Eye Care

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

TTTP 94 | Migraine Treatment

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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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.

TTTP 94 | Migraine Treatment

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.”

TTTP 94 | Migraine Treatment

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.

TTTP 94 | Migraine Treatment

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.

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About Dr. Charles Posternack

TTTP 94 | Migraine Treatment

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.

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Episode 83 - Specsavers Canada GM, Bill Moir - The Future Of Canadian Optometry

TTTP 83 | Specsavers Canada

This impetus for the Future of Canadian Optometry series began when the announcement was made that Specsavers was coming to Canada, making bold statements about their plans for the market and rapid growth across the country. They plan to open 200+  locations across the country in the next couple of years. In the third installment of the series, Dr. Harbir Sian speaks with Bill Moir, GM of Specsavers Canada, to answer the questions that have been bubbling up about the future of Canadian optometry.

In this episode, Mr. Moir discusses:

• What made Canada a desirable market for Specsavers

• Why he believes consolidation is harmful to optometry

• The Specsavers business model has been successful in other markets (UK and Australia)

• What his organization is doing to support optometry

• What he feels needs to change with the educational system

Aequus Pharmaceuticals present the Future of Canadian Optometry series. Stay tuned for all six interviews with guests from different large organizations within Canadian eye care.

Listen to the podcast here

Specsavers Canada GM, Bill Moir - The Future Of Canadian Optometry

Welcome back to The Future of Canadian Optometry Series presented by Aequus Pharma. If you’ve been following along, then you know that this series of conversations is a series of interviews that I’m having with leaders from various organizations that have a footprint in the Canadian Optometry market. It’s to ask them the questions that we would like to ask as Canadian Optometrists about what they see from their perspective as leaders from these large organizations that the future of our profession is. Also, what can we do as optometrists to make sure that we are heading in the right direction to make sure our profession thrives?

Now, if you’ve been following along, you know that the previous two interviews I had were with Dr. Alan Ulsifer from FYidoctors, the CEO of FYi, and Dr. Daryan Angle, the VP of Business Development from the IRIS Group. This episode number three is probably the one that most people have been asking about and looking forward to because this one is with Mr. Bill Moir, the GM of Specsavers Canada. He is the one who oversees all of Specsavers and planned growth across Canada over the next couple of years.

The reason why this is the one that so many people have been looking forward to is because that’s where this conversation started. This impetus for the Future of Canadian Optometry Series began in 2021 when the announcement was made that Specsavers was coming to Canada. They made bold statements about their plans for market or rapid growth for 200 and 250-plus locations across the country that they plan to open in the next couple of years.

The trickle-down effect, the 2nd and 3rd order effect of that other organization battening down the hatches beefing up their recruiting processes. OD is seeing their staff and optometrists being at least approached to be poached from them. A lot of the conversations I was having with you guys out there with colleagues across the country started in 2021 when those announcements were being made.

I was excited to finally sit down with Mr. Bill Moir to start to ask him some of these questions that I know many of us have had. I’ve been going around and asking, texting, emailing, and speaking over the phone about what conversations we should have and questions we should be asking when we have somebody from Specsavers sitting down. What do you want to know? I will say at the beginning of every interview, I ask every guest to be as candid as possible.

I know everybody is going to have their canned or planned responses. They’re looking and giving their corporation their best face, but most guests are willing to go beyond that, share their inner thoughts and what their personal feelings are. Bill was one of the guests who kept most of his answers close to the chest and played it from the most corporate direction.

At the same time, I don’t think you’ll be disappointed with this interview as Bill did share some great insights as to what has happened in other markets with Specsavers in the UK and Australia and what he foresees happening here in Canada as the gaps in the market right now, where Specsavers feels they can fill in and what they can do to change and for their own benefit too for them to grow. You’re going to love this episode and take a lot away from it. Thanks again for tuning in to The Future of Canadian Optometry Series presented by Aequus Pharma. Here is the interview with Mr. Bill Moir.

Mr. Bill Moir, thank you so much for joining me on this special episode to discuss The Future of Canadian Optometry. It’s good to have you here.

Thank you, Harbir. It’s nice for you to have me.

As you likely know, not long ago, I put essentially a call out, more so an invitation to the leaders of various organizations that have a presence in optometry in Canada, and simply invited everybody to come on and discuss what we think the future of optometry will look like. Since then, I’ve been talking to a lot of my colleagues from across the country and getting their thoughts on taking this national temperature of the profession. A lot of the questions and the conversation topics that we’re going to cover come from our colleagues across the country who have questions that they’d like to have answered and are not always able to sit down with someone like yourself to ask them.

Of course, Bill, someone like yourself and other guests who are part of this conversation is in somewhat of a unique position within the leadership of these large organizations that have this presence in Canada and in some cases, in other countries as well. You have this perspective from an angle that many of us don’t. I’ll ask these questions and I’d love for you to share them from your unique perspective as much as you’re able to or comfortable sharing. I start everybody with the same question. That is, from your perspective, how would you describe the current state of optometry in Canada?

There are lots of positives about the current state of optometry in the industry in Canada. The quality of education for optometrists is strong. Optometrists in Canada are well qualified to give good clinical care. However, I do believe that the needs of patients and customers in the market aren’t being met all the time. We see a trend of consolidation of players in the market largely by private equity firms and the net result of this for customers and patients is that they increasingly have less variety of eyewear.

They have higher prices and that leads to longer return cycles. We did a survey earlier on in 2022 and we learned that over half of Canadians don’t think eyewear is affordable and consequently. Over 1/3 of them haven’t had an eye exam in the last 2 or 3 years. We know that by making eyewear affordable, we can reduce return cycles and lead to more regular eye exams, which not only improves disease detection for the patient but also grows the industry as a whole.

If we look at the optometrist, this consolidation means there are less options for career development, career progression, and potentially less independence to practice and it makes it harder to compete and, therefore, harder to establish and operate their own business. Our aim is to reverse that trend of consolidation.

I understand Specsavers has a presence in many countries now and I imagine Specsavers do their homework very diligently before entering a market. Also, Specsavers have had their eye on Canada for a while. From your perspective, what made Canada look like a desirable location for Specsavers to land?

You’re right. We have been interested in the Canadian market for a long time. We spent a lot of time in the country, understanding the culture and the market before we decided to enter it. One of the things which are appealing about the Canadian market as far as there are lots of different optical players here. We don’t believe that anyone is servicing the need of customers in the way that we would like to.

As I said before, we’re seeing high prices and long purchase cycles leading to the market not being able to always offer the best clinical care. The consolidation in the market leads to that as well. The thing that we find most attractive in the market is we believe we can come in with a very clear offer for patients and customers. This will lead to us delivering the best patient care to customers and doing it in a way where we ensure the independence and autonomy for optometrists, opticians, and retailers.

TTTP 83 | Specsavers Canada

Specsavers Canada: Optometrists in Canada are well qualified to give good clinical care.

You’ve mentioned the consolidation part a couple of times. I did have a question a little bit later, but since it’s come up already, I remember in a press release or something, there was a statement that Specsavers’ intent is to reverse the current trend of consolidation in the Canadian market. Obviously, that’s a big point of conversation, generally speaking. For a large entity like Specsavers that has the intent to have a couple of hundred stores across the country and already 2,500, if I’m not mistaken, across the world, is that much of a different presence than the consolidated presence of other organizations?

We’ve seen this in other international markets in the past before we went into Australia. For example, many years ago, there was a company that had close to 50% market share. They had it across three different brands, but they’d grown by having acquired lots of small chains in independence and they dominated train supply to the independent optometrist competitors as well.

The end result was basically high consumer prices, long return cycles for customers, and consequently, little investments to grow the market. Specsavers operate quite differently. Our focus is on affordable eyewear and access to high-quality eye care, as well as the needs of our partners who own our stores and the local community. Those are the key things that we bring to the market. Specsavers’ optometrists are number one in Australia.

For all customers, eyecare needs the return cycles significantly reduced. The optical sector industry has doubled as a consequence of it. The detection rates find these things have increased dramatically as a result as well. What we bring by introducing that affordable eyewear, but access to high-quality eyewear, we encourage people to visit their optometrists more often. We set up more independent optometrists and opticians in their own businesses and communities to be able to service the needs of their customers locally.

In a setting like in Australia, if I’m not mistaken, their private practice optometry wasn’t as prominent as it is here in Canada, where I believe 60% of the market or so is private practice. With an entity Specsavers, any large entities going to come in and take up a lot of market share. It’s conceivable that it’s not the consolidated companies that are going to be losing the market share but a lot of the private practice optometrists as well.

We work with private practice optometrists. That’s what Specsavers optometrists are.

What’s the reception been so far for Specsavers in Canada with optometrists specifically?

