Yes, we can recognize specialists.” The majority would require a legislative change. That is more complex. It would take a lot more effort to be able to make those changes. In the meantime, we can provide the foundation, the education, and the evidence to help support it. When the window of opportunity opens to make those legislative changes, we can be able to help promote that.

There is generally an understanding that it is permissible to say, that you have had additional training in a specific area. We may not say it is a specialty, but residency trained in low vision rehabilitation. In this sense, hopefully, the CCSO can provide a pathway saying recognition through CCSO for a particular specialty area. As that continues to grow in momentum and the evidence, and the support from the public and the profession continue to build, legislative change can happen after the education and awareness.

To go back again to this idea of specializing or having additional training and offering specialty services, when I'm talking to the previous guests in this series talking, how do we offer ourselves from disruption and changes in the industry or how do we make sure that we are the ones that are succeeding or thriving through the changes that are happening? One of the most common things was to offer specialty services.

It was to make sure that you have had additional training. You are not doing the standard stuff. We all understand the standard refraction in the sale of eyewear, if it hasn't already, started to fade as part of our allure for what is drawing people in for their comprehensive eye exam. You start to get these offers and other specialty services like myopia management, dry eye vision therapy, and all these things.

If you can offer those things and let the public know that you offer those things, you are going to be able to continue to succeed from a business perspective to a clinical perspective. It is important for us collectively to think about how we are going to continue to offer those services. CCSO is a valuable resource for us as it grows over the years. Thanks for helping to put that together.

I couldn't have said it better. I'm getting goosebumps as you are describing it because that is why optometry has a bright future. We can continue to do more stuff and be able to help patients in new and innovative ways. That technology and research will continue to be translated into practice. This is why there will always be a role for optometry.

We are primary eye care providers, but as we start to differentiate ourselves for patients professionally and in the marketplace, there is a lot of value that we bring. Coming back to Canada, it has been fun to see those cultural differences. We are modest and self-effacing individually as a profession and as a culture. Having been down in the States for quite a while, I relish the opportunity to champion how wonderful the work is that we are able to do. We need to trumpet that more from the get-go.

We are not good at trumpeting, that is for sure. I love going to conferences. When I got to chat with my friends and colleagues down in the States, it was amazing to see how comfortable many of them are at talking with pride about what they do. They are comfortable with telling people that they are good at it, whereas we are self-effacing and we don't like to brag. We need to start doing that a little more. Let's talk about Waterloo a little bit. Let's talk about the Seeing Beyond 2020 campaign. This is a big campaign for the Waterloo Eye Institute. I love for you to tell us a little bit about what it is. What can we do as ODs and as a community to support them?

The Seeing Beyond 2020 campaign is a once-in-a-generation project. We have a $35 million target. We have already raised $26 million. Thanks to optometry, the industry, and folks. The outpouring of support has been incredible. What we are trying to achieve is to modernize the way we are able to be a national resource. There are three different components to that. One is clinical education and training, another is research, and the last part is patient care.

Waterloo School Of Optometry: The Seeing Beyond 2020 campaign is a once-in-a-generation project. What we're trying to achieve is to modernize and be able to be a national resource.

From a clinical education and training standpoint, it is a modernization of our facilities to better reflect the way that optometrists practice. Being able to now break things out to reflect so that there is pretesting, and less emphasis on the data gathering aspect and more about having the progression into being able to incorporate clinical decision-making. Being able to match that patient experience so that they go through that experience, and not like it used to be back in the day when you took a patient back. They spend the entire time in the room or however long that may be.

There is a notion that there are more streamlined pathways that can still result in good outcomes but not necessarily compromise that experience. It is important for our students to be able to experience that. They will have an integrated way of being able to explore that, and certainly an increased emphasis on ophthalmic imaging, how that works at the core of all the different services, primary care, and specialty services, and being able to emphasize and build up those specialty services that provide a unique resource.

Along with that are things like tele-optometry. Making sure that technology is available to them so that they can be prepared to jump into practice and help lead the way. From a research standpoint, there is going to be a second floor as part of our 16,000-square-foot extension that is going to be a center of excellence. On the one side, it will have biomedical research. On the other, it will have imaging research. We are covering the gamut from cell to society, the basic fundamental science of discovery, translational work, and clinical work. We can cover the whole gamut of not vision science but neuroscience and the like.

Make sure that technology is available to them so that students can prepare to jump into practice and help lead the way from a research standpoint.

Those are ambitious plans where our faculty have rallied together to identify where we have strengths, how we can double down and increase that capacity, and build out. Along with that is the ability to partner with the rest of the University of Waterloo. We have excellent faculties in Engineering, Math, Health, and others.

We can help to shape what that AI might look like to help build those bridges and resources that can help support AI and machine learning research to build out the ability to look at big data to help inform not just the individual patient care but population health, and support informed public policy and decision making.

Last but not least, being able to have state-of-the-art patient care so that our students are able to integrate and embrace that. Translating that research into practice more quickly and efficiently. Supporting the development of future clinical practice guidelines, helping to support the rational framework for incorporation of new technologies like tele-optometry, and then supporting that increased depth and breadth, particularly in specialty care.

The Waterloo Eye Institute is going to be a 16,000-square-foot addition to the existing building. It is going to be a complete re-modernization of our clinical facilities where all of that patient care will take place on the first floor. We will also have a tele-optometry hub or mission control to be able to recognize that we want to be able to integrate with that as we look towards the future.

It has been exciting. We are going to the final design. We anticipate being able to go to construction and tender it soon. We are hoping that folks are as excited about our ability to anticipate where the future will go. They see us as a national resource. I didn't go to Waterloo myself. I can relate to those who may not have attended Waterloo. If you are practicing in Canada, there are two schools of optometry. If we are talking about education before legislation and research for the Canadian context, I hope that everybody looks to Waterloo as being that support for your associations, colleges, and your practice.

That is ambitious. That is a word that comes to mind. I like the phrase cell to society. That is cool. That encapsulates everything in between. I didn't go to Waterloo. I went to the New England College of Optometry. NECO asked me for money all the time understandably. I'm sure every school does of their alum. I like to donate to the school and the undergraduate school that I went to. I want to help support the students coming through. I didn't ask bluntly, “Why should I help Waterloo?”

There is so much in there, and I'm asking facetiously here “Why should I?” You mentioned that Waterloo is working with our associations and with the Canadian Association. We're going to see potentially many of the graduates working in our offices, or our colleagues are going to be from Waterloo. It is only to our entire benefit overall for the profession and for the future of Canadian optometry.

This institute sounds pretty amazing. Research is not something I think of often, but it is extremely important, not just in the biomedical sciences but in the technological side and AI. It is amazing what you are doing there. What can we do then to support? The other question is when this is all done, who can come and see it? I love to see what I donate and contribute towards. What does that look like?

Thank you very much for your support. I do not begrudge those. You always want to support your alma mater, and I appreciate that. NECO is a great school. I know Howard Purcell, their president, very well. You do that because that is where you cut your teeth. That is the school where you came from. That is important to do. You framed it well.

The notion is that you always want to support your school. In Canada, with just the two schools, it is important to be able to support us because we support the profession. That can help to support you individually and grow. Those dollars invested will have a tangible benefit because we have the ambition to be able to support and be that national resource. It is not just a tagline or rhetoric that we are prepared to make the investment in time, talent, energy, and resources, and be able to direct that back to support the public and the profession.

You always want to support your school. But in Canada, it's essential to support us at Waterloo School because we support the profession and help support you individually and grow.

In that regard, we are going to have lots of events to be able to help celebrate. We do anticipate having a groundbreaking ceremony, whether ceremonial or actual. It will depend on the timing of working with the architects and the construction folks. We welcome everybody and anybody to come and attend our programs, visit the school, and see what we envision certainly during construction.

It is an exciting time because it has been something that has been in the making for a few decades, and the ability to come together. I'm the spokesperson for it, but it is a collection of folks who have been dedicated, passionate, and persevered to be able to make it happen. We are closer than we have ever been. It is exciting to know that we will be getting a shovel in the ground. Anybody is welcome to visit. We are happy to talk with folks about what the plans are. We are excited about the potential to be able to support the profession and continue all the good works you all do in your communities.

I might want to come by that groundbreaking ceremony. When it is ready, whatever the timeline is, the ribbon cutting ceremony, or whatever happens at that time, I will be there for that too. It is very exciting. Thank you again, Dr. Woo. I appreciate all the insight and for adding your perspective to this important conversation about the future of Canadian optometry. Are there any final words on that note you would like to share before we wrap up?

You are doing important work. This medium is not natural to me. When we visit in meetings and things, I'm comfortable doing those kinds of things, but I appreciate how professional, how polished, and how well you do this. It is important to help to get that message out there. Thank you for what you are doing. Thank you for the thoughtful questions and the challenges to the leaders in the profession in all the different segments. It is important that we get that word out there that we all want to work together and make ourselves available to your audience, the profession, and folks that they know. I can't thank you enough for the opportunity. You were flattering earlier, but I'm equally humbled and honored to be a guest.

It was very kind. Thank you very much for your time. I know you are a busy person. To have you on here has been an honor for me. Thank you, everybody, wherever you are. Make sure you check out the Seeing Beyond 2020 campaign and the Waterloo Eye Institute. See all the great work that is going on there and what they are ambitiously trying to build. All the support we can provide is going to be valuable. It is going to come back and pay off for the rest of us here in Canada in the future. Thanks again for tuning in. I will be back again soon with another episode. Stay tuned. Take care, guys.

Important Links

• Dr. Stanley Woo

• Dr. Richard Maharaj – Past Episode

• American Optometric Association

• Texas Optometric Association

• Seeing Beyond 2020

• Forac

• CCSO-CCSO.ca

• Waterloo Eye Institute

About Dr. Stanley Woo

Dr. Woo is passionate about helping people see. As an optometrist, he works tirelessly to promote eye and vision care for people of all ages across the continuum of care from wellness through chronic disease management to vision rehabilitation. Whether helping a child to see clearly for the first time, or a senior with legal blindness recapture the joy of sight with assistive technology, his sense of wonder never ceases. Education and scholarship have been avenues of inspiration.

Stan has mentored students and residents as they sought to fulfill their potential in health care. He strives to better understand how rehabilitation and technology may help the visually impaired optimize their remaining vision to maximize quality of life and independence, and even has a couple of US patents.

Stan enjoys pushing the boundaries of what’s possible and exploring how we can enhance vision and health. Dr. Woo has had the good fortune to be part of strong teams and is devoted to giving back through service. As President of the Texas Optometric Association, he learned invaluable lessons in collaboration with government and regulatory agencies. His Rice MBA team in medical and health care management presented a model for urgent care clinics to fill the network gap in the Texas Children’s Hospital system.

As the Dean of the Southern California College of Optometry, he applied a health systems perspective to help support the transformation of Marshall B. Ketchum University into an interprofessional health sciences institution. After many years in the US, including optometry school at the University of California at Berkeley, Stan is delighted to return home.

Serving as the Director of the School of Optometry & Vision Science since 2017, he and the team are rolling up their sleeves and poised to do great things in eye, vision, and health care at the University of Waterloo.

Episode 94 - A New Treatment For Migraine And Light Sensitivity - Dr. Charles Posternack, Avulux

Migraine is one of the most common and debilitating medical conditions in the world. Yet, despite its prevalence, it is poorly understood and often overlooked. One of the overlooked facts is that light sensitivity and migraine are actually closely related. Light sensitivity is one of the most common triggers and symptoms related to migraine attacks. In this episode, Dr. Charles Posternack, founder of Avulux, discusses the ground-breaking precision optical filter that has been providing relief to thousands of migraine sufferers around the world. Dr. Charles shares how it’s high time to address migraine more seriously and reach out to the world for the best cure it may have yet. Tune in now!

Learn more about Avulux at Avulux.com

Learn about the scientific studies about light sensitivity: https://avulux.ca/pages/understanding-the-science-behind-avulux-migraine-glasses

Want to offer Avulux? Contact defraim@avulux.com

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Watch the episode herE

Listen to the podcast here

A New Treatment For Migraine And Light Sensitivity - Dr. Charles Posternack, Avulux

For this episode, I have a repeat guest. One of my favorite guests from a couple of years ago was Dr. Charles Posternack. He is a physician, a graduate of McGill University, and a fellow Canadian now living in Miami, Florida. Most importantly for this discussion, he is the Founder of Avulux. If you haven't heard of Avulux, it is a precision optical filter that is incredibly effective for patients who are suffering from light sensitivity and migraine.

I'm very excited. The first conversation that Dr. Posternack and I had a couple of years ago had a lot of traction. A lot of people were interested in the conversation. Avulux has come a long way since then. There are some cool and exciting announcements to make here. Make sure you stay tuned through the entire show. Thank you again, Dr. Posternack, for coming back on. I appreciate having you.

I appreciate that you're having me on as a repeat guest. I didn't blow it too badly the first time. All kidding aside, I’m excited, particularly in having the opportunity to spread the message and share the word about Avulux to something that I'm incredibly proud of, and from my perspective, is the legacy of my career. I’m a Canadian physician. I went through McGill Medical School and did my specialty training there. I'm neither a neurologist nor an ophthalmologist. As the father of two daughters who suffer from migraine, I got involved in this about ten years ago. What has transpired during those ten years is gratifying, particularly in how much and how many people are going to help.

I'm sure how many people it has already helped is pretty astounding, but the number of people that will continue to get benefit from this is amazing. You mentioned you're neither a neurologist nor an ophthalmologist, but I feel that it's almost more important that you have the family history that brought you into this. I have daughters of my own. I know how far I would go to help them to cure a condition that is chronic and that they're suffering from. That's almost more important than somebody who's simply researching it for the sake of becoming a successful researcher.

It's not even a job. It's a passion. It's something I committed to a decade ago. I was going to see it through to the end. In all honesty, when we began this project a decade ago, there was no guarantee. It has never been done before. There was nothing like what we were doing. It was the time in medical science when there was a strong push in the field of migraine. Whenever I say migraine, I choke up because it seems like everybody either has a friend, a family member, or a co-worker who suffers from migraine, or they themselves suffer from migraine.

To put into perspective, migraine is the third most prevalent disease in the world of all diseases. It doesn't get attention like heart disease or cancer. While migraine doesn't kill you, the disability it causes is enormous. That is why it is also noted to be the sixth most disabling disease in the world. It's a genetic disorder that if you're unlucky enough to get it, you do look for ways to manage your symptoms to get along with your daily life. That's the whole purpose of Avulux.

It was about ten years ago that the FDA did come out publicly and stated, “As medical researchers, we need to find better mechanisms and better ways to treat our patients who suffer from migraine." In the US, they're very expensive to the healthcare system. The reality is people suffer, and they struggle to get through their activities of daily living.

Through the conversations that I've been having with patients since you and I spoke a couple of years ago, and I've stayed in touch since then, I asked my patients much more thoroughly than I used to in the past. I'd say, “Do you have any medical conditions?” They'll say, “I get migraine.” I'll write it down and then move on to the next thing. Now I asked, “Tell me about that. How often? How severe? How does it affect your life?”

It's incredible how many people simply say, “I can't function. I close the doors and blinds, and lay down. I have kids. I have a job but I can't leave the house.” How much of an impact that has had on people's lives and people's productivity, and the economy even on a greater scale? I know there's a lot of data on that. I wonder if you'd be comfortable speaking about the impact it has on the economy. You've already mentioned the medical system. It has quite a burden as well.

What we know now about people who suffer from migraine is almost 1 in 4 of them are going to visit an emergency room in the course of the year. More than 50% of them are not going to be able to get through their workday. Almost 60% of them can get through what we commonly call activities of daily living, whether it is picking up their children after school, cooking a meal, going out on a Saturday night with friends, or attending a social event or a family event on a Sunday. When you're dealing with a disorder that would inhibit 6 out of 10 people, you do understand how severe it is.

When you're dealing with a disorder that would inhibit 6 out of 10 people, you do understand how severe it is.

I had a wonderful guest a little while back, Amy. She has an online community that she's built primarily on Instagram called The Migraine Life. She talks a lot about that. One of the biggest things is creating awareness about this condition. Up until I spoke to Amy, I would say, “It is just migraines. It's a headache.” She would say, “I stopped people from saying, ‘It’s just migraine.’ It's migraine. It’s a condition and a disease. I have a migraine attack.”

It is helping to change the perspective on it. That’s step one for many people because we often dismiss it as a headache. From your personal experience with your daughters and the patients that you've seen or dealt with through Avulux, it's much more than that. Before we go into the stats of the effectiveness or efficacy of Avulux, I would love to know the history of Avulux or some of the science that led to what it is now. We'll then talk about exactly what it is now and why it's such a precision filter.

Traditionally, in healthcare, when you're talking about treatment or attempting to manage symptoms of a disorder, conventionally and typically, we talk about pharmaceuticals. There's nothing to take away from pharmaceuticals. They've changed our lives for the better. Some of the research and incredible work that has been done in the pharmaceutical industry have been spectacular, but not everything can be treated with pharmaceuticals.

The reason being is people do develop adverse events or side effects or medication interactions. For some people like in the case of my daughter, after a few months, she would become tolerant of the treatment, and it wouldn't have the same effect. There are other medical devices, particularly in the space of migraine like neuromodulators, that work. When you look at treatments, you typically think of pills. This is why it's important to get the word out.

People sometimes look at me and say, "How can glasses treat a migraine attack? How could they manage a migraine attack?" It's something that almost surprised me and that gets back to history. Probably nothing is more intimately related than light and migraine. This is something we've known about for years, yet no one ever thought about using light and the manipulation of light as an actual way to manage the impact of the actual disorder of migraine itself.

What did we know? We know that between 80% and 90% of people who have migraine suffer from light sensitivity. We know that 30% to 60% of all migraine attacks are precipitated by exposure to light. We know that once you're in an attack, exposure to light makes it worse, and usually will intensify it, which is why people run to a dark room. What people don't know is 40% of all people who suffer from migraine experience light sensitivity as a sole symptom in between attacks.

When the FDA asked for the inclusion of the “most bothersome symptom” that a migraine sufferer has in addition to the conventional headache disorder, the number one symptom was light sensitivity. You have this incredibly intimate relationship. Now it required medical science to understand, “How does light impact migraine? How can that turn into some kind of management property?”

That all started with the science in early 2010 and all the way to 2020. We learned that at the back of a retina, there’s a smaller number of cell types. They are intrinsically photosensitive called retinal ganglion cells. One of these cell types is what's called a melanopsin-secreting cell. When these particular cells are stimulated, they'll release a photo pigment which is a protein called melanopsin. It is thought that photo pigment would then go through the optic nerve and act directly on the thalamus of the brain, which we know is the pain center of the brain.

As that research was established, they were looking for how exactly these cells get stimulated. There was a very elegant study done in 2016 at Harvard. They took migraine sufferers and put them in a dark room, then they expose them to different colors of light and different wavelengths. What they found was light in the high-end of the blue spectrum that’s about 480 nanometers, as well as light in the red amber range of about 590 nanometers would stimulate the cells to release melanopsin. They found as well that green light soothes them.

I’m putting this all together into one study. It was a series of studies performed at different times. What we essentially created was a map. If we could create a lens that would block out the light, at the high end of the blue range at 480 and block the amber-red at 590, but let the green light through, maybe this can have some kind of management effect. That was the challenge.

We had to sit there and figure out how to create a lens. Once we did create the lens, we then had to decide whether it can pass through the phase-two part of a scientific trial. In other words, if I gave this lens to 100 migraine subjects, will they get better? If they won't, it stops right there. If they do, then the next thing in today’s world of evidence-based medicine is, is it a placebo or a real effect? That was Avulux’s ten-year journey.

Our first iteration of the lens came out in about 2016. It was what we call the thin film that we applied to the surface of the lens. The problem with that is it was a very messy technique. It made the lens very dark. Because it worked by reflecting the bad wavelengths of light, you are required to have a wrap frame. You had these very dark lands with a wrap frame. It would be very expensive to produce the equipment to make these glasses. You could never scale them up. What it did is it gave us a bit of encouragement that in fact, "Maybe this is going to work."

With that lens, we continued. We did our provisional pilot. What we did was we essentially handed it out to patients who suffer from migraine. What we found was astonishing. We told individuals, “Put these glasses on at the earliest onset of a migraine, whether it's an aura in your case. Maybe it was a little bit of tingling in your head, but you knew that was going to bring on a migraine, and then see what happens.”

What we found was when 38% of people put these glasses on at the earliest onset of a headache, they never evolved. They never develop their typical migraine. It was very funny communicating with them. They said, “I thought I was getting a migraine attack. I put the glasses on, but they didn't come. I guess it wasn't even getting one.” We knew what was going on.

We found another 36% of people where it took longer to help relieve some of their light sensitivity and migraine symptoms, but they found that they could either eliminate or reduce the dose of medication that they were taking up until then. From my perspective, the most important was the next extra 18%. These were people who didn't get completely better, but that's okay. These were generally the more severe cases of migraine called chronic migraine sufferers. They were able to continue with their activities of daily living. At the end of the day, that is the most important thing

It’s not like Avulux has to be used alone. It can be used with medicines or with other migraine treatments. The important thing about Avulux is it tries to help a person get through their activities of daily living. We eventually got a little more sophisticated in our lens development. Around 2018, we partnered with a military contract company to develop a new lens using nanotechnology.

The important thing about Avulux is it tries to help a person get through their activities of daily living.

Essentially, that is the Avulux lens now. There are photoactive dyes incorporated into the matrix of the lens. What they do is absorb the light at 480 and a 590 in a very narrow notch. It allows the green light through. Essentially, it follows the science as closely as we could possibly make it. The nice thing is when you do have a precision filter like that or what we call a narrow notch filter when you're looking through the glass, it's not too dark. It doesn't distort your color.

People have to be able to tolerate wearing your lens. Avulux’s lens looks like it has the lightest lens when you look through the lens. After a few minutes, you don't even know that you're wearing it because it doesn't distort light. That was the lens that we took. We progressed upon to do what we call an evidence-based medicine clinical trial. We hired a third-party clinical research organization to do a double-blind randomized clinical trial comparing Avulux with a placebo. To cut to the chase, we reached the highest scientific standard. We were able to prove that Avulux both clinically and statistically significantly was better than a sham lens in both the alleviation of migraine pain and light sensitivity at 2 and 4 hours post-application of Avulux. That's when we knew this work.

Migraine Treatment: Avulux, both clinically and statistically, was significantly better than a sham lens in both the alleviation of migraine pain and light sensitivity at 2- and 4-hours post-application of Avulux.

Thank you for outlining that. It's quite a journey. This show is a lot about the entrepreneur's journey and entrepreneurship in general. There are many hurdles. There are many times when someone might have said, "This is too expensive. It's not going to scale. It's not worth the effort," but you stuck with it. As you said earlier, you are going to see this thing through, and you have. It’s cool to get to a point where you have a military optical contractor.

We're already dealing with sophisticated lenses. In the case of the contractor who helped us develop this, they were in the world of lasers. They’re making glasses to protect the military, particularly pilots, from exposure or disorientation if lasers were pointed at them. It was thinking out of the box. We’re reaching out to smarter people than we were, and incorporating all of their knowledge and insights. We’re tying it together with what we knew from the science, and then sitting down and coming up with a product. What was interesting too is it was a real evolution, because we came up with the Plano lens well before we came up with the prescription lens. That's just since 2022 that we were able to come up with that.

It's not leaving any stone unturned and making sure you find every way to bring this thing to life, and it has come to life. You mentioned some of the numbers. They're astounding that such a high percentage of people who were the lens found some level of benefit. Some completely avoided their headaches. Some got a moderate amount of benefit. Some got a little bit, but that's more than they're able to get from anything else, so they could continue with their day.

For most people, when I talk about Avulux, it's a non-pharmaceutical option. It can be added to anything that you're currently doing without any side effects. I wonder if you could tell me a little bit more about the efficacy that you've been seeing or the data that you've been collecting from people who wear an Avulux?

The efficacy has been unbelievable. We've been involved in selling our Plano lens and our prescription lenses for quite a while now. What we typically see is approximately 95% of the people who purchase an Avulux lens are people who are self-referring. They're making their understanding that they do suffer from migraine and that they do have light sensitivity. That is the criteria that will determine how effective Avulux is. If you do have latency with your migraine, chances are it's going to work.

From our experience online, as well as doing pilots with other large-object optometric groups and others who are doing clinical research, between 90% and 95% of people who try Avulux will respond to it. As we talked about, it doesn't mean it's going to go away completely or that it's going to be phenomenally better. The fact that 95% of people keep it is because it does help them get through their activities of daily living. When you think about the fact that light is the most bothersome symptom, it makes sense. You're helping them get through their day. Look at our days since COVID. How many of us spend our days on a computer all day long being exposed to a digital screen? You can understand and see how important an option like this is.

Speaking of light, most of this conversation is going to be about light, but the most famous type of light is blue light. a lot of times I have patients come in who are migraine patients. I'm talking to them and digging in a little deeper about their symptoms. They'll tell me, "I'm thinking about buying some blue light glasses from Amazon. I bought them already, but now I'm thinking about any better blue light glasses that should help me."

We know that there's a lot of debate on the blue light topic. It seems to be leaning more in a certain direction that blue-light blocking is not as helpful as we thought it once was, or that some people would like us to believe it is. I'd love for you if you could first share your understanding of blue light and its effects of it, then where that fall in the conversation with Avulux. It’s blue light versus Avulux if we're going to try to create a hot take here.

No problem. It's like trying to compare an egg with a baseball bat. I don't want to profess to be an expert in blue light because I'm not. Typical blue-light blockers block blue in a much lower wavelength range between 420 and 450 nanometers. That's not going to have any effect on patients who suffer from migraine. The science is very clear that the stimulation and then the elicitation of the impulse of the melanopsin-secreting cell occurs in a very narrow band at 480. You're not even hitting the right wavelength. Is there any anticipation that a classic blue-light blocker would work on a migraine? The answer would be, “Absolutely, not.”

Migraine Treatment: The stimulation and then the elicitation of the impulse of the melanopsin-secreting cell occurs in a very narrow band at 480. You're not even hitting the right wavelength.

To reiterate, this is one of the most important things. I love that Harvard study and the graph that comes out. It's easy to understand. If you haven't seen the graph or if you haven’t tuned in to the previous conversation that I've had with Dr. Posternack, they have these migraine patients. They took them in a dark room and expose them to certain wavelengths of light and colors of light.

The graph that comes with is perfect. It's like for blue light, the bars go up. Amber light, the bars go up. Red light, the bars go up. Green light, the bars go down. That's expressing the patient's pain or sensitivity to light. It's very easy to see the difference. Blocking blue light is important, but that 480-nanometer range is where it's important, and then there's a different type of lens, which has been very popular in the discussion for migraine, also in concussion TBI, that type of space. That's the FL-41. I wonder if you can give me a little bit of background on what FL-41 is, and why it's been believed to be helpful.

