Episode 88 - Sports, Business, And Independence - Dr. Jennifer Stewart

Anyone who has a passion for sports vision can start offering this specialty service in the current clinical set up. This is what today’s guest shares with us. Dr. Jennifer Stewart is a former Div 1 athlete, business consultant, founder of a sports vision clinic called OD Perspectives, and creator of the Performance 20/20 sports vision training program. In this episode, Dr. Stewart discusses her journey from wanting to be a vet to becoming a well-recognized speaker, author, and consultant in the eye care space. She also gives us some insight into what a thriving specialty clinic looks like. Dr. Stewart is a strong advocate for private practice optometry. As such, she is active in consulting for and supporting private practice optometrists around North America. Join in and listen to what she has to say!

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Sports, Business, And Independence - Dr. Jennifer Stewart

Thank you so much for taking the time to join me as always to learn and to grow. I'm super excited to have you here because I have a wonderful guest that I've been hoping to have for a while, Dr. Jennifer Stewart. If you haven't heard of Dr. Jennifer Stewart, she is an optometrist, international speaker, writer, consultant, and entrepreneur with a deep interest in sports vision. Jennifer is a Cofounder of Performance 20/20. She is also the recipient of the Theia Award for Innovation from Women in Optometry. She is a fellow grad of the New England College of Optometry. Go, NECO. Thank you, Dr. Stewart, for joining me here on the show.

Thank you. I should have worn my NECO sweatshirt. I should have been all decked out.

I'm not, although I have this. It sits here. I've got this thing. They sent me that for doing some speaking thing a while back. I'm very happy to keep it.

Thank you for having me. I'm super excited to be here. I love your show. I've been such a fan. Thank you for asking me. I'm excited to talk about everything we have planned to talk about.

Thank you. Me as well. On a personal note, the first time we met in person was briefly at Vision Expo or something but it was like I was seeing a friend. That's the beauty of the digital world, social media, podcasts, and all this stuff. You get to know people. We're lucky to have so many good people like yourself in the industry, honestly. It's always fun going to events like Expo to meet people. Maybe it was New York. I also saw you speak at the Vision Monday thing at the Global Summit. That's what it was.

When you're on stage and speaking about what you do and what is to come in optometry, I was intrigued by what you had to say. One of the big things is I am a huge sports fan. Give me anything sports related, I will watch it, listen to it, and read it. That has been your career. You've been in sports. I want to start with before you became an optometrist because you are a high-level athlete yourself. Tell us a little bit about what types of athletics and sports you've been into.

I've done everything at this point. I was a track and field athlete all through high school. I competed in Division 1 track and field in college. I was a triple jumper, long jumper, and a shot putter. I was more of a field event specialist all through college. I spent a decade after college competing in triathlons in all different distances from short to Half Ironman. I've done road races, marathons, and trail races. I was competing as a cyclist for a little bit. I competed in Olympic weightlifting for the last few years. I was not in the Olympics but Olympic weightlifting.

It's the style of weightlifting, but still to compete in that is incredible. I've heard you speak to that a little bit. It's not just lifting weights. You have to learn the movements. There are a lot of mechanics and biomechanics that go into that to make it efficient. That's stuff that I'm happy to go into the nitty-gritty about but we will save the audience all of that detail. What do you feel like you took from your time? You're still competing in various sports. At Div 1 level, what did you learn competing at such a high level that you're able to bring into your career?

It was a lot of work and a lot of time management. As a Division 1 athlete and a pre-med student at the same time, I was the only one combining a challenging course load with a sport that is all year. I did indoor and outdoor track. From August through May, we were competing and training. Time management was the biggest. It's learning how to prioritize time, school, studying and work. That has helped me and it translated even now. I'm super efficient with my time. I schedule everything. I know when I'm most effective.

As we were talking about before, I'm a morning person. I am not an afternoon or evening person. For any hard work or thinking I need to do, I usually block out my calendar for the morning to do that. I do a lot of writing. I do all of that in the morning. Competing like that made you figure out when you are your best and when you do your best at certain things. I had to get it done at certain times. That's still how I work. Around 2:00, I shut everything down. I could still do other things but I know I'm not going to write an article at 2:00 or 3:00 because no one would want to read that.

I'm sure people would still enjoy it but fair enough. It may not be your best work. I had on Dr. Hayley Wickenheiser. I'm not sure if you're familiar with Hayley Wickenheiser, an ice hockey player. That was one of the questions I asked her as well. She competed at the highest possible level of her sport. Time management was one of the key things that she said too.

That translated into her going into medical school and all this stuff as well. The other thing she took away that I wanted to ask you and I've understood at least from my conversations with athletes is grit. It's the ability where you know you have to push through this practice or this thing. Would you agree that you get grit from your sports training and that translates?

I love the word grit. I’m always looking to do something new even when it's hard and thinking of a new business to start or a new venture. Even presenting in front of a huge crowd can be intimidating but you get up and do it. That's how I felt when we started our sports vision practice. It was a lot of work. Creating something out of nothing was challenging, but every day I got up and did something. Even if I didn't feel like I was making progress when I would step back and look a year or six months in the rearview mirror, I'm like, "We have accomplished a lot."

Sports Vision: Starting a sports vision clinic was a lot of work. Creating something out of nothing was really challenging.

I would agree that grit is part of it, grit and practice. The last couple of years have been challenging as a business owner. All of us at times wanted to give up and be like, "What else can we handle at this moment?" Grit gets you through and helps you be a better leader of your team. Going through COVID as business owners, none of us knew what to do or how we were going to come out of this but we had to keep pushing through, especially for our staff, to say, "We're going to be fine. I don't know when will open or how it's going to look but we will all be fine." That grit translates into leadership as well.

The grit that you learn from sports translates into leadership and business as well.

It's leadership by example. If your staff sees that you're continuing to push through no matter what the obstacles are, they will get the courage and motivation to do the same. Let's talk a little bit about practice. I'm a big sports fan myself. I've seen what you've done at least a little bit in the sports vision space. I find that super intriguing. I would love to learn lots more about it and share that with our colleagues too to see if there's any interest out there for our colleagues to get into that space a little bit as well. First off, how did you find yourself in that in that space of sports vision? You're an athlete but how did you decide to open up an entire sports vision center?

It took me a long time. I started when I was at NECO. I co-founded the Performance Vision Club, which is still thriving and growing. It’s amazing. I think it’s almost twenty years. I teach a sports vision elective at NECO. I knew that it was a field or a niche that I was interested in. I was introduced to a colleague, Dr. Don Teig, when I was a 1st or 2nd-year student at NECO. He was in Connecticut at the time and was one of the largest sports vision practitioners. He invited me to come by and see what he was doing.

I knew that it was something I wanted to do. I just didn't know how. I spent the time at NECO figuring that out and trying to get involved in the community and network. I went to every national meeting possible to be in the room with other people who were doing sports vision to be a sponge and learn from them. I thought, "As soon as I graduate, I'm going to start a sports vision practice." It took me ten years. Life gets busy. I bought a practice three years after graduation.

I was busy growing the practice and learning how to run a practice. I had two kids. I graduated from NECO in 2007. In 2015, we opened Performance 20/20. It was something that was always on the back of my mind. Every year, it was on my list. The year would go by and I'm like, "I didn't get to it yet but I will." There's never a good time to start a new business. My husband and I decided that if we were going to do it, we should figure out how to do it, and we did.

There are so many lessons in that. One is if you want to start a business or become something, you have to put yourself into it and fully immerse yourself in that world, going to all the conferences and speaking to everybody. Finally, there's never a perfect time to open a business. There's no such thing. There are always going to be crazy obstacles. You just have to do it. I assume they're mostly athletes. What types of patients or athletes were you seeing?

Mostly hockey, so Canadian people. My Canadian friends are very big hockey fans. I was not a hockey person at all. I had never been to a hockey game. I knew zero about hockey, but we ended up with a space in a large hockey facility. It ended up being the perfect location for a sports vision practice because we were around the athletes. There was a strength training facility, a chiropractor group, a physical therapy group, and hockey players everywhere.

I had to learn about hockey pretty quickly. I delved into learning about the positions, but I was very honest about what I didn't know. I didn't pretend to be an expert. By nature of the people we worked with, we mostly worked with goalies. I got to be good at understanding what the goalies' needs were. That translated to lacrosse. We had a lot of lacrosse players. It's another sport I had zero knowledge of. I had never been to a lacrosse game.

I probably picked the two sports I was least familiar with, but I grew to appreciate working with the athletes and understanding what they needed and how to design a training plan for that. I'm impressed with the work ethic of the athletes that we have, how much they love their sports, and how excited they were to teach me. That was almost 6 or 7years ago and we're still close with some of the first athletes we worked with. We're now much older.

It was a slow evolution of starting a business and at first, expecting that as soon as we opened the door, people would flood in and go, "This is the best business idea that we have ever heard. We want to give you lots of money." It doesn't happen that way. With grit, I got in front of anyone who would listen to me talk about sports vision. I spoke in front of coaches, athletes, parents and people. I did demos and pounded the pavement to get the word out. I networked and learned from other people.

I joined the International Sports Vision Association. I'm on the executive board. I found like-minded people who were equally passionate and excited to share their knowledge. I am in the role now to do that for other people. I'm excited about sports vision. I find my role now is more on outreach, education, helping people develop their sports vision practice, and helping them figure out what they want to do and how to do it and be out there talking about it.

I will open invite. We have our next conference in February of 2023 in Texas. It is an international conference. Please visit International Sports Vision Association if sports vision is something you're interested in. We have such an awesome program already set of great speakers. It’s not just optometrists. We have athletic trainers, physical therapists, and chiropractors. We're open to anyone that works with athletes. It's a great way to network and learn.

Sports Vision: If sports vision is something you're interested in, visit International Sports Vision Association. It has such a really awesome program and a set of great speakers. It’s a great way to network and learn.

That's amazing because that was going to lead to one of my next questions. What if there is an optometrist out there who is interested, how can they get involved? That's perfect. What you did is you immersed yourself in that world and attended these conferences. I recommend checking that out in 2023. Is there something you would say to another OD to tell them that it's a valuable specialty for them to bring in or lean into? Is it something that you can just tack onto your existing practice if you have space? Do you have set up a totally separate performance center like what you have?

My answer is all of the above. It has been fun. I've been doing my lecture for the NECO students. The way I set up the first three lectures was an introduction to sports vision. What is it? My second lecture was sports vision for the primary care optometrist. We decided to add that in for students who might graduate and are not in the right situation for them to open a Performance 20/20 completely separate from their location like I did, but they might be in a commercial location or an associate in a practice that might not have sports vision.

We talked about ways to even start talking to patients differently about their needs, fitting contact lenses differently, prescribing sports eyewear, which is a huge passion of mine, and making sure we're recommending independently tested protective eyewear. Every one of us could practice sports vision today, tomorrow or next week, depending on how we talk to the patient in our chair. That can go from that to opening up multiple locations of sports vision practices.

It's such a cool niche and a specialty because you can do it for the next patient you see after reading this. You can go in and talk to them a little bit differently about their sports and hobbies, and make specific recommendations without having any fancy equipment and spending any extra money. I've worked with lots of doctors on setting up clinics where they say, "I can't buy a building or open another space but I have an extra lane or a small corner of my office. Can I start doing additional training?"

We work together to figure out what equipment they can buy or fit, and develop a program from that. It can be as simple as thinking about your patients as athletes to developing this complex program and facility. The great thing is anyone can do it. It depends on where you are now and where you might end up tomorrow to be able to do that.

That's good to know. I've had a very big interest in sports and sports vision as well but I never knew where to start. Now I know. Every time I think about sports vision, I think about the thing where the person is tapping. Is that one of the things that most people are doing? Can you give me an example of a couple of different tests or activities that you run with athletes?

We have the synaptic sensory station, which is a big touch screen that athletes are using. That one is their eye-hand coordination or quickness of movement. That's one of my favorite pieces because it's a great piece of technology. It's also one of the most expensive. Sometimes people get stuck because they look at the price tag of this equipment. They're like, "I can't do that," but in starting a practice, maybe you don't get an OCT or an Optos right away, but you start with some other equipment and then put that on your list.

When I work with consulting clients, we have our dream list or our wish list of equipment, "What do you want? What can you afford? How do we get there? and plan for that. When I speak to the students, I tell them, "You could do sports vision now with a lot of the tools you're using." We use a lot of Hart charts and Marsden balls. I know that people are like, "I'm digging deep for my binocular vision knowledge." I'm not a binocular vision person. I didn't do a residency. We do a lot of this in free space.

One of my hesitations to start was that I refer out for binocular vision. I have some great colleagues that do that. I had some people reach out to me and say, "I would love to do it but I didn't do residency. I don't do a lot of vernacular vision." There are different ways of training athletes. We used a lot of that technology but we used it at a distance. We had Hart charts and Marsden balls. You get creative with balance. There are balance boards, BOSU balls, trampolines, and lots of ball tossing and juggling.

If you watched Hard Knocks: The Detroit Lions, they did their pre-season. One of the players was juggling. He talked about how he loves to juggle because it helps him with his hand-eye coordination. I was like, "There it is." We did a lot of work with ball toss trail strobes, which are the glasses that go on that flicker and block your vision to help you with anticipating and your brain processing quicker. Those are a little bit more of an investment than Hart charts and Marsden balls, but you can do a lot with very little and a lot of creativity. The barrier to entry is not quite as much as most people think. With some creativity, you can do a lot with less.

That's great to know. I find the analogy there. I've leaned into the dry eye as a specialty over the last couple of years. For me and a lot of ODs as well, when you look at a specialty like dry eye, I want to have the big shiny IPL plus the big meibography. The next thing you know, it's $150,000. If you want to start doing dry eye, you need to first start asking the patient the right questions. You already have a slit lamp, fluorescein, and some of the tools that you need. Do the questionnaires first and then slowly work your way. That sounds analogous to what you're saying about sports vision.

In any practice, a lot of the people that are coming in are athletes, whether they're kids or adults. We forget our adult patients are competitive athletes as well. It's not even having to go out and recruit new patients and new athletes to your practice. By asking better questions and then giving different solutions that they might not get at a normal exam, you're already a sports vision doctor. You're thinking about smaller prescriptions. I will prescribe minus a quarter in one eye for an athlete because it makes a difference.