It’s been very positive. We’ve had positive responses from our partners and associates. To be fair, we spent a lot of time, before we even entered the market, listening to Canadian optometrists about what’s important to them. What we learned is that the investment in clinical equipment and their independence is being able to act and develop as professionals while also understanding who they are personally, things like work-life balance and personal ambitions.

These are the things that are important to people and they’re important to optometrists in the industry. We know there are also significant differences by province. Not every province is the same, and we’ve had to adapt our model and benefits. They offer to suit different provinces where needed. There is a core model of enabling and supporting optometrists on and building their own successful practice that has been incredibly well received across the board.

We put a very high support environment around our independent optometrists. That allows them to focus on what matters to them, which is patient care where we can support them in all the other aspects of running their business, like product supply, marketing, finance, accounting, and payroll, all these things, which isn’t their core skillset, or they don’t want to focus their time. We’ve spent a lot of time crafting a high-support model which is right and meets the needs of optometrists in the Canadian market.

By making eyewear affordable, Specsavers can reduce return cycles and lead to more regular eye exams, improving disease detection for the patient and growing the industry as a whole.

On that note, I’ve been chatting with optometrists across the country. Before I even started doing that, when Specsavers was official or everybody knew Specsavers was coming into the market, I was curious what was the national, as much as I could, feeling or sentiment about Specsavers entering the market? Most of us knew that there was this intent for a long time, but when that initial acquisition of image happened and the first locations opened up.

I did my own little unofficial poll of as many people as I could from across the country in different practice modalities. I texted, emailed, and asked verbally. The question was quite simple. What is your initial sentiment about Specsavers entering the Canadian market positive, negative, or indifferent? I got about 41 responses and the answers were as follows, 1 positive, 26 negative, and 14 indifferent. First, I’d like to get your thoughts on that. Initially, how would you respond to that?

That’s disappointing. It also goes to show how little people potentially know about the Specsavers brand and the work we’ve done in other markets. What we’ve been doing is being as open and as visible as we can be to try and share more about the business and help people understand what we do and what drives us. We’re quite unique as a business in a number of ways. We are privately owned and led by optometrists, which makes us quite unique. We are purpose-led. Doug and Mary, who own the business, still actively lead and run it now and do that with the same level of passion, care and commitment as they always have. That means we don’t need to answer shareholders.

We’re not beholden to a bottom-line profit like a lot of private equity firms are. We’re driven by them because they’re optometrists and improving people’s lives through better sight. That’s our aim. It’s ingrained in our business in everything we do. We’re a customer and partner-led model, so customer-first because we’re a purpose owner with our ownership structure. We truly have a customer-first mindset in everything we do.

That’s from striving for clinical excellence and eyecare to making sure that the high-quality eyewear we have is accessible and affordable. We’re a partnership business. All Specsavers stores remain owner operated under a high support franchise partnership model. It’s called a Joint Venture. Our aim is to make them successful and support them so they can focus on the eye care where needs for their customers in local communities.

That’s what we want to try and bring to Canada. Our goal for Canada is to provide Canadian communities with exceptional clinical care, advanced clinical equipment with dedicated professionals owning their own businesses, and looking at the needs of their patients. We’re being as open and transparent as we can with people giving access to us to find out more about our business so they can get to know us and understand the good that we bring to the business.

We say, “When we went to the Australian market years ago, as a consequence of that, the optical market in Australia has doubled on the back of that.” The detection for patients has practically doubled as well. There are a lot of benefits we bring both to the industry itself and patients and customers within it as well.

If I can expand a little on the poll. When I ask these questions and I get a response, I would usually follow up with, “What’s the reason?” Between the negative and indifferent, some people shifted back and forth. Generally speaking, the optometrists we’re responding with indifferent, we’re looking at it more from a business perspective, “I’m comfortable with where my business is. It’ll be fine. There are always new players in the market. It’s all good.”

They’re not thinking a whole lot about it. The negative, some of them were worried about their business. The majority of the negative was more so concerned about the profession as a whole. Not so much about their business but the optometry profession across the country. Those were the interesting responses that I was looking into.

When I looked into that, the concern about the profession as a whole and these doctors responded with a negative response. Most of them were worried about the profession being devalued or commoditized, and a lot of those feelings were coming from what they had seen in other countries, including Australia being one of them and the UK. What is your thought about those sentiments from optometrists?

TTTP 83 | Specsavers Canada

Specsavers Canada: Being able to act and develop as professionals while also understanding who they are personally – these are the things that are important to people.

If we look at what we’ve done in other markets and plans here as well, we’re an optometry-owned business, so optometry is very much at the core of who we are. That’s what drives us and leads us. Our aim is to make sure we improve the industry, both for the professionals who work within it as well as the customers and patients who rely on it on a day-to-day basis.

Our aim is to grow the optimal market all in Canada by providing high-quality eyecare and affordable eyewear to encourage more frequent visits, change the market, more frequent visits to optometrists, improve the eye disease detection rates, as well as growing the market as a whole to get better patient care. We share our knowledge from across the globe.

We’ll work with key stakeholders in the market to continue to grow and strengthen the industry too. That’s from working with the colleges, investing in graduates to help grow future optometrists for tomorrow, working with associations across different provinces, and also working with different stakeholder groups across Canada to make sure we’re continually developing and strengthening the industry.

Generally speaking, making eyewear less expensive is one thing, but making eyecare more accessible. Does that also mean making it less expensive?

As I say, our optometrists are independent, so they have their own autonomy to run their practice, but that’s not our aim. When we’ve talked to customers, research tells us it’s the cost of eyewear and, often, the prohibited cost of eyewear stops customers from visiting their optometrist. We aim to use our scale to bring high-quality but affordable eyewear to customers and encourage them to visit their optometrist more often. As a consequence of that, they receive the eyecare they need. We don’t see any value in discounting the cost of eye care. It’s not our place to do that either because we have independent optometrists who take these decisions.

Is it the optometrist who sets the price of the eye exam?

That’s correct. We would try and always have optometrists that are like-minded to us. We want to have a cost structure and pricing structure that’s accessible to customers. Ultimately, it’s the optometrist’s independent practice.

You’ve already touched on the long-term goal for Specsavers in Canada.

Ultimately, we’d like to grow the Specsavers business so we can provide improved access, as I said, to high-quality eyecare and affordable eyewear to benefit more customers and patients. That’s the aim. We said we’re investing in rolling out 200 locally owned clinics, and they’ll be quick for the latest technology. They’ll be rolling out across Canada over the next couple of years, and we’ll cover and invest.

That’s a big investment play for us to cover 100% of every clinic's startup costs. Each optometrist and optician owner partner will have no costs to go into business. That will cover all the design, construction, displays, etc. We’re empowering the independence of optometrists by reducing some of the common barriers to ownership. By doing that, we aim to provide better levels of eyecare to patients. As I said, we encourage more regular visits to optometrists from Canadians as well as creating stronger career and business ownership opportunities for optometrists and opticians.

The key things that Specsavers brings to the market are a focus on affordable eyewear and high access to high-quality eye care, as well as the needs of partners and local communities.

With the current practice modality for an optometrist in Canada, the way we practice and the way our regulations are, does that align with that growth that Specsavers is planning to have over the next couple of years, or do you feel that it might need to change for that growth to happen?

I don’t believe it needs to change. There’s got to happen. The model we’ve got in the stores we’ve already got is operating successfully, so there’s no need to change in order for us to meet our mission. However, we would certainly be working with the industry to constantly see how we can involve, improve, and develop the way we work as an industry. We’re providing continued development and opportunities for optometrists as well as continually trying to improve what we do and how we do it to provide better patient care.

When you say industry, are there specific entities that you’re referring to?

Across the board, all the professional associations and colleges that deal with optometry and opticians across Canada.

When I put that initial invitation out there, the core question I’m asking every guest that’s coming on here is, what is your organization doing to support the growth and strength of the profession of optometry in the future?

Our aim is to make sure we improve the industry for both the professionals who work in it as well as the customers and patients who rely on it. We’re very partner focus and patient customer focus. We want to do that by providing high-quality eye care and affordable eyewear. It’s all about encouraging more frequent visits to an optometrist to improve eye disease detection rates as well as growing market share as a whole and giving better patient care. We found from research that people visit their car mechanics more frequently than do their optometrists. There’s something fundamentally wrong about that in the industry.

They’re driving the wrong cars, Bill.

Maybe they are, but they should be worrying more about the sight than the car. Over 1/3 of Canadians haven’t had an exam in the last 2 or 3 years. That’s what we’re going to try. That’s what we would like to try and change. We’re making it a considerable investment in our clinical proposition to make sure we deliver the best care, everything from the equipment which is available at our clinics to the development programs.

With the opportunities, we’ll be creating independent optometrists to work in them. We’ll share our knowledge across the globe of the work and work with key stakeholders to continually grow and strengthen the industry, so we’re working with the colleges, associations, and other stakeholder groups across Canada. We’re also interested in investing in research and continuing education as well. We run big clinical conferences in other regions to bring together professionals to try and continuously develop and grow our learning.