FL-41 is a very interesting technology and it came out in the ‘80s. If you speak to the individual who invented it, the word FL stands for Fluorescent. It was originally created to mitigate the effect of the flickering of fluorescent light when that was popular in the ‘80s and early ‘90s. You'd be working in a store where you'd have these large fluorescent lights above you, and they would constantly be flickering on and off. They were very uncomfortable.

FL-41 is a technology that has been very old. It's a technology that's been around for a very long time to treat migraine. If you look at a graph of the absorption and the reflection of light, FL-41 does not block anywhere near the amount of 480 and 590 that we do as a position filter, but it also blocks green light. It essentially is not allowing the healing light through. What it's doing is it's not even blocking enough of the high blue and then the red amber range.

It's letting in the red amber because it's got that tint to it. Studies have found that even that red range is uncomfortable or potentially harmful for patients who are suffering from light sensitivity and migraine. The biggest key when I talk to my colleagues about FL-41 is when you're talking about light sensitivity as we have from the Harvard study, that green light has been shown to be soothing, and the FL-41 completely blocks that out. It's not helpful in that regard.

Those two comparisons are probably the most common comparisons that I get when I speak to my colleagues about how we can help mitigate migraine and light sensitivity symptoms that our patients have. They'll say, “Blue light blocking or FL-41,” but we find that those only help with small parts of the spectrum. In fact, they don't help with other parts that we need to help with. That's where Avulux comes in.

On the topic of FL-41, one of the companies that have been very prominent in that space is a company called Axon. I'd love for you to tell me a little bit about Axon. There's some big news here with Avulux and Axon. I'd love for us to share and celebrate this. if you wouldn't mind, maybe give me a bit of background on Axon and what's happening now.

Axon Optics has been in the industry for a very long time. They've always been the gold standard in the world of glasses. The company's ownership included a very prominent neuro-ophthalmologist and an optical engineer, Dr. Brad and Dr. Steve Blair. They are the original inventors of the patent of what Avulux is now, essentially the blocking of the 480 and the 590-nanometer wavelengths.

It's always been a very respected company. It's a company that has led the industry. They're probably the most visited website in and around the migraine space. It is very exciting because Axon has decided that they wanted to offer their customers the best and the greatest of what they consider to be for the management of light sensitivity and migraine.

They've essentially stopped selling FL-41. Now they have become an Avulux provider. Their reasoning is quite simple. There was nothing bad about FL-41. It did help a lot of people and it probably still does. It just does not have the science behind it that Avulux does. It doesn't have the proven clinical that Avulux has. They felt that this time, they want to offer the best and the most appropriate option for those who've been their customers for a very long time.

They were the biggest name in FL-41. Dr. Brad Katz, somewhat of a pioneer in this space, realize that what was happening at Avulux was more helpful to patients than FL-41, so much so that they've combined forces now. What does that look like from practitioners looking to Axon? Are they going to come to Avulux and there are no more Axon Optics available at all?

The Axon Optics company still exists. They just don't sell FL-41 anymore. They converted everything over to Avulux technology. Any provider that used to work with Axon is more than welcome to work with us. We would love that. Our goal is without a doubt to get the Avulux lens to as many people who could benefit from it as possible. My dream, and other eye-care professionals in North America and around the world, is that they would be able to at least offer Avulux as an option to their patients.

The takeaway is that eye-care professionals should and they will become the first-line caregivers for people who suffer from migraine. All they have to do is stop when they bring their patients in. Ask them, “Do you have to suffer from migraine? Do you have light sensitivity?” They'll be shocked by how many people will say yes. Being exposed to Avulux, you're going to change their lives.

Eye-care professionals should become the first-line caregivers for people who suffer from migraine.

The one thing I love about being on your show is you have great reach. You have great respect. This is such a great forum for us. To be perfectly honest, it was from your first episode a couple of years ago that we were fortunate enough that an eye-care professional in Australia listened to it and hooked us up. Now we are a mainstream lens in Australia. We got our class-one medical device approval there. It was through your outreach from this show. For anyone who is tuning in, we'd love to have you become one of our distributors. I promise you, your patients will be very happy that you do.

It's very good to know that we have an audience in Australia. We know that they're tuning in. In that last conversation, we had stuck with a lot of people across North America and clearly in other parts of the world. I'm happy that it helped support such a useful product. That's something that's going to help so many people. We can do this to make the optical industry and healthcare system better. That's amazing.

We'll go into how ECPs can get their hands on this in a second, but I want to go back to what you mentioned about becoming the first line here. I don't think eye-care providers have wrapped their heads around how we can be the first line of treatment and healthcare provider for somebody who's dealing with migraine. We're told in school, we're experts on the light, optometrists. Optics is our expertise. If we know that light is the primary symptom and trigger for these patients, we have the power to now mitigate that, especially with tools like Avulux at our fingertips.

It's important to start to wrap our heads around that and realize we have the power to help many people. I’m comparing myself to myself 2 or 3 years ago when I would write down migraine and move on to the next thing instead of writing down migraine, let's ask a couple of more questions. Let's see if light is one of the key symptoms or triggers, and now offer. The minimum thing we can do is let the patient know that there is a tool and treatment option out there that could potentially help them.

I feel like we're doing a disservice if we're not at least doing that even if we don't sell it ourselves, “Just so you know, this technology exists,” but if you're going to talk about it, you might as well be selling it. I want to make a quick comparison. Anytime I talk about implementing a new treatment protocol, strategy, or whatever it might be, the easiest comparison or analogy I can make is to dry eye.

Dry eye is one of the biggest topics in eye care these days. When I started venturing into the dry eye world a few years ago, I thought, “Where do I start? I don't think I have enough dry-eye patients. I'm going to have to start marketing and bring people externally.” Some of my colleagues and the experts in the space were like, “Just mention it and say the words out loud to your existing patients. You'll be surprised how many people have this issue that you can treat right there in your exam room.” That's absolutely the thing.

We implemented a very simple questionnaire. I know that's one of the strategies with Avulux as well. Implementing a simple questionnaire triggers a conversation, “You scored XYZ on this. That tells me that you're having these symptoms. Here's how we can help.” I went from thinking that maybe 10% or 20% of my patients had dry eyes, to now saying 75% of my patients are dealing with some form of dry eye.

The same goes for light sensitivity migraine. You start asking your patients when they even give you a hint of they might be dealing with light sensitivity or migraine. If you implement a questionnaire, that would help you even more. You start mentioning it and you'll realize there's a very large proportion of your patients and existing people in your exam chair, clinic, and office optical that are already dealing with it. It’s not like you got to bring this product in and start advertising like crazy. Have the conversation. That's where it all starts. Going back to what you said about having providers across North America, Australia, and other countries offering this to patients, who can offer this and how can they start to do that?

Any eye-care professional who has an interest in what's best for their patients can do it. All they have to do is contact us. We have all the materials that they would need. We have a training program that we can help them with. We have a very cool ECP starter kit that we learn from our best practices in Australia. Essentially, it is a package that comes with three Avulux fit-overs, along with sales materials for the patient and a light questionnaire.

Essentially, it's on a dry-erase marker. It asked the patients, "Do you experience light sensitivity Do you experience it in association with migraine?" Some very simple questions. If the patient answers yes to any one of them, have the conversation. What's cool and what we've learned from our previous experience is to have these fit-overs in your office. If the patient is symptomatic at the time, put them over their existing glasses. They tell you, “This is soothing. This is cool.” Maybe they don't know, they don't have the history, they're not sure, or maybe they're waiting for a migraine to come. They can take it home with them. Leave a deposit. Take the fit-overs. This way you know you're going to help patients.

We've created this kit that literally within 24 hours, anyone who wants to become an Avulux distributor can be educated and have everything that they need to start selling Avulux to their patients the next day. It is our goal. We do want to get this out to as many migraine sufferers as we possibly can. This is a disease that has been under-treated for years and years. If we have something as simple and non-invasive as what we have with no adverse events, they can only get better.

Migraine Treatment: We need to get Avulux out to as many migraine sufferers as we possibly can. This is a disease that has been under-treated for years and years. If we have something as simple and non-invasive as what we have with no adverse events, they can only get better.

From any treatment standpoint, to have something that is effective and has no side effects or no adverse events seems like The Holy Grail. That's what everybody is hoping for and working towards. This is helping a lot of people. It's not necessarily going to help every single patient eliminate every single migraine, but it's going to help them feel better. On the other side, there's no downside to trying it and wearing it. That's amazing. ECPs out there, if you're interested in helping your patients in mitigating these symptoms, make sure you look into this. Dr. Posternack, where can people inquire further about Avulux?

We'd love you to visit our website at Avulux.com. There are tons of information on that website. All you have to do is reach out to us. Contact us through the website. We'll make sure you get started. We will do everything we can. We'll hook you up with our finishing labs. You can have your own lab. That's fine too. We have semi-finished. We can get to you, it doesn't matter how. Reach out to us and we'll make it happen.

I would encourage you to go to the website and read the science. The science is real. You'll be able to see a link to our clinical research. Read some of the testimonials. These are very real and honest testimonials. It's heartwarming to read some of the things that people write down. We're not here to treat or cure migraine. We're here to manage the impact of light sensitivity on those who have migraine. Many of them do have light sensitivity. By managing this one symptom, you can completely change their lives.

By managing this one symptom of light sensitivity, you can completely change the lives of people who have migraines.

Make sure you reach out through the website. The starter kit is something that's super helpful. I feel like when I'm implementing a new technology, I need my handheld a little bit. I need some simple instructions on steps 1, 2, and 3 on how to get the ball rolling. Having that beautiful starter kit to the box and everything well-made is going to encourage not just the ECPs, but their staff as well. That's always important. It is getting your staff, your front desk, your office manager, and everybody else on board, and speaking to patients the same way about these things. That's wonderful.

Thank you, Dr. Posternack, for coming on the show. Thank you for sharing all this wonderful information, and helping us bring awareness to this topic that is often neglected and overlooked, and realize how many patients we can help, and how many people around the world can be helped by such a simple and easy-to-implement technology. Anything else you'd like to share before we wrap up?

If you're going to be going to the Vision Expo Eastern New York City, please come by and see us. To put it into a more tangible perspective, in Canada, there are about six million people who suffer from migraine. In the United States, it's approximately 47 million. There are a lot of potential people who are waiting for your help.

Thanks, Dr. Posternack. It’s always a pleasure to chat with you. I'll see you in New York. I'll be there. If you're there, also give me a shout. I'd love to connect with everybody out there. Make sure you start by Avulux and chat with the rest of the team there to see what they're up to. Thank you, everybody, for all the support. I will see you in the next episode.

Important Links

• Avulux

• The Migraine Life

• Axon Optics

• Defraim@Avulux.com

• https://Avulux.ca/pages/understanding-the-science-behind-avulux-migraine-glasses

About Dr. Charles Posternack

Dr. Charles Posternack is the Co-Founder and President of Avulux, the company behind the world’s only lens clinically proven to block the harmful lightwaves that trigger and worsen migraine attacks.

After a long rewarding career as a practicing physician and senior healthcare executive, Dr. Posternack followed his heart to co-found Avulux. His two daughters both suffer from light sensitivity and migraine, and he set out to find an option that would help them. Today, those same women are two of the many Avulux success stories from around the world, and Dr. Posternack hopes that countless others who suffer from migraine and light sensitivity will enjoy similar life-changing benefits. Real-world experience shows that 90 percent of Avulux users find they can resume their daily activities while using Avulux lenses to manage the impact of light.

Dr. Posternack has been in the healthcare world for more than 30 years. He has held leadership positions as a CEO in both the not-for-profit and for-profit sectors. Dr. Posternack received his medical degree at McGill University in Montreal, Canada, and did his specialty training there as well. He has lived in the United States since 1992 and has held senior roles at the Cleveland Clinic and HCA Healthcare. He was also an Associate Dean for Academic Affairs at the Schmidt College of Medicine at Florida Atlantic University.

Episode 93 - Dr. Carly Rose - Living At The Edge Of Your Comfort Zone

The only way to face your fears is through. Learn how to be uncomfortable and live on the edge of your comfort zone. That is what is keeping you from success. If you see an opportunity but are too afraid to do it, how will you ever grow? If you know that social media and TikTok are the best way to grow your business, you have to have the courage to put yourself on display. Going from point A to point B is going to take some steps, and those steps will be uncomfortable but so worth it. Join Harbir Sian as he talks to the Optometrist at Eyecare on the Square and public speaker, Dr. Carly Rose. Learn how she grew her brand through social media marketing, especially on TikTok. Discover how she broke out of her comfort zone to really be her true authentic self. Find out how you can control and push through your human desires, and more. Start being comfortable in the uncomfortable today.

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watch the episode here

Listen to the podcast here

Dr. Carly Rose - Living At The Edge Of Your Comfort Zone

Thank you so much for taking the time to join me. I've been doing this for over three years, but every single time I'm super-duper grateful for everybody who's tuning in and giving me feedback, reviews, and all of those things. Thank you so much for doing that. Please keep doing it. Tell your friends and let them know about the conversations that we're having here. I'm trying to bring on guests that are going to bring us value in some way or another. In this episode, our guest is going to bring us value in so many ways. I'm so excited. This is a person I've been wanting to have on for so long. Finally, I have the one and only Dr. Carly Rose here on the show.

In case you don't know who Dr. Carly Rose is, she graduated from the Illinois College of Optometry. She did her residency in Cincinnati. She is doing her fellowship at the American Academy of Optometry. She owns two private practices. She is a very well-known and highly-demanded speaker on ad boards, and doing all the other stuff in the industry. She started her own residency location, so for people who are looking for a residency, make sure you check that out. She is the TikTok queen if you didn't know this already. Go follow her on TikTok. Thank you so much, Carly, for joining me here on the show. I'm so happy to have you.

Thank you for having me. I'm super excited. I can't believe we just met for the first time in person. When was that?

A couple of months ago.

When you went to Chicago. I'm consistently shocked like, "I haven't met you in person. I feel like we've met somewhere along the lines,” but this must be the first because of COVID.

It is weird when you meet somebody and it feels like you've met before. It feels like you're seeing a friend. The first time I had that feeling was in New York when I went to Vision Expo. I was running into all these amazing people that I felt were friends of mine, including Inna, who I know you know well, and Jennifer Stewart, and all these other lovely people. I was giving everyone hugs like we were best friends. I was like, "This is the very first time we've ever seen each other in person."

The first time Inna and I met was like that too. We talk on the phone and we text. We're friends. We are doing an event together and we were like, "Hi." It's so cool. It's like a reunion.

This was the case with you. For so many people, our community is great. The people that we tend to connect with online are good people. When I meet them in person, they are genuinely that cool person that I met online. The energy I got from you was a super cool person. It was one of the things I got. I was like, "This girl is cool." I don't know if you feel that way or not.

That’s not the adjective I used to describe myself often.

I want to dive into that a little bit too. The first thing I want to talk about is you said you're not a fan of being in the spotlight, but you are in the spotlight. You are doing amazing things, not just TikTok but your business, your speaking, and all the stuff you're doing in the industry. When I met you in Chicago, you went out of your way to come and say hi to me because I was doing a talk there in one of these big convention rooms off the side. You came all the way out to say hi. We chatted for five minutes. I turned around and there was a lineup of people behind me waiting to say hi to you. It was awesome. I feel like that person who's cool by association. That was me.

You were on the main stage.

I chatted with Carly for five minutes. I turned around and there was a lineup of students.

I broke into an event I wasn't supposed to be at. I was like, "Hi," and now I'm leaving.

That's awesome. Let's talk about that. Are you shy?

I wouldn't say I'm shy. Maybe that's by training because I also have a lot of years in the service industry like restaurants, and bartending. I can hold conversations because that's what that world is, but I don't enjoy it. Getting an audience is not a motivation for me. The motivation for me is more Machiavellian. It's a means to an end. I know that marketing is a piece. Now, I know more than ever that it's a humongous piece to tackle the goals I have set forward for myself.

Sometimes when we have goals or dreams, steps in the process to get there may not be comfortable. We were talking about this comfort zone. A patient recommended a book that I read called The Comfort Crisis. I haven't read it yet, but I have a feeling I'm going to love it because I've always been one to safely and intentionally keep myself outside of my comfort zone. I do that on purpose and by design. Being on stage, lecturing, and on social media is very much outside of my comfort zone, but I know it's important and so I do it anyway. I always tell my daughter, "You're allowed to be afraid. Fear is a natural feeling. It's a human emotion. It guides and keeps us safe, but be afraid and do it anyway."

When you're afraid to do something, be afraid and do it anyway.

That's the definition of courage. It's not that you're never afraid, it's that you're afraid but you still keep going. You're a courageous person as well. How do you keep yourself on that the edge of your comfort zone or even on the other side of that line? What are you doing? What are you telling yourself? Was there some point earlier in your life or career where you decided this is where I'm going to be?

The Comfort Crisis: Embrace Discomfort To Reclaim Your Wild, Happy, Healthy Self

Let's start with optometry school. I've always kept myself outside of my comfort zone since day one. It's a part of who I am. I'm a high-achiever, entrepreneurial, or whatever you want to call it. That archetype has been in my DNA since birth. I never planned on going to college. I was going to going to go hard toward building a business of some capacity. That has always been in my DNA, but in optometry school, I had my goals of private practice ownership. I thought it was going to maybe take money more years than I did, or be more time-consuming than what my reality found because once I stepped into private practice, I just kept going. It didn't stop at the ownership. That part took me by surprise.

I thought almost the end goal was ownership. That has proven to not be the case because now we were chatting that I have four business LLCs and a hundred more I can think of. To answer your question, yes, I always knew that that was going to be who I was in a professional setting, but I did not expect it. We had some catalysts, and it's much bigger than I anticipated. I'm loving it. I see all of the possibilities and now it's game on. Let's go.

People who get tattoos talk about it being addictive. If you get one, you'll like and love it, and you want to get another one. I feel like entrepreneurship and business ownership is similar. You start a business and see the things you can do, or get that positive feedback. The business is growing, and you realize the cause and effect of what you do and what it amounts to. It then starts to get addictive like, "If I could do it here, I want to start this other thing."

We could do anything. Now, all bets are off. What can we not do? Nothing. It's almost like going to the Cheesecake Factory and their menu is 100 pages long. It almost becomes a problem of too many things you could do. You have to be selective with your time, associations, and where you put your energy.

That becomes a whole other problem when you get to a certain level. You feel like you had this entrepreneurship gene from when you were born. I've heard that too. Sometimes people say, "Entrepreneurs are born. They're not made," but I'd like to counter that thought process because I feel like I wasn't born in that way.

I may have over time developed that through what I was saying where I did something and thought, "That was cool. It worked well. Let me try more." For somebody who's maybe starting out or they are early in their optometry journey or business journey, what would you say to them to try to encourage them to do what you've done as far as being at the edge of their comfort zone, or trying things that make you a bit uncomfortable?

We can even look outside of optometry. For example, one thing that I have wanted to do for a few years is taking an improv class. I saw its benefit to the whole leadership piece, having difficult conversations, and public speaking. Outside of optometry benefits all aspects of my optometry life and it's very uncomfortable. You're going into a group and alone. You have to do the most ridiculous exercises in front of all of these strangers. Little things like that are a very safe and easy way to challenge yourself. I've given lectures in front of 5,000 people live, and this improv class with twelve strangers made me more nervous.

I can imagine. That's making me feel a little uncomfortable just sitting here, but I've enjoyed comedy and I've never tried it in depth. Back in high school, we had certain things that we would do, and that stuff is tough. I've also heard that improv is the way to unlock a lot of those fears that we have. Can you share a couple of stories or one at least story experience from that improv thing that you feel resonated with you?

It was great. Going into it, the instructor set a lot of boundaries and expectations, "This is a safe space. This is a non-judgmental space. You are not allowed to judge other people. The more you bring to the table your authentic self or put yourself out there, the better this is going to be." What's the worst that can happen? My dad has this phrase that he said my whole life, and one of my very best friends said this phrase. We celebrated our 31st friendship anniversary. We've been together forever. She and I were best friends from a young age. When we would come across a challenging situation, he would say, "They can't eat you. No matter what happens, you're going to make it out alive. You're going to be fine." Knowing the reality of, "I am safe. This is fine," just physically do it. That's all you have to do.

When you're faced with a challenge, it's not going to eat you. No matter what happens, you're going to make it out alive.

I love it. The next time anybody is about to embark on an endeavor or go through some crazy experience, just remember they cannot eat you. You said a word that I was trying to get at, which is a very important word and I'm realizing more, and that is authenticity. When I was saying I got that energy and you felt like a cool person, that's what I was getting at. You felt very authentic and comfortable in your skin. Tell me a little bit about that. What does authenticity mean to you?

Authenticity has become a bit of a buzzword. It's losing some of its meaning, but if we're getting back to the meaning, it's being true to who you are, which requires a lot of self-awareness. It's an inside job. You have to know who you are to be able to maintain that identity. When you are in that alignment with who you are, you can feel it. It's tangible. That's when the magic happens and the floodgates are unleashed. It's like having a personal mission statement and a grounding place you can always come back to.

It's funny because before we got on this, we were talking about this idea of transparency and authenticity, and showing the good and the bad, which is exactly why Inna and I started our little live show and we call it Transparent to talk like, "This is who we are." Do you know Jimmy Deom and Roya's podcast? We did their podcast, and for the whole hour, we talked about I had gotten back from Costa Rica to do an Ayahuasca retreat. We spend the whole podcast talking about Ayahuasca. You can connect with genuinely who you are, who you came to be, and knowing that, feeling that, seeing that, and touching that. It's an inside job. You have to get real with who you are.

Comfort Zone: Authenticity is being genuinely who you are and who you came to be. You have to get really real with who you are and there are dark sides to that because you're human.

There are dark sides and bad sides to that because we're humans. Knowing and loving helps you know, and love other people because how you look at and think about everyone else is a reflection of you and how you view yourself. Continuing to get back to who you are, who you want to be, and your true identity, that's the definition of what we're trying to get to with authenticity. It has become such a buzzword. What does that mean anymore?

I do appreciate that it is a bit of a buzzword, but if you can define it like that, it helps because then people aren't just throwing it around. If somebody is throwing it around, you can ask them, "How would you define yourself like this?" You then know you're being authentic to yourself. I like that personal mission statement side of things too. It's something that you can always come back to like, "Am I making a decision that is true to me or authentic to my mission statement?" A few months ago, I was doing a talk to a small group of young entrepreneurs. It was maybe 50 people.

That's not a small group. My first lecture was one person. Fifty people is a good lecture.

It's funny because in my head it looked like it was ten people. That's why I said small, but then I remembered it was 50 people who registered for the event. I'll take back the small. It was a group of young business people in the area here. It was me and a few other people on the panel. We have very different backgrounds for the speakers. I'm coming through the eyecare space, but there was one older gentleman who was maybe 60 or 65. He's very accomplished in the real estate world. He was so calm in the way he was talking that everybody was drawn in.

They all stopped and listened.

Every sentence he spoke I was like, "I want to be like this guy." When I did my talk, I did a little bit on the authenticity side because it's been something that's important to me lately. Having kids makes that important to me.

Kids are mirrors. They show you everything.

In the past, when I was starting my social media journey, getting out there, and all this stuff a couple of years ago, I had people ask me, "Who do you think you are trying to be in the public eye? You're an optometrist."

I get a lot of that.

I had a slide that says, "Who do you think you are?" I pointed at them, "Who do you think you are? Make sure you know." After everything was done, at the end of the night, the older gentleman came to me and pulled me aside. He's like, "I liked your talk. You're doing great things." He's like, "That question you asked everybody, you need to ask yourself that question." I was like, "I do." He's like, "No." He looked me dead in the eye. He's like, "I want you to ask yourself that question." I was like, "My God." I got tingles. "I'm going to have to go home and journal."

I still do it now almost daily because he did that. I'm getting deeper like, "Who are you? What is it that you're trying to do?" Sometimes I'm honest, "I'm doing this for the likes." "This time you could do it for the likes but what are you trying to accomplish? Are you on that path?" That's where the authenticity thing is key to me. Coming to me like that has made it stick. If you're tuning in to this, ask yourself who you think you are. Pay attention to what Carly is saying here. It is going to help you on that path.

That reminded me of something else I did that is very uncomfortable. I sent an email to 15 or 20 of my closest friends and family asking to dirt on me, "What do I do that drives you crazy?" This is an anonymous survey. "What can I benefit from? Do you consider me loyal? Do you consider me trustworthy? Do you consider me lazy? Who is Carly? Blinders off, who do I show up as in the world? Who do I want to show up as in the world? What do I want to do with this one experience?" It is uncomfortable.

That sounds very uncomfortable. In general, how did you feel about the responses?

They rock you to your core. There was also a section to free type. I was getting paragraphs from people so I was like, "I wasn't expecting this." It was a lot to digest but it’s insanely valuable.

That's unbelievable. I'm so impressed with you. That's very cool because I think a vast majority of people would not do that, even if we know it's super valuable and helpful. I've thought about doing that but I get nervous because I know I'm very lucky. People ask me, "How do you do all the stuff? What's been helpful or important to you?"

Having a very small core group of people who tell me how it is has been invaluable. I tell younger people to try to develop that for themselves. It's an ongoing thing. They'll message me like, “That was dumb.” If I ask them, "Go back twenty years to the period of time we know each other and tell me what you think," I feel like there would be a lot of difficulties there.

That's all ego. We have two brains. We have the ego brain and the self brain. The more we're in alignment with who we are and who we wanted to become, we can feel it. That's where our emotions are good and numbing is bad because our emotions are the guidance system. It's our navigation. If I'm stressed, something's off. It's a tool to investigate those areas and get curious about them. Emotion is telling you something. That's all ego. The ego is there to keep us safe, but that's also why we like the likes. We can't even do it for the good either because that's not the authentic self. It's weird.

Your emotions are your guidance systems. They're your navigation.

It's weird but you're telling it how it is and I like that. I want to get into the business side of things here, but I like where we're heading. I want to ask you about Ayahuasca. How long ago was that?

That was in May. A few of my family and friends have also done it. We have a little bit of a collective experience. I've read a lot of books on it. I've been researching it for about a decade. I did a retreat that had medical staff on-site in case something went wrong. We did a health intake. There were Amazonian shamans. It was in Costa Rica and was a week-long, but we did four ceremonies and two breathwork ceremonies. I may be remembering that incorrectly, but we did four plant medicine therapies or ceremonies and breathwork. You then go home and try to put your life back together.

Is that how it feels that you have to put it back together?

Yes. It's like cleaning out a junked drawer. You have to pull it all out, figure out what you're looking at, what you want to get rid of, what you want to keep, and then put it all back together.

Taking Ayahuasca is like cleaning out the junk drawer inside of you.

Generally speaking, you would say it was a positive experience.

Yes, massively. I'm planning on going back, but it is a lot when you're also running businesses, have kids, and have other things where you can't put your entire life on hold. I'm thinking of the summer again. We'll see what happens. It was super cool.

Is this something you would encourage?

No.

How would you explain to someone to look into this or consider it?