Making sure that you're optical has good independently tested sports protection and that you're up to date on all of the standards of different lenses already sets you apart as a sports vision doctor because you know something more than the doctor down the street. You're up-to-date on the newest technology. You're looking out to protect your patient.

Sports Vision: Just making sure that your optical has good independently-tested sports protection and that you're up to date on all of the standards of different lenses already sets you apart as a sports vision doctor.

You're offering a service that most practices are not with a very small amount of education, investment, time and money. You're talking to patients differently about nutrition, supplementation, glare, contrast, and visual acuity. You’re asking good questions, digging a little deeper into what they might be struggling with, and recommending a macular supplement to help with contrast and glare. They are going, "I didn't even think of that," and being a little different and a little more thoughtful.

That is a perfect segue into the next segment of questions I wanted to ask you. A lot of this talk about specializing and asking unique questions is something that will distinguish your practice from other practices, chains, and entities out there. On my show, I've been having a lot of conversations about those types of things, private practice, corporate, private equity, and so on.

One of the core themes that keep coming back through those conversations is that optometrists have the power to distinguish themselves to weather any storm and overcome any challenge, obstacle, or competitor. I feel that way myself. You are very invested in that world of private practice and independent optometry yourself. You write for Independent Strong. Can you tell me a little bit about what that is and what your title is there?

I'm the new professional editor of Independent Strong, which is a newer Jobson publication, which is aimed at supporting independent practices, whether optometry, Opticianry, or independence in eyecare. I was super honored to be asked. In my whole career, I've been in practice for fifteen years. I've been in independent and private practice the whole time. I am strongly invested and truly believe in independent eyecare.

I love optometry and all of the ways that you can be successful. No matter what changes happen, optometry keeps evolving and things keep changing, but a private practice that provides great patient care and is always on the cutting edge will be successful. We can't rest on our laurels. Any business is like that. You can't be complacent. You always have to be improving and looking to be better. In independent eyecare, we have such opportunity to do that, whether it's specialties, dry eye, sports vision, low vision, myopia management, and aesthetics.

We have such a lot of different things we can offer our patients. Independent frame is looking at what you have in your optical independent labs and lenses, supporting other businesses that support independent practice, and being around other doctors that are independent. I'm a member of EyeDock. I've been a member for my whole career being part of organizations that are focused on independent eyecare.

I'm super excited to be on the team for Independent Strong. We are providing high-level content to support our fellow independent practitioners. I encourage you, if you haven't signed up or visited the website, we're working hard on some great content. We have 2023 pretty much planned out. I'm excited about what we're doing there. September was my first month as the editor.

I shared a lot about what brought me into optometry and private practice in my editorial and then talked about storytelling, which is one of my favorite things to talk about in one of my articles. Any part of optometry that I'm in is supporting my fellow independence, giving them a voice, and making sure they feel supported and feel that they are able to be successful.

In Canada, alarm bells are ringing. Specsavers is the new entrant into the Canadian market that's making a big splash and that has got everybody on the edge, but private equity has been a factor here for a few years now. The US is a much bigger market. Things like that have been happening there for longer like the value chains, the private equities, and so on. Do you feel from your experience that private optometry will always have a place in the industry? Will it stay strong? Is there a fear of potentially this all being gobbled up at some point?

If anything, it's growing. It could be the people I surround myself with. In every forum I was on, and you're on them too, I've seen such a change in the questions people are asking and the path that they're looking to take, especially new grads and newer practitioners. I've seen more posts about cold starts and practice buy-ins, "I want to practice the way that I want." It was COVID partially that people took stock of how they wanted to live their lives and how they wanted that to look.

A lot of them are choosing a private practice. Either it might be that they don't find a practice they want to buy so they're starting cold. When I was graduating, I felt like I didn't see that as much. Maybe it's social media, and you're seeing it more. A lot of my classmates are either now or a few years ago starting cold. We have been out for fifteen years, but I'm seeing it more in the newer grads and even our colleagues that have consulting.

There are a lot of cold-start programs that are coming out and are out now that are aimed at supporting these practices. If anything, there's going to be a resurgence of people starting practices that more support and align with their personal beliefs and values versus just taking a job to do it. That's super exciting. It's fun to watch people say, "I went into optometry for a reason."

There is going to be a resurgence of people starting practices that align with their personal beliefs and values instead of just taking a job.

I was talking to somebody about this who had a change in her role. She said, "I went to optometry school. I remember saying when I was interviewing that I wanted to do X. I came out of school and took a job. It couldn't have been farther from that." I interview students coming into NECO. They all say that they want to go in to help patients and spend time with them. They graduate, and they might end up in a role that doesn't support that. People are stopping and saying, "Why am I doing this? This is not what I want to do. How do I create the role that allows me to be successful and happy?"

There's always going to be a challenge. I sold my practice in June. I was in private practice. I owned my practice for twelve years. I was there for fourteen but we had a Warby Parker open up a mile down the street a few years ago. We were like, "Eh." We have Pearle, LensCrafters, Warby Parker, and Costco all within a 1 or 2-mile radius of our private practice. If you provide the level of care to your patients that you want to and differentiate yourself with service, product and staff, I truly believe that you can be successful with the Warby Parker right down the street.

That's incredible to hear that new grads or ODs, in general, are looking to open up their businesses. That's heartening and reassuring to hear. The pendulum tends to swing. It may have swung all the way one way and now it is coming back a little bit. That's nice. It's good encouragement for those who are concerned about the competition from these other entities to know that they can still survive and thrive with that. It all becomes noise in my opinion. It's just background noise. There's nothing out of all of those that sticks out and says, "You have to come and see us.” We have the opportunity to be that beacon that people see as, "That's the place I should go instead of the chains and so on."

You have some experience in the business realm consulting and so on. I would love to ask you a couple of quick questions. We don't have as much background in education as we would like to have. If you wouldn't mind sharing some key little things for someone to take home or take back to their office and say, "I have to look at these KPIs or metrics and work on these few things."

First is knowing that you should be looking at metrics and KPIs, and knowing that there are things you should be measuring. There's a quote about, "What gets measured gets managed, and what gets managed gets improved." I have it up on my board because I live by that. It's great to go in and say, "I need to fix my business. I need to be better." I'm guilty of it too. I would go to one of these EyeDock meetings and come back. I'm so excited, gung-ho and inspired, and I want to make changes but you have to know what you're doing before you can make those changes, and then know what you're going to end up with.

I've been a big fan of metrics forever. I've been a big fan of GPN, the Edge software. I've used it. I was their 2nd or 3rd account when it was four generations of technology from what it is now. First is measuring and not just saying, "I'm busy. I'm not making enough money. I need to see more patients because I need to make more money." If you don't know how many patients you're seeing or what the behavior is of those patients, you can't make good choices and changes, and then monitor if those are working.

First, if you're not measuring that, you should be. You don't have to do it with an Excel spreadsheet or a pen and paper. It can all be done for you. The Edge pulls that all out of your practice management system. As long as you're categorizing everything correctly, you can have a dashboard that you can look at. First is getting set up to do that, and then measuring whatever you are looking to improve.

A lot of people are looking at the capture rate. It's a big one. People overestimate their capture rate and then they wonder why they're not making more money. They're like, "Everyone is getting glasses. We just need to do this," but you have to look at how many are doing that. Capture rate is a big one, having a plan in place if the number is not where you want it to be, instead of going, "It's online sales. It's Warby Parker. It's Costco down the street," and not throwing in the towel if that number is not quite what you would like it to be.

First is measuring it and putting a plan in place to say, "I thought it was a lot higher, but what are we going to do about it?" and not re-inventing the wheel to do that. Just like in sports vision, there are people that want to help. I'm an EyeDock member. They have a great team that will help. The Edge team helps too. It doesn't have to be that you live in a vacuum and do this on your own. Whatever challenge one of us is having, guaranteed many of us have had this before.

It's not feeling like you have to start over and climb this mountain alone, but reaching out to consultants and people to help. Once you've identified that, it's education and having staff buy-in, not just saying, "You need to do better," running back to your office and going, "Do it," but embracing that it's a team approach and investing the time, money, and education in your staff.

You don’t have to live in vacuum and do everything on your own. Whatever challenge you’re having, it is guaranteed that many of us have had that before. Reach out to consultants and learn from them.

Speccy is another one of my absolute favorite training resources. It's an online training platform that is a lot of fun and a great education for everybody on our team. It helps us understand how to be better in our opticals. Once the training is in place and you're doing it, then continuing to measure, not setting it and forgetting it, being continuous on monitoring metrics, identifying to checking where we're at, and then continuing to make changes, and not feeling overwhelmed.

A lot of people go into it with good intentions. They look at a dashboard and they're like, "Forget it." Pick one per quarter. Pick one in January. Pick one on October 1st. I'm going to measure the capture rate and look at what our capture rate is currently. If it's not where I would like it to be, we're going to have a team meeting about that and make sure everyone in my office knows what capture rate means and how that affects our practice, bottom line, and success. How can we be better at it?

Every month, maybe you're saying, "Here's where we are. We're getting better but we all have to be in. I have to be better at recommending multiple pairs in my exam chair. My front desk needs to be better at reminding people to bring their glasses, sunglasses or sports eyewear.” I'm planting that seed. My technicians maybe mention that as well. My opticians are the final stop. They're fulfilling the treatment plan that I put in place. We're all working together towards this goal.

It's not biting off more than you can chew and feeling overwhelmed that you have to change twenty metrics. If you try to do that, everyone gets disappointed and discouraged, and it falls apart. If you focus on one at a time and then keep circling back, making sure that you're continuing to measure that, and supporting your team to do that, it makes a big difference.

Sports Vision: If you focus on one metric at a time and then keep circling back and making sure that you're continuing to measure that and supporting your team to do that, that makes a big difference.

That's amazing advice. Thank you. People get overwhelmed. I'm speaking for myself. I do this all the time. I'm like, "Everybody gets this, but let me speak for myself." I know that from my experience now. If there's one person that feels a certain way, probably other people have the same concern. A lot of times, you feel overwhelmed or you're almost scared to even look at the number in the first place but you have to rip that Band-Aid off and look at it. You know what your starting point is.

Just one per quarter. Don't worry about your transitions, non-glare, average frame price, average lens price, and capture rate and go, "We're going to do all of this," because it won't work. If you focus on your capture rate, and as your opticians are selling more frames, then hopefully by nature of that, everything will start to improve. You can start to look, "Let's pick one more." You have to keep remembering that we're still continuing our capture rate. We're not going to drop that but you can build. You're gradually layering on. You can then become nitpicky at smaller things but look at bigger picture ones first.

Thank you for that. That's encouraging for anybody who's not so comfortable with the metrics and that side of the world. Their business is a nice place to start one step at a time. At the end of every episode, I ask two questions to all my guests. Before we get to that, I have one more question to ask you. You're a mother, an entrepreneur, and a business owner. You sold your business. Congratulations. You're the editor of Independent Strong. You're on the board of all these things. You're an award-winner and all of these. The question is this. Are you a superhero? What is your superpower?

I wish. That is so flattering. We are all superheroes. All of us entrepreneurs wear a superhero cape at one point. All of us parents are superheroes together in pushing through. It's that grit. It's getting up and getting it all done. Sometimes I look at my day and my to-do list and I'm like, "How am I going to get through that?" I'm a big fan of lists. It's old school. I buy these Steno pads and make a list of what needs to get done. All day, even if I have already done it, I put it on the list and cross it off. My superpower is making lists, being accountable, and feeling good that at the end of the day, I've crossed all of them off mostly.

All of all of us entrepreneurs wear a superhero cape.

I truly love optometry. That's what helps. I'm so excited about the field. The last few years have been such a blessing to be able to get out there, speak to so many people, write, and be able to have a platform to talk about independent practice, sports vision, and all the things that I'm super passionate about and be able to hopefully inspire people. That's what I love. That's what keeps me going. I love doing things like this. I was so excited to be on your show. I'm such a fan. When you were at Vision Expo and you had a camera crew following you around, I was like, "That's amazing."

I blame Darryl Glover for that.

That was pretty awesome. I'm inspired by the people I've met. In the last few years, I've met so many people on LinkedIn, Instagram, social media, and Vision Expo East. It was like seeing old friends. I feel like I knew everybody. I'm like, "We're old friends.” I've never met any of you in person but we have all collaborated so much and supported each other. We are so excited about what everyone is doing. My favorite thing that I do is connecting people to help them either in their business or support. I'm like, "Have you met so and so? You should get together. You could collaborate well." What keeps me going is how many people I can meet and how I can help them meet other people to be more successful.

That's amazing that you do that. I would call that a superpower. That's beneficial. I'm sure it feels good to you, but that's uplifting the whole profession by connecting good people with other good people. Thank you for doing that. Before we jump into those last two questions, where can people connect with you if they want to learn more about you and say hello?

I am on LinkedIn, Instagram, and Twitter. I'm not good at Twitter. If you find me on Twitter, I'm trying to be a little bit better there. I'm super active on LinkedIn and Instagram. My consulting company is called OD Perspective. I have a website and a blog. I aspire one day to have a podcast, so you never know.

I like the tagline on your website, "Believe in your vision." That's very good.

I will be at meetings and the Optometric Management Symposium in November 2022. We will meet in real life again. I'll be at the International Sports Vision Association meeting and the EyeDock meeting both in February 2023. You can find me on Independent Strong. I'm super active there. I'm always looking for great content. If you've got an idea, shoot me a message. I'm also on the GPN eyeTHRIVE platform where I have a monthly column on communication. I'm also hosting a five-part webinar series on building your authentic practice. If you miss it live, you can still sign up as an eyeTHRIVE member and listen to the recording. I'm excited about that. I'm everywhere.

Going back to the superhero thing, there are even more things that you're doing that I didn't even know about. Thank you. Here are the last two questions. Number one, if we could step in a time machine and go back to a point in your life that was difficult when you were struggling, you're welcome to share that moment if you would like it. There's no pressure on that but more importantly, what advice would you give to young Jennifer at that time?

The freshman year of college was a huge struggle for me. This is why I especially love interviewing optometry students because they are in that realm. I went to college. I was very strong in academics in high school and went into college coasting thinking that I could get through it well. I failed miserably. I was academically not doing well in my freshman year first semester.