Do you think it’s important for the scope of practice in Canada to continue to grow?

TTTP 83 | Specsavers Canada

Specsavers Canada: Research tells us it's the cost of eyewear and the often prohibitive cost that stops customers from visiting their optometrist.

It’s important for any industry to grow, develop, and adapt to the needs of customers as they change. That’s fundamental. That’s true of the eyecare industry as well as anything else. One of the concerns I suppose I have is that the consolidation that’s happening in the eyecare industry at the moment, it means many clinics will essentially be swallowed by private equity own businesses. Without the focus, primarily, it often becomes about the pairing companies’ bottom line rather than the quality of eyecare for their customers.

That means that through these providers, often the cost of an eye can increase and become more expensive. That increases the time between purchasing new frames and visiting the optometrist, meaning that Canadians don’t get their eye exams as frequently as they do for their health. We know that from the research we’ve done. That’s the thing we are trying to solve and reverse by launching our brand with independent optometrists in the market.

I understand the concept of lower-priced eyewear results in more frequent visits back to the optometrist. How does that patient, either before they come in or after they leave, say perceive that as a high-value, high-quality eye exam?

There are probably a couple of things that are key. In reality, it’s two things. It’s about the clinical experience, and absolutely, it’s also about the patient experience. Our compassion and expertise to help people feel good, cared for, and smart is what we’re trying to do. We want people to receive the right care for them, give them self-confidence, and help them see better, but they need to have a trusted expert.

Part of that is around the experience they get in-store, the journey, how they’re led to do that, and the actual clinical experience they get. Hence, every customer who comes in, as part of their standard eye exam, would have an OCT. We know from other markets we’ve done that in that it massively improves disease detection. Also, from a customer feeling point of view, customers can see the value in that. They can understand the technology that’s being used. They can see that and have a greater trust in their eyecare professional because they’re receiving the right level of clinical care.

How much does it cost for an eye exam at Specsavers in Australia?

Australia is different and quite a unique market where the government pays for eye exams. It’s a very different model in Australia than it works over here.

In our case, that would be the same as here in BC. We have MSP in Ontario and whatnot. Would it be the equivalent of that pain for the eye exam with no additional charge?

It’s a more significant contribution the government makes. MSP is more of a top-up in BC. That’s how it works in Australia. Typically the clinics we have in BC charge $99 for an eye exam for customers, which is pretty much in line with the competitors across the market.

Is that how much you feel about a high-quality, comprehensive eye exam? Would you say, in your opinion, $99 is the appropriate price?

Technology will continue to provide better insights and diagnostic information to the optometrist.

The important thing for customers is to make sure we encourage them to visit their optometrist more often. For me, it’s not about Specsavers or maximizing the revenue from every single visit, but it’s about making sure our customers are getting a great experience and high-quality clinical care so that they return to the optometrists on a regular basis. That’s the key thing. From a customer’s point of view, they’re receiving better clinical care. From an optometrist and an industry point of view, you can argue we’re getting better lifetime value as well.

Would you agree that if, across the board and the country, an entity such as Specsavers, it could be any company, but if they have a larger footprint, is charging a set price, which is significantly lower or noticeably lower than most other private practice or other entities that it changes the perception of the value of the eye exam, and that specifically the service? I’m not talking about the eyewear, but the eye exam service, is the perception of the value of that service then if X company is setting it at a significantly lower price, then, generally speaking, the service is not valued as much as if it was set at a higher price?

Possibly. The way the market and the industry in Canada work in terms of how optometrists are rewarded actually encourages that to a degree. It encourages more of a status quo in the market, in particular, businesses wanted to go and significantly reduce the revenue that was charged to customers from eye exams. We probably struggled to get optometrists wanting to come and work for them. If I’m being honest, the industry selfs to a degree on what customers are to be charged and what a fair price is for an eye exam. The ways to grow are to grow the degrees of clinical care that are given, but generally, the market is quite self-regulating.

In BC, a few years ago now, I can’t believe it’s been that long. We had a pretty significant legislative or regulatory change where a large eCommerce player clearly contacts basically infiltrated the government and managed to change regulations to their benefit. What I’m asking all the guests is like, “Do you foresee potential regulatory changes, whether in BC or across the country, by any given player to improve their outcomes versus specifically the benefit of optometry?”

I wouldn’t want to predict what changes could be made to the regulations in the future. Clearly, the case was quite a significant change a number of years ago. Our aim, as we said, is actually to provide better access to eyecare and more affordable eyewear to Canadians. By doing that, it is to encourage people to visit their optometrist more often than we do now.

We don’t need or want changes in regulations in order to achieve that. We are happy to work within the regulations that exist in the market at the moment. It supports our model because we’re supporting independent optometrists and setting them up in their own businesses to serve the needs of their local community. It works very well with us.

In fact, what we’re trying to do is remove some of the barriers for customers visiting their optometrists. There are types of barriers that would encourage people to look at alternative channels to purchase such as online for example. What we are trying to do is make sure people visit their optometrist for their eyewear and eyecare needs so that they can receive good quality eyecare when they do.

With advancements in technology and so on, one of the topics that come up quite frequently now is remote services or virtual. How do you see remote, whether it’s refraction or an overall eye exam? How do you see that playing into optometry as a whole and Specsavers specifically?

There are different aspects of that. We operate tele-optometry services in some of our other markets. That’s an interesting proposition. It is an emerging service. It can offer flexibility, choice, and accessibility for patients. It’s an important area for us. As I said, we’re offering it in some of our other areas, but the starting point for this need to be patient care.

In ensuring this can be successfully upheld, we need to be able to successfully have health standard care that is set up by the colleges. We tell things like tele-optometry can be a valuable service for patients, particularly in remote communities. It needs to go hand in hand with the option to be referred to a doctor for face-to-face examination if needed.

TTTP 83 | Specsavers Canada

Specsavers Canada: We need to remove some of the barriers for customers visiting their optometrists.

I would never advocate it almost as a pure remote service. It can be a useful addition to help patients in remote communities get much-needed access to eyecare, but it needs to be done in conjunction and, in my view, in a store environment, and with professional handhold customers through that. The ultimate option is to see optometrists face-to-face if needed.

With all of those potential, the technologies being available to us is difficult to predict exactly which way it’s going, but I’m sure someone like yourself and others that I’m speaking to have some access to some information that might help guide you a little bit. Where do you see the optometrist and what do you perceive the optometrist’s role being 10 years or even 20 years from now?

There’s always going to be a real technology continually improving. Technology will continue to provide better insights and diagnostic information to an optometrist. We’ve done a lot of work in the sphere of AI and understand how that can get involved, but we still continue to see it as a useful suite of tools of technology for optometrists as opposed to replacing optometrists. In our point of view, we’re using levels of AI with the OCT machines we have in-store now. They provide a custom dashboard for our optometrists, so they can more easily detect issues with patients if need to. We’re constantly working on developing these things, but they are primarily tools for optometrists.

Of course, we know that AI is a big part of healthcare, but some concern that that’s going to then essentially move the optometrist out, and the technician can take that role and read a chart and say, “It’s red, you should be referred. It’s green, you’re okay.” How do you respond to that concern?

We’re an optometrist-led business. In our view, we would always see an optometrist as being a core part of the customer journey. As I said before, clinical diagnosis is key, but also patient care. It’s having that balance key. I still think I’ve trained an optometrist is going to be a core part of the journey for a while to come.

We touched on the educational system a little bit here and the level of education. The number of graduates is very different in North America, especially in Canada. I should focus on Canada here. We only have two schools and only one of them is English speaking. In the UK, it’s very different. There’s been quite an expansion in the number of schools in the UK. Of course, that means that there’s been a larger number of optometry graduates in the UK over the last decade or two.

That growth of the optometry graduates is exceeding the growth of the actual population. This question is twofold. Do you feel in the UK that there’s an oversaturation of optometrists in the market? Is that leading to a devaluation of their position? The second part is, do you foresee that growth in optometry schools and graduates happening here in Canada? Do you think it’s necessary?

I don’t know the numbers specifically enough to comment on the UK. In Australia, though, I can share some of the work we’ve done, where we saw a market a few years ago, which was under service. An optometrist undersupplied it and there weren’t enough optometrists to service patient needs. Consequently, that resulted in long waiting times for optometry clinics. It was a barrier to rolling out clinics to remote areas.

It resulted in less frequent visits to optometrists and a bigger strain on the healthcare business because eye disease wasn’t detected promptly. We actively got involved to improve that position. We worked with the industry to increase the supply of optometrists in the country. I see a similar position here from being honest. I see a real shortage of optometry graduates coming through and some real barriers to optometrists being able to practice in Canada. That is driving some of the same traits here and it’s resulting in the Canadian industry not being able to actively serve the needs of customers, particularly in some remote areas. It’s one of the barriers to giving patients accessible eye care.