It's like the improv class. You have to know what you're signing up for. You have to be ready to be uncomfortable, and then you got to be ready. There's a phrase in the plant medicine world that you have to be called to do it. It's basically healing for almost everyone that does it. I have yet to meet someone that did not have a healing miracle, but you have to be ready for it. It's like bootcamp. You're going to come out in better shape. Are you ready to walk through that? It's a lot. You have to be ready for it.

That's good to know. Let's talk about businesses. You have Eyecare on the Square, how long has that been open?

This will be its 10th year. My sister opened it cold. I purchased it from her almost five years ago, and then I opened a second location. We did a soft launch in December.

A second location of Eyecare on the Square or The Clear Experience?

Eyecare on the Square is primary care. I've always loved dry-eye. I brought in slowly all of these pieces of dry-eye equipment to build an internal dry-eye clinic and that grew a lot. We were out of square footage. Eyecare on the Square is around 700 square feet, and then we had two exam lanes, a full optical visual field, OCT, Optos, radiofrequency, LipiFlow, LipiScan, and IPL.

For 700 square feet, you had all of that? That's crazy.

It was insane. We were booked out far because we had all these dry-eye patients and comprehensive care. We couldn't expand. This space that I'm in right now came available and it's half a mile down the street. I moved all of the dry-eye equipment and then because I have IPL, radiofrequency, skincare line, and cosmetics, I brought in a nurse practitioner and aesthetician to do filler Botox, chemical peels, facials, and then expand on radiofrequency and IPL.

That's amazing. The dry-eye conversation has been growing a lot. It's gotten a lot of traction in the last couple of years. The aesthetics conversation is a little bit newer in our space but also gaining a lot of traction because these devices are coming over from the aesthetic space to eye care and have that application.

We have IPL and radiofrequency. We're doing that stuff as well. We've taken our second exam room and turned it into a treatment room. We're trying to grow that side of the business. I'm asking this selfishly, but I know there are other people out there. We have an esthetician, and she's reasonably busy, but I want to max it out. What do I need to do? What worked for you? We'll do a franchise. We'll open your first Clear Experience franchise here in Vancouver. I'll run it. What do I need to do to get to that level?

I alluded to the fact that I launched a fourth LLC that is a digital product. It's the best way we can describe it. I get requests daily on how I go from point A to point B in five years. That's longer than a 15-minute or 1-hour conversation, so I have started to flush it all out and then categorize it into buckets. We are putting it in video format like a masterclass style, but with downloadables and homework.

Let’s say I did door-to-door marketing with each location and this is how I did it. I called ahead, set up appointments, and brought swag bags, coffee, and bagels at least once a week for a year. This is exactly what I did. You say, "How do I make a swag bag? Where do I even start? What do I put in it?" We will have, "This is what I put in mind. I ordered it from Vistaprint. This is how I designed it on Canva." It's a step-by-step on how I did everything I did. I'm not a genius or anything. I google how to do things and then do them.

Comfort Zone: If you want to get from point A to B in your business, try doing door-to-door marketing. Call ahead, set up appointments, and bring swag bags.

I read about a book a week. I'm taking the information from the book. It's a Venn diagram. I pull a little from here and a little from here. This is the Carly Rose soup. I'm putting the recipe for the soup online for people to enjoy if they want to try to recreate it at home if they want to. We're starting with a marketing bucket. It's basically how to establish yourself as the expert in your specialty, and tell everyone about it. The next may be HR, staff, culture, and implementation. How do you get the whole team to love this mission that you're creating? That could be one. There are a lot of ideas I have cooking.

I love to have you back on 5 or 6 times to flush the whole thing out. We'll start a whole series on the Carly Rose's Corner. I know you do your own stuff and you're busy. Another thing is you talked about door-to-door. You take some bagels, coffee, and wag bags. Who are you taking that to?

We've done it for dry-eye. When we do it to dry-eye, we would hit local ODs to do OD referrals from dermatologists, rheumatologists, endocrinologists, or anyone that has a huge dry-eye patient base. They may not even know that they have a huge dry-eye patient base. We're about to do it for Ortho-K, so we also do myopia control. Our target list is other ODs. The way I want to position this is that I believe all things can and should be mutually beneficial. It is not a zero-sum game. It's not like I win, you lose. I believe all of us can and should win. Always take that to it.

If I'm marketing other optometrists, it's not like that. It's more like dating. How can I help you? How can you help me? How are we in this relationship together? How do we build trust over the years? How do we care for this patient base together? One of our first marketing events for Ortho-K is hosting an in-house wet lab because it's more hands-on. We're inviting the ODs into the community. We'll give a small lecture on myopia, the problem that it is, what we're doing about it, and what other resources are in Cincinnati that you can utilize. It's not me, that's fine. We all need to do something about myopia. It's that vibe. That's what I want to bring to the table versus like, "Refer to me."

The wet lab, are you doing that in your office?

Yes. We're doing Prokera amniotic membrane in that wet lab too. All the ODs in the community that want hands-on experience, it’s like, "How do you insert these things? Should you debride? How do you build for it? What's the patient experience? I've never even touched one of these things." "This is how you open the package. You have to rinse it." We're bringing the bio tissue team in. They're going to bring snacks and drinks and educate all of us with hands-on experience. At the end of that, if they decided they don't want to place Prokeras, but they know now the patient that could benefit from it whereas they might not have known before, then they identify and refer. Everyone wins.

Maybe there will be less than a group of ten. Maybe there will be a couple of people who say, "This is something I want to do. I'll implement this in my office," but I would not imagine it's more than a couple of people in that group who are going to make that decision. The majority are going to say, "It's cool but I'm not doing it."

Because I've seen it hands-on, I know now from my personal experience. I can talk to my patient, "Here's how it works. I've done it. I've touched it, but I'm going to send you over here to do it." I would feel more comfortable having that conversation and referring that patient over. That's a cool idea. You did something like that for dry-eye as well or was that just Ortho-K?

Yes. I've done about five years of dry-eye and stuff like that. Dry-eye is one that I've been chugging along with for a very long time. I might have even started lecturing on dry-eye before I had my own practice. I've been positioning myself in that platform from the dry-eye perspective for a long time, but then I realized that's just the prototype. It's plug-and-play. I figured out the prototype and now it can be VT, Ortho-K, aesthetics, or dry-eye. It's all the same wheelhouse.

You've developed that protocol now. As you said, you could plug any specialty into that because you know this is how the marketing side works. I'm going to be taking boxes of bagels and swag bags to different ODs around the area. What else? Could you share one other thing that's worked for you as far as may be connecting with the public versus connecting with ODs? Do you do anything public facing specifically?

It's social media. That's a biggie. It's free. Anyone can do it and no one is doing it, I mean we’re all doing it now. We’re filming one of the videos on this product. It’s really close. We've been talking about this for years. It's happening.

If you want to connect to the public, use social media. It's free and anyone can do it.

Put me on the list. I'll be the first.

You could be one of my beta tests. That's another thing. I am not motivated by money. I don't even know where to start on my pricing. It's crazy. Maybe you could beta test and say, "This gave me this much value." I need to figure out the value add. I want it to be a 10X value add because I want things to be a win-win. I want it to be a 10X value add for the provider from the cost. I want to know the value that it would add to your practice, and then I can retro the price.

I got you. You need to know then roughly what value has this added to a practice, and then you can price it accordingly.

Anyone can email me if you want to be part of this launch too because I don't know what I'm doing. I can put you on an email list and we can figure it out together.

How do people connect with you then?

I'm on social media. I have @EyecareOnTheSquare, @TheClearExperience, and @DoctorRoseTalks. For this digital product, we've secured the Instagram handle. There's nothing there but you can go follow it. It's @ForwardFocusAccelerator. That's coming. Those four Instagrams, TikTok, and then my email is DrRose@EyecareOnTheSquare.com. Do you know Gary Vee or Gary Vaynerchuk?

Yes.

I started listening to and following Gary Vee in 2018 because I bought a business. I realized I don't know what I'm doing. I'm not a business owner. I went to optometry school and didn't get my MBA. What the heck do I do? I started consuming content to learn. We're always a student. Gary Vee is huge in the business world. He's going on and on about TikTok and I don't even know what this thing is. I downloaded it and trying to figure it out. My friend of 31 years is a business owner. I called her and said, "Gary Vee says we need to do this TikTok thing."

We're in the mid-30s at this point so I have no idea what I'm doing. It took me a month to figure anything out about the app, and another month to post my first video. It was awkward and terrible, but it was important, so I keep doing it. I keep showing up. It's gamifiable. We don't create the rules of the game, but we know them, so we can use them or not use them.

Comfort Zone: Getting your first TikTok video out there can be awkward and terrible, but it's important. TikTok is gameable. You know the rules of the game so you can use that to your advantage.

There are a lot of important lessons in there. I'll speak for myself, but a lot of others are a bit shy to put themselves out there or "I don't think I'm going to create the perfect viral video, so I'm going to leave it," but it's about showing up and doing it. As you said, it's gamifiable so you learn what the rules are and what sticks and doesn't stick, and fine-tune it. What was the first big video you did that went nuts?

It's a blink exercise video. Why would you think that would go viral? Still to this day, I don’t know why it went viral, but it did. It doesn't have to be complicated. It's what you want to tell people and what you want people to know. It's important to blink when you're on a screen. That's what I'll keep telling 250,000 people that want to listen to me about blink exercises.

You keep finding little things that are relevant to eyecare and you never know which one is going to stay. I want to give a quick shout-out to my friend, Claudine. I don't know if you know Claudine Courey from Montreal, the Eye Drop Shop.

I know the Eye Drop Shop.

She started TikTok a couple of months ago. I remember talking to her and she's like, "How do you do this? It's annoying," but she's stuck with it. Now, she's got 20,000 followers on TikTok or something more. Her videos get lots of likes and views. She knows what's working. It's nothing fancy or crazy, but she's doing it and I love it. It's so cool to see somebody who figured out the rules a little bit and made it work.

it's pretty cool to watch.

She’s another fantastic entrepreneur and hardworking person who I'll have on the show soon. TikTok is gamifiable so do it, learn a little bit, watch some of Carly's videos, and see what stuck for her. I'll be honest with you, I had one massive viral video on TikTok and I haven't bothered to go back and make more. I'm not that interested in going back. I'm more of an Instagram person, but I see the value in TikTok as well.

I want to talk a little bit more about the stuff that maybe doesn't get talked about as much as it should. I was listening to a podcast, the Four Eyes Optometry Podcast and they had Dr. Jasdeep Soni. They were talking about burnout. Burnout is a common topic and it's a real thing. I have my personal perspectives on it. Have you ever experienced burnout? What does that look like for you?

Burnout looks like the ego mind and the self mind. One thing I realized that I was doing a lot of was things for external validation. That's what people-pleasing looks like. There was a quote I heard and I wrote it down because it was so good. It said something along the lines of, "Not having healthy boundaries means that you are more uncomfortable with other people's discomfort or perception of you than your own.” That's that ego mind. That honestly comes right back to authenticity. It's an inside job. Look at yourself in the mirror and ask yourself, "What do you want out of life?" Burnout comes from not listening to what we really want.

Not having healthy boundaries means you are more uncomfortable with other people's discomfort than your own.

That's a fantastic insight. That was what Jasdeep was talking about. After he'd gone through it, he realized that he wasn't in alignment. That makes a lot of sense. I've experienced burnout, but I don't know if I've experienced it in a very definite way. What I know is that I go through ebbs and flows or ups and downs. What I've learned is to lean into the downs or the ebbs. When I'm not feeling super productive, I let it be. I don’t force myself to do something when I don’t like it.

There are basic things that need to get done. I got to look after my family, go to work, and see my patients. I understand those things, but social media, podcasting, and all these other things, I love doing it. If I feel like I'm not loving it right now, I've become comfortable with like, "Let me get through this period and when I come back up, I'll be good." In fact, I come back with even more energy than the last peak that I had. That's been my way of working through the potential burnout. Do you have something that you've done that's helped you get through it?

There are a few things, but I do a lot of New Year's resolutions, words of the year, and all of that. My word for this year is inspired. It goes with all of this because it's the inspired action or the inspired thought. It's doing what you're inspired to do and not what you have to do. I may be inspired to clean my closet out and not question that. Go through the motions. It's yourself trying to talk to yourself. That’s what I think inspiration is.

Listening to that is like listening to yourself. Whether it's having a chill day or not doing social media, things are always opportunities or successes, in my mind. There are no bads anymore. The opportunity may be to rest, digest, and relax. As you said, that's an opportunity to come back better. Listening to the voice in your head that inspired thought or action helps a lot because that is authenticity.

That is a very great insight for people to take away from this conversation.

For tools, I meditate a lot because I have found that typical distractions and numbing no longer work. I can't binge-watch TV anymore. It doesn't work for me. I wish it did. There are some days I wish I could have a glass of wine and chill out. I have to chill out and that might be walks outside or any outdoor time. It helps me meditate, journal, silence, and all of those things, which it is hard to find silence when you have a family, multiple businesses, dozens of team members, attorneys, bookkeepers, and CPAs. It's hard to find silence, but I prioritize it in my time management. It's necessary.

You are aware that you need it. You implement that and put it in there.

I've only learned that by not listening and not doing it, and letting the water in the pot get too hot. I'm like, "I can't do that again."

Experience is unfortunately the hard way, but the best way to learn a lesson as well. Hopefully, some people can take these insights away so they don't have to get to that level. They can start implementing these things. I hope you're writing some of this down. If you missed it, go back to it again.

I also do tons of yoga and a little workout. I have to prioritize my physical body.

If you're not physically in a good place, you can't be either mentally.

I do a lot of intermittent fasting. If I eat junk and then try to work, my brain doesn't work. I can't.

Is that your daily routine where you have time-restricted fasting or you don't eat anything and do a proper fast for a couple of days? What is that?

I usually do 16, 18, or 20-hour fasts almost every day, but I listen to my body. It all comes back to listening to what you want once you flushed out your patterns. It is hard in the beginning because your insulin is spiking when it's used to spiking. Once you retrain your hormones and biochemistry to calm back down, it's not hard at all. You just listen to it when you're hungry. It sounds basic but it's not. I heard someone say that if you can control human desires like hunger, and push through that and realize, "I'm not going to die. This is just my ego brain trying to keep me alive, " then it releases your true power. You're like, "This guy is in control of this guy." It's not the other way around. The true magic is getting behind these urges.

Comfort Zone: If you can control and push through your human desires, you will release your true power. Like with hunger, you're not going to die because of that. That's just your ego brain trying to keep you alive.

There are many good books on that topic. One term that's coming to mind and it's going to sound silly is MonkeyBrain. I don't know if that's the name of the book.

There are the monkey brain and the reptilian brain. To me, I simplified it. It's all the ego. It's all that human form. It's human versus soul.

 That is a whole other conversation that I'd be very happy to go down.

We can go grab a coffee. Are you going to Expo East?

I am, yes.

Maybe we'll chat in New York.

That’s perfect if we can find the time. I'm sure your schedule is going to be fully loaded. We'll find some time. Tell me what's one difficult experience or challenge you've had personally in the last couple of years. I feel like a lot of times, it's tied to COVID but maybe not tied to COVID if you can, whether it's with your business or something else regarding your professional career.

It will always be staffing because there comes a time when as the owner and the leader, you have to make tough decisions. You're not ever going to have all of the information. The decision may be that you have to let a team member go, for example. That is heavy and hard. It almost feels like mom's guilt. It feels similar to me. It's realizing that sometimes the piece I play in someone's puzzle is not their savior, but maybe I have to be part of their rock bottom too. That's very uncomfortable.

You always hear the stories of, "I was let go from my job and it ended up being the best thing that ever happened to me because I went on to this new career that I love." I realized that sometimes that is the most loving piece like, "This is not a good fit for either one of us. We have to part ways in the most loving way possible,” but that is always going to be a very hard conversation for me to have.

That's a good perspective to have in the sense that you might be helping that person get to a better place.

That was a hard pill for me to swallow because I want to help everyone.

You have more staff than I do. You are dealing with it on a different level. How much staff do you have? You said dozens. What's the number?

We're a little over a dozen right now. I see the potential for that to almost double in 2023.

That's huge growth. I like to end every episode with the same two questions for every guest. I would like to apologize that we didn't get a chance to talk too much about The Clear Experience. It's amazing what you've done, what you've designed, the aesthetic of the place, and the color scheme. You got gold and dark green. I'm down for that dark green. It's very rich and luxurious looking. I love that. Great job with that. I'm excited to see that continuing to grow and I'm excited to learn from you. I'm going to be part of your Accelerator. For people who are interested in being part of the Accelerator, make sure you contact Dr. Rose.

People think my first name is Rose and I answer it. It's fine.

I heard somewhere that people with two first names are crazy. I don't know if that's true or not.

It lines up. There is a reason I went to a whole Ayahuasca retreat.

You got to have at least one screw loose. Make sure you connect with Carly. From the limited interactions that we've had, it's been amazing and positive. I love what you're putting out there. Carly, the two final questions I ask every guest. One, if you could step in a time machine and go back to a point in your life that was a particularly difficult time, what would you tell yourself? Feel free if you'd like to share that moment. I'd like you to tell me what would you tell yourself if you could go back to that moment at whatever age you were. What would you tell younger Carly at that time?

I did not have an easy childhood. The first 25 years of my life were very difficult. My mom passed away a few years ago.

I'm sorry to hear that.

Thank you. You're going to get a bigger answer. If you want my life story, I'll write a book.

The entire answer.

The first 25 years were rough. My mother passed away. My dad and I have had a lot of great deep conversations since then. A few months ago, he was at my house and we were kicking it. I said something like, "Wouldn't mom just die if she could see everything we're doing right now?" He got pretty sentimental in saying how he has a lot of regrets. He wishes he could have done things differently with our existence. I have two sisters. I was like, "No, that was my biggest learning lesson and I am so grateful for that quarter of a century of class." The class was in session for 25 years for me.

It was like, "Give it to me, life. I can take it. I want to learn." That is what it must have been. I remember being in optometry school and looking around and being like, "No one here knows how to cope with life.” It gives that comfort thing. My normal is being uncomfortable. I don't know what it feels like to be comfortable, calm, stable, and safe. I sat back and thought, "I have so many skills and assets because of my negative experiences and opportunities. I am so much more equipped than a lot of people to handle anything." I have yet to experience something that I felt was insurmountable. There's nothing I would change about it. I would tell myself to have gratitude for this because I will see the value one day.

That's a fantastic message. It's one that many people could benefit from when they're younger and going through a tough time. This is somehow going to make you better later on.

It sounds so hard to say. It feels like you're almost invalidating the victim's experience, but it's not like that. I am genuinely grateful for it. Release the anger and realize the blessing.

It's an amazing message. Thank you for sharing that. I appreciate that. It's not always easy to share things that were difficult in the past, but that's very kind. That's going to help a lot of people. This is the final question. In everything that you've accomplished to this point, how much of it would you say is due to luck, and how much is due to hard work?

We create our luck. Everyone has probably a similar amount of luck. Luck is a piece that I do not undervalue. It's the magic piece and it's the piece for all of the greatness, but there's a way to tap into it. It comes back to listening to that inspiration. If you follow the inspiration, you'll find luck. A vast majority of it is luck, coincidence, and divine intervention.

Comfort Zone: Luck is a magic piece for all the greatness and there is a way to tap into it. If you listen and follow inspiration, you'll find luck.

That's very interesting. That is a different answer than what most people will give me and I love it. That's fantastic.

What do most people give you?

Most people will say it's 99% hard work, which you can't take out the hard work. You didn't sit in a room and wait for something to happen and become who you are. You worked at it. The reason I find that answer so intriguing is I think in a very similar vein. A lot of people call it luck, but I don't like the word luck. It is divine intervention. It's the universe giving you opportunities.

It's conspiring in your support.

It's working for you.

I will button it up with this. The end result is my hard work. The what is my hard work. The how is the luck.

Tell me your why if you have it.

My why is ever-changing because as this thing grows, my why must grow. My why started with changing my storyline and my future. If I allowed my future to happen to me, it would not have been what I knew I deserve. The first why was changing my future, and then I realized that was almost so easy and achievable. If I can do it, anyone can do it. If I could go from where I started to where I am now, then I can do anything. Now, the why is how I can make a positive effect on humanity. We don't complain about what's going on in the world anymore. We do something about it.

That's a great perspective to have and a great why. To leave a better mark on the universe and make the universe and the world a better place. Thank you so much, Carly. Any last couple of words or final words you want to share here before we wrap up?

I am so grateful that you had me on to chat about this. This could open so many more doors in the future that we don't even know. We don't even know what's coming for us. It's super exciting. I appreciate it.

It is my pleasure to have you on. This one conversation has led me to five other conversations that I want to have with you. Maybe, we'll have you back some time and we'll go through some more of it. Thank you again, Carly. I appreciate it. Thanks for everything that you're doing, for inspiring the rest of us, showing us the opportunities, and possibilities within the industry, and leading the way in that regard. Thank you, everybody. Make sure you give Carly a shout. Let her know that you are tuning in. Throw a screenshot on Instagram or something and tag us. Make sure you leave a review and let me know what you think. Take care. I'll see you in the next episode.

Important Links

• Dr. Carly Rose - LinkedIn

• The Comfort Crisis

• Eyecare on the Square

• The Clear Experience

• @EyecareOnTheSquare - Instagram

• @TheClearExperience - Instagram

• @DoctorRoseTalks - Instagram

• @ForwardFocusAccelerator - Instagram

• TikTok – Dr. Rose

• DrRose@EyecareOnTheSquare.com

• Eye Drop Shop

• Four Eyes Optometry Podcast

• MonkeyBrain

About Dr. Carly Rose

Dr. Carly Rose was born and raised in the Greater Cincinnati area. She received a Bachelor of Science in Biology from Northern Kentucky University. Following graduation, she decided to experience city living and moved to Chicago in optometry school. When not learning about eyes, Dr. Rose spent much of those four years enjoying all of the food Chicago had to offer! After optometry school graduation, Dr. Rose chose to complete a year-long residency at the Cincinnati VAMC Eye Clinic. Following residency training, she furthered her experience by qualifying and becoming a Fellow of the American Academy of Optometry. She is a current member of the American Optometric Association, the Ohio Optometric Association, and the American Academy of Optometry. Dr. Rose has owned Eyecare on the Square, a full scope primary care private practice for five years. She founded Clear Eyes + Aesthetics, a luxury dry eye medspa just over one year ago. The most recent adventures include launching a residency location, speaking globally to fellow eye care providers, and creating accelerator tools for the optometric entrepreneurial community via the latest venture: Forward Focus.

Episode 92 - The Future of Canadian Optometry - Dr. Richard Maharaj, The Independent Specialist

We’re back with another installment of the Future of Canadian Optometry. Joining us today is  Dr. Richard Maharaj, who expressed that the original six conversations did not fully represent the perspectives of optometrists across Canada. In this episode, Dr. Maharaj dives into the perspectives that many non-business-owning doctors have about our profession's current and future status. He also shares a perspective of a growing area of the industry that he calls the Independent Specialist. You don’t want to miss out on the incredible exchange of insights and ideas by tuning in to this episode with host Harbir Sian.

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Watch the episode here

Listen to the podcast here

The Future of Canadian Optometry - Dr. Richard Maharaj, The Independent Specialist

Here's a very big Happy New Year. Welcome to the year 2023. This is our very first episode of the New Year. I'm excited for multiple reasons for this to be the first episode of 2023. If you've been tuning in to the show, you will know that in 2022, I did a series of interviews, which was called The Future of Canadian Optometry. I did 6 interviews with 6 different guests to explore where the profession is heading in Canada. Through those interviews, I had conversations with many colleagues.

I got lots of amazing feedback. I learned that there were certain aspects of our profession that we missed and didn't cover. I didn't want a big portion of our colleagues to be left in the shadows and not discussed the opportunities that they could have to grow, and for the profession to grow. The perfect person for this conversation or the person who brought most of this to my attention is this man right here, Dr. Richard Maharaj. He's no stranger to the show. Welcome back, Dr. Maharaj. I'm so happy to have you here.

Harbir, thank you for having me. I'm looking forward to the three-peat. I'm excited that you asked me to come back. This is going to be a great conversation.

I jumped into introducing you without giving you a true intro. Even though you've been on the show a few times, it's important to give everybody a little bit of context as to why you're the right person for this conversation. Previously, we have had CEOs, vice presidents, or presidents of these different groups. We even had Dr. Kerry Salsberg give the private practice owner's perspective. You have a unique perspective on this. Independent specialist is the term that I love that you've coined that we want to explore here.

Just so everybody knows who you are, you are the Director of Interventional Dry Eye Services at the Prism Eye Institute, which is a leading medical and surgical eye care and research institute with multiple locations in the Southern Ontario area. You are the Chief Education Officer at MyDryEye.ca and the Cofounder of the Dry Eye Summit, which has very quickly become one of the most recognizable names in dry eye education and innovation here, not just in Canada but across North America.

You're the perfect person for this conversation. I'm blessed to have you and your insight here. Why don't we share how this came about? I released those six interviews. You are kind enough to listen to all of them and even more generous to give me your honest feedback on them. You shared that although you felt that there was a certain light shed on conversations that needed to be, there was a good portion of our population and our colleagues that were not represented in those discussions. I would love to hand it over to you and tell me what you think about that.

Thank you. I'm fortunate enough to have both live and digital relationships with a lot of colleagues from across the country, young and old, and from all walks of life. One of the points that came back to me quite often was from some of the younger colleagues that describe themselves like, "I'm not a practice owner. I'm not part of a corporate entity. I'm just a person or an optometrist."

Those optoms that have been in contact with me generally are interested in dry eye and how to integrate it into their practice or how to do it stand alone. What I found from the conversations and what I was hearing from other colleagues was that the perspective of either the corporate owner or the private practice owner was adequately explored, and then some. The independent specialist or the independent associate whose voice certainly outnumbers the voices of practice owners is vacant. Where does the future of optometry exist if not with the individual?

Where does the future of optometry exist, if not with the individual.

If those voices are saying something but are not part of a larger group, then that message gets left out. I'll put my bias out there front and center. I don't think it's any secret, but I've been behind the movement toward the specialization of optometry in Canada for the last decade. The one thing that became a common theme in most of these conversations was the conversation around the comprehensive eye exam. How do we utilize that? How do we optimize that? What is the value of it? How does that impact eye care, eye care consumption, and the market in general?

I would submit that looking at the comprehensive eye exam is a sliver that is hyper-focused. I just don't think I've lived it. My involvement now with the Prism Eye Institute and the movement toward specialized optometry clinics within the Prism Eye Institute and our groups, which are growing nationally, suggests that there's a market in and of itself that exists outside the comprehensive eye exam and outside the traditional retail optometry space. That's where we can frame this conversation and see where it takes us.

Canadian Optometry: There's a market all in and of itself that exists outside the comprehensive eye exam and outside the, the, the traditional sort of retail optometry space.

That sounds good to me. I have to admit. I agree that is a lot of what happened there, whether it was by having my blinders on or the way that the conversations went with the different guests. Being a business owner myself and a practice owner, I was coming from that perspective. I'm guilty of not sharing or at least addressing to some degree that the vast majority of our colleagues who are not business owners and their associates are practicing some other form.