I was the only female athlete out of all the fall athletes who were stuck in study hall for the whole semester. I went, "I'm here on scholarship. What am I going to do?" That grit comes out. I had to buckle down, figure out how to be better, and put in the work and the time when I didn't have to do it before. I reinvented myself, focused on academics, and put the time in.

I struggled with college, freedom, sports, and a load of academics, but then I turned it around. From then on, I was a 4.0 student. I was this flip-flop, but that helped me through optometry school. It's a heavy load. I love being able to share that with the students I interview because they always ask me about the academic load going into optometry school. That helped me prepare for life, realizing sometimes you have to put a little more effort in there. You will be rewarded. It's a great lesson.

Everything that you've accomplished and that you're doing here and all the amazing things, how much of it would you say is due to luck? How much is due to hard work?

We make our own luck. What I love to share with the undergrad students that I talk to is making your own opportunities and networking. I'm part of the Optical Women's Association, which is an organization that is built on networking, supporting women, and developing leadership skills. Most of it comes down to putting yourself in the right place at the right time, but you have to be there to do that.

We make our own luck. Most of it comes down to putting yourself in the right place at the right time.

Go to meetings and events. Sit down at a table where you don't know anybody, put your phone away, talk, and introduce yourself to people. Connect on social media and LinkedIn. Say yes to things because a lot of it is luck, but a lot of it is not who you know but how you've been out there and the opportunities that you create by opening yourself up to doing cool things.

What I tell the students when I talk to the students is that I've never applied for a job in my life. All of the opportunities I've had have come from being out there and being visible and starting as a student. I tell the students this. I was the keynote speaker for our optometry career symposium and that's what I said. Go to the meetings as a student. Shake people's hands. Introduce yourself.

Start making connections. Join your local society and the AOA. Go to meetings, meet with people, sit down with them, and introduce yourself to reps, people, and companies. How you create these opportunities is by being visible, active and supportive. I love to create opportunities for other people. I feel like that comes back tenfold for me. It has been fun.

That's amazing. I love that answer. I do hope all the good work you're doing and all the support you're giving does come back to you tenfold. Thank you so much, Jen, for coming to the show. I love having you on. I'm so glad we're finally able to coordinate this.

We will be in real life at Optometric Management. I hope to see everyone there too.

I'll see you there. Thank you, everybody, for tuning in to this episode with Dr. Jennifer Stewart. Make sure you check her out and see all of the cool stuff that she's doing. If you're interested in sports vision, make sure you look into that as well. As always, if you got any value from this episode, please make sure you share it. Send a text message, put up a screenshot on Instagram, LinkedIn, or wherever and let people know that we're having these conversations. I will see you in the next episode very soon.

Thank you.

Important Links

• Performance 20/20

• Vision Expo

• Dr. Hayley Wickenheiser - Previous episode

• Performance Vision Club

• International Sports Vision Association

• Optos

• Independent Strong

• EyeDock

• Specsavers

• GPN

• Speccy

• LinkedIn - Jennifer Stewart

• Instagram - Jennifer Stewart

• Twitter - Jennifer Stewart

• OD Perspective

• Optometric Management Symposium

• eyeTHRIVE

• Optical Women's Association

About Dr. Jennifer Steward

Dr. Jennifer Stewart is an optometrist, internationally recognized speaker, writer, consultant, and entrepreneur.

She has a passion for helping optometrists and organizations with operations, sales success, practice management and sales team training through her advisory and consulting firm, OD Perspectives. She is the Professional Editor of Independent Strong, is an Adjunct Assistant Professor at the New England College of Optometry and a consultant for Coopervision, MacuHealth and Zyloware.

With a deep interest in sports vision, Dr. Stewart is the Co-Founder and Chief Vision Officer for Performance 20/20, which provides services for sports and performance vision training. She is a recipient of the Theia Award for Innovation by Women in Optometry and serves on the Executive Board for the International Sports Vision Association.

Dr. Stewart is passionate about sports safety, enhancing performance, and helping business owners achieve their goals. An avid Disney fan, she lives her life by the quote “if you can dream it, you can do it.” She is inspired to help others with their dreams.

Episode 87 - The Power Of Authenticity - Dr. Kiran Ramesh

Once you know and understand your values, that is when you can be your true authentic self. And once you're true to yourself, you can be true to your team and to your patients.

Dr. Kiran Ramesh is a successful business owner, consultant, speaker, and an all-around powerhouse in the optical industry. In this episode, Harbir Sian talks to Dr. Ramesh about how she leads with love and tries to empower others. She discusses how being your true, authentic self can be the key to reaching your personal and professional goals.

On the clinical side, Dr. Ramesh shares how uncovering her own binocular vision issues has led her on a passionate journey to build a successful neuro-visual practice and share the importance of binocular vision with her colleagues.

As always, if you find some value in this or any other episode, be sure to like, comment, and share!

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Watch The episode here

Listen to the podcast here

The Power Of Authenticity - Dr. Kiran Ramesh

I have an incredible guest, as always. I'm trying to bring on people who can help us, inspire us, empower us, and help us grow in our businesses and our profession in different ways, help us think outside the box. Dr. Kiran Ramesh, my wonderful guest, is the perfect person. She leads everything she does with her four tenants, which are love, connect, inspire, and empower. In my experience working with her and connecting with her over the years, I feel that she lives by those.

I've been feeling those four tenets from her every time I talk to her. She is a NeuroVisual Optometrist based in the Toronto area. Her practice was the best eyecare practice in 2019, and then she was best in training in 2020 from transitions. She is a powerhouse. That is the word that comes to mind here. I'm excited to have you on. There's going to be so much value out of this conversation. Thank you so much for coming on my show.

Thank you for having me. I'm laughing because I hosted an event and I ran into a friend of mine that I haven't seen in about a year. He literally called me a powerhouse, used the exact same terms, and texted me. I find that hilarious.

There you go. It's confirmed. If more than one person says it, it's real

It'll be my new title. Perfect. Confirmed by two.

That leads perfectly into the first thing I was going to ask you. If you were going to give a bio of yourself, a description of yourself, what would it be? I feel like now powerhouse has to be in there somehow.

That's what's funny. When I was hosting this event, I said, “I don't even know what to say because I do have a multitude of things.” I started off with that. I said, “Someone called me a powerhouse.” If I were to give a bio of myself, it's what you said. Everything I do is by love, connect, inspire, and empower. Those are the four values I use to run my practice. Those are the four values I use to bring anyone into my practice. If you don't have those, you can't be working with me. Those are the four values I use in my friend circle and my home. It's the four values that resonate most with me. That qualifies as to who I am or indicate who I am. I would use that.

That's probably going to pop in throughout our conversation. You can say this is how those four tenets have helped in this area of your career. You do have many different things going on in your career. Aside from being an optometrist, being a mother, you have your own consulting firm now and these other things working with industry. There are many things that you're doing. It’s an inspiration as well. Let's start somewhere a little bit different.

I talked to you about this as well. This conversation we're having is coming off the heels of a series of conversations I've had. There are six of them. It’s about the future of Canadian optometry where I interviewed the heads of or people in the leadership roles of certain organizations, FYidoctors, Specsavers, Luxxotica, Essilor, and Iris to ask them some direct questions about what you think is going on in Canada, where do you think your company's going, and what's the future look like. I know with everything that you do and how involved you are in the industry, I'm sure you have some interesting thoughts. I'd love to hear those if you wouldn't mind sharing some juicy gossip.

In some of the conversations I've had with industry, it's becoming a bit obvious, or even if we look to what has happened across the world. If we use something like Specsavers, for example, coming into Canada, they've commoditized the eye exam. An eye exam, they're not doing anything wrong. They're doing a proper eye exam, a comprehensive eye exam where they're doing OCTs on everyone. In terms of commoditizing, meaning they put a value to it, which what we consider comprehensive eye exams.

Now everyone needs to ask themselves what's included in your eye exam. Why is it any different than what they're doing? I know in our practice, that's what we've started to do. What value are we putting in that a patient is going to get through our eye exam? How can we justify the cost of an eye exam compared to if someone went to something like Specsavers or in general? In the past, it was like if someone went to Hakeem or if they went to any other clinic. It's never about the competition. I never focus on the competition. It's being aware of what you can do internally and what's better for your patients. All of us, like you, do dry eye. There's dry eye, low vision, myopia control.

Authenticity: The eye exam in Canada got commoditized. You need to know what value you're giving the patient through your eye exam and justify its cost.

What can you even do within your practice, not knowing that these people were coming to enhance the value of what it is that you provide? That needs to be the key. That conference of eye exam needs to be all-encompassing. You need to be able to convey that message of what your eye exam includes and make sure it does include more than what anyone else has. That concern about the commoditizing and devaluation potentially of what an eye exam is.

If you say we do a comprehensive eye exam, but we charge half of what everybody else charges, it's going to raise some eyebrows. Patients are going to wonder why there is such a difference. That does put a bit of pressure on everyone else. When you're a large organization and you can afford to have your eye exam set at a certain number, lower number, it puts pressure on everyone else. Generally, the pressure means everybody else brings their price down, or at least that's the assumption of what would happen.

They've got the money to market. You need to make sure you're marketing with every phone call that's coming in. Are you conveying what you provide? That's the key. In my clinic, we barely market externally. We did it a long time ago. It's like in life where you talk about what makes the biggest change. The biggest change is when you work on yourself internally. Same with your clinic. When you work on your internal clinic, you are going to get far more big changes as opposed to just constantly looking outside of yourself.

When you work on your clinic internally, you're going to get bigger changes as opposed to constantly looking outside of yourself.

I like that connection. That’s deep. That's the kind of stuff I love. That's perfect. Think of your clinic as a being and you get to work internally on the being. There we go. This is why I have you on. Let's talk about your clinic. You're a NeuroVisual optometrist. I want to know a little bit more about what that means and exactly what type of services you offer in your practice.

I graduated, did optometry, and became an optometrist. I did what most people did originally, which was primary care. Come in, get your eyes tested, go home. I only had team members when I bought my clinic. I had my babies. Things plateaued. When it was going up, things plateaued, and then I came back into the practice. When I came back into the practice, being back, it was a whole flood of patience. I thought, “I need more space. I want to expand.”

I looked at more space and I thought, “What am I going to do with this space?” Binocular vision was something that was always enticing. From there, I realized I had learning issues. That got me even more involved. That's what got me into vision training and vision therapy. I call myself a NeuroVisual optometrist because everything I do now is with the brain and the eyes. If you call yourself an optometrist, I feel like we need to gain more value of who we are and what we can provide. I started doing that. I expanded my clinic. We now have eleven team members. From there, it's gone on. We do myopia control, dry eye, and nutrition. I would like to bring low vision in next.

That being said, I don't do all of that. That's not my passion. My passion is NeuroVisual optometry, vision therapy. I had my own issues. I can relate to patients. I can talk to patients about that. I have other doctors that are passionate about dry eye and nutrition because that's what their internal being tells them. They were worried about the world and their health. That drove them into that. I have another one that specializes myopia control. Everyone does their own niche based on who they are as a person. Even within our team, we ask everyone, “Who are you as a person? What did you want to do as a child? What do you love?” We intertwine their role with who they are. From there, we expanded out. That's how we got larger.

A few things to unpack there. One, I always assumed you did the BV stuff from day one, but you didn't. You brought that in later. Also, you mentioned earlier that you had your own binocular vision issues that I thought you maybe knew about that earlier too, but you also only discovered that after you started practicing.

That's what's funny. After going through school, you think something like that would've been caught, but no. I was here and I started taking these courses. You're hearing all these symptoms beyond what you're taught in school. I went in and saw a colleague. I had an evaluation done. I had a major CI and issues with my fusion reserves. I went for training. It's crazy on how it changed how I practice, how it changed who I am as a person. Whereas before, it was practice and go do. That's where a lot of it was external marketing and all that. Once I realized how I changed myself, everything stopped.

I started giving myself breaks and started to empower my own team and myself. I literally took a whole turn onto how I started doing optometry and then started to become the voice of VT for Canada, Vision Therapy Canada, which at that time was called Canadian Optometrists for Vision Therapy and Rehabilitation asked me to be on the board of directors. I said, “I don't know if this is what I'm interested in because I don't like politics.” They created a role for me the director of internal and external affairs. They know that that's what I love to do. I went across Canada. That's where I met you.

I'd go across the different provinces, then I started doing lectures. I started speaking at the association meetings. I got the word across. I grew Visual Therapy Canada’s annual gala by almost 80%. I have numbers, I can't remember them. I grew their sponsorship, everything. It was great because the world started to understand it wasn't even just an optometrist, but it was industry. Industry started to understand what vision therapy was.

As you're speaking, I was like, “Yes, that's where we met.” BCDO, I remember there was a booth and you were there. Around that same time, I imagine it was with a lot of the stuff you were doing that my interest peaked. I don't do any BV still as I've started to venture into some other spaces and specialties, but that's always on my mind. It seems like maybe one of the most, if not the most, impactful thing that I could do as an optometrist is potentially help many people who have these underlying issues. It’s good to know.

Everything that we do can impact, like, “Here, you're working with the brain.” You can impact someone's life. With dry eye or with nutrition, you're impacting someone's lifestyle. You're impacting their well-being. There's so much in every discipline that we do that can change how people function.

In that period of time, what was that roughly timeline from when you came back from your maternity leave and you felt like things were plateaued to going back up in a trajectory again? How long was that?

2014 to 2017. I expanded, went from 2,000 square feet to 4,000 square feet. It went straight up. I opened up the VT practice. I went from 1 therapist to 3 therapists. 2017 was when I started going around and speaking. 2018 was when I started going around and speaking.

There's clearly been consistent growth in various areas of your practice. You said you've brought in other doctors with these awards, the best eye care practice, best in training. There's constant growth and success, if you want to call it that. Are there a few things that you can distill from that 2014 onward? Things that you did or implemented or psychological changes, however you want to phrase it, that helped that growth. If somebody wanted to approach it differently, what would you say?

Starting from when you start small. When you're in a small practice, one of the things, and you're the only owner, what happens is every little thing, the light bulb needs to be changed or anything. People start coming to you. One of the first things I did was I started to stop and book at about three hours of my schedule, which was in the middle of the week and time for me.

Authenticity: If you're a small business owner, make sure that you set aside some time for yourself. During this time, you should ask yourself what you need to do or where you want to grow.