When you say that Specsavers got involved in that, how can you elaborate on what that exactly involved?

We need to keep the levels of clinical practice and standards high in Canada.

We worked with the government, local colleges, and associations to grow the intake levels of optometrists across the country. We helped to fund and invest additional places in optometry courses, which relieved some of the shortages and stress in the industry.

Were there investments made in schools? Is that correct? Were there new schools opened or have these current schools increased their capacity? What did that look like?

It’s a combination of both. We helped to support them. As I say, they aren’t run by us. They’re independent colleges and university’s decisions, but we helped support where we could.

Do you feel that there’s a bit of a conflict when an organization is involved at the educational level?

We helped support as a market leader in the industry. It was something that wasn’t unique to us. All the players in the optometry industry were encouraged to follow that lead.

As you mentioned, you feel there’s a need for that in Canada to increase the intake of students, then the output of optometry graduates. In your mind, it’d be a similar setup. If you were to see it happen, it would be industry organizations, entities like Specsavers, FYi, or whoever is contributing to schools opening up and more students entering.

As a country, Canada has a shortage of optometrists. It’s as simple as that. There’s a need for us to develop more future optometrists coming through. As you said yourself, there’s only one college that has a relatively small intake every year. If you look at the growth of the population, there aren’t near enough optometrists coming through to satisfy that growth. That’s going to put a continued strain on the industry and the optometrist who currently work in the industry now. It’s going to result in the eyecare needs of many customers and many Canadians not being met.

From a professional standpoint, as the first part of that question, I know you weren’t able to comment on the UK market, but if there’s a larger influx of optometrists in the market looking for jobs, then it’s perceivable that their value will then decrease. There are a lot more optometrists. What they’re going to get paid or what their perception of their value? Is that going to decrease? Would you agree?

We’re all in this industry for the same reason: we want to provide good eye care to patients and detect eye disease if needed. That’s fundamentally why we’re all here. We’d all agree that the right thing to do is make sure we’ve got the right level of cover for an optometrist for customers' needs in Canada.

One of the unique things we have here in Canada is that we have the US neighboring us, and there are a whole bunch of schools in the US and there’s fairly open access. I went to school in Boston for us to come back to Canada from the US. The transition is fairly straightforward. That’s allowed the number of optometrists to stay at a reasonable level.

TTTP 83 | Specsavers Canada

Specsavers Canada: As a core part of the customer journey, the optometrist is key.

It’s not the one school that’s putting out their 80/90 waterloo. I can’t remember what their number is per year. The program in the US is essentially the same waterloo in New England college where I went to school and others have the same academic program, graduation four years, and the fourth year is all clinical, standardized exams, and all of that thing.

For optometrists in other countries, it’s not the same program. As you know, here we have the Doctor of Optometry degree and in other countries, it’s a Bachelor’s. If I understand, in the UK, it’s now a Master’s. What is your feeling about optometrists from other countries coming in? It’s a fairly rigorous program that they have to go through right now at 2 or 3-year program and exams that they have to go through. Do you feel like that process of those optometrists coming to Canada needs to change or is it okay the way it is as far as you’re aware?

It’s a shame for Canadian graduates who want to pursue a career in optometry that they have to go to the US often to get it. I’m sure you can also advocate it’s an expensive route to go down. That’s a barrier to many people entering our industry, which is a shame. It’s absolutely right that there are high levels and high standards for optometry caps in Canada.

That should maintain and that’s great, but we do need to also find a way to encourage more people into the industry and have more opportunities. It’s very prohibitive for people to go to the US to qualify who may then lose to the US for a number of years and may never return to Canada. I’m a big advocate of keeping the levels of clinical practice and standards at high in Canada.

Staying on the conversation about schools and graduates. These days, it’s quite a different market than it was a few years ago, where new grads now seem to be in very high demand. There are different organizations, whether it’s Specsavers, FYi, or others offering various incentives for these new grads or young optometrists high salaries, signing bonuses, or forgivable loans.

On the surface, that sounds pretty glamorous for a new optometrist to have all of these incentives put in front of you. I’m curious to hear your thoughts on whether you think it’s the optometrist who’s at an advantage or has the leverage here or is it possible that the incentives are potentially clouding their perception in their decision-making for the long-term of their career?

It’s interesting because optometrists are highly skilled professionals and it’s a competitive job market. We spoke to optometrists and we’ve had a number of focus groups to understand what’s important to them. Student incentives, the ones you mentioned, are important to them. Could they graduate with substantial loans, particularly if you have to go to the US to qualify? That can be a heavyweight for students, but what’s interesting in the work we’ve done is that we find there are other things that are actually as important to them.

Culture is absolutely key to having an alignment of values and maintaining their independence. The environment they’re going to go into, who they work with as a peer or mentor, having that in place, and the location of the clinic as well, plus ongoing development programs and growth, will be for them both professionally. Also, as their careers and earnings over time.

It’s not one thing that’s important to graduates. Focusing on some of these big financial incentives up as a standalone probably is not. It’s offering people a wider suite of things that they’re interested in. These are all the things we focused on. Things like the culture and the environment you work in are absolutely critical. We’ve been ranked as the great place to work in Europe for a number of years in a row as a pride ourselves in the right culture and environment for optometrists and not focusing on the financial aspect of what we do.

We’re demanding people as optometrists. We want the money, the location, and the culture. It’s not wrong to ask for it. What would you say if you had a young student in front of you considering going to optometry school? Would you encourage it or put a disclaimer on there? What would you say to that person?

Of course, I would encourage it. It’s a great opportunity for them. As I said, the reason why we’re all in it is to improve life for a better sight. That’s the reason why Specsavers was here. If we got an opportunity to focus on that, help their patients, and wake up every morning helping patients in their local community, that’s what they do. It is a very filling direction to go into.

Thanks for doing this, Bill. I appreciate it. Is there anything else or any other message you’d like to share before we wrap up?

No. I’d like to thank you for the opportunity and for having us tell a bit more about our story. We’re excited about being here in Canada and the journey that we are planning for the next few years. The people who are joining us on a daily basis help deliver high-quality eyecare and affordable eyewear to Canadian customers. Thank you for the opportunity.

Thanks for coming on, bill. I appreciate it. Thank you, everybody, who’s been following along with the show, Canada’s number one optometry show, and this special, The Future of a Canadian Optometry, conversation that we’ve been having. Make sure you share it with your friends and let all of your fellow Canadian colleagues know that we’re having this conversation. There’s been a lot of amazing insight and important information being shared here by the guests that I’ve had that is going to be very relevant to all of us going forward as we’re all hoping to grow the profession. Thanks for reading. Make sure you share it. Take a screenshot and put it on Instagram, LinkedIn, and everywhere that you are. Shoot me a message and let me know what you think. Thanks again, guys. Take care.

There it was. That was episode number three of The Future of Canadian Optometry Series presented by Aequus Pharma here on the show, Canada’s number one optometry show. This interview was with Mr. Bill Moir, GM of Specsavers Canada. There was a lot of good insight in there. If you were reading, you’re picking up some of the cues and some of those reading between the lines about what Bill was saying and the plans for Specsavers in Canada.

Let me know what you guys thought. Please send me some messages and leave some comments. Make sure you stay tuned. There are three more interviews to go. The next interview is with Mr. Rick Gadd, who is the President of Essilor Canada. After that, the next one is with Mr. Alfonso Cerullo, who is the President of Lenscrafters in North America.

Finally, we’re going to cap it off with a fantastic interview with Dr. Kerry Salsberg to give us the perspective of a successful independent OD from his perspective about what we need to do as optometrists to make sure our profession thrives in the future. Thanks again for tuning in and sharing this with our colleagues across the country to make sure all of us are hearing these conversations here on the show. I’ll see you again in the next episode, which is the interview with Mr. Rick Gadd from Essilor. Take care, guys.

Important Links

About Bill Moir

TTTP 83 | Specsavers Canada

With over 20 years of executive board experience, Bill Moir has always been passionate about people and outcomes. He has been implementing customer-led and store-focused solutions with companies including Comet, Google, Dell, and Coles across the UK, Europe and Australia.

Since joining Specsavers Australia and New Zealand in 2017, Bill has driven significant growth in the optometric industry and pioneered customer initiatives to advance eye health. He was also instrumental in advancing access to eyecare and eye health services during the Covid-19 pandemic.

Bill now lives in Vancouver and as General Manager of Specsavers Canada, he is keen to transform eye health and deliver high-quality and accessible eyecare to Canadians.

