Dr. Sherman Tung is the former president of the BC Doctors of Optometry and 2019 BCDO Optometrist of the Year. He has completed a residency in ocular disease and a fellowship in myopia management and now runs a pediatric specialty optometry clinic where he specializes in myopia management.
So, it's safe to say he is a great source for information on how to get started in myopia management and what treatment options to recommend to your patients.
I had the pleasure of picking Dr. Tung's brain about how he got started in myopia management and how we can all benefit from including this specialty in our practices.
You can also watch the full episode at YouTube.com/HarbirSianOD
Connect with Sherman:
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Listen to the podcast here
Specializing In Myopia Management With Dr. Sherman Tung, OD FAAO FIAOMC
Thank you again, as always, for taking the time to join me here to learn and grow. I truly appreciate your presence and your support. If you haven't already, please do subscribe. You can subscribe on YouTube if you like to watch. Subscribe on Apple Podcasts and follow along on Spotify as well. Make sure you leave a review, leave a comment, and let me know what you think. Tell me which guests you love. Tell me which content you love so I know which guests to bring on.
I like to bring on people who can help inspire and motivate us to grow and to do more no matter what profession you happen to be in. Our guest is an excellent example of that within the optometry field. His name is Dr. Sherman Tung. He is an Optometrist here in Vancouver in the beautiful Kerrisdale neighborhood. He has completed a residency in ocular disease and also a fellowship in myopia management. His practice is called Eyelab and is a pediatric specialty practice. Sherman himself spends a lot of time in myopia management.
We're going to dig into myopia management, learn a lot about Sherman's different practices, and different techniques. Also, we will learn a little bit about the business side of things. What does it take to start a specialty practice? Is that a good decision to make? A lot of Sherman's insights go back to his experience within our association. Sherman is the former President of the BC Doctors of Optometry, another pretty amazing title and an amazing amount of experience that he has within the association and networking across North America. He's applying a lot of those lessons to his practice now. He’s an incredible person to learn from.
Before we go into the episode, I want to thank our sponsor, which is Hoya Vision Care Canada. Hoya has the MiyoSmart lens, which is an incredible new technology for us as optometrists to offer our young myopic patients. The MiyoSmart lens employs the new patented DIMS technology to help slow down the progression of myopia. In a two-year clinical study, it was shown the MiyoSmart lens decreased myopic progression by 59% and axial elongation by 60%. To learn more about the MiyoSmart lens, check out Hoya.ca or reach out to your local Hoya rep. Without further ado, here is the episode with Dr. Sherman Tung. Stay tuned for more exciting episodes coming soon. Thanks a lot.
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Dr. Tung, thank you so much for taking the time to participate in this interview. Thank you so much.
No problem. My pleasure.
I gave a brief intro to you but I'd love for you to tell us a little bit about what you do, where you practice, and what your life is like day-to-day.
I’ll tell you a little bit more about myself. I graduated from UBC. I was born and raised in Vancouver. I did my schooling in Chicago. After Chicago ICO, I did another residency in ocular disease. That's why I was going towards ocular disease and then I got bored easily. I came back. I worked for corporate and then I got bored of that. I did my own private practice. I opened it with a partner and then I got bored. I then joined the association. What I like to do is pediatric optometry. I opened another clinic that specializes mostly in pediatric eye care. That's a little bit about me.
Some people get bored and they sit on the couch and watch reruns of shows and eat chips. You get bored and you're like, “Let me go even bigger,” every time. That's pretty cool. We're going to talk about the practice. We're going to talk about pediatric optometry, myopia control, and that type of stuff. I want to rewind. You’re the former President of the BC Doctors of Optometry. I'd love for you to share with me what your path was. How did you get involved? What led you to become the president of the association?
This is how it all started. One of the things that I was a little bit upset about at that time was I didn't know what my association did for me. It’s like, “Why am I paying all these dues?” I have no idea. Before I quit anything, I want to find out why I'm quitting and have a good reason before I quit. I joined the membership committee to learn more about what does BCO does for us.
You and I were on that committee together.