It was time for me to decide what do I need to do for my practice? Where do I want some growth? Within that time, probably half hour, an hour allocated when people could come to ask me questions. That took away all of the excess. It became to the point because it was once a week, sometimes, what they would've come to me before was already resolved.

That was one of the things. The other thing I started to do was I empowered my team. If they had an issue, tell me what the issue is, come up with a solution, and then I'll approve it. I was no longer coming up with the actual answers. Now is yes or no, which is fantastic because it empowers them to decide. They're capable of making these decisions. Those were two of the biggest things that I started to do. Once we started to grow it, realizing that you need a manager, you need someone to run the practice. From there, it was the manager and I that would take that time.

Once a week, we'd set up a meeting and say, “What are our goals?” We'd start with the beginning of the year. What are our goals? What are going to be our KPIs? What do we want to achieve? What do we want to achieve by the end of the year? We would work with the industry and say, “Here's what we want to achieve. What do you want to see from us?” We started creating all these goals and we would get everyone involved. That made the biggest changes.

Empowering the staff to come up with solutions and rather than you having to be the one to problem solve, they can solve it and almost puts you in a little more of a CEO type of a position where I'm making sure things are working well. The office manager thing, I have to say, is something that in our office has made a big difference. I know since we spoke about these types of things, we've started to implement more of that. That's made a massive change.

Having someone who can take care of a lot of those issues that bog you down a little bit on the day-to-day so you can think a little bigger, think on how you can grow your practice, that's been huge. It's been invaluable. We have two practices. We have an office manager in each office now. That person truly values their job in the office more, too, when they're empowered to take up more responsibilities.

One of the things for me, too, was cutting down my meeting time. I was no longer seeing anyone where, “Let me introduce what's new in the industry and stuff.” It was go through the manager first, see what needs to come to me. I got to come in and see my patients, which is what I wanted to do. I got to go in, have a meeting, and then everything would come to me. It literally is like you're a CEO. “Here's what's new in this product. Here's what's here.” I'm yay or nay on what's going to come in.

It's good to know. For me, that’s still something that we were, especially when you talk about the KPIs, working with your manager on the KPIs, the goals that you have for six months or a year or whatever it might be and then going to industry and seeing how we could partner with them or they can partner with us or however, you want to look at it to grow that. That's cool. You're looking at it like a CEO, which many of us don't do. As optometrists, we don't look at our practice, which is a business and we are the CEO of. We don't look at it that way. We need to start doing that.

On that note, one of the questions I was going to ask you later but seems to be on track now is we come out of school. If you ask 10 ODs, I bet you 9 would say this. What is the weak point when you come out of school? What's the one thing you felt not so confident in or didn't get enough training in? It would be business. I imagine most people would say that we lack that business acumen as optometrists coming out of school. Many of us do want to be business owners. How do you suggest that we, as individuals then, not necessarily within our clinic, how do we start to flex that or strengthen that business muscle?

Start from the bottom and then work your way to the top. The nice thing about having students come in is you're empowering them to become business owners. What I did was I literally went into a practice as a student and was hired as a receptionist. Within that summer, they taught me how to be an optician. I had to do everything in the practice. By the next year, I was a manager in the practice.

It's important as an owner to have every hat. Once you have worn every hat, you understand how a business should run, what worked for you, and what didn't work. Unfortunately, as a doctor, you're in this room and you have no idea what's happening out there sometimes. That taught me to understand every area, what flowed well. By the time I got into practice, I knew exactly what I wanted.

It's important for an owner to wear every hat because once you've worn every hat, you'll understand how a business should run.

I walked in and I said, “I'll work here if I can become part owner.” When I started working, I was able to literally go and I could tell each team member, “I understand where the weak parts are. We would work together and make them stronger. The reason why I can is because I've done that job.” That helps. Even during the pandemic when everything had to shut down, our practice was still open because we had to see emergencies. With limited team members, my manager and I could still do every role because we've done it in the past. Even right now, my manager's away for a month. She's been gone for a month. Everything I've taught her, she had to teach me again because you forget.

It's second nature. It comes back like this. It's important to know all of those different areas because then you see what's missing and what could be better. You can relate to your team members. When someone comes into the front, who's going to hear the worst of it? It's always going to be your patient care coordinators. By the time they come see the doctor, they're happiest. I can show them that, “We know this is going to happen. Here are different ways on how you can deal with it.” It's important if anyone can get into our practice, start from the bottom, get that exposure, do all those different roles. Even when I hired my associate, before she got licensed, she came in and I got her to see all the different roles in the practice.

That helps you understand the ins and outs of the practice and where the weak points could be, where you can make it more efficient. That's good. That's probably something I need to go through.

Honestly, it helps you understand how to run your business better. You're working on the internal. Now you're going to start working on your dispensing team or your patient care coordinators, or in my case, my therapist, or your contact lens specialist. You're like, “Let's work on these things.” Before you know it, your practice is flourishing.

That's good to know. Anybody out there looking to improve their business and the way the practice is run starts from the bottom.

It's never too late. Honestly, I will go sit at the front and I feel bad because everyone gets intimidated. My manager will come to me after. They're like, “They're a little scared.” I'm like, “I want to make sure things are still running okay and the way I want or that there's nothing happening that I couldn't make better for them.” It's good to take that time every so often. Sit in every person's different area and see what's happening.

I can see how that would be intimidating. A little bit of disclosure here for everybody who’s reading. Dr. Ramesh came into our practice virtually and helped us with some of the things that we were doing. Speaking of sitting in on somebody and making them a little uncomfortable, I had the pleasure of having Kiran watch me do a few eye exams.

To be honest with you, that’s something I would highly recommend to every optometrist, any business owner. After 10 years, 12 years of practicing, I'd been thinking about like, “I probably need someone to do this.” You get stuck in your ways. It's like driving. You pick up bad habits when you drive and you drive like that. If you were trying to take the driving test again, you'd probably fail badly. You didn't signal, turn too much, this or whatever.

Having you in there was huge. Little things that you suggested. Also, the philosophical approach to pushing your boundaries, putting yourself in an uncomfortable position to help yourself grow. I felt like it was super valuable there. From my perspective as a business owner, do what you suggested, sit in these different places. Perhaps make your staff a little uncomfortable.

With love. That’s where that value comes from.

Have someone watch you and make sure you're doing everything well, too.

This is what I tell people because I've gone into other practices as well. They always say, “We were worried before you got here, but you didn't criticize. You showcased opportunities. You were shining on what's possible.” That's what it's all about. It's doing it with that love and saying that you want someone else to get better. It might feel like it's intimidating, but we're there to support one another.

We should be there to support one another and not trying to compete or compare or judge. We felt that, the love and the empowerment. I appreciated that. That's a perfect segue to the next thing I wanted to talk about, which was KR Consulting. You've been doing this for a while now where you've taken all your experience, knowledge, and intellect. You're helping to support and grow practices and other businesses. I'd love for you to tell me a little bit about how that started and what's been going on with that.

During the pandemic, what was funny is I had a lot of industry call me and ask me what was happening, what's going on, what were my thoughts? I sat back and I thought to myself, “Why is it that they're calling me? What is it that I've done?” It showcased I've created something great in my practice, whether it's with my team and the growth patterns, and they see it. They've got all the numbers of all the clinics that they work with. I thought, “What do I love doing the most? What makes me happy?” It has to do with those values, the love, connect, inspire, and empower. When I started to understand my four values, I thought, “Why don't I translate this to support the rest of the industry? To me, what makes me happy is other people flourishing.

Be happy when other people flourish.

If you do well, if someone else does well, to my core, it makes me happy. In our mind, the way it started was because we had won the best eyecare practice of the year, I congratulated my team and said, “What do you guys want to do next year?” They said, “We want to win best in training.” I thought, “How do you win best in training if we've already won best eyecare practice of the year?” I thought, “Why don't I train other practices?” I was disappointed when I was at the academy that Canadians were not showcased as much as Americans.

My original plan was I wanted to train someone in each province. As a collaborative team, we would all go out for best in training, but then the pandemic hit. I was only able to train two other practices. That's how it all started. I thought, “Why don't I make this an actual business because I love it?” Going into people's exam rooms, even training my own associate, I train someone else's associate. I love that. Seeing them translate what I've done and the numbers that follow it. Do you want to talk about turn-ons? That's a turn-on.

The cool thing is there's such a tangible way to measure it. You can see whether it's contact lens sales or some other conversion or other numbers. You can see clearly the differences. From what I've learned from you and our conversations, the great thing is I saw so much value in that. I've been talking to our associates about not yet sitting in with anyone, but I've offered it to a few of them and said, “I'll sit. I'll be quiet. I promise no judgment.” It'll be helpful for both of us. Maybe I'll learn something from you and the way you do something. Maybe I can share some thoughts the other way around.

I feel the same in that when someone else succeeds. It gives you a feeling you can't replicate. At least as far as I've seen yet from someone with your level of experience saying that imagine, it is not something that you can replicate in any other way. That's pretty cool for you to be able to experience that many times with many different people. Who do you work with? Do you work with optometrists? Do you work with other people as well?

I work with optometrists and industry leaders or companies. Whatever I feel I'm connected to and as long as it's in line with my values, if it's supporting anyone for growth and it's to better anyone and it's something I believe in, then absolutely.

The one thing I for sure took away from our conversations was connect and direct. Those words are ingrained in my brain. Can you share with us what connect and direct mean? How do we apply that?

Connect is finding a way to connect with someone, which in my way, is finding a way to love someone or anyone that's around you. The patient walks in. What's the one thing that you like about them? Their hair, their clothing, the fact that they went on vacation and you went to that same place. There's got to be something that connects you. Once you get that connection, it becomes more authentic. Your relationship and interaction become more authentic. It's simple at that point to direct people to what you want them to do. Without going into all of the details, it's literally that. You connect, but when you're connecting, it's authentic. It's done with love.

Authenticity: Find a way to connect with your patient. You can try to find something that you like about them. Once you get that connection, everything becomes more authentic.

With every person that comes across your way, you should find something that you like about that person. Even if you do not like that person, there's got to be something that you like about them. That opens your heart. It's going to open their heart. You're going to be able to connect. It's simple to direct people to what you need. Some people call it manipulation. No, it's not.

There's the Robert Cialdini book. What's that one called again? I can't remember it now. It is similar concept in the sense of understanding where the person's coming from, what their goals are in life and desires are, and connecting with that. Ultimately, you're using that to develop a relationship with that person. We all have an end goal as far as the relationship that we're creating in the exam room and then direct. When you say direct, what does that mean if you were to expand on direct a little bit?

To me, direct is making sure that they get what you feel is best for them, but also their mind, what their needs are based on what you've connected with them. Let's take, for example, I had a patient come in and we connected on the fact that he has the cottage and he's out there during the summer. He came in for routine eye exam. He's an older gentleman. He wears glasses. People would never think to put this guy in multifocals. In my mind, I'm thinking, “I know what's best for this guy. He's in multifocals. He's out at the cottage. He wears his sunglasses. He can read outside. This is phenomenal.” The guy was on cloud nine. That's what he got. Directing them to what you think is best for them and what they need. It becomes simple once you've connected.

The Cialdini book is called Persuasion. I remembered now.

There's a nicer word than manipulation

That's what he says in the book, too, is like, “People will say that this is ways to manipulate.” We all have goals in life. Let's be honest about this. We're running a business. As long as you're doing it from the right place and the things that you're offering your patient, like you suggested, multifocals are going to help to make the person's life better. You're not just trying to swindle him, then it's okay. Also, now I know that I'll find you at a cottage in the summer. Is that correct?

Not me. That guy.

I thought that was the thing you connected with him on.

You'll find me in lots of places in the summer. I connected on the fact that he likes being outdoors.

The other thing that I was learning a little bit about is what you call the Sixth Senses. I imagine that the sixth sense is not like the movie, The Sixth Sense. You're not seeing dead people. If you could share with me what the sixth sense is.

Your five regular senses and then your subconscious. Sixth Senses is a team-building event that I created with one of my vision therapists. I love hosting different types of events. Even for my birthday, I like to have different extravagant ideas. I showcased this one event for my birthday and it was successful. I tried it on my team for a Christmas party. The beauty of it is working with all your senses, you realize the importance of the visual sense. You understand. You become connected with your team and you get to explore the subconscious that we might not be aware of and understand the patterns of why people are the way they are within your own team. It went well. We decided to do it for team-building events for other people.

We went out of our way and I even do it privately to anyone and anywhere. I picked sixteen complete strangers and put them in a room and had this event. It was phenomenal. Honestly, before I started, I thought I was going to cry because I thought, “What the hell am I doing? These people are never going to get connected.” They were from all walks of life, completely different. It was phenomenal. I ran into one of the guys a couple of months ago. He was like, “Do you remember me?” I said, “Yeah.” He said, “If you ever want to host another event, you can do it in my backyard. I have this oasis out there. It was the best event I've ever been to.” It's a lot of fun.

That Sixth Senses thing is a team-building event that helps people connect, learn more about each other, I suppose, connect on a deeper level. Is that what you'd say?

It opens up your eyes to who all of you are and gets your team connected, so you are more than just colleagues and friends. You become a family.

It's funny how sometimes the topics lead into one another. Talking about subconscious and less tangible parts of ourselves. One of the things I love about you is your energy. This is something that I notice and I respect in certain people I feel it in. You can connect differently with somebody with who you feel their energy. It's funny because several years ago, I thought that was all fufu stuff. My wife is the one who's helped me understand.

Now you get that feeling that you can feel somebody's energy or sometimes you can say the energy left the room or energy got stepped up. You could feel that. I've become a lot more aware of that. I feel like there are two different ways of looking at energy. There's the get up and I got energy to physically hit the day. There's the other energy where you feel somebody's presence. I'd love to hear your thoughts on both of those. How do you keep both of them firing on all cylinders?

This is something I teach my children right now as well because I want them to understand the power of energy, the power of your thoughts, the power of positive thinking, the power of you can create anything you want. It’s funny because we were on vacation with a bunch of people and my daughter says to me, “Mommy, are you a witch?” I said, “Yeah, I am. Why?” She goes, “You seem to get everything you want whenever you want it.” I go, “It's simple. You truly want something, you have your heart wide open, you're going to get it.”