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Episode 61 - The Business Of Treating Dry Eye: A Discussion With Dr. Bruce Dornn

Eye related problems make up a large number of medical cases in Canada, and Dry Eye is one common complaint. Helping people suffering from dry eye has been Dr. Bruce Dornn’s calling. Dr. Dornn has built a busy and successful dry eye practice, in which he has performed hundreds of advanced dry eye treatments such as radio frequency (RF) and IPL. In this episode, Dr. Dornn shares his insights with Harbir Sian into how ODs should start to build their dry eye practice. We also hear the key steps that have made his practice so successful.

Watch the episode here

Listen to the podcast here

The Business Of Treating Dry Eye: A Discussion With Dr. Bruce Dornn

I'm very excited to come back again with a wonderful guest here on the show, bringing clarity to optometry, business, entrepreneurship, and life, all of it. As always, before we get started, I would like to ask one little favor, and that is, if you get any value out of this episode or any other episode, please do share this show. Subscribe, follow and like. Do all the things that you think should help us grow. It has been an amazing journey so far, and I appreciate all the support that we have received. Thank you for that, and thank you in advance for all of the future things that you do to help support the show.

As I mentioned, we have a wonderful guest. His name is Dr. Bruce Dornn. He graduated from the University of Manitoba with honors in Microbiology. He attended the New England College of Optometry in Boston. He practices in his own practice, Dornn Eye Care. He also started, in 2012, his own company called Eye-Revive, which is a company that sells an extensive line of dry eye products available exclusively through optometry practices. He, himself, has a pretty extensive dry eye practice, and we are going to be talking a lot about dry eye and the business of dry eye. Thank you very much, Dr. Dornn, for joining me here on the show.

Thanks a lot for inviting me to the show. I'm excited to be here and talk with you. This is a topical issue for a lot of optometry offices now. It's good timing.

Dry eye is one of the hot topics in our industry. What you have said to me a few times is it's starting. We are growing this thing now. It feels like maybe we have been talking about it for a while but the place that we are going with dry eye, that we are at the beginning of it, we are still at the tip of the iceberg. Tell us a little bit about your practice in general, and then we will go into some specifics as well.

My wife and I started our practice about several years ago, where we are located centrally in Winnipeg in a major thoroughfare. We bought an old bank, renovated it, and we started this practice. It has been a long journey. My wife is an optician. She has been very instrumental. She set up our dispensary. She does all the HR and the staffing. She has been great on that side of it. We have slowly grown our practice over those years, as most people do. It has been several years ago when we started to get interested in dry eye. We try to diversify and make a subspecialty of a dry eye in our practice. That's where we focused our energies.

Several years ago, it was pretty early in the dry eye game. The fact that you started your other company almost several years ago, it's pretty impressive. Someone like myself, for example, has only been dabbling for the last few years, so you've clearly got a lot of experience in that area. If we could talk a little bit about how you’ve got into that, how you decided to start getting into the dry eye, and what were some of the early steps that you took in your practice to make that sub-specialty part of your practice.

There was a day and a patient where something clicked in my head that dry eye is the way for us to go and become fully invested. A patient came in, had dry eye and concurrent blepharitis. We have seen thousands of these patients. The patient was in my office, and I recommended some things. I said, "You need to go home and do some warm compresses. I'm going to give you some sample lid wipes and sample artificial tears. In about ten days, I would like you to come back, we will talk it over and see if you have improved and how things are going."

This patient comes back ten days later, sits down on my chair, and I say, "How's it going? How are things?" He goes, "I feel terrible. Nothing is improved. I'm not feeling any better at all." I'm like, "Describe to me what you are doing at home." He goes, "I took this base cloth. I put some warm water on it. I slapped it in my eyes. I did it once or twice. I didn't do it that often." I said, "Did you use the samples that I gave you, the lid scrubs?" He goes, "No, not really." "Did you use the artificial tear I gave you?" "No, I didn't even open the bottle."

At that moment to the realization was I had given him those things as samples, they were free, and to him, they had no value. They were these free items. His impression of what I did was, "He's not very invested. He gave me a couple of samples. He doesn't care that much about what I'm feeling." What I decided to do was bring in products that I would sell to patients. I would describe what they have. I'm going to give them my treatment plan, and then I'm going to get them to buy the products.

If they believe in what I'm saying and are going to be invested because this is an at-home maintenance treatment, I would like them to buy the product. It's going to be financially healthier for our practice but not only that, if somebody buys a product, they are invested. They are going to be a lot more compliant if they spent their own money.

We went out, sourced products, went to trade shows, looked at things, and we developed this product line that we are going to have in our office. I started noticing my compliance rate didn't just go up a little bit, it was a night and day difference between what I was doing before and the results I was getting now. That changed my mindset. I thought to myself was, "Dry eye, go all in. Do everything you can possibly do for a patient or refer that patient, or let somebody else deal with that." That's when I decided we were going to make a subspecialty out of the dry eye.

That's amazing that you thought to do that because of the thing that you were doing initially, "Go home and do some warm compress. Here's a sample." That's what the majority of our profession, including myself, were all doing for so many years. I found it was hard for me to make that switch to selling products. I felt like there was something uncomfortable for me when I was selling the drops to the patient. Now, I don't feel that way but a few years ago, I did. I feel like there are others out there who feel the same way. Is there something that you could say to encourage people to make that step, to start carrying these products in their office?

Dry Eye: Something that we've started to learn over the years is how important it is to have good staff. It's vital.



We all feel this, and I'm not sure why this sense of maybe subtle guilt that the patient has to spend their own money and buy products in our own product but the reality is if they don't spend that money in our office, they are going to go to a pharmacy, not knowing what to pick and what's appropriate. They are going to spend that money. They are more frustrated because they get the wrong thing.

Patients are much more satisfied if you say, "These are the exact things I want you to buy and the exact procedures I want you to do in this sequential order." When they see that, especially if you include a follow-up with that. I always follow up on my patients. I never say, "Go out and do hot compresses. I hope that works. See you in a year or two." I always have a quick follow-up in 10 days or 2 weeks. It doesn't blow up my flow or my routine. It's very easy to fit these patients in.

When they see that you are invested, they will invest. They know there's a problem. They are coming to you for that problem. They want your expertise. No one has more expertise in this field than an optometrist. We are the people that spend the time and the effort. We look at every part of eye health. Optometrists should think about that, and their recommendations hold a tremendous amount of weight with these patients.

From that point, you started carrying the drops and some of these other products, and now, you have some more advanced technologies that you are using in your practice. Can you tell us about where you are at now, what type of technologies you are using, and how long you have been using them?

I would break up our dry eye practice into three aspects. One is we have all the at-home maintenance products that the patients can get when we treat their dry eye. This is a condition you maintain. I described this to patients a little bit like if you are a diabetic. If you are a diabetic, you go to your doctor, your doctor first diagnosed you. They do some tests. They diagnose it.

They prescribed something or they treat you with insulin but they were also going to ask you to go home and say, "I want you to change the way you eat. I want you to exercise and lose weight." That is an at-home maintenance that you are expected to do on your own on a daily basis. To me, dry eye is very similar to that.

What we did was we broke our dry eye specialty into three types. We do the diagnostics. I went out and invested in some good diagnostics that I would be able to show my patients what it is I'm seeing. If patients see images of meibography, noninvasive tear break-up times, tear meniscus height, and they seem normal compared to what they have, very powerful images that they see.

Second of all, we obviously invested and got a line of products that we can give them to go home and maintain. We have all these products ready for them. A person comes in for a dry eye consult. For every single adult in my patients, we do a baseline meibography and noninvasive break-up time because half your dry eye patients are very symptomatic but the other half are asymptomatic.

If you want to find out about other groups, we started doing meibography on adults. We have two pieces of equipment. We have an OCULUS K5M, which is an exceptionally good machine. It's a little bit pricey but it's very good as far as diagnostics. We also have a Firefly, which is a slit lamp type device that you can do all the same tests, plus you can do a video when you are doing gland expressions and things like that. Those two devices were critical in being able to describe the patients and diagnose patients.

Thirdly, instead of prescribing, let's say, Restasis or Xiidra, we went out, and we decided we were going to the early adapters of new technologies like RF and IPL, which are revolutionary. Instead of treating dry eye medically, which surprisingly, in a lot of cases, doesn't work as well as we would like. We have all been through this.

We have given that prescription, the patient comes back 2 months, 6 months, and they were like, "My eyes are killing me. It's no better." It's frustrating because you have no recourse. What do you do now? Whereas once we started adapting RF and IPL, we can still use those medical treatments but now we have a very powerful treatment modality that is far more successful for my patients than using medical treatment.

Which devices are you using specifically? Do you have both RF and IPL?

If we could do something that's more effective than our old ways of doing things, that would be a breakthrough. 

We do. InMode has a tremendous workstation. It's called the InMode device. It's got both an RF and an IPL in one machine. The IPL is the Lumecca. They have developed a special handpiece that's just for eyelids for their RF, the radio frequency. It's a tremendous piece of equipment because we can use this right on eyelids with no shield. It's a bipolar type of technology.