After that, I moved up to the next level. I learned about it and half of the stuff, I didn't know what they do for us. They advocate for us. They have so many resources, all the networking. Because I was a new grad and I never tapped into that, I didn't understand what they did. One of the reasons why during my time when I finished graduating is that there were more Canadians that graduated from Waterloo than American schools at that time.
Find something that you love, find your niche, and charge for your services.
At that time, when I came back, everyone knew each other. I didn't know anyone there. That's one of the reasons why I joined the association so I can meet new people. I was learning about it. It’s like, “They do a lot.” Each time we have a negotiation for a contract with MSP, they go and negotiate. As I was getting more involved in helping the association, I found out that they do a lot for us. “Sherman, you've been involved. We’d like you to be part of the board member.” I was like, “One-year term, that's fine.”
We had this year where there was no succession planning and they were like, “We need someone to step up.” They looked at me, “Sherman, what do you think?” I was like, “No. I'm not ready. No way.” Somehow, I was like, “If I get elected again, maybe I'll consider it.” The next day, I was like, “I'm the president.” That's my story of how I went through. I was about to quit, learn more about it, and then how much the association does for us. I'm still part of the association. I might not be the president anymore but I do feel part of the committee and all different committees.
You're still involved and it's always appreciated. I've been part of the association my entire career. I know that when you were president, things were going in the right direction and people appreciated the work you're doing. Thank you for that. There are a couple of interesting things there. You were about to quit. Rather than quitting flat out like, “This seems useless to me. Let me learn about what is happening here. Maybe I'm missing something. Maybe I'm not quite seeing the full value in it. Why does this thing even exist if it sucks that bad?” It turns out, it doesn't.
There's maybe a miscommunication or misunderstanding of the full capacity and what happens. That's important in a lot of ways. Before somebody quits their job, profession or whatever, see what else is out there. You mentioned MSP. For the people who are reading who don't know what MSP is, that's our provincial health care plan.
Everybody talks about Canada having this universal health care. That's part of the government that pays for certain parts of health care. Our association negotiates with them to increase the fees that the government pays us for certain services that we do, so we're on the same page about that. What did your job as the president entail? Let's narrow that down. What was the coolest thing you did as the president?
It's personal growth, to be honest. Even though I gave a lot of time to the association, I gained a lot back from the different meetings you have to go to, all the leadership responsibilities. You have to lead by example. You have to go to these different meetings. One cool thing that I learned a lot during those meetings is that you need different leaders or forefront thinkers. It’s like, “Where's the profession going to go?” You pick one and you listen to them.
At the time, you might think, “They're crazy. Why are you thinking about that?” All we're going to do is glasses and eyes and that's it. That's not going to be the future. I learned quickly years ago, “That's not the way we're going to go. You have to specialize. You have to find a niche.” Find something that you love, find your niche, and charge for your services.
If you're going to be doing regular exams, what makes you different from someone else? That's what engrained me as a president. I learned a lot. What's the future going to be like? How do you want the future to look like? These leaders are shaping it. We hear the industry leaders, what the industry is telling you, and what everyone's seeing. It gives you that different insight. That's one of the coolest things that I learned as a president.
From being part of the association, I see that other provincial presidents come to our meetings and everybody's networking and discussing things. It makes sense that you would be chatting with the foremost people and the people who are cutting edge and whatnot. You would be a good person to follow as far as what you're doing in business and in your optometry clinic.
Here you are specializing in pediatric optometry, which I don't know how many people I know who are specializing. I know some people do VT. I had some people who like to do myopia control. You do those things. You don't do the regular stuff anymore. Maybe something that the rest of us need to catch up on is to start to specialize and cut down into that niche that you're saying. When is it that you decided to do pediatric optometry? You renovated and rebranded and everything in your practice. What was it called before? When did you make the decision?
I used to be at another practice. Back in 2010, when we first opened that new practice, it was like, “We're going to be a family eye care.” That's how we started. We outgrew that space. It was great. I had a great clientele. The problem was it was like a family GP. You do the same thing over and over. It wasn't getting that same satisfaction. I did enjoy optometry. The great thing about optometry is that whatever you do, there are many different ways and things you can do. There’s low vision, VT, and lots of different things.