They see it and sense it. How do I keep my energy up? One of the biggest things is you need to be seriously true and authentic to yourself. I don't ever try and get myself in any place. I don't ever try and do something. My heart's wide open to what I want to do and how I want to support people. Things show up. You need to create a path and try and get somewhere. It's always done from a positive way. What my parents taught me when I was younger is that the more you give in life, the more you'll get. Following principles like that, it keeps my energy up. I have more. We talked about the internal. The internal can be so many things.

If you want to keep your energy up, you need to be true and authentic to yourself.

It's you as a person, but it's also you and your family unit. Same thing at the office. It's you and your office unit. I make sure I'm always taken care of. I am always number one, which yes, I have my children, but I always made sure I made time for myself and my husband. We always had date night. A lot of times, people are like, “It's all about the kids.” That's how I keep myself energetic. If I need space, I need to go somewhere. I do it for me. People say, “You don't bring your husband to your conferences?” No, that's my time. It's important to always make sure you have time for yourself. Whatever calls to you, you go and do that.

I've always made sure that when I'm at home, I have time to always have dinner with my children. Wednesday night's the only time I work late. That's the only time they have dinner without me. I ensure that my family unit is secure. When I first had my baby, I stayed home for an entire year. I'd work, but I never went out in the evening. I never went out because I wanted to make sure that they knew what their bedtime routine was, whether it was me or it was my husband. If one of us was missing, they were secure. They felt secure. If I know my internal is secure and my home is secure, I can be doing whatever I want to do in my life. I have the energy to do it because I'm not worried about those other things.

Same with my office. I make sure my manager knows what's happening. My team's taken care of. Is my internal secure in the office? I can leave. There was a point where I was traveling twice a month. I was not in the practice, yet it was still growing. Why? It’s because that energy that I would bring back and the energy I leave with, it was always up there. People feel that energy. It's magnetic. It makes you want to be part of it. It makes you want to grow.

That's important. For me anyways, what I'm taking from what you're saying, that same kind of analogy maybe gets overused a little bit, but the airplane analogy. You put your mask on first, then you put the other person. You need to make sure that you are feeling fulfilled and healthy and that everything that you need in your mind and your body and so on. You can share that with other people. I feel like that's true.

Let's say somebody's feeling like they don't have that magnetic. I know it's maybe it's hard to say, “Here's step 1, 2, 3,” but what's an easy low-hanging fruit to get your energy to a point where you think people can want to connect with you a little bit more? To that energy field positive there. Would you say meditation? Would you say exercise? Would you say something else that you're doing that is helping?

All of the above. We all know exercise is natural endorphins. You need to do that. Meditation, I don't do it. I try. It goes up and down. It quiets your mind. It helps you focus. Personally, for me, what I feel like I'm attracted to when other people come in or I gravitate towards people, is when they're themselves. For every person, if they feel they want to be more energetic or have that magnetic feeling with others, you need to ask yourself, “Who am I? What are my values?” Going through your own values is a huge learning. That was one of the things I did a few years ago. Once you know what your values are, you start to understand who you are and what your purpose is. I'll give you an example. This might work. One of my values is friends versus family.

Friends and love. When I did my husband's, his was family. There's a reason why I don't have family as one of my values. It started to click for me. If we have an argument, when he's talking about his family, why it's important to him, I don't get that. For me, I don't value it the same way. For a person to understand their energy is to understand who you are and your values are and live and abide by your values. Just because my values are love, connect, inspire, and empower, that doesn't need to be yours, for example. You find out what your values are. Once you start to live and breathe your values, people automatically are connected to you because you're no longer trying to figure out who you are. You're you.

When we spoke on the phone, I said the same thing, “Be your authentic self, honey.” Those are the exact words that you said to me on the phone. What’s great is that you said the exact same thing but in a few more words here. It makes sense. If you're being true to yourself, then you do shed some of that weight and that excess energy that you're using to try to be whatever the other thing is maybe that you're trying to be.

This can even go back to the business, when you're being your authentic self, you're running by your own values, people trust you. Why do the industry come and speak to me? My numbers show that I'm doing well, but also, they trust me. I'm not going to say one thing or another to another person. I am who I am. I'm going to say it the way I am. You build that trust.

Thank you for sharing that. I know those are weird. Sometimes it's hard to tap into some of those because it's such an intangible thing. I feel like it's hard to put it into words sometimes, but thank you for doing that. That's a topic that when I start having that conversation with people, even people that I don't know that well, it feels like people want to talk about that. Everybody wants to understand that better. It's a topic that people think about more than maybe we used to.

Collectively, they understand the power of that having energy and these types of things. I usually ask two questions at the end of every episode. Before I go onto that, how can people connect with you? Where should I direct them? If people wanted to connect with you, how would they do that online or wherever else.

You can email me at Kiran@KiranRamesh.ca. That's probably the best way. I'm on LinkedIn, Kiran Ramesh. Yes, I have an Instagram. Social media, for me, again, that's not me being authentic. That's why you see posts for me every three months. I don't like to be near my phone at the end of the day. You can connect with me there and send me a contact and then I'll send you my phone number and my email. That'll be the best way to chat with me. I love chatting with people. I don't like to sit there and message. Call me. Come see me. Let's go hang out. Let's party. If there's a good party, you'll find me there.

That is you being true to you. I like that. On that note, an easy way to connect is to come to Vegas.

Vision Expo, I’ll be there.

The first of the last two questions. If we could step into a time machine and we could go back to a point in your life where you felt like maybe you were struggling. If you were comfortable sharing that particular moment, please do. If not, at least if you could tell us what advice you would give to yourself at that difficult time.

If I went back to a point in my life where I was struggling was when my parents were not on board with who I was and pretty much abandoned me, or I was in a house where I felt like I was suffocating and had to make a decision on whether I was going to live and be me or if I was going to follow societal norms. I'm someone who practices what they preach. Would I change anything? The advice that I give to myself is, you are doing the right thing because you're choosing to be you. I made the right decision. I chose to be me. I chose to forgo what society says and made the decision that I wanted to make.

Everything worked out in the end. Everything's positive no. Everyone came back into my life. The great thing was learnings that happened after the fact were the thanks that I got for people saying, “Thank you for opening the doors to something bigger for us.” To put some context behind it is I married someone who's Indian, but they're of a different religion. My parents were strict on we want the same religion, we want the same area of where you're from. In certain ways, it can get pretty scary at times. For everyone to come back and say, “Thank you for teaching us,” it's love that matters. It's not anything else. It's the same thing. Be authentic.

You don't have to worry about this box. Society created this box. Think about what you want to do and what you want to create. Find ways to maneuver around the box. It's the same thing that happened with the pandemic. You can choose to be controlled by what you hear, or you can choose to say, “There are all these opportunities that happen versus now we're stuck.” Try and look for those little holes and go beyond and create your own world.

Authenticity: Choose to be you. Forgo what society says. Society tries to trap you in a box, so you have to find ways to maneuver around that box.

Thank you so much for sharing that. I bet that's a message that many people need to hear regularly. Be you, stick with it, do what feels genuinely right and true for you. That’s amazing. Being from the same background, I can understand. I've witnessed it. As a guy, obviously, it’s a little bit different, unfortunately, in our culture. Thank you so much for sharing that. The final question is everything you've achieved in your career, in your personal life, everything that's going on, how much of it would you say is due to luck and how much is due to hard work?

All of it's due to hard work. How much is due to luck? I don't know. That's a hard question. Here's how I'm going to answer it. I look at people who do well and hear them say they're lucky. I look at them and I think to myself they've worked hard for this, and they're genuine, and they are who they are. We like to use that because we assume we're lucky and we think we don't deserve everything we get, but we deserve it. None of us are good at receiving.

The reason why we deserve it and we're good at what we do is because we work hard, but because we're also true, and we have that path and we follow. How many times I have to repeat myself, there’s genuine to who we are. Those big leaders are always who they are. They don't try and change themselves, but then they also work hard, too. I don't think they're lucky. They're authentic and they work hard.

Do you think the saying you're lucky is a form of humility?

Yes.

Being humble?

Yes. I would've never thought about it until if I look at people that say they're lucky and I'm like, “No, you're not. You're sweet. You work hard. You don't understand how amazing you are.” They're humble. They don't realize it, too.

My guess after getting to know you and seeing everything you've done, I would say it's all hard work, too, from your perspective. You've worked hard to achieve everything you have. Anytime I say the word success, I do this because everybody's got a different definition of what success is. Congratulations on all the good things that have happened and continue to happen for you. I hope there's so much more. I'm going to get the warm and fuzzies every time I see you achieving something. It's going to help me feel good. Please, keep doing more. Any last things that you'd like to share before we wrap up?

Thank you for having me. This was great. It was nice to spend some time with you. Optometry world, I hope this helps you out. Reach out to either me or to Harbir. Let's grow this world and make it stronger and better.

That's the best way to end it. I love it. Thank you, everybody, who's been reading. Thank you for all the support. Again, don't forget to share it. Take a screenshot, throw it up on Instagram, put a post on LinkedIn, whatever you do. Hit like and subscribe. Leave a comment. Thank you so much. Thanks for tuning in. I will see you in the next episode.

Important Links

• Dr. Kiran Ramesh

• Persuasion

• Kiran@KiranRamesh.ca

• Kiran Ramesh

• Instagram – @DrKiranRamesh

About Dr. Kiran Ramesh

Neuro-visual Optometrist, Clinic Owner, Speaker, Consultant, and Coach

Dr. Ramesh lives her life based on four main values, love, connect, inspire, and empower. She connects with patients, her team, colleagues and industry to better understand their goals, and in turn inspires and empowers all to discover opportunities, push boundaries, and understand their full potential. She operates a successful multidisciplinary clinic and supports the growth of others within the optical industry with peer to peer consulting and team building. In every area of her life her judgement and her actions are solely based on her heart.

Dr. Ramesh is the proud recipient of 2020 Best in Training at Transitions Academy and 2019 Canada Best Eye Care Practice of the Year. She completed her Doctor of Optometry at the University of Waterloo in 2004. She served on the board of directors for VTC (Vision Therapy Canada), is an associate member of COVD (College of Optometrists in Vision Development), clinical associate of the Optometric Extension Program, and is a member of the OAO (Ontario Association of Optometrists). She has 2 beautiful daughters, and a husband that always makes her smile.

Episode 86 - Dr. Kerry Salsberg - The Future Of Canadian Optometry

For the 6th and final installment of The Future of Canadian Optometry Series presented by Aequus Pharma, Dr. Harbir Sian interviews Dr. Kerry Salsberg to get the perspective of a successful independent optometrist.

Dr. Salsberg is the owner of modern and advanced practice named Eyes on Sheppard in Toronto. In this episode, Kerry shares his thoughts on the direction the profession is heading. He explains how optometrists across the country can embrace the coming changes.

Tune into all six episodes of The Future of Optometry Series on The 20/20 Podcast to hear the perspectives of leaders from various organizations in the Canadian eye care industry.

Be sure to LIKE, SHARE, and SUBSCRIBE!

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Listen to the podcast here

Dr. Kerry Salsberg - The Future Of Canadian Optometry

Welcome back to the Future of Canadian Optometry Series presented by Aequus Pharma. I’m very excited to bring you the sixth and final episode of this series. To do a quick recap in case you missed it, there have been 5 previous episodes with 5 leaders from various organizations that have a footprint in the Canadian optometric industry. We kicked off the series with an interview with Dr. Alan Ulsifer, CEO of FYidoctors.

Next was with Dr. Daryan Angle, VP at the Iris Visual Group. The third interview was with Mr. Bill Moir, GM of Specsavers Canada. The fourth interview was with Mr. Rick Gadd, President of Essilor Canada. The fifth was with Mr. Alfonso Cerullo, President of LensCrafters. As I’ve mentioned before, if you're reading, you've read that the sixth and final episode is with Dr. Kerry Salsberg. I wanted to wrap up this entire series and make sure that I got the perspective of independent optometry.

I don't want this to look like a big advertisement for all the various corporations that we could potentially work at. I want to make sure that we hear from a successful independent optometrist to hear what it takes to become successful in the Canadian market, what it's going to be and what it's going to take for us to remain successful moving forward into the future. Kerry definitely is the perfect person to talk about that. In this interview, one thing I asked every guest is for them to be candid. As I’ve mentioned already, some guests were candid and some were not. Kerry is about as candid as it gets and does not hold any punches.

That's exactly what I would love to hear from him because it's time for a bit of a wake-up call for us as ODs to understand what it's going to take for us to make sure that we are able to elevate our profession and what it's going to take for us to maintain a high perception for the value of the service that we provide in the public eye.

As always, I’m going to ask before I get into the episode the same thing I ask with every episode, which is that I hope you share this with our friends and our colleagues, whether you post it on Instagram, LinkedIn, Facebook, or send a text message with the link so everybody can tune in and learn Kerry's perspective as well as all the previous perspectives from our past guests on The Future of Canadian Optometry Series here presented by Aequus Pharma. Here is the episode with Dr. Kerry Salsberg.

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Dr. Kerry Salsberg, thank you so much for taking the time to join me here for this special conversation about The Future of Canadian Optometry here on the show. I appreciate you joining me.

Thanks for having me. I know this is a long time coming, and I’m glad that we could work this out.

It was well worth the wait. Definitely, you're top of the list for this particular, very specific conversation that we're going to have because you are the sixth and final installment in this series, The Future of Canadian Optometry Series. I deliberately wanted to keep you for the end because, in the end, I wanted to have the conversation rounded out by speaking with an independent optometrist. Someone who's been successful in that realm, specifically as an independent, and can showcase how ODs can do as independent and what it takes to succeed. You're the perfect guest for this, and I was more than happy to wait to make sure all the stars aligned. Thanks again.

I’m looking forward to this. It should be interesting.

Kerry, as you probably know and anybody who's tuning in for the sixth episode now, I’m sure, is familiar that I put a call out to the industry and the profession through the show. I did deliberately name some organizations by name to have them come forward to invite them on the show to talk about what is the future of Canadian optometry. What are these organizations doing to support the profession of optometry to make sure it continues to grow and thrive?

I’ve been fortunate to have some great guests and leaders from these different organizations who can give their opinions and perspectives than the average optometrists will get to see normally. I also feel like, again, you're in that position, a slightly different position, than many optometrists with the type of practice you have and the way you practice. I know that you're going to do this already, but I’m inviting you to be as candid, open, and share as much as you possibly can. I’m not afraid that you're going to be too secretive about anything. The first question that I’ve asked every single guest is, in your opinion, what is the current state of optometry in Canada?