I hope we can address some of it here. As I've been sharing these episodes, I want to make sure that this conversation about the future of Canadian optometry doesn't just get buried with those six interviews I did. I want this act to be an ongoing thing. I plan to have multiple more interviews with different guests to make sure that we continue to see the different aspects of our profession and hopefully, bring to light some of the potentially negative things that might be happening but more importantly, the positive things. When people ask me, "Give me a quick summary of those six interviews," I'll say, "Generally speaking, everybody I brought on says that they think that the future is bright and that our profession has a lot of good things going for it." I hope that we can see that and come together.

The other message I share with everybody is it's going to be super important for us all to work together to make sure our profession stays strong. The majority of our profession is practicing not as business owners. We need to make sure that the masses are hearing the message and working toward greater goals and pulling in the same direction to some degree.

Why don't we do this? I'll ask you some of this so we can keep some structure to the conversation. Otherwise, we will just banter back and forth. I'm sure that will still be valuable, but there's still some structure to the conversation. I'm going to ask you a couple of the same questions that I asked the other guests. I would love for you to put your spin on it or your perspective on it. The first question I ask everybody is this. In your opinion, what is the current state of optometry in Canada now?

The way I see it, we're currently in a state of transition. One could argue that we're always in a state of transition. It just depends on how close to the lens you want to be. If we're zoomed in super close, that tends to happen when we're highly stressed, highly anxious, and highly worried for whatever reason, competitive reasons or otherwise. If we zoom in, we will see that our traditional competitive landscape is right in our backyard.

That's the entrance of new players like Specsavers and also the existing other corporate entities like FYI and the other folks that were generous to share their perspectives on your show. That’s in the backyard of this competitive landscape of what I would describe as retail products, as well as the eye exam itself. It was Dr. Daryan Angle that brought this up. I completely agree that if you zoom out, you're going to see that optometry is thriving if you compare where we have come from and where we are now.

From a regulatory perspective, we are legislatively at the pinnacle of where we have been, at least in Canada. We're not yet at the space in which some of our surgical colleagues in the US are, but we are approaching that. From a regulatory and legislative perspective, we're probably the most advanced that we have been. From a market share perspective, we're also occupying the largest market share that we have ever had as a profession. There was a time when we fought to be recognized as a profession.

Zooming out, you're going to see that we are at a precipice of a very exciting time. I would agree with every other of your guests that this is an exciting time, but it does depend on where you are in your career, how seasoned you are or how new you are. That can be burdened with fear for various reasons. If you're a new grad, you're thinking about where you're going to work.

If you're a soon-to-be-retired optometrist, you're thinking, "How am I going to reap the rewards of this nest egg that I've built up over the years? How am I going to transition?" It does depend, but it's super important that we zoom out and remember that this is and will always be the most exciting time in optometry. The day that you ask that question will always be the most exciting time.

I hope that's the truth. I hope that's the case, that our profession continues to grow and our scope continues to broaden or expand. Every time you ask that question however many years down the road, it will be potentially the most exciting moment in the profession. There's no downhill trend at some point due to various forces or whatever they might be. That’s a good piece of advice there is for us to zoom out. It's tough to do sometimes.

Maybe I can clarify. Exciting doesn't always mean great. Exciting means that we are in the midst of change. As you've noted and as we have all experienced in the last couple of years, change is uncomfortable. It depends on where you are. We're very much a cyclical profession. If you look at any emerging profession, there are cycles. We are in one of those cycles. The discomfort is part of that change. At the time, it may not seem exciting from a happy perspective. When I say exciting, it's like you're about to get on stage to do that talk, and you've got those goosebumps and bubbles in your stomach. It's that kind of excitement where it's a nervous excitement. That's how I frame that.

Exciting doesn't always mean great. Exciting means that we are in the midst of change and change, as you've noted and we've all experienced in the last couple years, is uncomfortable.

That's fair enough. What do you see as some of the potentially disruptive forces? Disruption doesn't necessarily have to be a bad thing either. Sometimes that word tends to have a negative connotation. What are some of the driving forces that are changing the profession? We're in somewhat of a transition phase here, whether it's specific players like Specsavers, potential legislative changes on the horizon, or expansion of scope in medical opportunities. What are you seeing happening? What are some of the few key forces in there?

This topic was interesting. The independent specialist in optometry has the potential to be a true disruptor. This is not necessarily a practice owner, corporate, private or otherwise. A lot of the conversations talk about specialty eye care services as an adjunct or as an addition to primary eye care or comprehensive eye exam services. I would offer that that's perhaps a bit of a limited view given the demanding aging population that we're seeing, the increase in various chronic diseases, our ability to treat those diseases, and more importantly, our appetite, especially from newer grads that are being trained at such a heightened level.

That appetite to engage in specialty eye care services from our perspective is there. The demand is there. It's important to recognize that we do have to continue to market to the end user who is our patient that we are comprehensive in nature. We will provide you with a general physical examination of the visual system and ocular health. However, that is not an exclusion or isolation of other specialty services. Where I see the difference from the previous colleagues that you had on the show is that the over-reliance on the comprehensive eye exam has resulted in it becoming a commodity.

Whether anybody wants to acknowledge it or not, the commoditization of anything doesn't generally yield a solid outcome or a positive outcome for the provider of that commodity. When we talk about the eye exam, we have to have the latest technology and make sure we have imaging, OCT, and all these other things. If you think about it, what we're doing is we are inflating the value. Some of my colleagues talked about the perception of value. We will get to that.

We perceive the value to be greater by including these other things in it. To me, that seems to be backward because if you look at our 4 years of training, and then if you did a residency afterward for 1 or 2 years, of those 6 years, the majority of that time is spent learning how to diagnose and treat diseases. It's not to say that dispensing eyewear and treating visual conditions is not part of it, but we spent a lot of time treating diseases.

If we look at the percentage of time we spent learning and the percentage of our revenue earning based on that same ratio, it's inverse. If we're going to expand the comprehensive eye exam to include this, we also need to acknowledge why it's being positioned that way by some of the leaders that we had previously. I would submit that we are creating momentum toward making the eye exam a loss leader.

Another bias aside, I practice in Ontario. I can certainly attest to the devaluation of the eye exam because of OHIP's remuneration being below the cost of delivery but we can't keep on doing that. That's where I see the disruption being necessary. It’s to not just invest but put into the commonplace language in optometry that the independent specialist or independent specialization in optometry is not just a possible path forward but a necessary path forward.

To digress a little bit, you flipped it. You said, "We spent all this time learning the medical but that ends up being a small portion of what we do." It reminded me of something I heard on even my very first day of optometry school. It was the first week. One of our professors stood up at the beginning of the lecture and gave a ratio of 90% and 10%. He said, "90% of what you do is going to be refraction and 10% is going to be medical." I was wondering what you would say to somebody if you happen to be in that lecture reviewing it or auditing it. Would you stand up and say something to that professor? What would you say?

I would tell him, "I hope that's how it goes." I agree with that proportion of learning. I'm still baffled to this day that the proportion isn't reflected in our earnings. Spelling out a little bit about my history, I started from scratch with a referral-based practice in Ontario, which relied almost primarily for a time on referrals from colleagues from ophthalmology and optometry. It was unheard of at the time. I was focused specifically on the ocular surface treating a particular medical disease nonetheless.

I put my money where my mouth is and said, "I'm going to rely on the training that I've had." I did a fellowship, so I invested further time. I said, "I'm going to put my money where my mouth is. I'm going to invest in relying on that acumen, expertise, and specialized knowledge to generate the very revenue and value that I can bring to the profession and my patients." Reflecting back on things that I heard from colleagues, it’s either I'm crazy or it's never going to fly. It won't work in Ontario. I got slapped on the wrist by some colleagues. I thought, "How backward do we have it?"

What I would say to the professor that you mentioned is that we need more people and voices saying that we were trained for this. We're being trained at even a higher level than both you and I were. I'm twenty years out now. We are being trained at a much higher level with more focus on diagnosis and treatment. While legislatively provincially, at least I can speak to that, we still have some catching up to do on the billing side. We better invest in showing our patients what it is that we're best at and then, more importantly, valuing that.

Canadian Optometry: We better invest in showing our patients what it is that we're best at.

The word value is a tricky word that came up a lot. As open and transparent with each other and everybody else here, we don't need to beat around the bush. One of the big elephants in the room here was Specsavers. A lot of colleagues are worried that their presence was going to devalue the eye exam. We have been putting hyper-focus on the eye exam. That's what we have been trained to do. That's what we do as eye doctors. We do comprehensive eye exams.

We have been in the collective voice. It seems to be that we're worried that our bread and butter or the cornerstone of what we do day in and day out is going to be devalued. Therefore, patients are not going to look at what we do with as much respect as they previously may have. Do you think that's true? In response to that, we're trying to inflate the value of the eye exam and add in the OCT, the Optum map, and this thing. We add value to it, but in what other ways can we add value to what the patient sees in what we do then?

The one thing that I would say is to stop trying to add value to it. The value needs to be specific there. What I see that we're doing is we're leaning into optometry psychology of being less than or perceived as less than. I've talked about the psychology of optometry for a long time. I have done a lot of research on this. Our pervasive personality type is an ISFJ, which has us being anti-competitive or at least competitively shy. What we do instead is we try to inflate. We figure out ways to do that. As a profession, I can say that we have done that. This is one clear example where we inflate.

This perhaps might come from my close proximity to ophthalmology now, especially with my work with Prism. They're a group, and ophthalmology is a group that can hang up their shingles and open up. They have a waitlist right out the gate. With that comes a certain bravado, tempered arrogance, and sometimes more arrogance. There's this BDE or Big Doctor Energy. I have to put that for the PG group. That comes with that.

There are no apologies because they're not in a position where their patients have to perceive the exact value that they're paying. They get a remunerated service. The way I see it is let's not inflate the eye exam because we're deflating the service by doing that. Let's provide the eye exam and services that are needed and necessary for the population. It's no surprise to anyone. There are demographic prevalence studies on the increasing aging population. We know that AMD, glaucoma, dry eye, and myopia are going up. We know low vision is going way up in numbers. Specialty contact lenses and all these areas are expanding. The need for that is expanding.

Let's not inflate the eye exam because we're deflating the service by doing that. Let's provide the eye exam and provide services that are needed and necessary for the population.

Do we need to leverage the eye exam to get the patient there? No. I'm going to speak very plainly. We need to market the fact that this is what we do. We provide these various subspecialty services. Not just that, we recognize that internally. Imagine this to the public. I'm sure you get this too, Harbir. Doing dry eye as long as I have, I have patients that say, "I went to a dry eye specialist." They use the vernacular specialist, but in Ontario, we can't. I believe in BC you still can't.

That boggles my mind because I don't believe that it protects the public if they don't know the difference between a specialist and a generalist in our profession. I don't think it serves them well because they can go to anybody that says they're providing dry eye services and think they're a specialist. I would imagine the same could be said about low vision and other subspecialties.

What we have done is we have forced or painted ourselves into a corner. I've decided to take a step out of that corner and step on the paint. I'm leaving some footprints but I'm hoping some people follow me because that's the path forward. That also gets us out of chasing a fixed market share. The only way that we're going to increase capture for glasses and contact lenses is by forcing need, so telling them they need multiple pairs or decreasing the time between their eyewear purchases.

It's 2.7 years between eyewear purchases. That's Specsavers' model, but we can decrease that to once a year. The way we do that is by decreasing prices maybe. That's one method, but unless we increase pairs sold per visit or decrease the space between purchases, we're chasing a fixed market. I don't know about you, but I would rather be a true disruptor and define a new market.

I like that. We're going to hold onto that for a second. Let's make sure we get to that disruptor thing. I want to reiterate why you're the right person to talk about that. You're saying it's a fixed market. The interesting thing was when I was speaking with Rick Gadd who's the President of Essilor Canada, his business is selling lenses. He felt that there were still a lot of opportunities to penetrate different parts of the market and it wasn't saturated. It wasn't the number of people who were glasses.

Let's say we reached some threshold there, but it was that there are so many different types of lenses that we could be offering these people. We have been offering them basic single vision this whole time. Maybe we need to offer them task-specific lenses and anti-fatigue in the second pair potentially. In that regard, there seems like there's still quite a bit of opportunity. I do think it's not the same as what you're saying. We do have to change our perspective still. Otherwise, it seems like that Einstein line. The definition of insanity is doing the same thing over and over and expecting a different result.

We have been doing the same thing over and over and then getting upset that somehow the business is not growing, or somebody is taking away the market share. If you start to offer higher-end, more unique, and more specific types of options in the refractive and optical ophthalmic sense to patients, all of a sudden, you can grow your offering and then hopefully, increase your revenue and that kind of thing. It still sounds like there are a lot of opportunities for us in that more traditional sense. I don't know if you have any comments on that.

I don't believe that the glasses, contact lenses, and eyewear market is saturated necessarily. Any system has a peak efficiency. I don't think we're ever going to get to 100% efficiency. That's impossible. Let's say we can get to 60% efficiency, which we're still not there. How do we get there? What do we give up of ourselves as clinicians to get there? I'm going to say things that are perhaps a little unpopular.

I would expect nothing less from you.

The protection of our eyes from blue light and blue light-filtered glasses. The science is pretty clear to me that there's a lot of fear in a lot of the marketing that's out there for that. We're creating a market. Let's call it what it is. Our patients see it and hear it. If that's the mechanism to drive toward that 60% efficiency of a system, that's not a mechanism that I want to partake in.

I'm calling it out. We are a part of that system but we're a cog in a much bigger wheel. With any certainty whatsoever, I can’t rely on my colleagues or blame my colleagues for spinning that wheel. Some of us have looked at the science and heard the marketing. That makes sense to them. That's what they're going to carry through, but we also have to be cognizant of the why.

Simon Sinek talks about your why. What's the why of your practice? If we're driven toward the commoditization of an eye exam, then we shouldn't be surprised that we're going to start to commoditize various components of our practice. We need to separate and tease that out because the market is already straying that way. The entrance of Specsavers reveals that.

We're still going to do the disruption thing, but there's a question in my head that is somewhat relevant to what you're talking about. Commoditization is a topic that has come up through these conversations. There's the idea that these eye exams are services that are being commoditized. The commoditization is the answer to the commoditization for us to raise the prices. Let's say, for the ease of numbers, I used to charge $100, and I'm going to charge $150 or even $200 now. You have this perception of my service not being a commodity that is somehow more valuable, at least from the outside, before the person even comes in to get their service. Is that an answer? Is that a terrible idea?

I don't think it's a terrible idea. I differ slightly on it. I would suggest setting the service price from an objective standpoint as possible. Determine what your cost to provide that service is, and determine what margin you want to achieve by that. That's your price. The minute that we start to put the expectation of what that price should be on what it should be perceived as valuable at, that's when we start to get back to second-guessing ourselves. We're traditionally undervaluing ourselves.

Canadian Optometry: The minute that we start to put the expectation of what that price should be on, what it should be perceived as valuable at, that's when we start to get back to second guessing ourselves.

If we start to play that game, which we already have and it's why we're probably having some of these conversations, I think we undervalue. We could remain objective, take our natural instincts out of the equation and say, "It costs me this amount of dollars to provide that service." Let's say you want to have at least a 100% margin. Double that. To that end, we should be valuing what that service is, the work that we put into getting it there, and the value that has to the patient.

Essilor had an eye exam. They discovered that he had AMD. What did he say? "I can't even put a value to that." We're looking at it from a different perspective rather than what will everybody pay. That's what we have gotten into. We have gotten into this competitive landscape, but the number on average per 10,000 households of optometrists in the country is still very low. There are still way more patients that go around that are not being serviced. I don't know if we need to worry about the perception. Individually, corporate or private, it’s us that are creating the optics of this competition.

That disruption conversation is an important one. I want to go back. You already said it yourself but I meant to mention this already. The reason that you are the right person to have this conversation is not only where you're working now but how you got there. You started eyeLABS years ago, which back then was unheard of. The fact that somebody started a specialty practice and not providing straightforward and comprehensive eye exams but specifically specialty medical services, I would call that brave and a form of disruption. You’re paving your path. Lots of people have started to follow that path over the years for sure. It has helped you become this expert and well-known name in the field.

This is the reason why I think you're the right person for this conversation. You talked about the disruption and stepping in the paint. Play an entirely different game. What does that look like? I'll speak personally. That would scare me. I imagine there are lots of others that would be afraid of doing that. It's a lot easier to follow the already paved path and the model that's already there, which even I'm doing for the most part, day in and day out. How does one go down a completely different route? How do you have the confidence to do that? How did you convince yourself that you're not making a complete mistake?

One of the ways to do that and one of the ways that you are certainly doing and I'm attempting to do as well is to pay it forward by creating the language. One of the reasons why I texted you in the first place is because we need to have this concept of specialization in the vernacular. It needs to be part of that conversation. If the younger minds that are exiting optometry school and moreover, the younger minds that are entering or wanting to endeavor to enter into optometry don't think, hear, know or experience that specialized optometry exists, I guarantee it won't exist.

There's a word in Japanese called karoshi. It refers to death by overwork or suicide by overwork. That word doesn't exist in the English language. The fact that it exists in the Japanese language can help to articulate how their culture had to deal with overwork and this whole other societal problem. If a word doesn't exist, then we aren't compelled to use it or bring it into our culture.

If optometry's culture doesn't reflect the ability to specialize, then we won't continue to build on that. On the concept or the theme of disruption then, the reason why I think that specialization is true disruption rather than telemedicine and optometry or online sales is that I still think that it’s capturing a traditional market. When I think of disruption in optometry, we step inside the paint or step outside the paint. How do we create new footprints and step into a different demographic more meaningfully and with confidence?

When I did it, there were still dinosaurs outside my window. I was worried about the comet coming to kill us all. It was a time when I happened to see a version of this when I was doing my residency many moons ago. I saw glaucoma care was being provided by an optometrist in a practice. I thought, "This doesn't exist in Ontario. Why can't it?" I saw versions of it in ophthalmology because I worked so closely with ophthalmology in a lot of my different practices.

I was able to see. It was part of my personal experience that I was able to envision how to create it. It was still a leap of faith and all those things. I don't expect 100% of optometrists that are graduating to want to specialize. That's not what I'm suggesting. The Pareto distribution of 80/20 is likely going to happen. If we don't have a pathway and if we don't create value behind it, then that number won't grow as quickly as it needs to.

If we don't have a pathway and if we don't create value behind it, then that number won't grow as quickly as it needs to.

As it does continue to grow, what happens when the public starts seeing us as specialists in our particular domain within optometry? Our patients and the public become better informed as to what we do. All boats will rise. Tides will rise. The necessity of competing on the same battlefield starts to dissipate. I don't look at any of my colleagues as competitors, whether they're next door or across the country. Not in the least. Let's know who we are. We're working together. How do we better increase this basket size? We diversify.

That's such a great answer. I was asking you a question that I would ask if I had you in a different context. We're having this conversation in a different episode of this show, "Give me the goods on what your decision-making process was," but that's not the conversation we're having now. The conversation we're having is about the future of the profession. You're right that if we're not talking about it and if we're not using the words, then we're not creating that space or that opportunity for future optometrists to step into. That's what we need to do.

I googled that word while you were talking. You're bang on 100%. Karoshi is death by overwork or whatever you said. I never heard that word before. There are a lot of words like the independent specialist and the idea of having a specific dry eye clinic that does nothing else other than ocular surface disease. These things didn't exist before. It doesn't mean they can't exist or shouldn't exist.

These are the ways that we can continue to broaden our horizons and grow the profession. Otherwise, we're trying to grow this market share by doing the same thing over and over. It doesn't make a lot of sense. It might work, but it will take longer versus, "Let's open this whole new door and explore it." You've done the ocular disease thing. Are there any other aspects of that specialty type of approach that you've seen other ODs are doing?

I can certainly name names but generally speaking, the specialty contact lens area is one of the most exciting opportunities. It perfectly aligns our work in refractive care and physical and visual optics to disease. It's a beautiful marriage. I don't know if I told you this but once upon a time, I used to have low-vision services. I provided low-vision services in another practice. The appetite for low vision doesn't seem to be very high but the demand for it is increasingly high. It's going to continue to grow, unfortunately. Those are the two areas. I see some colleagues that are doing it.

To be honest with you, when I get messages on IG or email and when people are reaching out to me, it's very often younger colleagues that are looking to figure out, "How do I build a dedicated and specialized practice?" That's number one. Number two is, "Is it even possible? Am I having pipe dreams?" When I joined Prism when we merged our entities and I took over the optometry services there, part of my mandate was growing out the specialty arms of eye care at Prism at a national perspective or level. That's the goal long-term.

One of the first things that I created internally was a fellowship program to bring on an optometry colleague that wants to either provide specialty dry eye services. That's going to expand specialty contact lens services. We're going to have an intro program which we will eventually expand and get accredited potentially. Who knows? Long story short, it's trying to expand and diversify our offerings so that the public sees it. It's not just the language of our younger colleagues but it's also the language that our public is using with us It's adding that into the vernacular.

That's very important. If we're talking about the perception the public has of our profession, we need to make sure they're hearing these words and seeing that we offer these services. Going back to the specialty contact lens thing, for years, I didn't do a residency. For years, students would ask me, "Did you do a residency? If you went back, would you?" I would always say no because I wanted to come back and start my business. Over the years, that has changed. I've changed it too. If I did a residency, it would be in specialty contact lenses because I see that too. There's a massive value in that.

If there happened to be students out there tuning in, that would be my take on doing a residency. I have almost gotten to a point where I regret not doing it because I want to implement so many things into our practice. I just don't have experience with it. Anybody out there who's got specialty contact lens experience and wants to work with me should do a little self-promotion here while I'm at it. We already answered this to some degree but it doesn't hurt to ask it outright. The question I ask all the other guests is this. What is your definition of private practice versus corporate practice optometry?

A lot of these guests I had on were part of certain entities. I would ask. Where do FYI, IRIS, and so on fall on this spectrum? I know you don't like that necessary. A few people said that they don't necessarily like that binary distinction. When they would give me the answer, I always took it because they were mostly falling into the corporate bucket, and they didn't want to be labeled as that. I know you have a different take on it. Tell me what you think about the whole private versus corporate, and how we should look at it.

The sentiment at a surface level in general is that private is generally equated with freedom to operate whereas corporate is equated to being hyper-controlled or having a hierarchical structure to it. I don't think that's necessarily a true reflection. Both private and corporate are points on the spectrum between freedom and control. I always get philosophical. I know you appreciate this, so we can talk about it. The difference is the degree of consciousness that these different modes of practice may exhibit.

In private practice, you may have a little bit more looseness to the structure of patient intake, patient marketing, point of purchase marketing, in-exam processes, and exit hand-offs. That whole process in private practice may be very different, a little bit more loosey-goosey, and certainly more variable across different practices, whereas, in a corporate environment, it's fairly structured. It's a little bit more refined. In some cases, it's very refined.

What I mean by consciousness is how aware are you as a doctor working in each of these environments of the degree of influence those practice modes exert on both you and your patients. You become more refined in the marketing of the practice and the processes of the practice. Dr. Daryan Angle at IRIS talked about the intake process and how you never have to repeat your complaint so it’s never heard again and as a patient, you feel heard. That's beautiful and wonderful, but that is architected and structured.

How you want to see it, both good and bad, subtract from your "freedom to operate." The notion of autonomy somehow sets in. Any of the corporate folks will say, "You have the autonomy to practice the way you want to practice." I don't know if that's necessarily true. Going back to the concept of language, what's the language of the practice? What's being mandated? What is the expectation of the corporate practice owner versus the private practice owner?

Those things all exhibit influence. We are a product of the environment of our inputs. Our outputs will reflect that input. The difference is in the degree of freedom that you have by virtue of your consciousness of what's being surrounded. It's a long answer, but that's how I see it. It's a fundamental degree of separation between consciousness.

Canadian Optometry: We are a product of the environment of our inputs and our outputs will reflect that.

I like the whole philosophical side of things that you bring in always. I didn't do this in the previous conversations because I didn't want to color it with my personal experiences but I'm open to discussing it with people. I'm sure that we have two different modes of practice. I'm sitting in the sublease practice next door to LensCrafters. The other practice is a private or independent practice. In the exam room, 95% of what I do if not more is the same as what I do in the other practice. We have the same technology and the same setup in the exam room.

The difference comes like I know that this patient should be going next door here. I know what lenses they carry next door. I like to recommend specific lenses to patients. I'll put the name of the lens down on the prescription that is specific or beneficial for this patient. Does it make sense for me to write the specific name of a different manufacturer that they don't carry? Of course, that does.

Could I say I'm doing the same thing I would do in the other office? Not exactly because I have that in my stream of consciousness if I'm using that phrase correctly that those are the lenses that they offer. I'm going to write that on the prescription for the patient. It does impact the way I practice a little bit. The handoff situation is entirely different here. While that's all true, this is my independent practice next door to LensCrafters. Anybody from LensCrafters would say, "You're an independent doctor. You practice however you want."

It is true to some extent, but there's always going to be that influence on some of the decisions that I make, whereas in the other office when I walk out the door, pretty much every frame that's on the board and every lens that we sell is a decision that I and my business partner have made for it to be there. That's the autonomy and the decision-making that goes into it. It is tricky. I deliberately ask it as a binary thing. I know it's not. There's a lot of overlap but it's to get people talking and sharing their thoughts. I don't know if you have any comments.

You're in a perfect position to speak to both of those experiences. The question you're going to ask yourself about how independent you are is, "Is there something that you can't do?" It's not you specifically, Harbir, but anybody here. Whether you're in private practice with an independent owner or you're in a corporate setting, the answer probably for everybody is yes. There is probably something that you can't do, not because it's illegal or because you can lose your license but because the practice doesn't facilitate it, allow it, discourages it, etc.

The question you're gonna ask yourself about how independent you are is: is there something that you can't do?

If the answer to that is, "Yes, there's something that I cannot do," then you have to acknowledge that there's a degree of control and influence over what you're doing. To paint corporate with an automatic brush is a bit shortsighted and narrow. Take that for what it is. It's not to say that corporate is better or private is better, but we are all being influenced to a degree.

That's perfect. Here's where I want to take the conversation now. I'll let you share if you feel like we have missed anything. I wanted to start to lean toward new grads and students who are coming into the industry. They're trying to make their decisions, "Where should I practice?" It's hard when you have no experience other than in school. Looking at that spectrum, there will be different modes of practice along that spectrum from highly controlled and very little autonomy even though they will say, "You can practice however you want within the confines of what we have set up."

Are there things within that setup that you can't do that you wish you could do? Is that the way you want to continue to practice moving forward? On the other side, there's almost entirely complete freedom or at least freedom in this sense of if I had a young grad come in and say, "I want to do low vision," let's figure out how we could bring it in. If you want to do low vision now, I can't help you. If you want to do low vision moving forward, let's plan how we can do it.