Myopia Management: These leaders are shaping it. We hear the industry leaders, what the industry is telling you, and what everyone's seeing. It gives you that different insight.
One of the things that I was always interested in was myopia management. As a business mind, if you want to open an office for myopia management, it might be a little bit hard. I found another doctor. I hired her as an associate. She does the VT stuff. I see a lot of kids and it’s like, “You need VT.” There's not a lot of VT doctors on the west side of Vancouver. I saw a solution to that. I was getting a lot more myopia management patients. I need to create this bigger space. I put two and two together and it’s like, “Let's make a pediatric office that does kids exams, VT, and myopia management.” Most of these are geared more towards kids. That's the reason why we opened up a pediatric office.
When did you officially open Eyelab?
We officially opened in February 2020. There's never perfect timing. You roll with it. It is what it is. We did close for two months. During those two months, I had time to study for my fellowship, which I got with myopia control. I’m also working out all the different protocols to give us that extra time to be like, “What are our protocols? What are our procedures?” It prepped us for when we do open full time, we have everything all set so things will be more organized.
What advice would you have for somebody who's getting bored as you did of the family practice setting and wants to specialize? What is it that they should look for psychologically and mentally for themselves to be prepared for it? Also, what should they see in their practice that they can use as landmarks to say, “This is a good time for me to make that leap into a specialty.”
It depends on what type or stage in your optometry life. If you're young, within the first ten years of your career, go for it. Whatever you love, whatever you find, go for it. The only way you're going to learn is by going for it. One of the characters of an optometrist is we don't like to take risks. Most optometrists don't like to take risks. I don't know why. If it's within your first ten years, go for it. What's the worst-case scenario? You can work with someone else later down the road.
If you're going where you have a big patient base and you're like, “What I'm going to start doing?” You got to start thinking about how to strategize. You can't go cold turkey and say, “I’m seeing these patients.” You don’t build up these patients expecting to see you. That's the part where you might hire an associate. Let's say your mission is called Eyes Vancouver. You might want to branch it out like Eyes Vancouver Family. You might want to do Eyes Vancouver Kids, Eyes Vancouver VT, or something along those lines. You can still have your name and you can branch it out. You might want to do that if it's more than ten years. That's what my advice is.
You have to look at your clientele. One thing that I learned as president is most offices don't have a strategic plan. I know it's hard. If you can, take maybe 2 or 3 days out the whole year, have your retreat, and have all your staff members. It’s like, “What's our vision for the next 2 or 3 years?” Plan it. If you think about it, you still need your whole team to buy into it. That's something that you might want to consider, strategic planning. It’s like, “Where do we want to see ourselves in five years? Are we happy doing the same thing that we're doing?” If you are, you might not want to do this stuff. If it's something like, “I want to incorporate this,” you might want to consider that.
That's a good idea, having a plan and vision of where you want your practice to go. If you're more established, you should probably slowly branch off and create that niche versus cold turkey. It would be hard to be like, “My practice is running smoothly. I'm bringing all this revenue.” All of a sudden, you stop that, “I'm going to try this other thing.” It's hard to get that revenue or get all those patients back in the door and back in the chair again. It makes sense to ease into it.
I wanted to focus a bit on your specific specialty. You see a lot of kids for myopia management. Myopia control is a hot topic. The prevalence of myopia is increasing. Can you give me your main treatment options for kids that you would be seeing in your practice? What are your go-to’s? If you don't mind, what would help you lean towards one or the other if there are certain criteria that you're following as well?
For your readers, if you’re an optometrist, the best example I can give you is glaucoma. There's no one silver bullet that will treat your glaucoma. It's not like, “Let's use prostaglandin,” and you're done. You have to see what type of glaucoma you have and what's your systemic. You'll then figure out what is the best thing to do, SLT is the best thing to do, or maybe surgery if it's end-stage. It’s the same thing with myopia. There are different stages. You want to be aware of what's the best option for that child.