The current state is, one, uncertainty. In Ontario, we're going through this OHIP process or negotiation process. We have staff and associate shortages. We have all these new players coming in. It's a big free for all right now. With that, comes concern, uncertainty, and anxiety. The pie may be getting a little bit bigger, but the slices are getting much smaller. We've heard about Specsavers coming in and all these online players. I think that the dust will settle. I don't think the market is big enough to accommodate all these new players. You see this in the stock market with marijuana stocks and pizza parlors. If it's too good to be true, the strong will survive.

That's for us to decide who's going to survive. Right now, gathering from talking to a lot of colleagues, there are concerns. That's good to have those concerns. You can't be myopic and have the blinders on. You have to know who your enemies are and your allies are. The state with Covid going on and we're starting to get the patients coming back into the practice, there's a little bit of apprehension in anxiety.

You touched on a lot of different aspects. There are topics there, which we're going to try to unpack a few as we go through. Obviously,  there's a feeling or a sense of some negative feeling. Anxiety is the word you use. I can't quite put my finger on what it is, but some disarray is happening in the profession. Are there positive things that we can look at right now? What's something that you would look at and say, “That's a good thing in our profession?”

The future is bright. There are so many niches when you think of optometry. When my dad was practicing, he was doing refractions and dispensing glasses out of a drawer. He couldn't even showcase that. We've come a long way, whether it's myopia control, macular degeneration, aesthetics, low vision, and dry eye. We have so many specialties, so we can create our own destiny.

The future is ours in terms of figuring out what you enjoy and how you create a niche because it’s what's going to happen. The generalists are dying. You can't switch dials all day long. You have to have a specialty in order to differentiate yourself, like the products that are coming out, the technology, and the contact lenses. I have ADD and I’m constantly being bombarded by all this stuff.

When I graduated, it was a stale profession. You had some new daily disposable contact lenses and that was exciting, but now, it's coming at you at a million miles an hour. I’m excited about all the opportunities and the technology that will be born out of a lot of these new niches that we're seeing right now.

The future is bright. We're not running for the hills, but you have to be very careful in terms of how you plan the next 5, 10, or 15 years. You have to have a plan and direction. If you're going to be a one-person operation, spinning dials, and trying to compete in terms of the optical and contact lens market, you're going to have a tough go for the next five years.

If you can create a service that not many people in your area are doing, then you're going to be fine. It's planning and not practicing in a 10x10 room and in the dark. You have to know what's out there and the competition that's coming in. Get online and figure out what some of the new services are being offered. I’m excited. The next 10 or 15 years in optometry are going to be transformative and it's going to be completely different than what's going on nowadays.

That's definitely good to hear that somebody like yourself feels that the future is bright, there's a lot of positivity to take away and things to look forward to as long as we're proactively building that for ourselves. To go back to what you said earlier, enemies and allies. I’m curious to tap into that a little bit, and again, if you're comfortable sharing. Who would you slate as those people in the profession right now? Who should we be looking at with a bit of caution and as potential supporters of the profession?

Somebody told me once that the shoe market was X millions of dollars before Zappos came around. The shoe market now is twenty times that. Zappos to the old cobbler would've been competition. I don't look at all these new players as being competition. I think it's going to expand the market and there's going to be greater awareness and education.

Certainly, there's going to be some pain as new players come in and it may be erased to the bottom in terms of pricing points, but by creating awareness of the harms of blue light, UV, and the importance of getting an eye exam, it only can help us. There is going to be some turbulence over the next couple of years. No doubt. The fear is that Specsavers has very aggressive growth plans.

There are going to be 200-plus locations in a span of two years. That's tremendous growth. We have to be aware of the competition, but you have to up your game. The greater awareness will strengthen the profession. That's why the pie will get bigger. It's just a matter of how much independent optometry will have a slice. Do I think that online businesses are good for the profession? Probably not. I do look at it as every person that comes into the market. There's an opportunity for us to get better, stronger, and be better business people. It's a kick in the pants to get your game on. Maybe I’m insulated.

Optometrists must be aware of their competition and level up their game. The pie will only get bigger, and it's just a matter of how much slice the independent optometry will have.

I’m not concerned about any of these players. I practice at a different level, not in terms of my skillset, but I have a very focused and laser-focused direction in terms of where I see my practice. Although we were successful when we grew from one doctor in a room about this size of the whole practice to now over 10,000 square feet with 40 staff and 8 doctors.

I’m not resting on my laurels. It's always what's next. What do I have to do to better myself to provide a better patient experience? Having this competition fuels that and makes you think about how am I going to survive and compete. I’m not worried about the competition. I’m aware of the competition, but definitely not worried.

I feel like we've had a few kicks in the pants over the last decade or so. You're right. I agree. Sometimes, if you could take it that way, you take it as a little bit of a wake-up call. Let's start thinking about new ways to practice and serve our patients. On that note, I did an unofficial poll. I don't remember if I mentioned this to you. When Specsavers announced that they were coming into BC before they'd officially opened any stores, I started texting colleagues across the country asking if I saw them in person, “In your opinion, what is your initial sentiment of Specsavers coming to Canada? Positive, negative, or indifferent?”

It’s about 40 votes and the result was 1 positive, low 20s like 23 negatives, and 17 or 16 indifferent. Obviously, it skewed pretty heavily to one side. I would probe each person and ask them, “Why are you negative? Why are you indifferent?” The way that it all seemed to flush out was the people who were indifferent were, generally speaking, practitioners and business owners like yourself who were doing well or comfortable.

They're forward-thinking and growing their business and they're saying, “I’m not worried about my business from a business perspective.” The people who were negative were somewhere worried about their business, but the big chunk of it was worried about the profession as a whole being devalued. What do you think about that? Do you feel that there is a reason to be concerned about that side of things, like the whole profession being devalued by a large player that perhaps brings down what the perceived value of optometry is?

That speaks to what I was mentioning before, which is the generalist doing refractions in a slit lamp and an OCT. There's going to be pricing pressure. In order to get a chunk of that pie, there will be a race to the bottom. I know that some retailers are offering $80 to $90 exams. You have Specsavers that are offering OCT and power to them. They figure out that a lot of doctors are charging for this for $95 or whatever it is and includes an OCT. In that respect, in terms of the optical, the contact lens, and the general eye exam, you will have to do something and make sure that we don't commoditize the eye exam.

We've already done it with contact lenses to an extent that we've done it with glasses. It's the Zara or H&M factor, which is disposable goods, but there's also a little bit of backlash. Now people are going, “I want to buy quality as opposed to quantity.” It's important that you establish relationships with your patients that something that may not come as easy to some of these chains and online players. Lifelong relationships are super important. Listening to your patients, being curious about your patients, and establishing. The biggest thing is listening. If we could do a better job listening to our patients as opposed to dictating recommendations and treatment plans, we can regain some of the lost market shares.

Competitive Pressures: Lifelong relationships are important. If optometrists can better listen to their patients than dictating recommendations and treatment plans, they can regain lost market shares.

These chains are basically commoditizing the exam, which I don't think is in anybody's best interest. We have to be concerned about that, but our fees have gone up. It’s the right thing to do. It sounds counterintuitive. When patients say it's too expensive, what they're saying is it's too expensive for the service or product that you're offering. If you can show value, even though it may be more expensive, it's not always about the lowest cost dollars. If we up our game plan and provide something that nobody else is doing, we're safe. Everybody has to do that to survive.

When someone is in your office, they've had an eye exam and they're at the end of the process, and they say, “Wow, that was worth $200.” I’m deliberately trying to pick a little bit of a higher number. I know that's not as high as some people charge, but it's more than what I charge. Let's say $200 for an eye exam, but they felt good because they went through the process, got all the tests, you listen, and serve that patient well. That was $200 well spent. What about before they even walk in the door? They're seeing that one of the chains does a $90 eye exam or $95. Let's say Specsavers include OCT, but somebody else charges $150 to $200. How are we going to show that patient at that point that there's a difference?

It's tough. I don't think a website cuts it or listing your service. I don’t think that resonates. People don't know what a visual field exam is or a cover test. It's word of mouth and you have to start. If you're starting fresh, you have a little bit of a problem. You have to do something. You cannot be a refractionist or do standard eye exams. Whether that's vision therapy or pediatric, you have to differentiate if you're starting. If you have a full contingency of patients and you have thousands of patients, then it's your job to make sure that those patients don't migrate to these chains. You're going to lose some. I know that I’ve lost some where they go once or twice to a chain and then they come back.

That's a good lesson. I can afford to lose those patients as part of a fact-finding mission, but you have to. It's all about service. As much as the patients don't like paying more, it's easier when I’m charging the fees. Some of my colleagues are charging 1/3 higher than what I’m charging with the expectation that it's good quality because they have no other way of comparing it.

If they know that somebody is $250 versus $95, there's an expectation that there's a differential. If they hear it from other patients that you have to go to Eyes on Shepherd or to your practice, they've already been pre-sold. The worst thing that doctors can do is bring down their pricing. If anything, you have to go the other way around but create service and value that the patient is able to feel and to pick up on.

Competitive Pressures: The worst thing doctors can do is bring down their pricing. Create service and value that patients can feel and pick up on

What do you think are some of the forces? We hear about consolidation. There are companies like Specsavers coming from overseas and there are online. What do you have to be, as an independent or as an associate doctor, working at somebody else's practice? What do you think may be the biggest threat right now to the profession or is there one, generally speaking?

You mentioned before the word indifferent. If you're indifferent, resting on your laurels and you have this annuity, you make X number of dollars every year and you don't have to worry, you're going to ride out the storm and retire in 10 or 15 years, the profession is in trouble. If you see this as a stimulus to get better, learn more, market more, and merchandise better, it's great. It's a wake-up call for the industry that has historically been complaining about a lot of things but making a lot of money and a good living. The ability to generate X number of dollars a year without working hard, that's over. You're going to see a practice erosion.

Patients are going to migrate because you haven't provided them with something that they can value. As an independent practice, I’m able to pivot and be so nimble. If I see a new device or new product, I can literally have that in a day. Our practice has been known to carry all the latest technology. One of our advantages or value added is that every time a patient comes in, they're going to be exposed to new technology and new product offerings. It's important because we only have touchpoints with these patients every year. Some practices, every two years. You better have something different so that they can judge that you're a progressive practice. Again, complacency and indifference will be the deathbed of optometry.

I love that answer because the direction I’ve been taking this whole thing is that there's something else out there that's going to be the death of optometry. What you're telling me is that we need to look inside or within and fight for that. Thanks. I needed that. On a similar note, a big part of this is the call-out. This series of episodes I have is asking these corporations and organizations what are they doing to support the profession. Do you think they have any responsibility to actually support the profession of optometry?

No. I don't think it's their mandate or any responsibility. It ultimately comes down to the almighty dollar. At the end of the day, they have to appease shareholders and their investors. It can be ruthless and cutthroat, but I don't think they need support. Frankly, if these companies are saying that they're supporting optometry, I’d be scratching my head and thinking, “I don't know about that.” I don't believe that. These players are here to make money and to seize market share, and that's it.

What Specsavers’ model is that you own the practice in some respect. What should they be looking at, in your opinion, when they make a decision to go work at this corporation or that organization or own a share in that practice? Do you have any thoughts on how they should make that decision, whether they should go independent or become an associate at an independent practice if we're looking at that ODs career path, but an overall profession for the benefit of the profession as well?

It comes down to freedom of practice and how you see yourself if you're being dictated by the corporation to pump out prescriptions. What kind of luxury do you have to bring in new technology and niche services that may not translate to greater net revenue for the corporation but provide fulfillment for the doctor practicing? Before we started, I said there's no free lunch in life.

At the end of the day, all these incentives and bonus offers will erode over time. We've seen it historically with managed care and Specsavers. No knocks against Specsavers. In fact, we should be applauding them. They've done a great job. What a great business plan and they've known how to tap into the consumer psyche, so kudos to them.

There is no free lunch in life. At the end of the day, incentives and bonus offers will erode over time.

I also know that if you're an optometrist there, there's probably going to be erosion and remuneration for yourself over time, just as there has been with managed care. As an independent practitioner, I can dictate how hard I want to work, what I want to do, how much time I can take off, how much time I can spend with patients, what technology I want to bring in, and what products I’m going to align with.

For me, being nimble, able to pivot, and able to decide my own destiny is a big thing. I get it. If you come out of school and you have $250,000 in debt, you're in panic mode and survival mode. You have to pay that back. I can see the lure of going into some of these chains and new players, but at the end of the day, these companies are there to make money.

They're not there to satiate your demands for what you want to make per year and they will cut costs. One of the best ways to do it is to take your percentage of whatever you take in, and that becomes eroded over time, so I’d be cautious. If it's too good to be true, it usually is. I’d also do research. I’d contact, other players that have been working for chains and see what the pluses and the negatives are. I don't want to criticize any of these players because they do have a business model. Independent optometry is not for everybody, nor is working for a chain. That's what makes the world interesting.

Competitive Pressures: Medical companies are here to make money, not to satiate demands you want to make yearly. They will cut costs, so be sure to take your percentage of whatever you take in.

That was one of the questions that I posed to each of the prior guests. For our conversation here, I like the fact that we're flowing through this a bit more freely, but with the previous guests, I had a much more structured interview process. One of the guests gave me the question, “Was companies are handing up these incentives?” For example, when I spoke with Dr. Ulsifer from FYi, I said, “You're giving these new grads forgivable loans.”

When I spoke to Bill Moore from Specsavers, I said, “You have these big salaries for some of your locations.” Do you think that the new grads have the leverage and the power or is that being clouded? Are their career paths and decisions being blinded a little bit by the money or the dollar signs? It’s interesting to hear the mixed response depending on if a corporation did have one of those incentives or if it didn't. Coming from an independence perspective, your perspective here sounds like it's not the OD who has the power in that decision or has the leverage, really.

You have to decide on the destiny that you want, whether you're with Iris, FYi, in a buying group, or working with these chains. The fact is there's a cost for that. They're not being nice and helping you grow your practice. Often, there's an issue. You don't want to deal with the administrative duties of a practice you've been practicing for a couple of years. You want to sail it into the sunset and see patients. There's a cost for that. Now, you can leverage some of their vertical integration and their cost savings on stuff. The salaries commiserate with maybe what you made before. As an independent, I feel that I can dictate what I want to make and how I want to practice.