There's a spectrum. There are extremes to that. Deciding what type of practice you want to be in is a big thing that new grads, young ODs, and even season ODs should be thinking about when they're making the decision of where to work. In that light of making decisions of where to work, the question that I ask all of the guests is that there are a lot of these incentives being put out there like bonuses, high salaries, and forgivable loans.

A young grad comes out and sees FYI saying, "We will give you $50,000 to pay off your student loans." I don't know exactly how the process works. I apologize. The term is a forgivable loan. I imagine you don't have to pay the money back other than you have to work there. Do you see that as leverage for the student or the new grad? Do you see that as potentially clouding their judgment and their decision-making? It's not to pick on FYI but anybody who's offering those incentives.

It's plain and simple. I see it as bait. I don't think it's true leverage. It's the optics of leverage. What does a new grad come out with in terms of concerns or worries? Their stresses are their loans, "Where am I going to work to pay off those loans?" A few ODs reach out to me saying, "I'm not worried about paying my debt." You could frame it however you want to frame it but it's clear what the motivation is to the recipient of that.

With that in mind, it's leverage. Is that a bad thing? I don't necessarily think it's a bad thing if they have the ability to offer that and make a business model that makes sense. Economies of scale will allow it. My opinion is that I've always treated any new coming student-doctor that wants to join our team with a meritocracy. I developed a fellowship program. You need to do three months of fellowship before you get officially indoctrinated into our specialty team. That's it.

Part of that is you will receive payment for that fellowship at a particular rate but there's no free pass. I'm not looking for 100% of the people. I want the people that want it. I would like those that are in it for the right reasons. I've taken the opposite approach. I'm not handing it out. I have a list that we keep of people that want to join. That list is ever-growing. As I put this out there, I'm realizing that I should probably dial this back. I look at that.

In the same country and the same market space, we have colleagues that are willing to do whatever it takes to become a specialist. On the other side of that spectrum, we have, "Here's $50,000. I'll pay your debt." I'm not saying that's not right or it's disingenuous but from my optics or the way I see it, and I don't know if I'm reading this right, you might see it the same way and I won't call you out on that, it seems to be plain as day to me. I don't know if there's any way to see it differently.

I see it the same way. As we were talking about before, I try to ask the questions in a way that didn't come off as biased. Sometimes I can't help it but I try to ask them a little more in a neutral fashion to get a genuine answer from the guests and potentially even tease out an answer that they might not give otherwise. I feel that way. I do feel like when you come out of school, you're likely going to be a little naive, but not everybody.

Even when I started practicing, I felt like I was taken advantage of to some degree by being offered things and promised things upfront. For a little while, it was true. Shortly after, I realized that this is not going to pan out the way it was laid out to me when I came out as a new grad. I managed to step out of that situation. I feel like there's a potential for a lot of new grads to end up in situations where they're being promised something. Also, perhaps not being told the full truth or they're not asking the right questions to uncover the full truth, whatever it might be.

It's very important for these younger ODs to make sure they're asking repetitively or aggressively to make sure they know exactly what situation they're getting into and not get locked into something that they're going to be unhappy with. I'm also sharing my opinion. I get it. You have to pay your debt. That's fine. If that is the most important thing you have to do, then you do it.

If I could still pay the debt if I go here or I might get less money but I might get more experience, in my case, a better experience, culture and environment wins every single day of the week. I took less money for sure to be in that environment. I still think that's the right way to go. That's what we're trying to cultivate here. It's not that I don't pay my ODs well but I try my best to make sure when they come to work that they're happy to be here first, and then they're happy that they're getting paid after that.

I couldn't agree with you more. I understand the frame of mind that new grads and new doctors are in but I don't particularly care for that.

I could go on about that. I appreciate that you touched on this earlier when you were talking about using the language that will allow current optometry students and prospective optometry students, more importantly, to see that there are these other opportunities within the profession and maybe help them choose their path. Let's go to that prospective optometry student or maybe an undergrad student who's looking at potential career choices. What advice would you have for that person if they are thinking about going into optometry?

You touched on such an important thing. Before I go to the advice that I would give them, I would even go so far as to talk about the selection of those lucky folks or smart individuals that are getting into optometry schools in Canada. The selection criteria or the manner by which we attract interest to our profession is crucial. I don't know if we have given any attention to that. How are we attracting optometry students? How are they being introduced to the idea of optometry?

Canadian Optometry: The selection criteria and the manner by which we attract interest to our profession is crucial.

Generally, it's through their community of optometrists perhaps at a younger age. Maybe it's their parents that want them to be in the healthcare profession. How are UW and Montreal attracting and then selecting that intake? That is very much our future. You can see it. Universities are migrating, student populations are changing, and people are coming in from everywhere across the country to Waterloo and Montreal. We need to think about how we're marketing the profession to the public. It ultimately comes down to that.

To your point about what I would say to that prospective student, what I would say is, "How much do you want it? More importantly, what do you want to do with it?" Ultimately, if you think you have what it takes to get in, then you will probably get in but how are you going to pay it forward? My experience with the students over the last ten years has changed from, "I want to graduate and get into practice right away." That was where it started versus now, "I want to graduate. I'm thinking about residency in one of the various areas. I'll probably go to the States to do this and then come back to Canada. Maybe I won't but I want to practice with specialty contact lenses," or whatever subspecialty they choose.

I hear that more and more. Are we listening as a profession to the younger folks that are coming out the gate? If we're listening, what are we doing about it? How are we investing in it? It is wonderful to have an investment in the School of Optometry in Montreal as well as its diagnostic labs. It's great. I see tremendous value in that and respect that. We need more investment in the public consumption of our profession, not just what we're providing to them at a community level but how we're marketing it. Let's not just invest in our schools. Let's invest in a national campaign, not just from the CAO. Colgate did more for dentistry than dentistry did for dentistry. Let's call it what it is.

That's wonderful. I like that because I was going to ask you who's going to put the money up for that. It sounds like if Colgate did it for dentistry, then who is it?

Colgate needs an eye drop out there. Let's not reach outside of the optometry walls. We have enough corporate optometry enterprises. Let me put that out there. Let's get FYI, IRIS, and all the big groups to put those dollars together. Let’s get a national campaign that goes toward marketing our profession to the degree that it needs to be marketed to the end user so they fully understand what we can do, how we can do it, how fantastic, and more importantly, how indispensable we are. I got off what we would say to the students. I got back to the industry. What I would say to the students though is this. Be passionate, be sure that you want to do something with it, and be willing to put in the work because an easy ride will probably be just that easy at the beginning, but it may not end up that way.

Given that you assume the students who have chosen the path to go into optometry are smart, passionate, ambitious and so on, I assume you would tell that prospective student that it's a good decision for them to go into optometry. Is that what you're saying? I don't want to put words in your mouth.

You read it right. It is a fantastic profession. I still think that the future is bright. I don't see dark clouds. That's also part of my personality. I'm all about reflecting bias. I see an opportunity where I can find it. When there's no opportunity, I create one. That's the mindset that you need to have. It's not going to be for the person that gets dissuaded easily. That could be said about life as well. You have to be willing to deal with a very rapidly changing landscape but that's not unique to optometry.

Dentistry and veterinary sciences have gone through their turmoil. Look at the human resource market post-COVID. I don't think anybody can escape the fact that everything is going to be changing rapidly. What do you want to do with it? That is the question, but I am and will always be an advocate for our profession. We have a wonderful opportunity to do far more than what we're doing now. The question is how fast we can get there. Once we get there, where do we go next?

My sense is that young people are looking for a dynamic profession, somewhere they can grow and try to potentially challenge themselves. If they have a skill, the gig economy is such a big thing. I find even within optometry that we almost have our little gig economy. If you have a skill or a talent, you're artistic or creative, you're good with media, you're a good speaker, or you have good medical acumen in different ways, there are a lot of opportunities to grow in these different aspects of it and still be an optometrist. That's a cool thing about the profession for sure.

I'm speaking with my personal experience in mind here. I'm like you in that sense. You make of it what you will. If you come in, and you don't have that dynamic personality and don't feel like you want to do anything outside of the box, then you might come in and think it's a stale profession. You're spinning dials as we have done for a hundred years. If you have that type of personality where you want to go out and change things, then you might find it quite welcoming.

Like you, I've connected with so many people virtually and in person. It's cool to see what so many different people are doing in the profession. We need to showcase that more for sure to the young people who are thinking about going into optometry. We need them to see that it's not just sitting in a dark room spinning dials. It's so much more than that.

Maybe it's on the industry. Maybe it's on us individually as optometrists and the CAO somehow, but going back to what I was saying earlier, one of the throughlines of all these conversations is we all have to pull in the same direction here. We all have to think about how we are projecting the profession, not just to the public but to the young potential students in the future too. Before we wrap up, do you feel like we touched on the independent specialist thing enough? Do you feel like there's something else you want to add? Did we miss anything?

I think we hit it. I feel like I'm a bit of a vehicle for some of the conversations that I had independently. We covered a lot of the single-person messages. Here's the thing. The independent "associate" or the non-owner still occupies the largest percentage of the optometry demographic in Canada and the US as well. We are that voice. We just don't have a consolidated hierarchy to structure our voice. We have our provincial associations and international associations.

It's so important that if you're a part of the practice now and you have an owner that listens, use that voice. Carry your voice up and make sure you're heard. That's part of it too. There's a bit of disenchantment with our ability to affect change. If you're part of a practice where they listen well, then that's not always the case. Leverage that, use that and speak up. Bring a specialty into your practice or at least voice it. That's the way that this is going to move. At least that's how I've seen it.

It's so important that if you're a part of a practice right now or you have an owner that listens, use that voice, carry your voice up,  and make sure you're heard. 

I'll throw this out there as well. I talk about specialization. The Canadian College of Specialties in Optometry or the CCSO is a group that is moving this agenda forward on a national level. We're still in our infancy. There's still a lot of work to be done. The CCSO has a fellowship program that is being developed. That is hopefully going to be the first step forward toward a recognized specialization in optometry. That's close to happening in low vision. Ocular surface disease and dry eye disease will be hopefully on its heels.

That's great work. Tell me where can people look that up? How can they connect if they wanted to learn more about that?

CCSO-CCSO.ca is the website. Google Canadian College of Specialties in Optometry. I said, "Google," not OpenAI because if you do OpenAI I and type that in, it will probably create a whole subspecialty program. I don't know if you've looked up OpenAI.

I have not.

It's a web. You will get lost in that.

I don't know if I should look that up.

Don't do that.

Search the Canadian College of Specialties in Optometry. I want to echo what you've said a few times. I'm a business owner but when I present these conversations, I don't have just the business owner perspective in mind yet. A lot of my questions are going to come from that. I'm always thinking about the associates and the other independent practitioners across the country. I don't know what kind of modality you might be practicing in but it's very important for us individually and collectively to know that we have a voice. It's important to share it. I don't think that you have to practice a certain way or be stuck in a rut or whatever the case.

Now than any other time, at least in my recollection, the associate has so much power. If somebody came to me and said, "I'm going to leave unless you change this," I would change it today because it's hard to get good associates. If you feel like you're a good associate and a good doctor and you have something important to say, make sure it's heard. That's ultimately saying all pull in the same direction to make it, so our profession continues to grow.

If there's anybody out there who feels like their perspective has not been shared yet, and this is the seventh installment in this series, I'm happy to do more interviews to shed more light on our profession and the direction we're heading. Please be sure to get in touch with me @HarbirSian.OD on Instagram. You can go to The2020Podcast.com and Info@The2020Podcast.com.

I'm pretty easy to find online. I'm sure you know that by now. If there's anything you've found valuable in this conversation, please be sure to share it. Throw it up on Instagram, LinkedIn, or wherever. Text your friends, share the link with them, and let them know that Dr. Maharaj was on here sharing his amazing insights. I'm excited to share more of this with our colleagues. Thank you for tuning in. Thanks again, Dr. Maharaj, for being here.

Thank you so much, Harbir. I always had a wonderful time chatting with you. I love what you've done with this whole platform. I have a lot of respect for you for putting it out there in the first place. That's fantastic work. Hopefully, your audiences can chime in whenever you put this out on IG, etc. What's your subspecialty? What do you want to do full-time if you could? Put that in the tagline. Let's see what we can drum up.

Thank you so much. Thanks again, guys. We will see you in the next episode.

Important Links 

• Dr. Richard Maharaj - Previous episode

• Dr. Kerry Salsberg - Previous episode

• Prism Eye Institute

• MyDryEye.ca

• Dry Eye Summit

• Specsavers

• FYI

• Dr. Daryan Angle - Previous episode

• Rick Gadd - Previous episode

• Essilor Canada

• eyeLABS

• IRIS

• LensCrafters

• CAO

• Canadian College of Specialties in Optometry

• @HarbirSian.OD - Instagram

• Info@The2020Podcast.com

• http://YouTube.com/HarbirSianOD

About Dr. Richard Maharaj

Dr. Richard Maharaj is the director of interventional dry eye services at the Prism Eye Institute a leading medical and surgical eye care and research institute with multiple locations in Southern Ontario.

He obtained his Doctor of Optometry from the University of Waterloo School of Optometry and is an active Fellow of the American Academy of Optometry. He is a clinical adjunct faculty for the University of Waterloo School of Optometry, the Canadian Association of Optometrists Section Chair for Ocular Surface Disease, Editorial Board Member for The Journal of Dry Eye and Ocular Surface Disease, and Chief Education Officer at MyDryEye.ca and co-founder for the Canadian Dry Eye Summit - a national conference dedicated to educating eye doctors in dry eye disease management.

He also serves as the chief scientific officer for AI4Eyes, developing artificial intelligence diagnostics for eye care. In 2018, he was honoured as one of the Top 40 Canadian Optometrists under 40 by Johnson and Johnson Vision Care. As a published international speaker and clinical scientist on diseases of the ocular surface and the psychology of health care, he remains an active member of both national and international professional associations.

Episode 91 - The Evolution of Treating Dry Eye - Dr. Alfonso Iovieno

How can optometry and ophthalmology work better together to improve patient outcomes? Corneal specialist Dr. Alfonso Iovieno shares his thoughts on treating dry eye and how these two fields can join forces to improve patient outcomes. He explains the challenge of dry eye having a very broad range of symptoms, making the diagnosis a bit unclear at certain times. Dr. Alfonso and Dr. Harbir Sian also explore the wide range of available treatments and technologies currently being used and studied right now to address dry eye issues, particularly the "big guns" that yield the most efficient results.

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Watch the episode here

Listen to the podcast here

The Evolution of Treating Dry Eye - Dr. Alfonso Iovieno

Dr. Alfonso Iovieno works as a Clinical Associate Professor at the University of British Columbia. He's based right here in Vancouver. Dr. Iovieno obtained his medical degree and completed his Ophthalmology Residency at the University Campus Biomedical in Rome, Italy, and then subspecialized in Cornea, External Disease, Ocular Surface, and Complex Anterior Segment Surgery during his three-year fellowship training at the University of Toronto and Moorfields Eye Hospital in London.

Dr. Iovieno also completed his PhD in Ocular Microbiology Immunology between the University Campus Biomedical and the Bascom Palmer Eye Institute in Miami. Those are some big-name academic and training institutions that we're all very aware of. The last thing I want to mention before we get into this, Dr. Iovieno, true to his Italian background is an avid soccer fan. Thank you, Dr. Iovieno, for joining me here.

Thank you very much. Thanks for the invitation. I'm glad to be here with you. The only thing I want to tap into my background is that I like to travel a lot as the last part of the background said, hence my experiences in many countries.

We could probably have an entire episode talking about soccer and traveling, but touch on the soccer thing because I'm a pretty big football fan myself. What do you follow? Do you follow Italian soccer or English soccer? Who's your team?

I follow Italian soccer and I'm a Southern Italian, so my hometown is on the outskirts of Naples, so I follow Napoli. That's off to a pretty exciting start to the season. We're having a lot of fun.

Napoli is a historic team and had some good runs and some big players in the past. Maradona, if I'm not mistaken.

There you go.

Thanks again for joining me. The conversation that we want to have is around dry eye and more specifically, the collaboration between optometry and ophthalmology in the treatment of dry eye. This is a topic that gets talked about a lot in meetings and casual conversations but doesn't get spoken about in public like this as much as it should. There's so much opportunity for us to elevate both professions and more importantly, the patient experience and patient outcomes by collaborating and elevating that collaboration. Thanks for taking the time to have this conversation.

It's my pleasure.

Let's start with the various forms of dry eye. Sometimes pigeonholes of the condition, I feel like we say dry eye in a patient's mind and even a doctor's mind will go to one specific set of symptoms, but it's a very broad range of symptoms, diagnoses, and ocular signs that we could be looking at. I wonder if you can, maybe in your opinion, break it down into some of the few categories of the types of dry eye that you're seeing, and then we can go into a bit of the diagnosis aspect of it too.

It's a good chunk of the patients that we see as optometrists and ophthalmologists are affected by its condition that primarily or as a secondary add-on to their primary solid eye pathology. Academically, dry eye patients used to be divided in hyposecretive, evaporative, and neuropathic ocular pain. A lot of this black-and-white distinction has blurred very much.

We'd see these patients with their conditions and focus on their signs and their symptoms. Based on their signs and symptoms, assign them to a specific treatment. It's a whole spectrum of dry eye for which there are many treatments available, but the general umbrella of dry eye now doesn't tend to be divided very much between different categories.

Having said that, there are patients that suffer from dry eyes, a consequence of immune disease. They're very peculiar and will probably be more responsive to certain kinds of treatment versus the dry eye that tends to happen in patients after refractive surgery or the form of dry eye that tends to affect mostly post-menopausal women. They will all have some specific features that are more likely to respond to some treatments in particular.

If we could dive into that a little bit more if somebody who has a particular autoimmune condition, a Sjogren's, or something like that. If we were to make a bit of a distinction between some of these particular forms in postmenopausal women, would there be different signs that you would encourage optometrists to be looking for somebody who maybe doesn't practice dry eye in-depth, but ways that we can maybe see clues that we would know to go down a certain path?

For example, to take those categories into account, a good chunk of my dry eye patients in my practice come from that autoimmune background. That's because of my collaboration with dermatology or with rheumatology for the care of secret passing conjunctivitis or other complex anterior segment diseases. Those patients have oftentimes a very severe form of dry eye, but it's also a very "rewarding" form of dry eye to treat as a doctor because they're the ones that would respond to medications both from the point of view of signs and symptoms.

Dry Eye: Many dry eye patients come from an autoimmune background.

Those are the patients for whom I can confidently say that I can cure them. Although a cure is not a word for a chronic condition, I can make them feel a lot better. They will present and will be extremely light sensitive, foreign body sensations, and invariably covered in punctate erosions involving the cornea, and the congenital eye and they're the ones that have a standard treatment such as lubricating agents would not touch them very much. They will need to pull out the big guns almost from the get-go with the understanding that the response in their case would be very prompt and satisfactory.

On the opposite end of the spectrum are the neuropathic ocular pains patients, for example, the ones that develop this condition following their refractive surgery. Their signs will be very mild, if not absent at all, but on the other hand, they will have very depleting symptoms. The treatment approach for them is in a way collateral. We don't have any ideological agent that we can give to them and know that they will respond exactly to that. We try to optimize the surface as much as possible and we achieve a certain degree of success in treating them in order, at least in making their symptoms better.

That's wonderful. I want to go back to the big guns, talking about neuropathic pain. Three of the most hated words, when put together, for anybody who treats the ocular surface, is pain without stain. It's like, "How do we fix this?" Do you have any thoughts on why we get this neuropathic pain and how might a primary care optometrist approach that when they have a patient in that setting?

I wish I had a more precise answer for you. If I knew exactly what was going on, I'll be probably richer than I am at this point in time, but the truth of the matter is that there's a lot of science going on to that extent. There are centers of excellence scattered throughout our country and the United States where active research is ongoing.

There's something happening at the level of the peripheral nerves of the cornea, either in the form of the development of neuromas, aberrant regeneration, or maybe there's something at the level of neurotransmitters level on the ocular surface. Once we'll have a better understanding of this, we'll have also better ways for the ophthalmologists that would have to deal with these patients. On its hands the armamentarium for dry eye, which includes anti-inflammatory medications. Moving on in those patients more frequently than others to the use, for example, of autologous serum.

Dry Eye: Centers of Excellence scattered across the country are actively researching dry eye treatments. Something is happening at the peripheral nerves of the cornea other than the development of neuron regeneration.

The presence of neurotrophic growth factors in the autologous serum seems to be one of the reasons why that treatment is justified in patients with neuropathic ocular pain to the use of scleral lenses, which as I tell my patients, “It's like you're sticking your head in a fishbowl and that's a way of seeing the activity of those upper and nerves on the surface of the eye. “

People are venturing into low-dose naltrexone, Amitriptyline, all the way to very diluted topical anesthetics or even cannabinoids for the treatment of those conditions. There's such a tremendous momentum of research in need from our patients for new treatments. I'm sure something new and possibly groundbreaking will come up in the next few years.

All of those things that you mentioned with the low dose anesthetics, the cannabinoids, or Amitriptyline, have those shown some potential positive effects, or is it all anecdotal at this point?

They have. There's no abundance of literature on this, but there is some. I haven't ventured into the more experimental treatments myself, but I do work in conjunction with some neuro-ophthalmologists who are more versed in the use of those types of medications. We have put some of those patients on gabapentin, Amitriptyline, even topiramate, and low-dose naltrexone. These are systemic medications.

The side effects profile from this medication can be quite significant at times, limiting the compliance of the patient, but sometimes the motivation is so strong that if patients do notice some improvement in their symptoms with systemic medications, even if the improvement is not massive, they will still be very tempted to go for that. If I had to pin it down to a percentage, I would say probably in about 50% of the patients, we'd be able to achieve some success.

The side effects of dry eye medications can be quite significant at certain times. Nevertheless, patients' motivation is so strong that they still acquire them in hopes of some improvement.

As I've ventured more into the space of dry eye and treating it and the more of these patients that walk through the door, I realize how much it affects their lifestyle. Quality of life is more important than what I want to get at. You think of it initially as a, "You got a little dryness and irritation," but there are patients who walk in and say, "I can't take it anymore. It affects every aspect of my life."

It's difficult to have that conversation, especially when you have something like this where we don't have any obvious treatment modalities for it, but it's good to know that at least there are some bright spots and some opportunities to help those patients. You touched on it, but often those patients will see, at least to some degree, having these neuropathic symptoms after they've had some refractive surgery, whether it's a cataract or laser surgery. Is that a well-documented thing or is that anecdotal as well?

This is what I tell my patients regardless of the type of surgery, they're going to have on the surface of their eyes, their dry eye will get worse. If they do have dry eye, what I tell them is, "You're looking into at least a few months of worsening of your dry eye condition, which will then, with a little bit of work, return to what it was before. It will not be ameliorated by the surgery and it would not be worsened by that.”

Regardless of the type of surgery people will get done to the surface of their eyes, dry eyes will still get worse.

The only exception to me using this spiel would be patients that are undergoing refractive surgery. For the refractive surgery bit, honestly, the effect of either Lasik or PRK on the corneal nerve plexus as such that there is a subset of patients, not the majority of them, that will experience persistent worsening of dry eye symptoms.

Given the popularity of refractive surgery procedures, a lot of people are trying to work at why this is happening or what can be done to prevent it or treat it more effectively. We don't want to do any procedures on any patient whose ocular surface is not being optimized. That comes from many points of view. Even something as simple as an intraocular lens calculation can be sometimes completely thrown off by an uneven tear film.

Every patient that would approach any cornea procedure should have their dry eye and ocular surface optimized by means of using topical lubricants if they were not using them before. Some surgeons advocate the introduction very early on of cyclosporin or lifitegrast in patients before the advent of a surgical procedure. These are all viable options, but this is not something that should be because the outcomes for those patients and their satisfaction will be very dependent on that.

That's perfect. Thank you for defining the difference there between those two and why PRP potentially may be more valuable. We started to talk about optimizing the ocular surface for refractive surgery. As I was mentioning, I do this and I've spoken to multiple colleagues that are starting to do this when a patient is looking to go get cataract surgery or laser surgery, we talk to them about the importance of optimizing the tear film and the ocular surface and how that, in theory, and hopefully in practice, you'll confirm that it can help to improve the readings that you get before surgery or the outcomes of patients will have after surgery. Is that generally what you have seen?

Yes, very much. In reference, to cataract surgery, when we are using premium IOLs where the level of precision or our calculation has to be held to higher standards compared to mono-focal lenses. Any interference with measurements of astigmatism and all the other preoperative measurements that we do before cataract surgery will translate into suboptimal outcomes from the visual standpoint. It's particularly important for them.

I don't think that patients preoperatively necessarily have a different treatment approach that would apply than any dry eye patients that come from a clinic that's not going to have any eye surgery done. The same thing that I would use for any other dry eye patient, I would use them for these patients, but it's important to consider that those treatments have to be put in place a number of weeks and sometimes even months before the patient can undergo a successful surgical procedure.

It's good to hear it from you, a surgeon and somebody who's an expert in the field to have that confirmation of the importance of doing that. Hopefully, that'll encourage some of my colleagues to have that conversation a bit more preemptively before a patient goes in for consultations and so on. Not necessarily treating them differently than any other dry eye patient, but making sure the patient's awareness of the importance of treating that dry eye.

Let's say we have a patient like that in your exam chair who has dry eye and you mentioned that surgeons and doctors are preemptively getting started in certain treatments. What types of treatments would you be offering this patient? It will depend on the type of dry eye they have but adjusting to them weeks or months before their surgery.

If the patient has any component of meibomian gland involvement, either a meibomian gland dysfunction, posterior blepharitis, or anterior blepharitis, care takes precedence, so the patient will be on warm compresses. Depending on the severity of blepharitis, we can consider the use of oral doxycycline or any of the available devices for the optimization of meibomian gland health. When it comes to the surface itself, if there's a reduced tear meniscus or punctate erosions present, those patients will be on tear substitutes.

Generally speaking, I have a low threshold for introducing anti-inflammatory treatments. That is a point that I want to get through. Because of the cost of such treatments or because of the medicinal, in a way nature of them, sometimes where we hold back on the use of cyclosporin or lifitegrast more than we should. We leave those types of drugs for patients who are more severe in our books. The early introduction of this type of medication goes along with a lot of the patients who are the highest responders to them are not the ones that necessarily present with a ghastly ocular surface, but they're the ones with a mild to moderate dry eye.

We know that the window of intervention of those drugs is going to be better for them. That's based on the literature we have available. Other patients before surgery will need other types of intervention obviously based on their severity. In the vast majority of patients, this will be sufficient then whether we move on to the use of punctum plug or punctum occlusion of sort, autologous serum, or things like that, then that will be dependent on severity.

Dry Eye: Whether autologous serum is superior to PRP is still debatable. But having access to either is still valuable in treating dry eye patients.