Having said that, there are four things that are in the market. The one I like to go to is orthokeratology, OK lenses. That's the type of lenses where you wear nighttime. It reshapes your cornea. When you wake up in the morning, you can see clearly for the whole day. That’s my specialty. Sometimes not all children can put hard contact lenses. Parents are not comfortable with that. You have your specialty, multifocal design from CooperVision like MiSight and those types of contact lenses.
Each one has its pros and cons. Some have their limitations and what the parameters are. You got to keep that in mind. The third one is atropine drops. Lastly, the newest one is from Hoya, the MiyoSmart lenses. I’ve been eyeing that for a while. That one is a pretty good lens also. If someone can’t do contact lenses or drops, MiyoSmart will be a good option also.
Orthokeratology has come a long way, but it's not commercialized yet.
We'll come back to the MiyoSmart in a minute because there are some cool things to chat about there. If you don't mind, as briefly as you can, what are the parameters or limitations of ortho-k? What patient are you fitting into ortho-k? Which one would you put into the MiSight lens? I have a couple of questions about atropine as well.
Orthokeratology depends on what type of lenses you're using. It's not one type of lens and that's it. Within the parameters of ortho-k, there are different treatment zones. There are different sizes you can manipulate. There are different curves you can manipulate. In the beginning, when I first started, if you use one of those that are commercialized brands that you can use, they have such a parameter. It's usually less than one doctor who still has some issues with the rule. It’s usually anything below -5. Those are your nice and ideal patients.
You always want to start with easy patients, the -1 or -2. As I learned through this fellowship process, you start to customize your lenses. When you can customize your lenses, you can go up to -8, -9, -10. Back then, that couldn't fit people with astigmatism. Now, we can do bitoric ortho-k lenses. Back then, you couldn’t. Now, I can do that because it's different bitoric base curves.
Orthokeratology has come a long way but it's not commercialized yet. I design most of my lenses on my own. I try to make them. That's why I could fit way higher different parameters. When you're starting out, talk to your lab. They'll tell you which lens they feel comfortable using. They'll tell you what the parameters are. It’s not easy first. There's one piece of equipment that you have to buy if you start ortho-k. It's bare minimum. You have to buy a topographer. If you don't, you won’t know how the lens fits on your eyes. Don't practice ortho-k if you don't have a topographer.
It's basic advice. I appreciate that. Have you had much experience using the MiSight lens from Cooper?
Yes. For my patients that are under -1, usually, I don't fit them with ortho-k yet. For -1, that's where I might fit them with a MiSight or MiyoSmart. MiSight is great for that. Sometimes kids don't feel comfortable sleeping at night or they don't like the comfort of it. Maybe I’ll have a sixteen-year-old, ortho-k might not slow down as much. Maybe I'll start with MiSight. Those are the patients where I start MiSight with. The drawback of MiSight is it's hard to mask. Let's say you’re -4, -1. You could get away with it. If you're -4, -3, then you can’t. Those are the pros and cons.
Do you prescribe atropine a fair amount or not as much since you do lenses more?
We can never promise that we could stop the progression. It’s impossible. You'll be lying to your patients. You can slow it down. I don't use atropine as my first line of treatment. I use it as my second line of treatment. If they're still progressing quickly, then I will start them on atropine. That's how I do it. Before, I do start on atropine. Now that I have more options, I usually use atropine as my second line.
When you say the second line, the first line didn't work, so you stop using it and then you start atropine. Do they overlap at some points?
I usually overlap.
You double them up.
Yes.
That's been a question that I've heard come up. If we know option A will decrease or potentially decrease progression X amount, option B will decrease at Y amount. What if you put them together? Would it increase it or improve the results significantly?
Myopia Management: You always want to start with easy patients, the -1 or -2. As you learn, you start to customize your lenses. When you can customize your lenses, you can go up to -8, -9, -10.
We're waiting for all those studies to come out. We’re doing a lot of those studies.
The fourth option that you had mentioned was the MiyoSmart lens from Hoya, which is an exciting new option. I want to dig into that a little bit. MiyoSmart is based on DIMS technology. Would you be able to elaborate a bit about what the DIMS technology is?