What they have done that makes this very applicable to optometry is when you use a bipolar type of RF energy, you are very precisely controlling where that energy goes. It creates a very low-level electrical current when you place that on the eyelid, that current is precisely controlled, and as the current goes through, the skin creates a bit of resistance, which creates bulk heating.

That bulk heating is very specifically confined right in the dermis, right where the meibomian glands are. We can bulk heat those, which we are always trying to do with hot compressing. That has always been the goal here. We are able to do that right at the level of the gland itself. Whenever I do RF, I immediately follow that with a gland expression. Manual expressions are much more effective when I use RF.

We have combined that RF procedure with the IPL when we are doing patients because the IPL now we are treating on the superficial part of the skin, the epidermis, and we are able to get rid of a lot of those small neovascular vessels. We are stopping the inflammation. It's a little bit like dentistry and that you are brushing and flossing, doing two different things but they are very important, and they both have their function.

I have heard different things from different practitioners, and because I'm early into the game, I'm not doing some of the more advanced stuff. We do IPL and RF but we do them separately for different people. You are saying that you are doing both, so you will do RF first and then do an IPL on top of that. Are there benefits to doing it that way?

There are benefits. We were an early office that had the InMode technology and the RF and the IPL in it. At that stage, it wasn't being widely used in Canada in optometry offices. The company was great. They sent me trainers. They gave me lots of support and marketing, but in reality, they weren't the expert in eye care. They knew they had great technology.

They knew this works well in the dermatology world but now optometrists had to start using the technology, which is excellent, and trying to use that in a way that's going to be the most effective for dry eye, especially MGD. There are an awful lot of MGD out there. If we could do something that's more effective than our old ways of doing things, that would be a breakthrough.

I slowly getting a little more experience and learning on what's effective and what's not effective. I started playing with the energies. I started to combine the technologies together at the same time. InMode didn't recommend this to me. They weren't saying do them together. That wasn't their recommendation. This is something that I started to do off label on my own.

I suddenly discovered when I did my post-treatment meibography and noninvasive tear break-up times, I was seeing two big changes with my patients. Those noninvasive tear break-up times would go way up. I could start to see differences in the meibography, in the health of the glands, and the like. You could see in dermatology, the collagen would start to grow, neocollagenesis and the glands would start to rejuvenate themselves.

I wanted to see that myself. I have done over 700 of these procedures already. I have had a lot of chances to try this and try that. We have come to the conclusion that using this combination therapy with manual expressions in my office has been successful. I would say for the majority of my patients, we are getting between 85% and 90% success rates. Again, we are seeing the patients multiple times. We are educating the patients. When we do the procedures, we try to do everything we possibly can to get them back to that normal state.

The fact that you have done that many procedures gave you the ability to test and see what works better and what doesn't work as well. That's pretty amazing. You gained the confidence to do those things because you know exactly what are the results you are getting, or if there are any side effects or other benefits that may come from doing it a certain way, which I'm not quite there myself yet. I'm always following exactly what the prescribed settings are. When you start to venture out a little bit and do those other things, you start to get amazing results 85%, 90% of your patients are noticing an improvement. That's huge.

Not even them anecdotally noticing the improvements. Before we start, we do all meibography and tear break-up times, and we look at the glands, and then we compare that to after post-treatment. Several weeks later, we look at this. I wanted to see for myself, "Is there quantitative values that tell me that the tear break-up times are improved, that the patient is feeling healthy? There is less keratitis." That is the proof that I needed that this is effective.

Dry Eye: You have to combine your in-office treatments with at-home treatments. When you start doing that, your practice is going to become far more financially healthy and your success rates are going to go way up.

When you have that proof, you become more confident. I am very confident in recommending these procedures to my patients. They sense that. When patients sense that you are like, "This is going to work." We have a procedure and technology now where we can treat this condition that you have had for many years. I'm very confident we are going to have a good prognosis here. That comes across to the patients when you start getting that experience, it helps them be confident in you doing these things.

I can speak from my own experience there as well. I find it funny that when you start promoting these types of treatments and options that you have, the first people who come to you are the ones who have the most chronic refractory condition that nothing else has helped them. They are like, "I'm willing to try whatever." That also puts a lot of pressure on you then as a practitioner to fix a problem that no one else has been able to fix.

With RF, I have had a few patients who were using drops every 30 minutes to an hour for years, and that was the only way they’ve got even a subtle bit of relief but now they are down to using their drops maybe a few times a day and able to get through the day, sometimes they forget to use their drops. It has been pretty amazing to see that again, both anecdotally and physically, in the tear film, meibomian gland, and all that. I could speak to it, my experience is a fraction of yours but it's nice to see that it parallels what you have been seeing as well.

What I say to patients is, "My goal here is to get you to not use drops." The ultimate goal for dry eye treatment is to get the patient producing their own tear. Not only is that way more convenient for the patient but it's healthier. When you produce your own tear film, things are going to be better. That cornea is going to be healthier. There is a cost associated here. A lot of doctors worry, "Are patients going to be willing to pay the cost of what these procedures are?"

You have to look at it again from the patient standpoint, if you write a prescription for Xiidra, Restasis, or they are buying artificial tears very chronically, look at the cost of the patient there. They are spending sometimes $2,500 to $3,000 a year on drops. They are forced to use drops continuously throughout the day. This is not a great scenario for the patient, and they are doing that for the rest of their life. The costs associated with that are much higher than you doing four treatments of RF and IPL and getting them to produce their own tears now, and they may not put any drops in their eyes whatsoever.

It seems to resonate a lot with patients when you tell them, "I would like to get your eyes functioning in their normal way. Let's get you back to normal functioning, so you don't have to depend on drops or medications." That resonates and I feel like there's more of a movement of this holistic health and natural versus medications and things like that.

I often tell patients like a holistic approach, talking about Omega 3s and all these other things as well. Patients appreciate it but the cost conversation happens frequently. What would you suggest to optometrists who are guilty, scared or whatever it might be to have that conversation to say, "I’ve got this treatment option for you, but it will cost you. This is how much is going to cost you $1,500, $1,800 or $2,000 or whatever over the next 4 or 5 weeks?" What would you suggest to that person as far as getting over that hump and getting comfortable talking about it?

Most ODs that are not in this field yet or looking to get in this field that's the number one thing in the back of their mind. That was in the back of my mind when I first bought this equipment because it is a big investment to go in and get something like this. The key is combining this technology with diagnostic technology.

A Firefly Slit Lamp is a fairly inexpensive item, you could easily put it in place of your current slit lab. You would now have the ability to do meibography and noninvasive tear break-up times, which is very important that you can do noninvasive tear break-up times. Tear meniscus height, shoot videos, and show patients the keratitis on the front of their eye when you put fluorescein on.

What's important is you need to do the diagnostics. You need to be able to show that patient, what their gland situation or their corneal health looks like compared to normal. I always have these comparisons. "Here's a patient with normal gland tissue. Here's you, you've got 75% of your gland tissue and are dropping out. The sooner we treat this, the better. This is like any other eye condition I treat in my office. If I see glaucoma and AMD early, I want to treat it early. A dry eye is exactly like that. The sooner we treat this, the better your prognosis is going to be."

I give patients the option. I tell them. "We have two ways we can approach this. I can prescribe you medications." I described what those medications are. "You are going to be on these drops for the rest of your life. I have to be honest, they are fairly expensive, especially if you don't have insurance. When we use these medications, we are not rehabilitating your glands. We are stopping the attack on the glands but we are not rejuvenating the health of those glands. That's one option. We can do that."

I do have some patients that do that or they start with that. They may switch later but that's what they want to do when they start. I say, "We also have these procedures, RF and IPL." I described them very basically. "The RF is going to treat in that dermal layer deeper down where the gland is. The IPL, that's going to treat more on the superficial part of the skin. We are treating the neovascular blood vessels. This is absorbed by any red or brown pigment. These vessels are leaking. They are abnormal. We want to get rid of them. That's what these treats are, not only does it treat but they will treat some of your Demodex and your blepharitis. We get a double benefit there.

It's not just what you do in your office. It's what the patient does at home.

I also described, "We are going to do the gland expressions because we want to get you producing your own tear film and manual expressions are critical." If you don't see what's going on from treatments 1, 2, and 3 like with LipiFlow in some of these devices, you don't see what's happening. It's important that the doctor looks at that between treatments so that they know what's happening with that expression of meibo.

When I talked to them about that, they heard that, "I could be on this drug for the rest of my life. That might be $2,500 a year." They can do the math in their head. That's expensive. My treatments are $400 per treatment. I tell them, "It's going to be a minimum of four treatments. It may be more. I have severe rosacea patients where I have treated them 6 times, some patients, even 8 times." They understand that.