That's an important point that you brought up there about the introduction of some of these pharmaceuticals early on. In the past, I have been guilty of that, but I will save the cyclosporine as a 3rd or 4th thing after I've tried a few other things. It's not as effective as I thought it should be, but then also reserve it for the more complicated cases where maybe I should be introducing it a little earlier on. Would you think it's a first-line therapy or a second for that person who seems to need it? Would you be introducing it right off the top, "Here's your lubricants plus your cyclosporine?"

Yes. Honestly, I would give the patient probably no longer than a couple of weeks to see if they receive any benefit from the treatment with artificial tears, preservative-free, depending on what's the frequency of use, and their eyelid hygiene optimization, but if they don't respond, I'll introduce it right away. We've also didn't mention that's often the case of not paying enough attention to that.

Stage zero of dry eye treatment is the environmental modifications. We've all been surprised when we heard from patients, “I sleep with a fan directly onto my face or above the bedroom,” or any other things that if detected and modified will make a very significant impact on this patient's quality of life. We'll facilitate any further medical intervention that we planned for this patient's dry eye. Digging a little bit into their personal history and their habits, it's also something that goes a long way.

It's very important. You're right. The environmental factors get overlooked a little too much. I've had so many patients tell me they'll go on vacation to some tropical destination, Jamaica or something, and come back and say, "For two weeks, my eyes felt amazing." Let's think about you being in a warm, humid climate and not staring at a computer screen all day and all the factors that you eliminated for those few weeks, how valuable that can be trying those address those day-to-day.

I'm a little bit contact lens intolerant myself. I don't wear contact lenses very often, but when I use daily disposables, I don't tolerate them very well. I remember when I was living in Miami. When I was at Bascom Palmer Eye Institute, I thought, "How is it possible to anybody over here has any dry eye?"

It's humid down there. Getting back to then the various treatment modalities, you touched on the fact that there are various technologies. Dry eye has been the target of a lot of new technology and technological advancement and a growing specialty in radio frequency, IPL, low-level light therapy, and all these different technologies out there. Have you had much hands-on experience with these technologies?

Not very much. The only one I have a little bit of hands-on experience with is IPL. That was a few years ago. With the newer technology, I haven't had a chance to test them out myself. This is a reflection of how much interest there is in dry eye research, and how many patients ask us for additional treatments and more effective treatments than what we have available.

On a lot of this newer technology, there isn't enough of a scientific background or pedigree to come up with precise guidelines and conclusions, but I do look at all these efforts favorably. Out of this, something substantial will come up. One of the mistakes is the thing that we are going to find the holy grail. We're going to find the one device or the one drop that we give to everybody and solve everybody's problem. That's not true for many chronic diseases. As doctors, we treat hypertension and diabetes, why would it be the same for dry eye? We will need to approach this in a multimodal way and if technology helps us in that sense, that is very positive.

The best dry eye treatment must not be seen like the Holy Grail. This must be approached in a multimodal way.

That's another good point, not to think that there's any silver bullet. What I forgot to mention in your introduction is that you're an ambassador for TFOSS, Tear Film, & Ocular Surface Society and the DEWS II report is the holy grail or bible of dry eye definitions and whatnot, but in that definition, it says it's a multifactorial disease. We have to always treat it that way and try to address the various factors that may be involved.

I agree with you. There is still a lot to be learned and understood about these various technologies and their application, but again, it's a very positive sign that there's a lot of energy being put into this area where we might be able to come up with new solutions to help our patients. Hopefully, they'll become, at some point, officialized and studied well enough that we can be on here again next time talking about how all of these can be used to help our patients.

One of the core topics, as I mentioned off the top, is to talk about dry eye, but more importantly and specifically about the collaboration between ophthalmology and optometry, and the opportunity that we have here to improve our patient outcomes with this collaboration. I wanted to dig into that, in general. What are your thoughts on that? We'll dig in a little bit more about how we can improve that collaboration.

I don't know if the situation that we have here in British Columbia is representative of the rest of Canada, but I have to say that dry eye is one of the areas in ophthalmology, and in your segment where I do see the fruits and the benefits of a respectful and effective collaboration between optometry and ophthalmology.

The thing is the incidence of this disease is such that the mass of patients that need treatment for dry eye will be overwhelming for almost every health system. Having more than one health professional dealing with these patients is a winning move. A lot of these patients will need many treatments. We need a model approach. Oftentimes, our time is restricted. Our clinics are busy and there are patients that need much attention from many points of view. Dry eye patients do require a certain amount of time and a certain level of expertise.

The optometry community has been at the forefront of dry eye science, at least in British Columbia. Every optometrist I have interacted with has been very up-to-date, versed, and predisposed toward the treatment of these patients. Collaborating on this and in the care of surgical patients or refractive standpoints is one of the very many elements where the collaboration between optometrists and ophthalmologists can flourish.

This might be a tough one, but how do you see that coming to fruition? As you said we understand that with ophthalmology, your time with patients is quite brief, you're very busy, and lots of patients are coming through. There is a lot of handholding required with dry eye patients. We're all very familiar with that as it can be quite a challenging condition to treat, but where do you see that overlap happening? If you could give me an example of a patient whom you think both ophthalmology and optometry could work on and collaborate with.

For example, one of the situations that you mentioned before, so preparing patients for surgery, cataract or refractive surgery is one of them. The optometrist oftentimes will be the port of entry of a patient with a cataract or a patient that's interested in refractive surgery. Putting in place at an optometry clinic, the preoperative treatment that will then influence good measurements on our end, and good outcomes of our surgery is one possibility.

Among optometrists and ophthalmologists, there's obviously personal interest or research interest. The fact that some optometrists in our community have put together dry eye clinics where they have acquired the latest devices and are able to offer a comprehensive approach to these patients from any point of view, from ecological with the technology, either at the diagnosis or at the treatment point. It's something that has to be recognized by whoever has the willingness and desire to explore this type of field and provide a standard of care to patients.

Telling patients, "We have artificial tears here. If it's bad enough, you can go and get some cyclosporin there. If that hasn't worked, that's about it. You got to live with it and that's the end of the road." I don't think it's standard of practice in this day and age. We have to be able to offer more than one modality of treatment. Ophthalmologists or optometrists would want to dwell on that and offer the whole range of treatments to patients that need to be recognized.

Dry Eye: In this day and age, medical practitioners must offer more than one modality of treatment. Ophthalmologists or optometrists who want to offer a whole range of treatments to patients needs to be recognized.

In my mind, for a long time, the relationship between optometry and ophthalmology has seemed somewhat one-way. I'm not trying to put on a negative spin on it, but in general, we're referring to ophthalmologists for treatment and then the patient will come back to us. To have it a little more open and two-way where perhaps an ophthalmologist sees the opportunity for certain treatment modalities and has the patient coming to see the optometrist who's developed that dry eye clinic and the patient has open access to both, that seems an ideal scenario. To be able to create that would be very nice. Any suggestions in your mind as to how we can maybe better the opportunity for this collaboration or if there are any last thoughts you want to share on that?

Honestly, there's probably enough expertise on either hand to build on that and keep the lines of communication open. That's what matters the most. That's for the interest of our patients, knowing that in a specific area, there's somebody with an interest in dry eye and somebody willing to collaborate on the care of patients before cataract surgery or refractive surgery. At the same time, among ophthalmologists, there's somebody who may have more of an interest in dry eye than in other areas of ophthalmology. If we keep the lines of communication open and build on the interest and expertise of one another, that's a win-win game.

One final question on that for you. We're in BC so we're going to be a little bit biased as to how things work here, but would you encourage optometrists to write or somehow call the ophthalmology office and express that interest in that area? What would be the best way for us to connect?

I've heard of optometrists reaching out to our office and saying, "I have done fellowship training. I have done a specific training in this area. I have acquired this technology. I now fit scleral lenses. I do that," making your community around you aware of that is something that goes even beyond ophthalmologists and possibly reaching out to rheumatology or patients that treat with autoimmune diseases to the refractive surgery clinic, which may not be the same as an ophthalmology office in a hospital like mine. Informing everybody around you that this treatment or this option is there, is paramount.

Thank you. That's maybe a question that optometrists would like to be answered. "Do we call you? Do we email you? What's the right thing?" It's because sometimes we're a bit tentative about that. We know you're busy, especially someone like yourself who has a lot on your plate. I appreciate you being open to that communication. That's important and much needed so we can improve that collaboration.

Thank you very much, Dr. Iovieno. Thank you so much for coming to the show. I appreciate it and you have great insights and things that we can all learn from. It's not just simply in the clinical sense of treating dry eye, but in this important conversation about collaborating and learning how we can all work together. I appreciate your time. Thank you.

Thank you. It was a great pleasure to be here and to hear and know about your successful show. Thanks for the nice conversation.

Thank you. Next time we'll talk more about soccer.

We should do one on soccer only.

You got it. Thank you to everybody who's tuned in. Thanks for taking the time. I'm sure you found Dr. Iovieno's thoughts and insights very valuable. If you did, please share it. Take a screenshot and put it up on Instagram or share it on LinkedIn. Don't forget to leave a review. Leave a comment. Hit like and do all the good things that helped our show grow. I will see you in the next episode. Take care guys.

Important Links

• University of British Columbia

About Alfonso Iovieno

Alfonso Iovieno is a Clinical Associate Professor at the University of British Columbia in Vancouver, Canada. Dr. Iovieno obtained his medical degree and completed his Ophthalmology residency at University Campus Bio-medico in Rome, Italy. He then sub-specialized in cornea, external diseases, ocular surface and complex anterior segment surgery during his 3 years of fellowship training at the University of Toronto, Canada and Moorfields Eye Hospital in London, UK. Dr. Iovieno also completed a Ph.D. in ocular microbiology and immunology between University Campus Bio-medico and the Bascom Palmer Eye Institute in Miami, Florida.

His research focus has spanned from ocular surface immunology to corneal infections, corneal transplantation and keratoprosthesis. He has won numerous awards and recognitions and holds several patents for biomedical devices. Dr. Iovieno regularly presents and moderates at national and international meetings and has been extensively involved in training courses on the latest techniques for corneal transplantation. He is a member of the bord of directors of the Italian Society of Corneal Transplantation, member with thesis of the Cornea Society and the Tearfilm and Ocular Surface Society Ambassador for Western Canada. He has authored over 90 papers in peer-reviewed journals and 15 book chapters.

Alfonso Iovieno lavora come Professore Associato presso la University of British Columbia a Vancouver, Canada. Il Dott. Iovieno si è laureato e specializzato in Oculistica presso la Università Campus Bio-medico di Roma. Ha successivamente completato un percorso triennale di fellowship cliniche in cornea, superficie oculare e chirurgia del segmento anteriore presso la University of Toronto ed il Moorfields Eye Hospital di Londra. Ha inoltre conseguito un dottorato di ricerca svolto in collaborazione tra il Campus Bio-medico di Roma ed il Bascom Palmer Eye Institute di Miami.

La attività di ricerca del Dott. Iovieno spazia dalla immunologia della superficie oculare alle infezioni corneali, trapianto di cornea e cheratoprotesi. Il Dott. Iovieno ha ottenuto numerosi premi e riconoscimenti in Italia e all’estero e svolge attività di relatore, moderatore ed invited speaker ai più importanti congressi nazionali ed internazionali. Il Dott. Iovieno è membro del consiglio direttivo della Società Italiana del Trapianto di Cornea (SITRAC), della Cornea Society ed è ambasciatore della Tear Film ed Ocular Surface Society per il Canada. È autore/co-autore di oltre 90 articoli in giornali peer-reviewed, 15 capitoli in libri e detiene 2 brevetti internazionali per device biomedicali.

Episode 90 - Shawn Kanungo - How To Leverage Disruption

Disruption changes the status quo of a particular industry. It can be good or bad. In your company, how can you utilize disruption in your favor? Shawn Kanungo is an internationally recognized speaker, consultant, and disruption strategist. He has spoken on some of the biggest stages across the world for many different industries. He has even been called the "best virtual speaker ever" by Forbes Magazine.

In this episode, Shawn shares his insights on:

• How to become a prolific speaker/presenter

• How the optical industry can embrace disruption

• How to inspire innovation

Tune in to this episode now to know how to leverage disruption!

Be sure to connect with Shawn at ShawnKanungo.com.

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Watch the episode here

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Listen to the podcast here

Shawn Kanungo - How To Leverage Disruption

Thank you all for taking the time to join me here to learn and grow. I'm so grateful for the support and I'm going to ask a quick favor right off the top. If you get any value from previous episodes, if you love this episode, which I'm sure you will, please do share it. Take a screenshot and throw it up on Instagram, YouTube, LinkedIn, and wherever you are. Text a friend and tell them that I'm talking with Shawn Kanungo because this is going to be such a great conversation.

If you don't know Shawn, he is an epic speaker. He's spoken on massive stages across the world for massive organizations. He is an innovation strategist. He spent twelve years at Deloitte in innovation strategy and now he goes around the world talking to companies about disruption and innovation. He's just a super fun and energetic guy, so I'm excited to have him on the show. Thank you so much for coming on, Shawn.

I'm super excited to be on and, to be honest with you, the way that I actually met you, if you don't mind me getting into it, is because of the podcast. I was going down to Orlando for Transitions Academy. I was in Toronto. I was grabbing a bite and then I saw you grabbing and eating this burger. I texted one of my best friends of the world. Her name is Sonia Delhon. She's an optometrist in Edmonton. We talked every single day.

I took a picture of you mid-bite, and I told Sonia who you're friends with. You guys went to school together in Boston. I'm like, “Is this Harbir?” She's like, “Yeah, it is.” I'm like, “I listen to this podcast.” Then I came up to you and I said, “Are you Harbir?” It turns out, we ended up in Orlando. We took an Uber ride. We saw each other there a couple of times. You asked me a question on State. I was at Vision Expo. I did a presentation there. You were there. I was in Dubai for Essilor India. Do you show up on the screen through a video? We are just meant to be together. I don't know. We're just meant to be. I'm so grateful that we are friendly now and we're buddies. It's amazing, these collisions that happen through these conferences.

I forgot about the Dubai thing. That was so funny. I wish I was physically there in person. That would've been super cool.

He was unreal to see. We were doing rehearsals for this Essilor India event and the team was going through some of their videos. I was talking to somebody and then I heard your voice. I'm surprised. During the actual presentation of the Essilor team, then I recorded it. I sent it to you. I tagged you on Instagram. It was so cool.

I appreciate you doing that. That was cool because I had no idea that that was playing there. I appreciate that. It comes full circle. I appreciate that you had already listened to the show and it was a weird moment for me for someone that I've never met before to walk up to me in the airport and be like, “Are you Harbir?” My wife and my friends that joked about the video that we shared eventually after from Transitions, and they were like, “You felt like you're famous or something.” The thought crossed my mind, but I was like, “There's got to be something more because there are not that many people who listen up.”

If you've gone this far, but after all this hoopla that we chatted about how we know each other, if you've gone this far. I think rate, review, and follow this show because, as I wanted to learn more about the optometry space or eye care space, part of the reason why I jumped on this show is its sounds.

You are putting in the time and effort to make this great and we need voices like yours in this space that are putting on content and looking at the eye care space in different ways. You're getting really great guests. To me, it's been amazing insight and learning from the people that you are just bringing experts together and it's been a great learning for myself. Somebody who's not in this space. I'm not in this industry. Your show has been amazing resource for me just to learn about this space. I want to thank you. If you're reading this, give this guy a rating and review, please.

Thank you. I appreciate that. I'm glad the show could be a resource for someone outside the industry to learn a bit about what we're doing. The goal of the show is to provide insight to those who are within the industry, but I'd love to bring on guests like yourself who are not in the industry, so we can see and hear your insights from a totally different perspective and then apply them to our industry so we can grow and do different things differently.

That's basically what you're about is this disruption and innovation and I want to bring that to eye care. If we just rest on our laurels and if we just continue to do the same thing that we've always done, the profession's going to die. That's what I want to get into. First of all, tell me about what is innovation, strategy or disruption. You are a disruption strategist. Tell me what that means.

To define disruption. Disruption is something, someone, or some technology coming out of nowhere and changing the status quo of a particular industry. My job is to walk into organizations and work with leaders to essentially disrupt themselves before they get disrupted by the market. It's to continuously look at what other industries are doing when it comes to innovation. How are they going off and innovating their businesses and their practices? I try to help organizations and leaders see where they can apply these innovations in their own businesses. I've had the great fortune of working with some amazing companies around the world when it comes to this idea of innovation and disruption.

Disruption is something, someone, or some technology that comes out of nowhere and changes the status quo of a particular industry.

The beautiful thing is that I'm not an expert in their particular industry. I am not an expert in eye care. What I have the pleasure of doing is looking at every other industry and seeing how you can take bits and pieces and copy and remix ideas from other places and implement them within your industry. That is a little bit of what I do.

We need that in eye care. As optometrists, we tend to be slow to move and we feel like we are getting disrupted. One of the ideas I like is my friend Brianna Rhue, who's been on the show and I think you met her at Vegas in Vision Expo. The way she says it is to become the disruptor instead of being the disrupted. She's a disruptor herself. She's got this technology company. I like that and I'm starting to share that, not just in the show, but I'm doing these lectures. I'm throwing that in those times for us to be the ones who disrupt.

Before we get into that, you are an innovator. You are trying to push the boundaries of what's happening within this space. Let's be honest. It's a very traditional space. It's a very slow-moving space. How do you feel being or trying to push this industry in new ways and what is that like? The immune system usually of an industry rejects you. It rejects new ideas. How do you feel doing that?

People sometimes ask me things like that and I look back over the years like a teenager and as an adult. I've weirdly put myself in really uncomfortable positions. I don't really understand why even in social settings. They'll be an open mic or something like that. I don't even know how to sing that word or whatever. I'll say, “Fine, I'll go.” It's terrible. I know I did not look good, sound good, or whatever, but I'm like, “I'll do it.”

I'm comfortable with being a little out of place and with people potentially judging me and maybe not looking very good. I'm okay with that because as the saying goes, it's at the end of your comfort zone is where you grow. I'm comfortable with being uncomfortable. I don't know why or how. I've just kind of done it over the years.

About that slow-moving thing, a few years ago, it was right before COVID or something like that, we had our conference here in BC and I did a lecture on digital branding and social. These are lectures that are for credit. We needed credit every year to keep our license, so it was a good turnout.

There were 100 and something people in this little thing and it was full. I was not expecting how many people to turn out for that lecture. At the end of it, somebody put their hand up and goes, “Why do we need this information? What's the purpose of this? Why are you doing this lecture?” Either my presentation was really bad or I'm further ahead than I realized in this conversation, these people don't realize the value of having a digital footprint or presence at all. Having a digital footprint is not a new thing. That's a ten-year-old thing at that point.

There's a lot of that at so many different levels where there are people in the industry. The majority of the industry's kind of slow to move and recognize where there's an opportunity. I'm just comfortable with just getting out there and just talking about it. The more times you say something to people, eventually, they'll kind of catch on and say, “Maybe I should be online. Maybe I should be on social media and have eCommerce.” It's weird that I don't get frustrated about it really a whole lot. I feel like I'm sharing the right message. I'm just going to keep sharing it.

That's amazing and I'm glad that didn't detract you from continuing on it. I think you're on the right path. I think the punchline is that the world is it continues to move towards digital. The world values digital, and I know we'll talk a little bit about it. The fact that you are trying to push this industry to embrace digital or even content is a beautiful thing.

It's just one of the things when you do lectures that are on something that's a bit of a newer or an uncomfortable topic or something that people are not embracing it. You'll get some glossy looks and that type of thing. You just have to. I mentioned Brianna. You got to keep pushing people and tell them to get comfortable with disruption. Our industry needs that otherwise. We end up just complaining about the fact that things are not going our way and there's no value and benefit in that.

Not to put age about it because there are some older optometrists who are really forward-thinking. It's nice to see the groundswell of the younger optometrists, generally speaking, are more comfortable with technology. More importantly, schools are starting to implement conversations about disruption and the various eCommerce, digital players, and things that are out there. Technologies that are out there and coming. AI and other virtual stuff are coming.

That's a good point. We should chat about that because, to me, the tragedy is that in optometry school, they barely touch the business side of things. They barely touch the disruption. How do you innovate your practices? How do you delight customers in new ways? How do you create a brand? How do you develop a community? How do you work with creators? They don't teach any of that stuff. How do you build alliances and joint ventures? How do you work with a startup? They don't teach any of that, and I get it. There's a medical side to it. I look at the business and it's like 70% about trust and how you do that in new ways or in a digital way. That's the game now.

How To Leverage Disruption: The tragedy is that in optometry school, they barely touch the business side of things and the disruption.

I see a new opportunity for you, Shawn. Professor Shawn Kanungo, you can go around to the schools doing these lectures. Do a lecture series on all this. That's all you. It's your forte.

We'll do it together.

Give me a couple of whatever off the top of your head. A couple of things about disruption like mindset-wise. It's not just optometrists. It's people in eyecare in general. Is there something a way we need to change the way we think so we can be comfortable with disruption and welcome it?

I think to have a disruption mindset is number one, to not be so siloed in your particular industry and in your particular craft or practice. The reason why you have been successful is because you have had focus. The problem is that now industry lines are blurring. You need to have a deep generalist mindset. You need to have an understanding of what's happening across different industries and different verticals, not only from a business standpoint but also from your patient, consumer, and customer perspective.

They're seeing things in ways that you may not be seeing it. Their experiences on Amazon and Uber by touching a button and how they interact with other services will impact what you do in your practice. You have to be constantly looking at what other industries are doing and how people are interacting with those companies and consuming content and services in new ways, because, at the end of the day, is going to impact how you deliver your patient experiences. This idea of becoming a deep generalist is important to have this disruption mindset.

The other thing that's really important is not get complacent. Not to fall into the status quo of what you're doing now and it's not about transforming. I'm not asking any of these to go off and start doing these artificial intelligence eye readings off people's phones. No. I think it's about starting small and continuously experimenting around new ways of how you can make your processes a little bit faster or how you can make your client or customer experiences a little bit more delightful.

You can put out that piece of content that might be a little bit more uncomfortable for you. That, to me, is innovation, and it's just about creating value in fundamentally new ways and it could be very small. I want to demystify this whole idea of innovation and disruption that it has to be this big, massive, or transformative thing when it can be like the smallest step in the world.

That's a really cool way of looking at it. When I see disruption, I think of some large change that has to happen, but really it can be a small step-by-step process.

That's how disruption starts. Every disruptive technology or every disruptor, it starts small. It starts in the basement, garages, and weird people on the internet. It just starts small and then it bubbles up. If you want to disrupt yourself, you have to take that same approach, which is to start small with a small experiment and then it goes from there.

Every disruptive technology, every disruptor, starts small. If you want to disrupt yourself, you have to take that same approach—starting with a small experiment and then going from there.

That's a great piece of advice. A simple mindset switch right there is just to do the small uncomfortable things. It's perfect.

To be honest with you, do you know how hard it is to change people's minds? I cannot pummel people with this information and convince people to change. The more information that I give when it comes to disruption and innovation and how other people think, that's not going to change anybody's mind.

If you're reading this and you're getting pummeled with information, that's not going to change anybody's mind. What's going to change your mind that this is important is when you start to flex the muscle. When you go get off this show, you're running at your desk or in your car right now. The change you are going to go off and make is like when you go back into your practice. You're like, “Let's just try something new.”

That is the biggest mindset shift to me. You have to go off and try it and do something different. That's the quickest way to change your mind. You have to actually take some sort of action. That's the key. You have to do it and then learn from it and then go from there 100%. If anybody hasn't seen Shawn speak, please go to ShawKanungo.com or where can they go? YouTube?

Put in Shawn Kanungo anywhere, TikTok, LinkedIn, YouTube, or Facebook.

Search this guy and Forbes said that's the best virtual presentation ever. I was like, “Who is this guy?” I watched your stuff and I was amazed. For virtual, you're on a stage in an empty auditorium. All this cool setup. In live presentations, like when I saw you at Transitions, your presentations are at a different level. One is your energy and the way you speak and your body language.

The other is the visuals that you have. By far, your presentations are the best that I've ever seen. I know my word is not the same as Forbes, but it's incredible. I want to ask you a little bit about that because many of us, myself included, want to be better at performing and presenting. I use perform deliberately because a lot of times when you're speaking, even giving a CE lecture, when you get one of these accredited lectures, most people go up on stage, “Here's how we do this thing and here's the next thing.”

We can make those fun, vibrant, and energetic. There's no reason not to. In fact, we should be trying to push the boundaries, so I want to learn from you. Please share a few of the things that you've done. I know you didn't get to where you are overnight. For somebody who's starting out and is perhaps standing at the podium and talking. What's the next step? How do I get bigger and louder?

It's interesting because I'm still learning the craft. I still feel like a rookie in the game and I see amazing speakers everywhere. I get inspired by rock stars, standup comedians, and other speakers that are doing cool things and people on video. I'm almost trying to get better and I'm actually not the best. I have a lot of filler words. I'm not the best, most articulate speaker, but to me, it's about the message at the end of the day.

It's about truly delivering something that you are unbelievably passionate about and doing that in a way that is story based. Doing that in a way that's authentic and genuine to yourself. Regardless of the fact that you are not the most polished speaker in the world, it's about the message and storytelling at the end of the day. My recommendation when it comes to speaking, and there are lots of great resources out there, is to try to connect with people. It's to create stories that will tug on people's heartstrings that will resonate with people that will be relatable at the end of the day.

How To Leverage Disruption: It's about delivering something that you are unbelievably passionate about and doing that in a story-based way, in a way that's authentic and genuine to yourself.

The other thing is that I think a lot of times, if you're saying something that is not informative, insightful, or funny, if it doesn't create value, then why are you saying it? You should only create a presentation that creates value. To get very technical on you, the way that I break down a presentation, let's say it's a 60-minute presentation. There are only so many concepts that I can bring. Let's say there are 4 or 5 concepts.

I want to be able to make sure that those concepts are actually provocative and insightful. There's something in there that maybe people in that room have not heard of or that they've never even thought of in that particular way. I'm trying to dissect those particular concepts. Bringing examples or stories and doing it in a way that is almost counterintuitive and pushes people to think. I begin every single presentation by saying, “You are going to disagree with me at the end of this presentation,” and it's going to create tension.

If I create a tension throughout that presentation for you, that means I did my job. If you agree with everything that I say or that I didn't do my job or didn't say something that you already don't know, I'm trying to provoke. I'm trying to get you to think. That's what a great presentation does, that you're meditating on this later. You're like, “That's the biggest compliment to me.” It's like I was thinking about on the drive home. I was thinking about that. That's my one piece of advice.

Tension creates attention.

Tension creates attention.

I like that. Let's go. I'm going to steal that.

It's not fluff. You're deliberately presenting concepts in a way that will make a person kind of be like, “What? I know I've done that.” One of those concepts I wanted to talk about was your idea of waste. I don't want you to give away what you know here but the concept of waste. It resonated with me. Maybe one other time I heard it and I thought it was valuable.

There are a couple of podcasts I listen to entrepreneurial types that happened to have come up very infrequently, but with these two podcasts, but the idea of doing things in the less efficient way might create more value. Correct me if I'm wrong. Some people might look at it as wasteful, but I'd love for you to share that and what the benefit of that is.