This lens didn't come out in 2019 or something. It's been out for a while. It's been out since 2013, 2014. They were designed by Polytech University in Hong Kong. The whole idea of myopia management is based on the hyperopic defocus and the peripheral myopic defocus. The idea is that if you wear regular glasses or wear regular contact lenses, on the peripheral, you’re going to get a hyperopic defocus, which means that the focal point is behind the retina.
Those send signals to the brain and the brain will send a signal to the retina and the eyeball will elongate. Every single time your perception goes up, you get new glasses or contacts, it sends those signals again, over focus, and your eyeballs get longer. The idea with ortho-k is that your central vision is still clear but your peripheral raise in front of the retina. Now it doesn’t send those signals. That's how it slows it down. DIMS technology mimics that. Instead of using the OK lens, you’re using the lens.
You can see these little prism peripheral blurs. In the center part, you can see clearly. On the outside part, it causes that myopic defocus. It loses that light in front of the eye. By doing that, it slows down the progression of myopia. The reason why I'm excited about it is when I went to a conference and I started learning more about this. There are patients that don't want to wear contacts. They're too young or they can't put them in. The only option is atropine at that time. I was waiting for this lens.
By 2016, 2017, they released it in Asia. They commercialized it by Hoya. All the colleagues in Asia were like, “Sherman, this lens is working well. It works.” I was like, “When is it going to come to Canada?” Almost every single month, I'll be calling my rep, “Is it here yet?” “It's coming in July.” “Is it here yet?” “There might be some delay.” “Is it here yet?” “There’s COVID.”
Finally, it was released sometime in August 2020. My rep was like, “Here you go, Sherman.” You have to do a course or a class to learn more about the lens. Once you get certified, you can sell the lens. I've been using it since. There are patients that have been using it for about six months. It’s a good alternative to slow down the progression. That's why I'm excited about it.
The lens came out a few years back in Asia. They did some proper studies as well as studies go. They did a two-year clinical study and it showed some pretty significant results.
I’ll tell you what I love about that study. It was a randomized, double mass study. That's one of the reasons why I liked it. There was no bias. The study shows that it can slow down myopia progression by 60% or 59%. They also did something cool. They also looked at the axial length. That's going to be the feature of myopia. You have to measure the axial length. They also showed that it could slow down by 60%.
Everything has pros and everything has cons. One of the things with this study was the subject group. It is between 8 to 13 years old for Asian patients. Some can argue, like, “Does it work for a different ethnicity? How about someone who’s 14 or 15? Does it work?” If it works between them, you have to extrapolate the data and use your best clinical judgment. I feel comfortable using someone that's under eight. For someone that's over fourteen, I still feel comfortable prescribing it.
By extrapolating and by using my personal clinical experience, that's the age group that tends to progress the fastest. It’s that preteen, early teen years. Of course, I've had plenty of kids who are -3 by the time they're five years old and trying to jump on that lately. My first line of treatment has been atropine, but it's going to be changing significantly. I'm doing that course to get certified in the MiyoSmart lens. What do you say to someone like me who's trying to get more into myopia management? Is the MiyoSmart lens a good, easy way to get into it? What are the benefits from a practitioner’s and the patient's perspective?
Each patient is a little bit different. You have to ask about their lifestyle. If the child doesn't play a lot of sport and stays at home, the lens might be a good option. If you start the lens off in six months or one year and you do get some progression rapidly, then you might want to think about changing to OK lenses or a different type of method. You might want to add atropine too. Is it a good starting point? Yes. For someone who doesn't want to go into OK lenses or doesn't want to go into MiSight or other options, it is a good option.
Whatever you love, whatever you find, go for it. The only way you're going to learn is by going for it.
Be aware. Don't think of it like, “This will solve all problems.” Sometimes that’s where doctors feel, “I feel comfortable.” It’s the same thing with the glaucoma analogy. It’s like, “This person has glaucoma. I'm going to give them a prostaglandin and it's going to solve everything.” Keep an eye on it and make sure you still follow them up every three months. How are you doing? If there's something not according to what you want, you might want to refer out to another colleague of yours that specializes in that or call them up or ask for a second opinion.