I don't do a package. I don't do a discount. I say it's $400 a treatment. They understand that I'm not apologetic about it because I know what works. In the long run, you are saving money. I feel good about it because I'm doing something that's incredibly effective. I'm saving them money and aggravation and not having to put drops in over the course of their lifetime. To me, that's the discussion that works well. Those are the key points that I try to use.

All of that is important but the visuals, especially the meibography and stuff like that. It could be a big turning point for anybody who's maybe not getting the conversion or uncomfortable about having that discussion. Somebody who's starting on this, maybe they don't have any advanced technology in their office. Would you recommend that's where they start? Start by getting a good diagnostic tool first, and then look at the treatment technologies after?

It's almost something you could get at the same time. If I was starting from scratch, knowing what now, what's going to be effective and what maybe wasn't effective for me, as I was going through this journey, if you think about how much this technology costs in your global investment, I would get the diagnostics and the treatment together. I would get them both because when you pair those things together, you get a powerful tool that you can show people what's going on.

A lot of ODs don't realize, and that's something that turned the corner for us is we started doing meibography on about every adult patient. You will be shocked at how many of those patients come in here with more than 50% gland loss. The thing that I have learned more than any other thing in this journey is that auto-immune disease is far more prevalent out there than we think. As optometrists, we can start diagnosing and seeing this. I deal with rheumatologists GPs, and specialists far more now than I ever did before the dry eye.

I am writing a report to a rheumatologist at least ten times a week. I'm sending them copies of the meibography and saying, "Here's a twenty-year-old patient with 80% gland loss. What is going on? Could you do a workup and see?" You would be shocked. How many of my patients come back and they have Hashimoto's disease or JRA, and they didn't know it. I have had a number of cases like that.

Young patients that if I weren't doing these baselines, they weren't going to bring it up to me. They thought, "My eyes always burn, sting, and hurt me. I thought I'm a person who has burning eyes." That's the way it is for me. That has changed the way that I look at things, and I'm way more invested in systemic medicine than I ever was before I started dry eye.

It's not surprising, and we understand that there is that connection between these systemic diseases and dry eye for so many years, we have said, "It's dry eye." Now, we know that there's so much more potentially happening in the background. Again, coming from somebody who sees a lot of these patients and treats a lot of them, it's pretty interesting to hear how many you found to have that connection. That will wake up a lot of us and our colleagues too to look into that a little bit more.

Taking a step away from dry eye, I know that's our main focus here, but in general, your business and practice as a whole, are there a few things that you can think of that have helped your practice grow over the years? Whether it's creating a subspecialty or it's training your staff a certain way, or anything else that you could think of?

It's a very generic question but I wanted to make sure I put it out there. A couple of things that somebody else might be building their practice. A friend of mine or someone I know who might be building their practices a little earlier stage. What kinds of things you might recommend or suggest to someone in an earlier place?

The most valuable thing we have here in our office is our staff. Our staffs are amazing. The patients interact with the staff more than they interact with me. They are talking and asking them questions about the products we sell and the procedures we do. Whenever patients come in for RF, I have four techs. One of those techs is doing the RF. I'm not doing that on the patient. I'm coming in, and I'm doing the IPL or the manual expression after.

Dry Eye: Dry eye is universal. You don't have to go out and advertise for these patients. 30% of people walking into your office have dry eye. A lot of them don't report it, but it's there.

It's important that you train your staff. Good staff doesn't happen by accident. It's a product of including them, letting them know about this technology, educating them because they want to know. The thing that shocked me when we first brought the InMode, the RF, and the IPL, my plan was to train one of my more senior techs. She was going to be the one that primarily was going to do this procedure. We did train her, and we did have the other staff watching when the trainers came in. One by one, almost immediately after, the other techs came to me and said, "I want to do this. I love this."

Women love skincare. A lot of our staff are females. They are very invested. They know a lot about this. They do skincare routines and regiments at home. They were super interested in all of this. I was amazed at the buy-in. Now, we have four staff that are able to do this. We rotate them through. We do a lot of these procedures.

It's nice to have more than one person being able to do, check people in, do the consents, get them, worked up, get the ultrasound on there, do the RF before, so it saves me huge amounts of time. I can focus with the patient on educating them and talking to them about where they are at. That has been the single most important thing that's grown my dry eye practice is the involvement of my staff. Don't be afraid to teach them things because they want to learn.

Something that I have started to learn as well over the years is how important it is to have good staff. It's vital. I don't know if there's anything more important than that. Also, I have learned that I like to include the staff in everything I can, whether it's meetings with reps, bringing in new products, getting everybody trained up so we are all on the same page. The staff has reported to me, they like it as well, being included that way. They are not just an employee, they are part of the business and part of the practice as well.

They want to be included in making decisions and giving input and ideas. They are all wanting to be invested that way. The second thing that has been invaluable is having products in our office. The patients buy stuff that we have sourced. We have the Tranquileyes XL Kits that we sell for hot compressing.

I always have my MG patients going home with that kit, and doing at-home moist heat, compressing is important. I have a tea tree foamer that we use as part of our product line with Eye-Revive but all my patients with blepharitis will maintain some of these good results we get, which have to be maintained over the months and years following.

We also have a line of skincare. We've got something called E9 in our product line, which is a product we developed with my parent company, Eyeeco out of California. We initially use it with patients who are on Xalatan. The side effect of Xalatan, they start to get these dark circles. This E9 product is a nonsteroidal anti-inflammatory. What it will do over, let's say, four weeks of putting it on nightly will take away about 38% to 40% of that dark area and all the darkness under their eyes.

It has been a great product. I said, "If it works so great for this, why don't I try it on some of my patients that have contact dermatitis and the flaky skin on the lids?" I started doing that. It was remarkably successful for that. I could avoid using a steroid, I would use this instead. Once we brought RF and IPL on, now I would use this as my post-treatment product. I would sell them some of this. They would go home.

You can see when you have a dry eye patient, and that dry eye patient has bought into your treatment plan. They are going to go through four RF and IPL gland expressions. They do this to be successful, and they want it to last as long as possible. We always give them at-home maintenance products that they can use on their own to try to make the benefits of this last as long as possible. That's a real key with dry eye. It's not just what you do in your office. It's what the patient does at home. That part of our business has grown exponentially.

The nice thing with that is patients come back, they buy again on their own. I don't see them. They are coming in. They are buying more E9. They are buying more lid scrub. We've also got an overnight sleep shield, which I use with a lot of my patients. There are tremendous amounts of lag of the thalamus out there. The silicone shield seals all the way around your whole socket and traps humidity as you sleep. It creates such a hyper humidity chamber. Even if there is that little gap, it helps prevent that overnight dry eye.

That's something that a lot of ODs should look at because there's a tremendous amount of people that wake up and they say, "When I open my eyes in the morning, I'm afraid to open my eyes because they hurt so much.” You have to combine your in-office treatments with at-home treatments. When you start doing that, your practice is going to become far more financially healthy. Your patients, your success rates are going to go way up.

That's all advice that we can implement now in our offices. The subtitle of the show is Business Entrepreneurship and these different factors but the entrepreneurship part is something that I focus on with a lot of guests. I specifically bring a guest on who has this entrepreneurial streak, and you do your perfect example of that.

Dry Eye: Dry eye is universal. You don't have to go out and advertise for these patients. 30% of people walking into your office have dry eye. A lot of them don't report it, but it's there.

Not only with your own office but now with Eye-Revive is this other company that you have started many years ago. If you could share with us what motivated you and what got you over that hump? There's always a hump that people have to get over before they take something from being an idea in their head to an actual tangible company or product. What was it that got you through that?

The story is I had gone to a trade show down in the states. This was a Vision Expo East of New York. I saw some products I liked there. I thought, "These are the products I'm going to incorporate in my office." I met Eyeeco, which is the parent company that I distribute products for here in Canada. They had some products that I have never seen before like the sleep shields. The moist heat compresses, instead of doing a generic microwaveable mask. This was a very precise way to do hot compressing. I brought them back. They were very successful. When I initially came back from the trade show, I brought a lot of products with me, and I was surprised how quickly I burned through all these products.

I called the company back up and I said, "I would like to order more." They said to me, "We don't have a distributor in Canada. You have to get it in the United States." I said, "That's a problem because I don't live in the United States, and I can't wait six months or a year to go back down there and get some more." They said, "Why don't you figure out how to bring it up? You could be a distributor. We will sell it to you, and you can sell it to other doctors if they need it."

I had to get it myself anyway. It's a lot of rigmarole, learning how to import things, and how to deal with Canada Food and Drugs. I brought it in. I brought a little extra product. If they had a doctor that called from Alberta, BC or Ontario, and they wanted to try something, they would direct them to me, and I would sell them something. It started pretty small that way.