The idea to get technical is the idea of costly signaling. Costly signaling is the idea that by putting in extraordinary effort, maybe even wasteful effort, can result in greater significance, value, or meaning with your end customer, end patient, or your end user, for example. The highly digital world. When everything is efficient and seamless, and we can press a button and get something delivered to your door. To double down on things that are more meaningful can actually create more value.

As an example, for those of you reading this, I showed up here with a nice camera. I showed up here with a nice piece of audio. I didn't have to do that. I could have showed up in my hotel room, my AirPods on, but no. I wanted this to sound delicious and put in the extra effort for the camera and audio to sound great because maybe there will be five more people that read this and be like, “That was interesting. I read this because it sounds like he put in a lot of effort.”

The crazy part is, as humans, we are rational because this sounds better in your ear. What's going to happen is that the message is going to land a little bit deeper with you. When we think about our business, we're always thinking about how do we make it so efficient. It's like how do we make things more meaningful, magical, and memorable with our end customers, and that might require more waste.

When we did our virtual keynotes and presentations, I would rent out 700-person theaters to do virtual presentations. It sounds absurd. I'm doing it all over Zoom, but it shows that somebody put in this much effort and it must be valuable it comes back to everything that we think. For example, lipstick is made up of all the same ingredients, but there are some companies that put a little bit more time in the texture and the weight of the thing, and we just feel a little bit better.

This is why, for example, wine, it is statistically shown that if wine is served in a better wine glass, for some reason, in our mind, it tastes a little bit better. This is absurd, but it comes back to the way that we consume. The way that we consume whatever is all clouded by perception at the end of the day. I believe that by putting in effort, it can result in so much more meaning with our end patients or customers.

How To Leverage Disruption: Putting in effort can result in so much more meaning with our end patients or customers.

That concept really resonated deeply with me. I have used to own an eCommerce eyewear brand. A lot of that was building relationships and trust. To do that, I felt like I had to go out of my way. I had to do some of these inefficient things. I wrote a handwritten thank you card to every single person and every single pair of glasses.

It doesn't take that long, but it's a lot less efficient than just simply box it and ship it. There's a story about a much bigger company that I heard when I was starting my eyewear brand that led me to think about that inefficient and wasteful way to approach the company. It was about Airbnb when they were very little and it's still part of the Y Combinator and they were sitting down with the guy at Y Combinator. It was like it's not really picking up the way they thought it was supposed to and whatever. They realized that the photograph’s properties were not as good as they should have been.

He goes, “Why don't you guys go out to New York and do it yourself?” All the way to New York and take photos? That's crazy. That's so inefficient. That's inexpensive. That's what he said. Sometimes you got to do the inefficient and wasteful things. We know the punchline of that story. They turned out to be fairly large company, but because they did that wasteful thing in the beginning, a lot of people probably would not have done. That stuck with me. I love that you talking about it too.

Look at all the things that we think are wasteful now. As everything is so Zoom related. Why do I have to meet that person? Why don't we just Zoom? It's just easier. It's more efficient. When you meet with somebody, it might be that 45 minutes to drive there and maybe the 45 minutes of the conversation is probably a waste of time, but you might build a deeper relationship. You might build that deeper trust. You might meet somebody you haven't met before, which is in a highly digital world.

Don't disagree that some things have to be digital. To make it really practical for your audience, booking and setting up a fast, seamless, and efficient booking site is really great. At the same time, providing extraordinary customer experience and extraordinary customer support when they're in trouble and maximizing those moments will create even more value.

Providing extraordinary customer experience and support when they're in trouble and maximizing those moments will create even more value.

You have to do both. You have to be really great at digital and you have to be really great at creating and maximizing those moments. You have to be great at both. I try to show up with anything that I do. Do it with effort. That's why I'm trying to learn about the industry when I do a presentation. I'm trying to create slides that are beautiful and relevant. I'm trying to show up with effort in everything that I do.

I can tell that it comes true 100%. As I said, there's nobody that I know. I'm sure because you are a speaker. You speak internationally, you go to these conferences, you see other keynote speakers, and you can see others doing certain things. I haven't seen it, so I have nothing really else to compare you to other than what I've seen.

It’s a totally different level and it's inspired me to up my game dramatically. In fact, after Transitions, I was putting together a new lecture that I've just started to do. I did it for the first time in Vegas at Vision Expo. Your presentation now, it is not anywhere near your level, but it still inspired me to take it to a whole another level. It's significantly more visual and storytelling. While still providing that educational aspect, the slides don't have as many words for me to regurgitate for people to write down. It's like, “Here's an image. Let me tell you a story and then you can extrapolate the value from it.” I love doing it. The number one thing you said earlier that I heard after that lecture was true and authentic to you. I was like, “That was it. That’s the best.

That means the world that you took that extra effort and it was fun for you. You got that feedback that it was authentic, genuine, and great.

Thanks. I appreciate it. You're helping me elevate. I'm going to keep trying to take it to a different level. I'm going to be doing that lecture a few more times. Hopefully, getting good feedback. The costly signaling theory. I think that was an important one, and I think that's something that many of us as business owners need to take away. We know as business owners, we need to make things efficient, but we also need to keep in mind where we can do that extra little thing. Sometimes it's a small thing like handwriting a note, but it has a disproportionate fact on the end user or the customer.

We forget that human beings value everything. Products and services, it's all based on a story. Yes, there's utility in many things, but for many of our experiences, it's based on a story that we tell. We need to understand that everything that we deliver is a story at the end of the day. How do we make that story better for folks?

How To Leverage Disruption: We forget that human beings value everything based on a story. There's utility in many things, but for many of our experiences, we need to understand that everything we deliver is a story at the end of the day.

We have to think about that too. Like I said earlier, I used the word perform because we have to think about ourselves as performing. We're not acting and faking it, but we are performing and giving the person a podcast, almost the person we're interacting with, whether virtually or in person. You want them to leave feeling like the experience was elevated.

I want to go back to something we were talking about. You asked me the question I'd like to get your perspective on. I was saying how I've kind of been comfortable with being in uncomfortable positions. I've been comfortable sort of putting myself out there and getting whatever feedback I get back, but a lot of people are not comfortable with that.

This was the question I asked you on stage at transitions. What would you say to somebody who has an idea, wants to be a disruptor, wants to put themselves out there but is afraid of the backlash or the negative comments or people laughing at them because that was what you're talking about? You got to be comfortable being laughed at. What advice would you give to that person?

I remember I was speaking with one of my brothers-in-law. Super successful, sold as first company, and made millions off of it. He went to this entrepreneur circle. All these entrepreneurs. They also made it super successful. All came up with disruptive ideas. I was just fascinated. I'm like, “You're like in the Illuminati. What did you learn from the Illuminati?”

He said something to me that changed my perspective of the world. He said, “All those people in that room, they were just as vulnerable as everybody on the street. They didn't know where their next direction was going to be. They felt this idea that other people are disrupting and don't know what they were doing. They're going in the ether in this forest, and they have no idea where they're going to end up.”

The main punchline is that no one really knows what the hell they're doing, and to me, that's inspiring. That's inspiring in the sense there is no path, playbook, or blueprint. Even the most successful people in the world understand that there is no blueprint. To me, that's inspiring. If you have a particular idea and want to disrupt, I think the thing that holds us back a ton is that, “I haven't done this before. How do I go off and do this?”

They're scared because it's uncertainty. We would rather choose death over uncertainty. We fear uncertainty more than death itself. You can get it. It's against our nature to go down this lonely, uncomfortable, and scary. However, if we can understand that when we're sitting in that fire, when it's uncomfortable and lonely, that means we're actually pushing ourselves outside of our comfort zone and trying something new.

One of the most beautiful ways to make that journey a little bit more comfortable is to try convincing one person around you. It could be a fan, follower, or partner to come along on the journey with you. You have to make those inroads, whether it's a product, service, or new process. You have to show them that there is some value there, but you just have to convince one and then the journey will be a little bit more comfortable.

Eventually, you'll convince another person and then you'll sort of build a movement around what you're doing and that will make the journey a little less scary for you. Every disruptor and innovator goes down that path and they will always go down that path. No one really knows what they're doing. I think that's inspiring. To me, when I'm trying something new. Now, I'm like, “I don't know what I'm doing, but I know this is where I should be.”

The idea of even successful people don't really know what they're doing is inspiring and it's a powerful thought. In my mind, if I'm starting something new, I'm afraid that somebody who has done it before or knows more than me is going to judge me for doing it wrong or not doing a good job, but most people are so consumed with their own insecurities or their own things that they're trying to do that they're not even going to pay attention to your faults, flaws, or failures, so it's worth getting out there. In fact, they might come to you and be like, “How did you do that thing more than anything else?” I think that that's a good way of looking at it and starting with that one person.

What I learned working with organizations is that starting in management consulting, what I would do is I would go on a company. Part of the reason why they hire you is they're like, “All the best practices from this industry and other industries.” What I would do, I'm like, “This is consulting. You take the best practices from these other industries or in this industry, remix it, and put it into what they're doing.”

What I realized is that that's not making anything innovative. That's what you're supposed to do. What I realized is that actual real strategy consulting. Real innovation consulting is working with the client to do something you and they have never done before, which is what creates the results. It's not the same thing you've been implementing with other clients in the past. It's actually working and collaborating with them to build something new.

The fact that both of you and the client are both doing something that you've never done before. My thought would be you are helping them do something they've never done before, but you've seen it before, but you're saying that's not the goal. That's crazy and scary almost for you. I would imagine I don't know where this is going to go, but let's see what we can create.

What I realized there are some consultants that are there to help them do something that the industry. Some companies are just trying to get up to standard. Being in innovation, your job is not to create or copy and paste innovations. It's to create. It's to handhold them through creating something new. It's been an amazing ride and experience to try to do that, and that's why I love what I do.

If you are innovative, your job is not to copy and paste innovations. It's to handhold them through creating something new.

What's the best, biggest, or most exciting stage that you've spoken on?

It was an awesome stage. It was amazing. To be honest with you, I just came back from something and we had to push this a little bit. I'm actually on this advisory board for the University of Alberta and talking to students. It was like a speed dating thing where they could meet me and there were hundreds of students that sort of came through and I met them at once.

It's not a stage. I'm sitting at a table, but I find it so valuable to give back to these students and provide value to them. I'm at the age now where I've been punched in the face way too many times that now I can go back and give some advice and learn from them too. I'm also learning from them. To me, those experiences and being able to be on that stage is not even a stage is really the most rewarding because I know that I'm going to say something to them that they will remember.

I remember just talking to these students and asking them a question. I'm like, “What are you guys looking for? Coming out of school, what do you want right away?” One guy that was sitting there, he was like, “We want to get money. We want to be able to retire right away.” Everybody around him was like, “Money right off the gate.”

I told him. I'm like, “I'm 38 years old. The fact that you were coming out of school and you're saying that the most important thing to you is money is the stupidest thing I've ever heard in my life.” I said that exact thing and I said, “If you optimize for status right off the get,” and I see this mistake all the time with kids coming out of school. They're optimizing for position, title, and brand docking to get like $1,000 or $1,500 more on their salary.

Are you going to make $1 million in twenty years? Why are you worrying about that small amount of money that you're going to get right off the get? I know some people might have financial concerns within their family, so I get that. For most people in that room, they didn't. If you're optimizing for status right off the get, then you are fundamentally setting yourself up for failure later. You should be optimizing for experiences and whatnot.

I'm bringing this up to say that I saw that shift and they're like, “I might have just changed their trajectory right there and then.” You and I. We have kids. We've been in our industries for a while now, and I see you're passionate about your work. I'm certainly passionate about what I'm doing, but there are so many people that we know and I know we're getting philosophical, but how many people do you know that are your friends?

They're now sitting at 40 years old. They're like, “I don't know if I made the right decision in life. I wonder if I should do something else right now. I wonder if I got into marketing, I would've been happier than being a doctor now.” I would say that 80% of the conversations I'm having with my closest friends are having that discussions internally. I don't want these kids growing up, when they get to my age, to be like, “I actually followed a path that I probably shouldn't be on.” What are your thoughts?

I have never had any issues with making the conversation philosophical. I'm happy to go down that path anytime. I 100% agree with you. That resonates deeply because of the conversations I'm having with optometrists. I did this series of conversations with six capsules of episodes about the future of our profession. One of the common discussion points was like, what are new grads or young optometrists doing? What are they choosing?

They're being enticed by money. Corporations are giving them forgivable loans or they're giving them incentives, bonuses, and things like that. My question to them is, “Are you going to pick the money or will you pick your happiness and the betterment of your profession?” Sometimes those things align and that's amazing, but a lot of times, they don't.

You're going to take the money and work in an organization that may not be the most conducive to you having a fulfilling career. Also, maybe not conducive to the betterment of the profession in the long term based on the corporation's goals. You could choose to potentially make less money, but you are expanding your scope. You're learning more. You're taking the bumps and the lumps because it's going to make you better at what you do in the future.

That is a key question and topic of discussion these days. I'm biased because I'm the guy who didn't take the money and took the lumps and the hard road to get to where I am. If somebody were to look at me and say that they like what I'm doing, that's how I got there. I'm not going to tell you I'm successful or I'm better than anybody.

If you look at me, you say, “You seem to have done something right. That's the way I went.” I didn't, for better or worse, take the money upfront. That's my experience. I 100% agree with you, but I'm biased because that's my life and that's my road. I appreciate you sharing that and I think that's going to be an important message for people in our industry to know.

I hope that people in this industry keep dreaming. Keep dreaming of things you want to do with your practice and business. A lot of folks that I meet within this particular industry are thinking about other things. They've run their practices like well-oiled machines. I think that there is so much more to explore in this industry. We haven't even cracked the surface of what's possible.

I think this industry is one of the most important industries in the world. We can't get complacent because this is people's livelihood. This is the most important asset that we have is our eyesight. In my opinion, your duty actually is to continuously innovate. Your duty is to go off and try to experiment because this super important.

How To Leverage Disruption: The optometry industry is one of the most important industries in the world. We can't get complacent because this is people's livelihood; the most important asset we have is our eyesight.

It's great that you have the opportunity to influence young people at that very impressionable age to give them that insight from your perspective about having the passion, experience, and value of that versus taking the money upfront. In the long-term, you probably end up making about the same amount of money. If you take that extra $10,000 or $20,000 upfront now, it is not going to affect whatever that last number is at the end of your life, so I appreciate that insight. Shawn, I always ask two questions when I wrap up the interview. Before I get to that, I want you to please share with us where can people find you, listen to you, and see you. Where can they go?

First of all, follow this show, subscribe, rate, and review wherever you are. Spotify. That's the most important thing. I started this conversation by saying that 99.99% of your audience have never heard of me and don't know who I am, but they know who you are. You're putting in so much effort into this show. Follow Harbir everywhere. He is on every social media, TikTok and whatnot. You can follow me after you follow this show and him. I'm @ShawnKanungo anywhere you can find me on LinkedIn and all social media platforms, so that's what I'd say to that.

Thank you. I love it. Thanks for being the hype. I appreciate that very much. Please go find Shawn, and yes, please do rate and review the show as well, but go find Shawn. I guarantee you are going to be inspired in so many different ways. The theories, thoughts, and lessons that you share are really high value. The quality of your content alone is inspirational. It's going to inspire. There are a lot of content creators in the eye care space, and reading your stuff is going to inspire them to up their game.

There are some people out there putting out super high-quality stuff, but even then, watching you, I think, is going to help elevate the game. Go follow Shawn. Follow him on all platforms. Shawn, if you've listened to the show before, you probably know that there are these same two questions I ask every guest.

The first question is if we could go jump in a time machine and go back to a point in our life that was challenging and difficult. If you're comfortable, you can share that specific moment in what was happening, but more importantly, I'd like you to share the advice you would give young Shawn. It's like a rapper name, Young Shawn, at that time.

I was ready for this question and every time you ask it, I always reflect on my most difficult time. My most difficult time was when my father passed away. I was about 25 years old. I had to take over his accounting practice. I learn so much about how to take care of my family, run this practice, and sell a practice.

I became a man right away because before that, I was just a boy. I was partying. I was playing hockey. I wasn't focusing on my career. That was the day that I became a man. He died suddenly and I had to take care of everything. What I learned actually was I don't know if this is like an East Indian thing or Brown thing. When someone dies, there's usually a rush of people coming into your house, right?

Every day, you have people coming for weeks. People just at your house, helping you more and whatnot. The day that people weed out, it must be the second week. It's like the fifteenth day and your house is empty and it's just you and your family and everybody has moved on and they should. Everybody should move on.

The realization is that everyone moves on. To me, life is short, so it's like you have to make every day count. I know this sounds like air and fairy and motivational, but everyone moves on at some point. No one is thinking about you beyond that point. It's a realization that. That's the day that I learned that you need to keep moving. That's why to this day, that day got me hungry and I'm still hungry to this day because I know that tomorrow may not come. That was the one inside thing that I got from that moment.

You have to make every day count because everyone moves on at some point.

Thank you for sharing that. That's heavy. Imagine, even after all these years, it's still hard to think about that time losing your father. I can only imagine how difficult that was, so thank you for sharing that, Shawn. There's something you said that reminded me of a clip of yours I saw and a stoic saying that I like to keep in mind, which is Memento Mori. I feel like that's a reminder there, like you said. This may be your last day, you don't know. It's a matter of you move forward, live your best life, and have a great day. I know you were speaking about that on stage. I don't know if you want to share a little bit about that.

Memento Mori is this idea that remember you will die. It's the reminder that life is short. As the story goes, there's this thing called the Roman Triumph. In Ancient Rome, the successful general, after a huge military parade down the street, would be the highest moment for this general. There would be a slave at the back of the chariot that would whisper in the ear. At the most important day of the general, the slave would whisper in the ear of the general, “Memento Mori.”  Remember, you will die. You are still a mortal. Remember that tomorrow is a blessing.

I talk about the idea of disruption, and to me, it's like you never know what's going to disrupt you, the pandemic, a new technology, or somebody coming out of nowhere. It's a reminder to continuously innovate and to continuously be hungry, and try new ways of doing things. I have this app and it's called WeCroak. It reminds you five times a day that you will die and it's for you to reflect. I can't tell you how many times this is like you're with your kids or if you pick up your phone, you're like, “I should remember this moment.” It's a good reminder. It's a Bhutanese culture. They do this. They remind themselves five times a day and now you can do it through your app. WeCroak. That's my advice. Remember, you will die.

I think it's important. It sounds crude and it's not in the nicest thought to have to remind yourself, but there's a lot of value in it because it makes you want to make use of your day, your life, and your experiences. Thank you for sharing that. The final question is, everything that you've accomplished to this point, Shawn, how much of it would you say is due to luck and how much is due to hard work?

I would say that it is 90% hard work, 10% luck. There's luck in everything. I love luck. I think the hard work creates luck at the end of the day. If you don't put in the work, you don't get the luck. I work pretty hard and I'm trying to create more luck for myself.

How To Leverage Disruption: Hard work creates luck at the end of the day. If you don't put in the work, you don't get the luck.

That's a great answer and I know you work hard. I was on your website. The list is endless of the performances or the talks that you're doing. It's like 500 talks a year. I was like, “This guy.” How are you everywhere? It's crazy.

I'm here with you. That's the most important thing.

I appreciate it. With all of what you have going on, you have been an amazing guest. You have been very present and I appreciate that very much because I know you're a busy guy, so thank you so much, Shawn, for coming on. I know there is going to be so much value in this episode. I hope everybody reads it from start to finish. Go back and read again. You probably need to because there are so many gems in this one. Thank you so much, Shawn. I appreciate you coming on. Thanks, everybody, for tuning in to another episode of the show. As Shawn said earlier, make sure you rate, review, like, share, and do all of the good stuff. I appreciate it very much. I'll see you in the next episode.

Important Links

• Shawn Kanungo

• Transitions Academy

• Brianna Rhue - Past episode - EPISODE 78 - BECOME THE DISRUPTOR WITH DR. BRIANNA RHUE

• TikTok - Shawn Kanungo

• LinkedIn - Shawn Kanungo

• YouTube - Shawn Kanungo

• Facebook - Shawn Kanungo

• WeCroak

About Shawn Kanungo

Disruption Strategist

As a globally recognized innovation and disruption strategist, Shawn Kanungo works at the intersection of creativity, business, and technology. He spent 12 years at Deloitte working closely with leaders to help them better plan for the opportunities associated with disruptive innovation.

Kanungo’s work has been featured in the Globe and Mail, The Guardian, CBC, and CTV. He’s been recognized by Avenue Magazine as one of their “Top 40 Under 40”. In 2021, Forbes called Kanungo the “best virtual keynote speaker I’ve ever seen”.

A prolific content creator, Kanungo’s content on innovation has garnered millions of views across LinkedIn, TikTok, YouTube, and Facebook. His first book, The Bold Ones: Innovate and Disrupt to Become Truly Indispensable will be available on December 6, 2022.

Episode 89 - Dr. Joseph Allen - The Story You Haven't Heard About Doctor Eye Health

Dr. Joseph Allen is arguably the most well-known optometrist around the world thanks to his incredible YouTube channel Doctor Eye Health, which has well over 700,000 subscribers. But, Dr. Allen isn't just a social media celebrity. He is residency trained, a fellow of the American Academy of Optometry, and a Diplomate of the American Board of Optometry. In this episode, Dr. Allen shares some stories about what it has taken, personally and professionally, for him to achieve this level of success in his career. This interview will bring you a whole new level of appreciation for Joseph and Doctor Eye Health.

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Watch the episode here

Listen to the podcast here

Dr. Joseph Allen - The Story You Haven't Heard About Doctor Eye Health

Thank you so much for taking the time to join me here, to learn and grow. I'm happy to have you all. I'm always grateful for everybody who reads and even more importantly, everybody who shares, comments, and leaves a review. I am excited. I have one of my absolute favorite people here, Dr. Joseph Allen, whom most of you have heard of. If you haven't, make sure you read this whole episode because he is going to tell us a lot about what it's taken to get to the level that he's at. Dr. Joseph Allen, aka Doctor Eye Health, the biggest name in eye care online.

Not to overshadow his actual academic accomplishments. Dr. Joseph Allen graduated as salutatorian and magna cum laude from the Rosenberg School of Optometry. He is a residency trained. He's a fellow of the Academy of Optometry and a diplomat of the American Board of Optometry. He is a very impressive person, but also a super humble, kind, and friendly person. I'm happy to have you on the show. I’m happy to have you back.

Thank you. This is a huge honor for me. I read your show. I'm always impressed whenever we get together at any meeting. It's always a huge pleasure.

I've had you on the show a couple of times. The first time we did a little collaborative IG Live. We talk about the day in the life of an optometrist. The second time was during COVID. I did a panel discussion and you were generous to come on and share your insights at that time as well. The first time I had you on is in the early days of your YouTube channel. You had about 50,000 subscribers at that time, which even then was a mind-blowing number. Now, you're sitting at well over 700,000 subscribers. To me, that is unfathomable as somebody who a long time ago tried to start a YouTube channel. First of all, I want to know what does that mean to you? I know you're striving to increase that number and reach more people.

It's mind-blowing. When I started it, I didn't know if anybody was going to watch, follow or subscribe. I had the drive of like, “This is something useful. This is something people want to watch.” It didn't happen the way I thought it would. Some people have that idea when they start a YouTube channel, they say, “I'm going to build this social media account and I'm going to get all these followers,” and then they realize very quickly that it doesn't happen overnight. It's not going to come instantly.

You have to work hard to even get one person to hit that subscribe or follow button. There are unicorns out there. There are people's channels that will post one video and somehow they made 2 million subscribers off of that. Nobody can explain that. It's been a long journey. Every day when I see that 1, 300 or more people subscribed in a day, I try to be very thankful for that. People leave too. I have people who unsubscribe every day. Thankfully, the amount of people who do subscribe is more than the number of people who unsubscribe in a day.

You're heading in the right direction. There's no doubt. What's the target? Is there a number in your mind that you would reach and you would say, “I've made it,” or have you already surpassed that number?

I surpassed that already. When I hit 100,000, it shocked me. I was exhausted. That was right at the beginning of COVID. There was a lot going on at that time. I don't think I appreciated it at the time, but now that it's continued to build. I want to hit 1 million. That's a huge benchmark in the YouTube world. That's when they send you a big gold play button. It'll be a big moment for me at that time.

What is the plaque that you have?

That one is the Silver Play Button. When you break 100,000, they send you one of those. That was huge for me.

That seems like a massive milestone. I can see you get into the million the way that you're going. I knock on what I truly hope you do and I will be celebrating with you. We're going to talk a little bit more about some of the emotions and what happens behind the scenes because people don't see that enough and they see somebody like yourself or some other person on Instagram who created a big account and puts out content regularly.

They assume that they're just putting out content. They don't think about what goes into it. I want to rewind the clock a little bit and ask you, if I saw Joseph Allen at ten years old, would I be able to say, “I see that thing a personality trait, behavior, something in him that might lead to him becoming Doctor Eye Health?”

Maybe not necessarily a personality trait. At ten years old, I loved movies. I quoted movies all the time. I still do. I drive friends and family nuts because if there's a scenario that reminds me of a funny movie, I'll start acting out and quoting it. Some people who don't know what I'm referencing will be confused. I was always interested in technology. I played a lot of video games as a kid. If somebody didn't know how to get their VCR or DVDs. That's how old I am.

They didn't know how things work. I was the guy that would call over and I'd know what wires to plug in to get everything working. Even in high school, I was part of the Computer/AV Club. If the computer system broke down in high school, they would call me over the intercom to go fix something. Thinking back, I'm like, “I have at least slowly built up the general knowledge of, ‘How should this at least be built?’ The mechanical things of like, ‘I need to set up a camera, microphone, and lighting.’ I enjoy getting everything put together.”

One of the first times we spoke, I still remember this because, at that point, I had more YouTube videos than you did. This is a long time ago. We were chatting because you're like, “There's not a lot of optometrists in this space.” I was like, “Here are some of the settings I use,” then you asked me about color correction. I was like, “I have no idea. This guy only put out a few videos, but he's already way ahead of me as far as his knowledge in this arena. It's amazing I loved it. I'm going to stay glued to this man right here because I know his videos are going to be high quality.”

Clearly, there are certain traits that you've carried through from your younger years to now that help you enjoy and optimize what you're doing. I want to step away from the digital world for a second because something we were talking about offline is that I assume people see you online and just think that's what you do. It takes so much time to create the amount of content that you create. You are one of the most highly trained and educated optometrists that I know. You're still seeing patients. If you don't mind, describe to me what your day in the clinic is like and lead over to how do you balance that with all the YouTube stuff that you do.

The easy answer is that there isn't a balance. I'm in the clinic two days a week. I don't own a clinic myself. I work at a privately owned clinic, who is owned by two of my mentors. They're practicing fifteen years more than where I'm at. They have built an astounding dry eye anterior surface disease large-scale clinic. They're building their second location. We usually have 2 to 6 students a trimester. It's a big busy clinic and very focused on disease and practicing at the full of our scope in the state of Minnesota, where I live. On a typical clinic day, I'm seeing patients every twenty minutes or so, sometimes more if we have to double book or overbook.