A lot of this question comes from personal experience. In conversations with other colleagues, one of the challenges I have when it comes to specializing in something and one of the things I've been working on specializing a bit more is in the dry eye. One of the biggest hurdles is when I bring in something that's a new technology, there's always a fee attached to it for the patient.
Talking about pricing and getting reimbursed adequately for the services that you're providing is important when you're trying to specialize. Can you give some advice? You don't have to talk about specific dollar amounts. Do you have pushback from people when you’re trying to recommend specialty options? How would you encourage someone like me who's trying to get into the area to overcome that mental barrier that I have talking about price?
Some patients might be put out by how expensive things are. How I approach it is a little bit different. The first thing is I'm providing a service that will solve your problem. If I can do that, give you a plan, and educate you on what I'm going to be doing and where your value is going to be, then most of my patients will be agreeing to my services.
My question is, why is it expensive? If you can take the time to educate them, why we're doing this, how will it benefit you, what I'm trying to achieve there, and you apply the process. Usually, they'll buy it. If you go, “This will help you do it. This is the cost.” No one's going to buy it. It's like an investment. You invest in getting your eyes better or investing to slow down the progression. What is your plan? What are you going to do?
Some things might help. For example, you can show your qualification. If you do a lot of the dry eye stuff, “I do dry eyes. I got certified here. We have the latest technology. We’ll show you each equipment, why we're doing it, and how we're solving it.” If you set down the time and discuss that with them, they'll appreciate it.
If price is the issue, they might go somewhere else. They’re like, “That doctor didn't address that.” Usually, you pay what you get. A lot of patients understand that. If you provide a great service, you believe in it, and you educate your patients, I don't think you should think the price. If I decide not to, I won't lower your prices because of that. You still have to believe in your services.
Stick to your guns. Believe in what you're doing. I find that there's a disconnect between me saying, “It’s $500 to get this treatment and it will make you better,” and the person feeling the results of that treatment. Once they feel the results of that treatment, if it worked the way you said, then they'll say, “That $500 was worth it.” How do you get them to understand that the treatment is going to benefit them? Education is the key there.
Believing in what you're doing is probably the biggest initial hurdle. Believing that what you're doing is helping the patient, you're going to be reimbursed adequately for it. I'm going to keep saying that because it's one of the biggest things that I've had to deal with, being comfortable telling a patient that they're going to pay this fee for this service. In the beginning, there were a lot of patients who are going, “Forget that.” As I've learned to explain it to them a lot better and educate them more appropriately, you see that their reactions are different on the whole.
I'm not sure if you do this. Do you have any brochures, stuff that's geared towards your branding?
No.
I'm going to use for example, “Here's a brochure. Here you go.” They're like, “This is dry eyes plan. This is not your plan.” If I list out all the different types of myopia management, it’s like, “This one is for you. This is why I'm not doing this one.” You can customize, “Your child's prescription, this is where it can go towards.” Maybe you can do a list of dry eyes, “Here's the whole dry eyes spectrum. This is where you are at. What we're trying to do is we’re trying to get you from here to here.” Sometimes that might help.
Do you have brochures or content like that printed out in the office that you had with your branding on it?
Myopia Management: Some patients might be put off by how expensive things are. Approach it a little bit differently. Position yourself as providing a service that will solve their problem.
Yes. With every single consultation, I will give them something to take home that's customized for them. When they take it home, they understand that plan was geared towards them. If they do go price shopping, they'll go somewhere else. That’s what will differentiate you. They go somewhere else and they’re like, “You didn't talk about this. You didn't talk about that. Where's the brochure that’s customized for me?” One funny story is when I went to Kiehl’s. This is the first time I ever went to Kiehl’s. Have you have ever studied the Kiehl’s?
I've been to Kiehl’s.
They sell stuff. They’re like, “Let's do a skin test.” I was like, “What’s a skin test?” You go in there and they're like, “Let's do a customized skin test for you.” All they do is hand you this litmus paper and you put it on your forehead or whatever for five seconds and they're like, “Let's match it. This is your skin. These are the products you need.” Here I am. I was like, “Okay.”