I love the administration. I love being able to meet with my doctors and management and decide where our practice is going to go. I don't want to be governed by a corporation that says, “We have to improve our revenue or decrease costs.” I don't want to be part of that equation. I look at it more from how much money I can make to what life I want to live. It’s very important. Again, that dollar and loan forgiveness is a big lure, but that's fleeting. That 2 or 3 years where you've removed some of that pain, there's a cost for that. You either pay now or pay later, but you always pay. It's a difficult decision to make.

We were saying earlier offline the demand for ODs. I was saying one of my pain points these days as a business owner is I can't find associates. It's hard to find people to come and work. In general, it seems there's a shortage or a high demand, however it is. Pendulum seems to have swung one way. Usually, when that happens, it swings back. Is that what you see? At some point, it's got to reach a peak, and then it's going to somehow come back. If you put on your future goggles here, what do you see in that regard?

I liken it to the real estate market. Not too long ago, it was a seller's market buyers could not afford. Now, it transitioned. That pendulum analogy is very fitting. I don't know where these associates have gone. I know there was a cry that there were too many optometrists in the marketplace and too many schools graduating optometrists. As a practice owner, you have to be very careful in terms of who you bring on. Right now, if you have a pulse, we'll take you. That has long-term consequences. You have to take a breath. First of all, a lot of doctors that are bringing on associates do not need associates.

They haven't filled up their day. You have to do an analysis on your practice and figure it out. Are you better off not bringing in associates, condensing your hours, and maybe working a four-day work week instead of a five-day one and having gaps in your schedule? Most practices that feel that they need to bring on an associate typically don't. Sometimes, it is a lifestyle issue. Everything reaches an equilibrium. There's homeostasis and there will be. I just don't think it's right now. This is a very turbulent time for bringing in associates, finding qualified staff, and staff that lasts more than 2 or 3 weeks, and the pricing pressures to bring on those staff.

You can have somebody that should be paid $20 an hour, and they're asking for $28, but they're not worth that extra $8 premium. You have to be on the sidelines right now. There's so much uncertainty. Marketplace doesn't know what's going on. The stock market is in a quandary right now. Are we going to be in a recession? How bad is inflation? Are the rates going to go up? There are so many things that are uncertain right now. You have to take a breather and tread water. There will be some equilibrium that happens, but it's tough for independent businesses for sure.

For sure, it is, but it will be interesting to see how it all plays out. I can't imagine the way it keeps going this way for more than another year. We'll see how it all plays out or what kinds of changes will come about. You mentioned this earlier. You feel like the future of optometry is bright. What do you think the job and optometrist's job will look like 10 or 20 years in the future?

A lot of the stuff that we do will be online. Technology is improving. I can see where companies are going with the delegation and having your staff. A teleoptometry thing is going to be huge. If you're in a rural setting, you're going to have a reach of probably twice or three times your current population pool because of teleoptometry. The whole profession is going to be different. We are going to be using drops to treat myopia and molding new corneas. We're going to be using light therapy to treat all sorts of diseases that people can do at home. People are going to be able to do self-refractions, and these things shouldn't be scary. They're opportunities. We have to be current.

We have to make sure that we understand what some of these potential threats are. What we're doing with the equipment that you see behind me is going to be antiquated. I don't know, but I can tell you that going to conferences and seeing in terms of the future of lens design and imaging technologies, I’ve had the privilege of seeing the latest in OCT scans. We're talking about going from 100,000 megahertz to 400 megahertz and taking pan-retinal scans in 10 seconds. The traditional fundus BIO exam will be a thing of the past, thank God, because, with a click of a button, it takes a 360-degree scan, anterior and posterior, and everything in between.

Competitive Pressures: The optometry practice must be current. Everyone must ensure they understand that some of the equipment being used today will soon be antiquated.

That's 4 or 5 years away, a lot of change. Think about optometry from 1920 to 1980 was basically the same profession. You then had soft contact lenses, disposable contact lenses, great designs in multifocal imaging technologies, and myopia control. All sorts of things. I can't imagine what this profession but this is parabolic. We're on that hockey stick upturn. That's why we have to be excited, but we have to be knowledgeable. We have to go on the internet, go to conferences, talk to colleagues, find out what's the latest and greatest, and grasp onto something. Don't wait for everybody else to be doing it. Nobody remembers the second person on the moon.

They remember the first person on the moon. We also have to be able to part with our money. I see so many doctors complain about how much money they make, yet they're driving fantastic cars, going on luxury vacations, and having cottage properties. For every dollar you put into your practice, the return on investment of that can be $2, $3, or $4. People are very apprehensive to invest in their practice. You have to invest in your staff and your practice. It's exponential in terms of growth. When new technologies and new products come out, embrace them. The worst thing you can do is have a paperweight, but the best thing is you can offer new services and get clientele that way. Embrace the future.

There are some potentially very expensive paperweights out there carrying if you don't put them to use.

It's funny because we have pretty much every piece of technology. Probably duplication. I won't get into the company that we did business with. There was one device that didn't live up to its expectations. It pales in comparison to all the equipment that has brought not only value to the doctors but to the patients and has increased revenues. I don't think there's anything in our practice that I could live without now. We're one of the first ones to bring in Whitefield imaging, and I’d be lost if we didn't have that. The same thing with OCT and digital auto phoropter. I can move my shoulder now. It's amazing.

I’m starting to get a little pinch going here. It's taken a few years. Count has come up in almost every interview, interestingly enough, and I’ve never expanded on it, but the word delegation. That word has come up a lot when I ask that question about the future of our profession or the future of what an optometrist job is going to look like. What does that mean? Is that something we should be afraid of?

No. Patients judged the exam based on the one-on-one interactions that they have, whether it was 5 or 10 minutes. The perceived value can often be 20 or 30 minutes. As the patient goes through the gate of tests, they're spending upwards of 15 to 20 minutes doing pre-testing. Think about you have your visual fields, wide-field imaging, refraction, and tonometry. If you're doing VA, some doctors are delegating refraction, which I don't think is a bad idea, but it's getting all that data, understanding it, and then communicating it with the patient as opposed to typing in stuff. One of my big pet peeves is not facing the patient and my screen. Not too long ago, I was still writing on paper charts because I could do this and still face the patient.

Scribes are very expensive. As much as they're great, in the next year to two years, you're going to have digital scribes. You're going to have offsite scribes. Delegation is the way to go. Your time is valuable. Whether that means seeing more patients per day or less patients per day and having a lifestyle bonus, delegation is important. You got to train your staff. Gone are the days when patients expect you to do every procedure. That's how businesses run efficiently.

As part of that, the tele-optometry, as you mentioned, the upside is expanding the reach that we will have and the number of patients and geographically how far we can reach. On the flip side of that, should we be afraid of corporations being able to do the same thing, first of all? Secondly, AI and other things interfaces like that potentially replace the role of the doctor and settings like that. Again, with the digital refraction, I saw something about alternatives coming through the FDA. It’s getting some FDA approval in the states. That's obviously coming. Should we be afraid that we're going to be kicked out of this picture entirely?

No, embrace it. The good old days of putting up a sign in front of your office and be guaranteed annuity, whether you're a good doctor or a bad doctor, those days are over. You have to be at the cutting edge, or at least aware of it. We own those patients right now. It's for us to lose those patients. Unless you are progressing your practice and maybe doing things that are uncomfortable to you, getting uncomfortable to be comfortable later on, you're doing yourself a disservice by not being aware of these things. There's nothing that is coming out that is scaring me. As long as we can figure out that opportunity, that new service or new technology provides. Corporations are going to do it because they're going to chase those dollars too.

If you are not doing uncomfortable things to progress your practice, you are only doing yourself a disservice. You must figure out the opportunity that technology can provide.

The benefit of being independent and running your own business is that you have a lot of skin in the game. You care and you have great relationships with patients. I’m not saying that you can't be an optometrist at Costco and have great relationships, but the one main advantage that we have is that we have trust, we listen, and we're curious. I’m sure you're the same. How much time of an exam is spent talking about their vacation in the restaurants that they've been to and their family?

How's Billy doing with softball versus doing the exam? What the patient perceives is that you're turning all these dials and you've done an exam and spent the majority of your time getting to know a patient. What a wonderful opportunity. If I was a dentist, I’d go crazy. We could talk, but we couldn't get any feedback. The twenty conversations that I have a day with my patients, they value that.

They're willing to spend a little bit more to have that one-on-one, especially with Covid and being secluded and outside of many social circles. It's a great opportunity to bring them back for public life, having those conversations, checking in with them, and seeing how they're doing. An answer to your question, embrace technology and change. It's the only way that you're going to survive.

You've already hit this throughout the interview here, but if you were speaking to a pre-optometry student or looking for a profession to go into yet, what advice would you give that student?

Make sure you understand the profession of optometry. Work and volunteer or go into a variety of settings to understand where you see yourself. Not everybody is a business person and some people want to check in and check out them, and that's fine. Understand what the future of optometry is going to look like. Some are competitive pressures. Make sure that this is the right thing for you. Knowing what I know now, I would absolutely go into optometry. It's so exciting. For somebody that is like, “There's something shiny,” I love it. I went to Mito in the spring and talk about a trade show. I was wired.

The amount of money that these companies are spending on introducing new products is mind-blowing. There's no better profession. If you're in the healthcare profession, I think of optometry. I’m not saying this because we're having this conversation, and I don't want to sound like I’m 100% upbeat because there are days when I go home and go, “What the hell am I doing?” This profession is incredible and I’d love my kids to go into it. My son wants to be a baseball player/optometrist. We'll see what happens there. For my kids that want to go into it, I’d welcome it. It'd be great. I had the fortunate pleasure of working with my dad for 25 years and it was a great opportunity. I love that. It's been a wonderful ride and I have a few more years to go.

Hopefully, many more.

I hope so.

I appreciate that answer. It’s interesting to hear that you would encourage your children to go into it because that always is the tell-all at the end. When I’m talking to patients and they're asking, what would you do if this was your kid. I said that I’m always giving you the answer without you asking me. I’m always giving you the answer based on like, “If this was my child, what would I do?” In a situation setting like this on a podcast, I’m asking you this question.

Guests often feel compelled to sugarcoat the answer a little bit and make it sound nice to the optometry community. That's generally not the answer I want and definitely not during this series of conversations, not the answer I want. I’d like to hear genuinely if there's something negative that you want to tell that kid. How old are you before you go to optometry? 22? When you want to tell, “It's actually harsh right now. I’m not sure,” or you want to tell them, “No. Stick with it because ten years from now, this is going to be an incredible profession to be in.”

If you look at the aging population, you look at all the opportunities. You can be a salesperson or medical optometrist. There are so many different niches that you have. The one big challenge that we all face, and we talked about it before, is managing people. You have to be a leader. You can't be a manager or a boss anymore. You have to elevate your team. To be honest with you, I actually love it when my staff decides that they want to venture into something else. They want to go into real estate. They've learned how to talk to people now. They see a bigger, better future. You got to let these people go. Nothing is forever.

One of the biggest challenges all medical practitioners face is managing people. You have to be a leader instead of a manager or a boss. You have to elevate your team.

That means there's a constant churn of staff, and you have to manage that. When you have a staff of 40 people, there's going to be 3 people that are out sick. There's going to be somebody that has to move to the city. As we practice in Toronto, the city is getting prohibitively expensive. To make that commute an hour and a half away isn't feasible. It's a challenge, but it's also such a pleasure to see the ability to hire 40 people and for them to provide food for their families and grow personally and professionally.

It's wonderful. For other people, it's a headache. To see people grow and create this business family is great. To each his own, everybody has a pain point. My pain point is making sure everything flows properly. I am a little bit of a perfectionist when it comes to that. I get very nervous when I’m late for an appointment. It makes me crazy more than it makes my patient. These are some of the stresses that I have, but as long as you're working towards a goal to minimize those, you're good.

Dr. Salsberg, any final words of wisdom you'd like to share on this topic of The Future of Canadian Optometry?

To my colleagues, don't bury your head in the sand. Get out of your 10x10 room. See what's going on at the retail chains. See what's happening in terms of merchandising if you have an optical gallery in terms of marketing. Embrace administrative technology and be aware of the environment. It's not so scary. When you practice in the dark and think in the dark, it can be quite challenging.

Competitive Pressures: Optometrists must not bury their heads in the sand. They should get out of their room and see what is happening at retail chains and merchandising.

We are so fortunate to have a stable of patients that we have. We have to culture and nurture that patient pace. It's fun. We're doing this 8 or 9 hours a day. I want to have new technology and talk to patients. Granted, this has been a long day for me and you get a little bit parched, but it's great leaving the office. When you have a great day, your staff are happy, and your patients are happy, what more could you ask for?

That's a great way to end the episode. I appreciate you sticking around these late hours after work after a long day to share your insights. Dr. Salsberg, thank you for joining me and thank you to everybody who's been reading. This is the sixth and final installment in The Future of Canadian Optometry Series on the 2020 Show, presented by Aequus Pharma on Canada's number one optometry show.

Make sure you send me your messages and leave reviews. If you got something for Kerry that you want him to know, shoot those messages over. Let's keep this conversation going. Maybe we'll have even more of these episodes in the future if we feel like we want to ask more questions. Thanks again for joining me on this journey, guys. I appreciate it. We'll see you again soon.

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There it was, the sixth and final episode, the interview with Dr. Kerry Salsberg, owner of Eyes on Shepherd. I hope you enjoyed it. I hope you found some great insight like I did. Even some of the words that came out of my mouth that was like, “I guess I got to get my act together too.” Kerry didn't hold any punches. He tells it straight. That's exactly what we all need to hear. As ODs, how do we, as colleagues, come together to make sure that our profession continues to grow and thrive in the future? I hope you found a lot of insight.

If you haven't read any of the previous interviews, please go back and check them out. Once again, there are five other interviews with Dr. Alan Ulsifer, Dr. Daryan Angle, Mr. Bill Moir, Mr. Rick Gadd, and Mr. Alfonso Cerullo all prior to this interview with Dr. Kerry Salsberg. All right here on The Future of Optometry Series presented by Aqueous Pharma on the 2020 Podcast, Canada's number one optometry podcast.