My students are seeing patients in between which I have to go and then I see the patient, but also help teach the students by reviewing, “What made you make this decision? We should take a picture of that. What other technology could we use? What could help us make a better diagnosis?” I’m drilling them about medication options, “We're going to prescribe an oral medication. What type of oral medication options do we have? What if they're allergic to that? What other option?” You push them a little bit further.

Imagine challenges on your own clinical abilities too or forces you to stay on top of things.

I do enjoy and not only does it push me to teach the other students, but being in a clinic with a bunch of other specialists. We have a cornea contact lens specialist who's fitting Sclerals and Ortho-Ks. Dr. Trevor Fosso does some lectures. He knows so much more about those than I do, but I aspire to learn from him. I'm always asking him questions. We have a pediatric specialist that knows everything about myopia control that I could hope and dream for.

I have my mentor, Nicholas Colatrella. He does a lot of anterior surface disease, dry eye things, and a lot of amniotic membranes. I get to learn from him. Dr. Stacy Hinkemeyer, Dr. Colatrella’s wife and co-owner. She's in residency-trained ocular disease specialist as well. We have Dr. Shalon Ronning. We brought on a new student or a recent grad. We are always just pushing and learning. It's great.

Doctor Eye Health: We should constantly be pushing and learning.

There's a well-known quote, “You're the average of the five people you surround yourself with.” That's generally referred to in your personal life. To me, it occurred that could be applicable in your clinical career too. You used to work in a different office. Now, you came to this one. You've surrounded yourself with these experts in these different fields so you can absorb information from them. It's going to make you a better clinician as well.

There's a phrase, “You don't want to be the smartest person in the room. You always want to learn from other people.” That serves many purposes. First, “Who I am as a person?” I want to always be learning and striving to be a better doctor. In the world of YouTube when I started this, I knew I'm putting myself in a public space. I am an ambassador for our profession. I have to know my stuff. I have to make sure what I'm saying is accurate. I need to be on top of what's fresh and new. It helps me in both worlds.

You have been an ambassador. Continue to be a shining light for the optometry world. I can imagine the amount of awareness that you've brought to our profession in eyecare in general. The number of people you've been able to reach is incredible. It's far beyond what anybody else has been able to do. It's amazing. Let's go back to YouTube then. How many comments and emails do you get from people around the world, and how do you deal with them? I can only imagine your inbox must be flooded every morning.

It's a lot. First, there is the YouTube comment section. When I first started it, I was answering every single one. I'd be done with whatever else at 9:00 PM. I'd sit in front of the TV. I would have Netflix on, but I'd be sitting there commenting on every single comment on the channel. As the channel grew and more people jumped on, you cannot keep up with the comments. You got the other platforms, whether it be Facebook, Instagram, or TikTok. You have to accept the fact that you can't get to everybody. You got emails. I get emails. It's got some cool stuff because you get fired up when someone has a positive remark or they tell you, “Thank you,” or shares an in-depth story. You get for some people who give you negative feedback. That's how the internet is.

We call them keyboard warriors, the people who feel like they're somehow superheroes because they're sitting behind a screen and got a keyboard. What negative comments can people make? You're putting out educational content about eyes. What's somebody going to say? I can't even think of one, “The lighting in the background is not nice enough?”

People would pick small things. In one video I posted, I had a booger hanging, there is broccoli in my teeth, or people tried to correct me, saying that I'm wrong about this subject. People will argue, “Your dry eye is not caused by this and that. It's caused by soybean oil.” Who knows? Maybe there is some truth to that. There are a lot of claims people will make that aren't evidence-based or factual based. The tough thing is that I have to be in this space. I believe we owe it to our profession, the patients, or everybody reading. We have to be more evidence-based and have that. It makes it difficult sometimes to handle those comments.

We get those comments in the exam room. That's one patient at a time. Somebody asking, “I've heard that I can do exercises for my vision. This thing will help if I pour honey on my eyes,” or some random things. I'm like, “I don't know. Maybe?” I cannot say yes to that because there's no science behind it that I could. If you do it, then you come back and you say, “Harbir told me to do it. Now I'm in trouble.” That's one person at a time face to face. The number of comments you must get, I can't even imagine the craziness.

I put out the one video many years ago about nearsightedness and its causes. It gave a common understanding of what it wasn't. I can't tell you how many comments I got on that one video about, “This is made up. You want to sell glasses. The base method is the thing,” and so on. The question I have to ask is if somebody's trying to start their channel, can you give us some tips and tricks and advice on 4 or 5 things that you would recommend somebody do that would help them go on, and get on the right track?

That's a big thing. A lot of people don't realize that there's a lot that goes into building a channel. Number one is having clarity. Spending some time understanding why you want to be on social media. if you want to build a YouTube channel specifically, are you doing it because you want to build something as big as a channel as that I've made? You can build a channel specifically for the goal to just attract patients and bring them into your clinic. That could be your main goal. If that was my goal, the videos I would make would be a bit different from the videos I'm making, which is purely to build the channel independent from any clinic to be a resource of video education for the public.

Many people don't realize that there's a lot that goes into building a channel. Number one is clarity and spending time understanding why you want to be on social media.

Can you distinguish 1 or 2 things of what are you doing specifically to build your channel versus drawing patients in? Is there a certain hook, the way that you're talking, or things that you're doing that are geared to that?

I don't talk about the clinic where I work at. I don't advertise that. There are a few videos I've done more where we did a tour of the clinic or I talked about the dry eye testing that we do specifically at our clinic. That is amazing because, in that video I posted, I had two patients who traveled to come to see me as a provider specifically for their dry eye. One guy drove an hour and a half in Minnesota. This other gentleman flew from Dubai into the United States. He like, “This doctor who does dry eye lives in Minnesota.” He took an airplane to Minnesota, got a rental car, and drove all the way to our clinic to see me.

That's cool. In general, most of my videos are meant to keep people watching my videos. At some point in almost every video, I'm like, “If you want to know more about Demodex mites that we talked about, you can check out this other video I did all about Demodex mites.” I refer to it. At the end of the video, I'm like, “If this video helped you out, don't just hit the like button and subscribe, but you may also like this other complete playlist I built all about dry eye treatments specifically.”

It builds this idea that people can binge-watch all of my content. They can sit there for one hour and learn more. That is a little bit different. I'm not trying to tell people, “Come see me.” I'm telling people like, “This is all information I want you to know about.” People after a while, thankfully, are feeling comfortable enough with me that they say, “This guy knows this stuff. I want to go see him.” They're tracking me down.

We listen to a lot of podcasts. When you listen to one podcast for a long time, it's almost like you know the host or that person. You know the weird and quirky things they say. You know how they talk and personal things about them that come up through conversation. It's almost like you become friends with them. I can imagine people feel that way about you. I imagine if you put out how a little more frequently where you work, you'd probably have a lot of people showing up just to say hello or get a selfie with you. What else? How important are the lighting, the background, and that type of stuff?

You can get fixated on it and I have. I'm friends with other big people in the YouTube space now. There are channels that don't get fancy and they do amazing. It's about the quality of the content that you're putting out. Everyone worries about the camera picture. I've spent thousands of dollars on good cameras and lenses, but most of the time, if you have a mediocre-quality camera or whatever you're shooting with your phone, that's more than good enough. The audio does matter. To anybody, if you're going to start a YouTube channel, have a good microphone so that you can pick up good sound quality because if the sound is bad, people will be faster to skip off of it sooner.

Doctor Eye Health: Most of the time, if you have a mediocre-quality camera or whatever you're shooting with, that's more than good enough. But the audio does matter because if the sound is terrible, people will be fast to skip off of it sooner.

The quality of the content, having a good title, something that's catchy, having a good thumbnail so people understand by looking at the picture, “This is about dry eye. This is about eye disease or improving my eyesight.” They're able to click that video and in the first few seconds know that, “This is the video I want to watch. This person is speaking clearly. I can understand what they're saying. I understand what this video is going to deliver to me.” That is important. Worrying about the lighting and the quality of the camera picture and how things are set up is more vanity than anything.

All of your thumbnails have your own face. Your picture of you looking at something pointed or at least there's another image in the background that depicts what that video is going to be about. How important is it for your face to be on there? There are going to be some people who are a bit less comfortable with that.

That was a choice based on a lot of research. I didn't have any formal training in marketing and advertising. I didn't go to school to become a YouTuber or anything like that. I went to optometry school. When I started this out, it was not growing. I wasn't getting anybody watching. I spent a lot of time listening to podcasts or watching other YouTube videos and trying to learn from other people about how to build a YouTube channel. They've done marketing research and have found that, “People's facial expressions, do we become familiar with it?”

It invokes emotion. There are even small fine details of people with their mouths slightly open. People may more likely to click on that than somebody who has their mouth closed, and their eyes are popping open. They're able to see contrasting colors. There are a lot of people who constantly dig into the research of this and the psychology of why people click on it. I'm comfortable with my face on it, but I have some thumbnails that don't. If the videos on colorblind glasses, I have one that's colorblind glasses brand versus another. It doesn't have my face on it, and there are other ones.

We won't even go into the keyword thing and all of that because we'll be talking about that for days.

I'll have some CE that if people want to get into this, then they'll be able to come to see me and break down how I do it.

Come to Vancouver please and talk to it. I've alluded to this now a few times. I want to get to a little bit more of the personal stuff. We talk about your professional career, your YouTube, and your unbelievable 700,000 plus subscribers. Some of the stuff we've talked about offline over the last couple of years is, “What's going on behind the scenes? What are the challenges? What are some of the struggles?”

Let me phrase it to you this way. What is one thing you would want people to know about what it's taken you to build this channel up? I know you've already said that in the beginning, it wasn't growing that well, but personally, what would you share with us so people can understand a little bit more about what you've been working on and how much you've been working?

It's not easy for me. In fact, it’s something I do have to work on. I have to wake up every morning and tell myself, “I need to not only come up with another idea of a video,” that the video is on a certain topic and it could be a topic that's not necessarily a sexy topic in eye care. For example, tea tree oil. People have been asking if tea tree oil is good or bad for your eyes. That all stems from one research article that was published in early 2020 or 2019.

I had to research that and read probably 15 to 20 different articles all in tea tree oil and Demodex, and not just read the abstract, but request those articles, deep read those articles, know and understand the subject, and then find a way to structure that video that it's entertaining, addresses the problem, and gives a resolution and a call to action for people. It's a lot more challenging to put that all together, but then muster up the energy to be on camera, look excited, and show that emotion. Once you're done, pull it over to a computer and sit in front of that computer for maybe 6 to 10 hours, hearing your own voice over and over, all the times you said the wrong word, slurred your words, or the retakes.

I'm running a TV channel about eye care. When you're mostly a one-person job, it is stressful, especially considering I make a lot of my own income off of the channel. I still work in the clinic two days a week, but a lot of my income is based on how good the channel does. It runs as a business, then I have the stress of like, “I have to do this and I have to do it well because the better it does, potentially not only more viewers, but more income it may make for the channel and to keep me able making stuff.”

The kind of stuff that most people don't see is, “Turn on a camera and you'd say something about a topic,” but reading fifteen articles about tea tree oil. There's pretty much nothing you could do. You'd have to pay me for sure. Other than that, there's nothing you could do to convince me to do that and to make it interesting. The other part that a lot of people don't see or think about is the editing part. I know that you do enjoy that to some degree. I enjoy it too. When you sit down and edit, it's amazing to see it come together. Once a month or something, I enjoy doing that. Do you do two videos a week?

I do one full video a week. It's been my goal to get to two videos a week. I found that when I push myself that hard, I would burn out and the quality would go down.

To spend that many hours in front of a screen to edit one video is incredible. That's a lot of work that many people don't see. Everybody sees that five-minute video at the end of it. How many hours went into it, the stress of it, or the time spent reading? That's the thing I wanted to highlight and bring forward. When people know that, they appreciate your content a lot more, at least I know I do.

If there was a blooper reel of all the times I've said the same sentence or paragraph 2 or 3 times because I stumbled over my words, used the slightly incorrect word or there are videos where I've had to decide, “I didn't notice this when I first shot it, but in editing, I'm seeing like I misspelled the word inflammatory behind me.” There are things you have to learn to laugh at yourself.

In that case, you have to rerecord the whole thing.

In that specific case, I would've had to. When you do something like that, you think, “This isn't a sexy topic. Maybe only a few thousand people will ever see it. It's not a big deal.” In that case, that video happens to have over 1 million views now. I know that some companies are even showing it during like CE lectures and things like that to other doctors. I'm honored, but at the same time, it's like embarrassing.

Pick one where I haven't made a spelling mistake.

The true reality is that we are all human and we all make mistakes. It helped me in my own personal development in dealing with the stress of being a healthcare professional because a lot of us, especially those coming out of school, get this feeling that we need to know everything and be right about everything.

The reality is that you're human first. You're a human before you're a doctor. Understanding that you weren't born knowing all this stuff. You had to learn it through school, reading articles, listening to mentors, and getting experience. That changed my own mindset even about making mistakes in YouTube videos. Sometimes it's like, “I can redo that.” Sometimes you got to be like, “It's more important that I'm getting this information out there right now, this day than it is for me to spend another twelve hours remaking a video.”

Many of us, especially coming out of school, feel that we need to know everything and be right about everything. The reality is you're human first. You're a human before you're a doctor.

I was referencing this quote in another show, “Done is better than perfect.” That is the better way to phrase it. There are a lot of people who dwell on perfection and making sure every little detail is correct, but getting the content out there, and doing the thing is the more important thing. The next time around, you can improve it. I understand that for some people, it's easier said than done. What would you say has been the biggest challenge that you've faced in this whole journey of yours?

That's a tough one. I may have to think about that.

Let me ask you another one. Is there a point where you didn't want to make another video? Have you felt like quitting?

Maybe not all the time, but it does come frequently. Early on when I first started it, after about 1 or 2 months, I hit an existential crisis because I was spending so much time not just planning my content, but learning how to shoot content, edit, playing around with the editing software. You work all day. At that time I was working 5 or 6 days a week and still making content. I'd come home and sit in front of the computer until 10:00 to 11:00 at night. I'd do that every day trying to make one video, then launch it and five people watch it like nobody watches it.

That was going on for 1 month or 2. Nobody watching or subscribing. I had eight subscribers and they were all my family and friends. You'd go on there and try to find the channel. It wasn't even coming up because, at that time, when you first started a channel, YouTube doesn't even realize who you are or where you fit in the web of everything that exists on YouTube. I was like, “What am I doing this for? Why am I spending so much time on the weekends, on Saturdays?”

I'm at the clinic for eight hours with my gear, shooting a video by myself and doing hundreds of retakes because I keep on saying things wrong and I'm nervous. I feel like I look and sound funny. I'm thinking, “My friends are out. They're going on a hike, to a movie theater, or out to dinner. They're doing all this fun stuff on the weekend, and I'm sitting here still working. Why am I doing this?” That was so early. I wasn't making any money from the whole deal. It was tough. I'm very thankful that at that time, one of my good friends, Alex lives in Texas.

I was telling him about it. He's like, “You're being too hard on yourself. How about you dial it back? Stop trying to push out one video a week. Why don't you do one video for 1 month or every 2 months, whatever works for you in your time? At the end of it, you'll at least have a nice library of some videos to share with patients, or be able to be like, ‘Look at this cool stuff I made?’” That took some pressure off my shoulders. I kept on with it, but slower, then the channel started taking off a few months later.

Now the challenge is that with such a big channel, with many followers, and then the pressure of being like, “You've had all this success, what's next?” It’s like, “I'm still trying to make the video for next week. What if that video only gets 4,000 views instead of 100,000 like other videos?” You feel like you're not doing as good of a job, that somehow your video's not as important as the other ones.

You have these inner battles of perfectionism and the voice is telling you you're not doing something good enough or there is something wrong with the lighting or the camera, what you're saying isn't accurate, or that your own personality isn't as entertaining or attractive as some other YouTuber, doctor, or professional. I'm thankful I have a therapist now. It brings up a lot of deeper emotions of self-doubt and self-criticism. That's probably the biggest and hardest challenge I think.

I appreciate you sharing that because there are a lot of personal feelings coming through. I enjoyed talking to you work your way through that. I felt like I resonated personally with so much of what you're saying. That's why I'm grateful that you were open to sharing that with us here because I guarantee you 100% that there are many people out there and I bet readers resonated with something that you said there at some point, if not multiple things that you said.

There's that impostor syndrome sometimes people get, or the pressure once they are achieving more and better or in the beginning stages where you think, “What's the point of any all of this? Nobody's even watching or paying attention.” Many people are going to be feeling that. The point of this whole show is to share those stories so other people in our industry can say, “I can do this too. I can do the thing that I want to do as well. It's not going to be easy or a straight path. it's going to be a struggle, but Joseph and somebody else did it. They got through it. I can do it too.”

The biggest thing that has helped me, and what I've even told the other professionals who are thinking about getting into the social media space of talking about their passion and our profession is that it's very easy for us to get hung up on how we look or sound, “Am I professional enough? Am I saying this correctly?” and those self-doubts. Unfortunately, when you break it down and think about it, that's self-centered.

Doctor Eye Health: It's easy for us to get hung up on how we look or sound. When you break it down and think about it, that is very self-centered. The reality is if you're making content, you’re making it for another person and not for personal reasons. You’re doing it for somebody out there who needs it.

The reality is that if you're doing this and you're making content for another person like, “I'm not necessarily making a YouTube video for my own personal reasons. I'm doing it because I know that there's somebody out there right now who is struggling because their doctor said something about glaucoma, but they don't know what it is. They were either afraid to ask their doctor or their doctor told them ten minutes of something, but they only heard the two words, ‘You have glaucoma. You could go blind,’ or something. I need to step up and make this an educational five-minute video. The hope that this person will find it, watch it, and be like, ‘I get it now. That's why I need to take these eye drops. That's why I need to keep seeing my doctor.’”

My hope is that I'm doing this not for myself. I'm doing it because it's going to help somebody. If anything, it's going to encourage them to go back and see their local doctor and ask them the appropriate questions. Thinking about that helps me overcome my own anxieties and self-doubt. I hope the readers can maybe take that as motivation if they ever want to step into the space.

I didn't think of it that way, but it is that powerful to think about. You're being selfish if you're just worried about how you look and sound. It's more about getting that information to the person whom you're creating the information for and helping somebody. That's powerful. I love that. Do you feel you are successful?

Let me tell you why I'm asking questions like this. This is my own personal development. I would tell my own quick little story here. I did a series of interviews with leaders in these various organizations. I had to mentally prepare myself to interview these people. Part of this interview is a friendly conversation. We're friends. We can joke and stuff, but I didn't want to have that type of conversation with those people.

I had to mentally get myself in the state of mind to ask a question and keep a straight face. I feel like that energy is transferring over to spilling to the following interviews that I'm doing now. I would love to know your personal insights, not just the surface level like, “You're a big YouTube star. What's that like?” Feel free to not answer or give an answer that you're comfortable with. It's all good. I think somebody would look at you and say, “He's successful.” Do you feel that way?

Probably, no. I loved that you had all of those interviews. It takes a lot of courage to do that. In fact, I think those are the hard conversations that we, as a profession, should be discussing. Our professionals are discussing those issues behind closed doors. You and I know that at every meeting, we're talking about these concerns and potentially, how they may impact us individually and our profession down the road, whether it be happening in Canada or the US. The fact that we're not publicly talking about this or inviting people like you've done from these companies or from these players in the industry to discuss these things is a huge failure. We need to be talking about this. Thank you for bringing so much to light.

To go back to your question, do I feel successful? What does success mean to me? That is a tough question. If you would've asked me when I was first finishing optometry school, success was graduating optometry school, then getting through residency, a job, and paying off student loans. Once I completed all those tasks, I felt a bit lost. I've entered a world of much more self-reflection and battles within my own head. I’m still trying to find what success means to me, maybe not even trying to find success, maybe just trying to be comfortable with myself, enjoying life, and being surrounded by friends and family. What would I find value in that's beyond money or accolades and all of that?

The older I get, the more I feel that way as well. I question myself as to exactly what success means. It's more about living in the moment, enjoying who you are, and being happy within your own being and own body. That's my definition of success these days, but it's always changing. I wanted to see if you had any thoughts on that because from the outside looking in, somebody's going to say, “Look at that, 700,000 subs. He's successful.” What's next for Doctor Eye Health or for Joseph Allen? What's the plan? What are you doing? What are we going to look for?

This is something I've been spending more time on. I've been doing a lot of journaling and trying to think goal-oriented like, “What is something that I would like to accomplish and get off my bucket list?” Next, I am maybe contemplating the idea of having a podcast and talking more about optometry, but more about doctors, not so much about the general consumer. I’m writing CE. I want to get into that realm and potentially write a book, whether it be about YouTube, healthcare, or optometry. That's something on my bucket list. I want to write and get something published like writing a book.

At some point, we'll see a gold plaque in the back there.

That'll be huge. I'll be very honored. I don't want to just do it for myself, but also to be like, “This is for like the profession of optometry. This is a representation that our profession matters.” Even one time, the surgeon I worked with a few years ago was like, “Whoever thought people would be this interested in eyes?” We've got our little club of eye doctors who are super passionate about it, but whoever just knew the general public would be so interested.

I started making those YouTube videos. It was in 2012. It's funny because multiple people told me, “It's nice what you're doing. It's fun to watch, but not a lot of people are going to watch videos about eyes.” That's not the reason I stopped. People were saying that. I'm not surprised to hear people would've said that to you a little while ago. I'd be surprised if somebody said that now after seeing your YouTube channel. We underestimate how many people there are in the world and how many potentially may be interested in a certain topic. It's cool that you pursued it and that you could show everybody that no matter how small or niche of a topic it is, there are going to be people out there.

I'm not the only doctor who's making content on YouTube. I'm quite honored that I've inspired several of these other channels and other doctors to do. I may never be always the largest channel out there. These other doctors may be better at making content. They may make more viral content than me. I'm thankful for what success I have had, that I've been able to reach and help many people with their knowledge, even enough to go to their doctor and ask the right questions so that they can get better treatment.

I may not be the largest channel out there. Other doctors may be better at making content or making more viral content than me. But I am very thankful for what success I have had and that I've been able to reach and help so many people.

There are always two questions I ask every guest before we wrap up. I asked you these before you came on the panel. I would feel more complete in this interview if I asked you them again. You may or may not remember what you answered at that time because that was many years ago.

I'm a different person now. A lot happens.

Those were lockdown days. It was a long time ago. The first one is if you could hop in a time machine and go back to a point in your life when you were struggling, and it could be recent or many years ago, you could share that moment if you're open to it, but more importantly, what advice would you give yourself in that moment of difficulty?

I'll be vulnerable and open up about this. I'm dealing with divorce. I had a dark time, not just with losing the relationship. The relationship has dissolved. You enter these dark times when you have a lot of questions and you reflect. You think that either nobody cares or you've done something wrong, that you're somehow less than other people. In these dark times when you have these thoughts that you feel like there's nothing for you to keep going, there's no sunrise on the other end. You lose hope.

In these dark times where I've had, I've been thankful that I do have friends, family, and my coworkers, the other doctors I work with at the clinic. They care about me. There are many people that do care that you exist and that you are in this world. They care what you do. This is even more important. You are more than optometry.

Harbir, you are more than your show. Your profession and what you do is a small nugget on the outside of who you are as a person. You're a friend and a husband, you have a sense of humor, intelligence, drive, passion, and dreams. I'm not jumping on this show because you have a cool, awesome show. I'm jumping on this because I like you as a person. That is more valuable than your profession, YouTube channel, show, a book you write, or even your job as an optometrist or the clinic you own. It's about you, not necessarily the work you do.

Thank you for being vulnerable and open in sharing that. I appreciate that. I hoped we would be able to have an open discussion. You have gone all in. You've blown me away with how much you've been open to sharing about yourself and helping us understand who you are more than just the YouTube person. The final question is in everything that you've accomplished to this point, how much of it would you say is due to luck, and how much is hard work?

I do put a lot of work and hard work into everything. There is some luck. There’s a 70% and 30% split or something like that. It's 70% hard work and 30% luck. I was born to a middle-class family with an educated father. Both my parents were very well educated. My father happened to go to college. My mother didn't, which was a shame because she's brilliant. All of the opportunities that led me to the place that I am now, there's some luck in that I was even born in this generation and this time.

You could answer 70/30 and stop talking, but that's not what I'm looking for. I'm looking for exactly what you did there and giving that description. You're more generous than a lot of guests. Not to take anything away from other people, hard work is hard work. You can't sit in a room by yourself and hope that something magical is going to happen. You have to get out there and do the work. A lot of people will say, “99% hard work.” Hashing it out the way you did. The fact that you were born, where and when you were born are all very important things that we don't have any control over. I appreciate that. Any last words of wisdom you want to share before we wrap up?

You're making me think, “I need something profound.”

Give some Michael Scott quotes. That'll be a perfect way to end. If you missed 100% of the shots, you don't take Wayne Gretzky or Michael Scott.

There are many good quotes from The Office. I didn't watch The Office. I'm newly going through it. I love it when he's drinking white wine, smells it, and is like, “This is white.”

A great way to end the show with a nice laugh and a nice joke. Thank you so much. I appreciate this so much. This interview was everything I was hoping it would be, if not more. You are candid and open. You're like a shining light for the profession. Everything you're doing, the number of people you're reaching, and the amount of awareness you're creating are incredible. I don't want anyone to overlook the fact that you are highly trained and still seeing patients at such a high level. I appreciate on that level that you're pushing the profession forward as well. Thank you.

This is a huge honor for me. I appreciate it.

Thank you to everybody who's reading. Make sure you share it. This is one of my absolute favorite interviews. Please make sure you take a screenshot, put it on Instagram, throw it up on LinkedIn, and send a text message to a friend. Hit like and subscribe. There's a whole bunch of stuff you're supposed to do. Please go ahead and do it. Make sure you let me know what you thought. I always love hearing the feedback. We'll see you guys again in the next episode.

See you.

Important Links

• Dr. Joseph Allen

• Episode 11 - A Day In The Life Of An Optometrist With Doctor Eye Health (Aka Dr. Joseph Allen) – Past Episode

• YouTube channel – Doctor Eye Health

• YouTube – Dr. Habir Sian

About Dr. Joseph Allen

Dr. Joseph J. Allen is a practicing optometrist in Minnesota and the founder of Doctor Eye Health, an educational YouTube channel with more than 700K subscribers. There he provides information about eye health, ocular disease and vision products. His videos cover a range of topics that his subscribers frequently ask about: eye floaters, glaucoma, dry eye syndrome, contact lenses, eyeglasses, and more.

Dr. Allen has been featured in Ask Men  and Oprah Daily  and was awarded the Media Advocacy award  from the American Optometric Association in 2021. In his free time, he enjoys rock climbing, running, playing video games, hiking, and biking.