The next thing you know, I stepped out and I spent $150 or $200 worth of products. My wife is like, “That's great for you.” I was like, “Okay.” I saw the value. I’m like, “This product is based for me.” Even if I go somewhere, I’m like, “Maybe I'll go buy from The Body Shop. Maybe it’s cheaper.” They might not have the same product or they might not be doing a skin test. Something that's personalized makes a big difference.
That is genius. That's excellent. That's an amazing thing that we could implement in our practices. You've already been doing it. Do a legitimate test. We're not making something up here. Show the patient where they fall on the scale and what treatment is specific to them. That's awesome. Good job, Kiehl's. I want to go back to something that you mentioned earlier super briefly about axial length. Do you have anything that measures axial length in your office?
Axial length is going to be the future. They're going to be into myopia management. The reason is axial length will precede your prescription change. Sometimes that will change how you treat the patient. Let's say I have a little kid or their parents have -7 each. You see this five-year-old kid and you're like, “What's the risk?” You measure their eyeball length. Let's say I measured it to be 25 or 26 millimeters. That's a high number. I might have to monitor this kid a little bit differently. Maybe I can't wait one year. Maybe I'll have to see you back in three months. If something happens, I will start treatment earlier.
What I'm using is my OCT that can measure the axial length. It was not accurate. I decided between two different products to see which one I'm going to buy. Axial length machines are not cheap. They're about $30,000 for each one. If it's something that I believe in and it follows my vision statement, then I'm most likely to get it.
I’m going to check back in with you on that too, because I'd love to hear about how useful that is in your practice. Maybe that's something I'll look at down the road for me as well. I love this whole conversation. We've covered a bunch of different topics, your experience in the BCDO and giving back to the profession and the importance of that, learning to specialize, how to specialize, and when to specialize. Within that, myopia management.
We're going to talk about two completely different things here. The last two questions that I like to ask everyone at the end of the show are a little bit existential, some people have said, to prep you for that. Before we get to that, I want to put out there if people want to get in touch with you, what's the easiest way? Where can people find you? Where can people find your clinic? What's the best place for everyone to go?
I'm located in Kerrisdale, Vancouver. The best thing to do is to look me up. You can follow me on Instagram, @HelloEyeLab. Go to our website, HelloEyeLab.com, to find more information.
The first of the two questions, if we could hop into a time machine and go back to a moment where younger Sherman was struggling, whether it's financially, mentally, school, or whatever it is, you're going through a tough time. You could share that moment if you want to share exactly what was happening but more importantly, I would like you to share what advice you would give yourself at that time.
That probably would be when I was in university. One of the things is that I didn't feel like I maximized my university, you pretty much go to school, try to get the best grades you can, and then you go to the next level, professional school. One thing I highly regret or never did was enjoy the university. All about the university is to learn oneself. There might be subliminally I learned about myself but there are no lessons that are like, “It's not about the test score. What can I take from this?” I read one of your blogs or something that resonated with me.
Each patient is a little bit different. You have to ask about their lifestyle.
The quote was, “In school, you learn the lesson and then take the test. In life, you get tested and then have to learn the lesson.”
Even though I was being tested outside, I didn't take it and learn my lesson until years later. That's how TOMS Shoes came in. That filled in that gap to learn more about me. Even though there was much growth for me, I didn't find it like that. I thought it was easier than undergrad, to be honest. That's where I learned more about myself, living in a different city. Going back, I wish I took a little bit more opportunity to be a little bit wiser.
Sherman, that's good advice. I'm not looking for any specific type of answer there. It’s what comes to mind. If that's what comes to mind, that's great. That's important. In undergrad, that is where you do learn a lot about yourself. High school may not be comfortable for everybody but it's a fairly comfortable environment in the sense that it’s super safe. When you go to university, things expand. It's a chance for you to meet new people and do different things.