What I started to see was in my own practice, how this grew so quickly because I would prescribe something to the patient when I saw them on their annual exam but throughout the year, they would come in, and they would buy it 3, 4 or 5 more times in the year. Suddenly, we are selling five times more than what I'm recommending. That started growing.

I thought, "This is a real opportunity." I started to attend trade shows. We developed the Eye-Revive company. I partnered with a company called Neutrogena out of San Diego. They had some Omega 3 supplements that are amazing. The Eyeeco company started developing new products. They asked me to come onboard and start helping them.

With the help of another ophthalmologist, we developed their Tea Tree Lid Cleanser. We developed E9. We created bigger goggles that were proprietary for optometry because they were using these goggles as a moist heat in a spa-like environment. We created something that's more medicinal. It kept adding. The key is, get yourself involved.

If there's something you are passionate about, you are interested in, get yourself started, and then once you get started, you will see one thing will lead to another. They are all little building blocks, and there's this natural evolution of the way that your company, your business or your online products it's going to grow itself. You will see that it will start to take off. You have to try to bring in new ideas. That's the number one thing that I could recommend to people.

You were confronted with a problem. I feel like this is where a lot of businesses and an entrepreneurial journey start is you are confronted with a problem, which is you wanted to get this stuff in your office but importing was all of that. Instead of using that as an obstacle or as a roadblock, you thought about how you could turn that into something even bigger or better, which was amazing.

That is inspiring. Any aspiring entrepreneurs out there, maybe look at problems that you are facing as the thing that might propel you into starting a business. I'm big into philosophy and stoicism, and Marcus Aurelius is an ancient stoic philosopher and emperor, and one of the sayings is, "The obstacle is the way." Ryan Holiday's book named that as well. It's relevant in an entrepreneurial journey. If there's an obstacle, that's often the way you have to go to get to your next step.

That was similar to what you had to go through. Dr. Dornn, there are two questions I would like to ask everybody at the end of each episode. Before we get into those questions, I would like to offer you a chance to let people know where they can get in touch with you or learn more about Eye-Revive or anything else that you would like to share.

I would be happy to answer any questions that people want to email me. My personal email is DornnEyeCare@Shaw.ca. They can contact our online company, Eye-Revive.ca. I have a great staff. We have a chat line. It can be completely anonymous. They can go on the chat line, they can ask a question about a product, and we will respond to them right away and describe how the product works and how they would use it.

The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph

We do have special vendor pricing for optometry offices so that they can sell this product in their office. We don't sell our products to any pharmacies, anyone but optometrists. We sell to the public, and we sell the optometrist. We have a lot of great customers. They buy a lot of products from us. They have successful dry eye practices. I have learned a lot from them. Optometrists, we can learn a lot from each other. There are a lot of successful people out there that are doing some pretty amazing things in the dry eye space. I try to learn as much as I can from them because they have some tremendous ideas.

What's exciting to me, we are at the stage where optometrists are poised to do more than just diagnostics and refraction. We are at the stage where we are going to do procedures now. What's happened in my office that I never anticipated, when I started doing this, my goal was to treat dry eye. I had no plans on doing anything but that, but what ends up happening is when you do IPL and RF, especially IPL, that energy from the Lumecca can treat any brown lesions.

When you have a patient coming in, and they have damaged sunspots and brown lesions around their eyes and on their face, you can treat that. When I'm doing my procedures, I tell patients, "I'm going to treat that." It works remarkably well. When people have fine lines and wrinkles, and people are all concerned about our appearance, and we want to look good. This comes from the dermatology world. I tell my patients, "This comes from dermatology. They have been using this for years to treat dry eye and wrinkles."

One of the early patients that I treated and was an interesting case. She had bad rosacea. Right around her eyes, I did the treatment. It worked extremely well. She came back after her fourth treatment and she goes, "I have a complaint. The skin around my eyes looks great. Except as soon as you get below where you didn't treat, it's now all wrinkly. I've got that crepe paper skin. I want to treat it all." I was so amazed by the difference between around her eyes and lower down on her face that I did it for free. I treated all the rest of it to see, "What benefit is there to the skin?" It's remarkable. She was in her 70s. This was an older patient.

What I have seen happen is the medical aesthetics of this, and a lot of ODs are like, "That's not for me. I'm not going to do that," Think about this, if you have a rosacea patient and you treat their dry eye because they have bad ocular rosacea, you are very successful, and they are going to say, “You are a good doctor." If you treat all the redness on their cheeks and all over their face, where they have all these neovascular blood vessels they are like, "You are a great doctor." Their wife says, "Look at my husband, and he looks so young."

I have had patients where the wife was upset because the husband's skin look too good, and she's like, "We spent all this money on him. He looks way better than I do now." We have branched off a little bit into this medical aesthetics, which to me is exciting. It's easy to get into once you have good equipment. There's no question about this, InMode got some of the best technology on the market.

Their RF is bipolar. That's second to none. I never have to use a shield. I never have to worry about side effects on patients, and we can do upper and lower lids. The Lumecca is the strongest source of IPL energy that you can get on the market. It is extremely effective. If you are interested in dry eye, if you want to get into this field, you should look into this stuff.

As someone who's getting into it now, I will be looking to you, and I have already attended one of your lectures to learn more about how you have brought it in and in the settings that you use and all these things. Any aspiring ODs out there who are looking to get into it, do reach out to Dr. Dornn. He's got an amazing wealth of knowledge. For Eye-Revive. It's Eye-Revive.ca. The last two questions I like to ask every guest, number one is, if we could hop in a time machine and go back in time to a point in your life where you were struggling, what advice would you give to yourself at that time?

If I was starting out, knowing what now, I would invest in the dry eye technology as soon as I started my practice because when you start your practice, you are not busy. You have the time to spend with patients. Dry eye is universal. You don't have to go out and advertise for these patients. They are 30% of people walking into your office have dry eyes.

A lot of them don't report it but it's there. The patients coming in, if you have the technology and the time, you will be able to spend that time learning while you are starting. If I were a new OD, this is the way that I would start my practice. I would delve into dry eye become specialized in it. It is a tremendous way to grow your practice.

I would go out to my local GPs or even if there's a rheumatologist in the area. I would introduce myself, and I would say, "I have a solution for your dry eye patients. They want a solution." That's one of the things I did early on when I started doing this. I went to my local GPs and I said, "I have a way to treat these patients, especially patients you have with arthritis, rosacea and any auto-immune like thyroid patients," and they started feeding me patients. You would be amazed how quickly that grows. If I'm a new doctor, that is something that I would recommend to anybody because those GPs want to work with you. They want a solution for their patients. There's no one better suited to do that than an optometrist.

Creating those relationships with other professionals, who could then refer to you. You have said that. That has been a huge factor in the growth of your dry eye practice, those referrals from other professionals. Maybe there's a bit of shyness or fear around approaching others about this stuff but obviously, there are huge benefits to doing it. Thank you for sharing that. The final question is, with everything that you have accomplished through your practice, your business, and everything else, how much of it would you say is due to luck and to hard work?

You can create your own luck. You just have to keep working hard.

It's a combination of both. There's the old saying, "You have to be good to be lucky." If you work hard, things are going to come your way. If you work at things, you get experience and confidence, and then you can sometimes create your own good luck in your own good fortune. In optometry, there are a lot of things happening now.

In Ontario, there has been some labor action, and we have been in Canada a little bit dependent on provincial healthcare and what has been fantastic about this is I have seen our practice grow into something that we control our destiny. The patients come to us. We do these procedures. It's a self-pay type of thing. What has been satisfying is the efficacy of this, "How much improvement I have been able to see?" Not only from their anecdotal reports but when I look at them quantitatively. You can create your own luck. You've got to keep working hard, and there are a lot of smart ODs out there that could do well with this.

Thank you very much, Dr. Dornn, for taking the time to join me here, sharing all your expertise, knowledge, experience and everything. I'm going to be back in touch with you. I've got a lot more to learn from you.

Anytime, let me know. I would be happy to share my experience. I will share as much knowledge as I have. I love training ODs. They are exciting and a great group of people to be around. If anybody’s got questions, drop me a line.

Thank you, everybody, who's tuned in, whether you are on Apple or Spotify, thank you very much for taking the time. Thank you for all your support. Don't forget to hit like, subscribe and take a screenshot, put it up on Instagram. Tag me. Let me know what you thought, what was your takeaway from this episode. I always love hearing you guys' feedback. We will be coming back with another episode. Take care, guys.

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About Dr. Bruce Dornn

Dr. Dornn graduated from the University of Manitoba with a honours degree in microbiology. He attended the New England College of Optometry in Boston, MA, graduating in 1997 with his Doctor of Optometry degree. He worked in Denver, Colorado until 1998 and returned to Winnipeg where he founded Dornn Eye Care.

Dr. Dornn is also the founder of Eye-Revive.

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