You moved to Chicago. When I moved to Boston, the same thing happened. You realize that all these years you've lived in Vancouver or wherever you grew up, you've had a bubble of some sort. When you move away, all of a sudden, you're meeting completely different people from completely different places who do not think like you most of the time. You are forced to learn. It's beneficial if you can try to start that process in undergrad, like you're saying here.
To let you know, a lot of university students have volunteered for me. I'll share some of my wisdom with them. Sometimes I’ll be like, “Come on in. Do you want to learn something about life today?”
Listen to Uncle Sherman.
Little fun things I like to do.
Storytime with uncle Sherman. I love it. That's great advice. The last question, Sherman, everything that you've done up until this point, everything you built, president of the BCDO, your practice, how much of this would you say is due to luck, and how much is due to hard work?
It can be different. What I believe is that if you put your hard work into it, opportunities will arise and that's where you become lucky. If you don't put in the hard work, you can't be lucky. At the same time, some people work hard and they don’t get a break. In my case, it’s 50/50. I'm lucky to see the opportunity and then I know that's the time when I need to work hard to seize that opportunity. If I don't see that opportunity, I won't work hard. Does that make sense to you?
You have to be lucky to see those opportunities also. That's where I feel like some luck. It's the perfect timing where it gives you that luck to get into it and then I became president. Back then, it was competitive to get into optometry school. Guess what happened? There was 9/11. Enrollment was down. I was lucky to get into it. If you take my OAT scores or whatever, if I'm not prepared, I wouldn't be lucky to get in.
50/50 is great. Most people answer it's all hard work or it's 90%, 99%, or whatever. It's impossible to get there without hard work. It's humble of you to appreciate and acknowledge that there's that luck involved. That's cool.
Myopia Management: Axial length is going to be the future. They're going to be into myopia management. The reason is axial length will precede your prescription change. Sometimes, that will change how you treat the patient.
That's for me. I wouldn’t give my advice. It’s like, “50% luck, that’s what Sherman said.” I celebrated my birthday and I thought about it. I was like, “Huh?”
What did you do for your birthday, anything fun?
I decided to postpone it.
I'm sure everyone will be happy to still attend and celebrate with you. Sherman, any last words of wisdom, any last things you want to share with us before we wrap up?
You asked me about being president. I've been around all different types of optometry, corporate, industry, academia. At the end of the day, we won't be able to practice what we want to do without the association. They’re the one that's always fighting for our rights. It’s our union. If we don't support and invest in them, our whole degree is useless. Be involved in the association, join the association, and see what you can do. The more optometry association, the stronger we are and we’ll have a louder voice.
I cannot agree more. Sherman, I don't know what large percentage of all the opportunities have come to me through the profession because of my connection to the association, either directly or indirectly meeting people like yourself and many other amazing optometrists. On top of that, we don't have a profession unless we have someone advocating for our profession and that’s our association or whatever provincial, state, society, or association in the US as well. Make sure you get out there and be part of that. Make sure our voices are heard.
Thank you so much, Sherman. I appreciate you taking the time to share your wisdom, your expertise, and your insights. A big thank you to everybody who’s reading. Whether you're listening on Apple Podcasts, watching on YouTube or Spotify, whatever it is, make sure you subscribe. Make sure you leave a review. Let me know what you think. Give Sherman a shout if you have any questions about myopia control or pediatric optometry. I'm sure he’ll be happy to help as well. Thank you and we will see you again for another episode. Take care.
Important Links
YouTube - Dr. Harbir Sian
Apple Podcasts - The 20/20 Podcast
Spotify - The 20/20 Podcast
@HelloEyeLab - Instagram
About Dr. Sherman Tung
Dr. Sherman Tung was born and raised in Vancouver. His passion and dedication for myopia management led him to pursue a fellowship in both the FAAO and FIAOMC. He was honoured to be named BC Optometrist of the Year in 2019, the highest award given to an optometrist who has not only contributed to the advancement of optometry, but has also demonstrated a fervent commitment to serving the community and improving the visual welfare of the public.
In his free time, Dr. Tung enjoys spending time with his beautiful twin daughters. He is also very passionate about Ultimate Frisbee and can be considered an amateur foodie.