I hope you've loved this series, guys. I hope you give me as much feedback as you can, and I’m very open to as much constructive criticism as you can provide because I want to continue to make this better. As I’ve said before, there's a chance that I’ll have some of these guests back on. If you think there's something I missed, I’d love to get back into it with them with any of the questions that you'd like me to ask in the future. Thanks again for joining me on this ride. It's been a great journey. I’ve learned a lot. I hope that there's been value in this for all of you that has helped and will help us as colleagues and professionals to continue to grow. Thanks again for joining me, guys. I’ll see you in the next regular episode right here. Take care.

Important Links

• Aequus Pharma

• Dr. Alan Ulsifer – Previous Episode

• Dr. Daryan Angle – Previous Episode

• Bill Moir – Previous Episode

• Rick Gadd – Previous Episode

• Eyes on Shepherd

Episode 85 - Mr. Alfonso Cerullo, President Of LensCrafters - The Future Of Canadian Optometry

Given the challenges in our country, like COVID, and the current state of Canadian optometry, Canada still has a solid market from a business perspective. As a profession, Canadian optometry still has a high demand for doctors to grow because of the elements which play a massive role in the industry. In the fifth installment of The Future of Canadian Optometry Series presented by Aequus Pharma, Dr. Sian speaks with Mr. Alfonso Cerullo about his perspectives on the profession's future. Mr. Cerullo shares his thoughts on the following topics: independent vs. corporate optometry, what increasing access to care means, the value of the eye exam, and emerging technology. Tune in to this episode and be sure to check out the entire series of interviews with leaders from various large organizations in the Canadian optometry space.

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Watch the episode here

Listen to the podcast here

Mr. Alfonso Cerullo, President Of LensCrafters - The Future Of Canadian Optometry

This is the fifth of six installments or the fifth of six interviews that I'm doing with leaders from various organizations across Canada that have footprints within the Canadian optometric market and in the industry. Generally speaking, they are large players in the industry. We are talking FYIdoctors, Specsavers, IRIS, and LensCrafters, which is going to be our interview.

If you haven't heard the previous four interviews, I highly encourage you go check out Dr. Alan Ulsifer from FYIdoctors, Dr. Daryan Angle from IRIS, and Mr. Bill Moir from Specsavers. All of these interviews have been valuable and truly insightful into what the future of Canadian optometry is going to look like from the perspective of these different leaders in different organizations.

What I have said along the way is that some of these guests have been very candid and very open. They have been open to discussion, open to face these questions head-on, and open to answering the question that I'm asking. Some guests are not so open. It has been interesting to hear your feedback as these episodes have been rolling out and to hear feedback from people who are listening and from my colleagues who tell me, “This person was open. This person was not so open.”

I appreciate that feedback. I appreciate you sharing. As I always make the request, please do share this with our colleagues across the country, whether you post it on Instagram, or post a link on LinkedIn or Facebook. Send a text with the link to your friends so they can tune in, whether they are watching on Facebook, YouTube, Spotify, Apple, Stitcher, or wherever platform because all of these conversations are valuable.

What I would love for everyone to take away from this is that we all need to be collaboratively, as optometrist and as colleagues, pushing in the right direction. Pulling in the right direction or however you want to look at it, and making sure that the public has the highest possible perception of our profession and what we do in the service we provide.

The fifth of the six episodes is with Mr. Alfonso Cerullo who is the President of LensCrafters and For Eyes. LensCrafters is one of the biggest retail met brands in North America and the biggest one under the EssilorLuxottica banner. Having Mr. Alfonso Cerullo on was very interesting and sharing some valuable insights. One, I'm going to tell you right off the top. I love that Alfonso shared that optometrists have the power. We have the power to decide which direction our profession is going, and which corporation we want to work with, whether we want to work independently. Ultimately, we have the power

 If we make a decision to work with a certain organization that may not be driving the profession in the right direction, that's on us. If we make the decision to work in a certain direction to make sure the perception of our profession is always elevated, that's on us. That's our responsibility. Without giving away too much from this interview, here is the conversation with Mr. Alfonso Cerullo. I hope you enjoy it.

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Mr. Alfonso Cerullo, thank you so much for taking the time to join me here on the show, in particular for this very special set of conversations that we are having that I have called The Future of Canadian Optometry. Thank you very much for joining me here.

Thank you, Dr. Harbir, for the opportunity. Thank you so much.

My pleasure. Alfonso, you probably know this now. A few months back, I put an invitation on the show to invite leaders like yourself and from other organizations to come on to share their thoughts about what's going on in our profession right now. I ask every guest at the beginning of each interview that I would love it if you could be as candid and open as possible to share your thoughts on what you think is going on these days. I start every guest with the same question. From your perspective as president of LensCrafters and For Eyes, what do you think is the current state of optometry in Canada now?

I have to say that from a business perspective, Canada is a very strong market for us. Looking back to the last months, this 2022, then also starting from the middle of 2021, we are doing very well. It's a very solid and strong market. We are very happy to be there. We are also experiencing some trends that start a little bit early here in North America. Many related to the doctor and supply. There is a strong need for doctors, and if we don't handle this carefully, it could be a potential challenge for the Canadian market.

LensCrafters: There is a strong need for doctors, and potentially if we don't handle this carefully, it could be a potential challenge for the Canadian market.

For optometry as a profession, from what you've seen in Canada, particularly, and from the service provider's or optometrist's perspective, do you think that the profession is strong? Is it growing or is it doing well? Do you see some pitfalls or challenges right now?

There are several types of challenges. We cannot forget COVID. COVID-19 starting in 2020 has been a strong element of disruption for all of us and any professional in this market. Including the ODs. All of us out there are trying to rethink how to do the things that we used to do in a different way. Technology played a strong role during COVID. As a result, people change their mindset personally and also the ODs. The work-life balance became even more a very important element in the life of people and the life of doctors.

This generates some change in some disruption in the industry. On top of those that I just mentioned, let me say there’s a lack of supply. We need more doctors. We know that there are more practices that are growing. There are new players coming into the market. The demand for doctors is going to grow. Let me say together with these different needs that the people have over work-life balance, this can generate some disruption. As I said before, technology can come in our favor like tele-optometry and remote care. This could be an element that can mitigate these potential needs.

That's something we are going to touch on in a little bit. You use the term disruption there a couple of times. That is going to be my next question. It is related to disruption and the various disruptive forces. COVID was maybe the biggest global disruptive force that we have faced together. Here in Canada, what other forces would you say are potentially disruptive? We hear a lot about consolidation, new players, and eCommerce. Which of those do you feel is maybe playing a bigger role? What do you think optometrists should be looking for?

All of the things that you mentioned are already there. All of the things that we know in the market. There are new players that are coming out there that have their own strategies. eCommerce is playing a big role. Considering how important is eye care or vision care, one of the most important elements that we should look at very carefully is the availability of doctors or the number of doctors that we have in the market. LensCrafters operates in US and Canada, but looking overall at North America, we know that on average, there are 1,700 new grads joining the community. It’s a little bit less or a little bit more every year. They are joining the family.

When you look at the number of doctors every year who retire, they are almost in the same range. You have 1,600 or 1,700. In terms of head counts, and the number of people or doctors that are available to serve the community, we are almost there, but then there is a material element in terms of work-life balance that is reducing the availability and the access to the care to the entire market and community. Together with the fact that there are more doors. Yes, there are new players coming, but there are also private entities in corporate businesses that want to open new practices in the market.

On one hand, this is something very good for us because it means that this industry is very healthy. There are new operators that want to come. What is important is to make sure that we are continually giving access to care, which is the final goal of all of us. We are continuously giving high-quality vision care to patients.

What is important is to ensure that we are continually giving access to care and high-quality vision care to the final patient.

We need to make sure that we make it appealing to new people or young potential doctors in this profession, the doctors and the ODs. We need to work with schools and make sure that the school of optometry are very visible and there are more doctors that are joining them. We are supporting ASCO in all ways possible. One of their last campaigns is Optometry Gives Me Life.

We have been a leading supporter of this campaign to make sure that new generations see optometry as a very solid and strong profession from a business and professional standpoint. They can be very instrumental in serving the community, for access to care, and giving the gift of sight to the people. I strongly believe that as long as we have enough doctors and the doctor community is strong out there, all the other elements that can be disruptive are mitigated. That's what I think.

There has been a lot of talk about this during the series of conversations that I have had. There’s a fair amount of talk about the demand or the potential lack of supply of optometrists. You touched on a couple of things that make the profession seem desirable and attractive to potential candidates and students who may be going into that path. That's one of the questions I will probably be asking you again towards the end of the interview. Do you feel that having more schools is part of the answer?

I don't know if it is a matter of the capacity of schools and if we need more schools. There are some states at least in the US where there are areas that are not covered by schools. This can facilitate access to the schools and make sure that the people choose to go and choose an optometry school that they want to go to. What we need to do even more than most schools is to create a strong awareness of this profession. Making sure that when the students out of high school have to decide, they know that there is a strong profession out there that the market needs. There is a stronger demand. It’s a good moment to join this industry.

These are the things that we need to make sure from everywhere, and that these new potential doctors are knowledgeable and they know. They have this awareness that the doctor, the ODs, and the optometrist are out there. It’s something that can be good for them. I guess that now, optometry doesn't have the same level of awareness of the people that should choose a school that another type of profession has.

As part of that conversation of there being not enough doctors, some have suggested through these conversations that there should be more schools. There should be more acceptance of students, and therefore greater output of ODs on the other side of it. I will say within the OD community, there's some concern that if that's the case, then it lowers the bar to entry and therefore lowers potentially the quality of the professional that's being out there and being put out there. It then devalues almost the profession in a way, if there's now potentially an oversupply of ODs at some point. Do you feel that that's a legitimate concern? Is that something that may happen?

I have had several opportunities to talk with the schools. The schools of optometry will never allow that. They will never ever lower the bar down to let more people get in. It's something that I don't think is going to happen. All the schools that I had the opportunity to speak to always made this point. It's more a matter of having more people trying to start this school, trying to start this profession, and trying to become optometrists, rather than saying, "Considering that we don't have much, let's lower the bar down.” I don't think that this is something that is going to happen. It’s a risk. I don't think it's happening, and I hope that it is not going to happen.

The schools of OME will never allow lowering the bar down to let more people get in.

The core question that I post when I put that initial invitation to the various organizations in our industry was, what is your organization doing to support the profession of optometry as a whole to help the profession in Canada to grow and thrive in the future? I would like to know from your perspective and as president of LensCrafters or if you are willing to speak beyond that to EssilorLuxottica as a whole, what would you say is the organization doing to support optometry?

A quick introduction. We know that LensCrafters is part of the EssilorLuxottica group. EssilorLuxottica is a new company that is coming from the integration of Essilor and Luxottica. It's the bigger player on a global scale in this industry, and LensCrafters is the optical retail chain here in North America. It’s the corporate retail chain.

We are part of a vertically integrated business. All we do is all about spectacle and eye care instruments. We round the industry. We’re trying to be an open player to elevate the industry. Even because of the position that we have as the leader of the industry, we strive to let this industry grow. Only if the industry grows that we can grow in terms of business.

Looking at LensCrafters, it's our biggest optical retail chain in North America. We have overall 1,000 stores split between the United States, Canada and Puerto Rico. All we do is make sure that we provide high-quality eye care and eyewear. That's what we do. If you look at our brand value proposition, we want to set the standard in the industry to make sure that every patient every day in every store can have these high-quality eye care and eyewear.

Also, we always say, and this is something public that we are always sharing in the market, we want to be the trusted optical retailer in the community. Trust is something very important for us. You build trust. Thanks to the many things that you have to do as an optical retailer. Good stores, equipment, product and environment, but mainly good doctors. When you look at the community and you want to be a trusted optical retailer, the doctor is essentially one of the main characters of what we are doing.

LensCrafters: So when you look at the community and want to be a trusted optical retailer, the doctor is essentially one of our main characters.

We work around you to make sure that the doctor is very visible in the community. He can showcase the high-quality service that we can provide. The question is, what do we do? First of all, we are always committed to making sure that we are always a cutting-edge store. Our remodeling and relocation of new stores is something that is part of our strategy. It’s a constant element. We are talking huge investment in terms of CapEx, and this is one of the elements. The doctors that want to join us can see that they are joining a company that is looking at the store as a key element of the community, and put them in a position to showcase a high-quality journey. That’s the first one.

The second one. When a doctor joins us, in both cases, if it is an employee where it is allowed by law or if it's a sublease, a doctor that is joining but is a completely independent doctor, at which we are subleasing part of our stores. In both cases, we make sure that we always have up-to-date equipment for this doctor. We make sure that all the best technology that is out there in the market is present in this practice at a very convenient price.

This equipment can be very expensive. You can have an optomap. You can have the Drum, this digital refraction equipment and all this stuff. Setting up the practice can be a challenge mainly for new graduates because they are also paying for their schools. By joining LensCrafters, they can have all this technology in a very beautiful store with a very good deposition in the community, and at a very affordable price. Everything is included in the lease.

It's important to say that you will never feel alone in LensCrafters because this doctor is going to join a huge community. We are more than 800 sublease doctors and more than 2,300 employees. The community is very big. When I say 800, it is the sublease holder. In each practice or the sublease holder, there are other doctors. You can multiply the 800 by 2. We are talking about thousands of doctors that are part of this community. They will receive newsletters. We have a moment that we come along together and so on and so forth.

Also, we are a leading player in all the major industry events. Many of them are in the United States, but I also know that the majority of doctors that I know from Canada used to join it when they were talking about AOA, the Academy, Vision Expos, and East and West. Everyone is coming there to understand where the industry is going. In all of these, there's always a leading player. It's a solid company that invests money to make sure that we are providing high-quality eye care. You can join a huge community of doctors, so you can be up to date and be part of it, and you can have a leading position in all major industry event

In the terms of making sure the profession continues to grow. You've described there a setting for an optometrist to grow and pursue their career, and be part of a community. It's nice from that individual optometrist's perspective. We are looking across the entire country, for example, with various challenges that are happening such as in Ontario with their negotiations with the government there and things like that. How would you say LensCrafters is elevating the profession or strengthening the profession of optometry in those types of situations?

The example that I always used to share is the following. Now, if you want to be an independent doctor and you are a new grad, it is not going to be easy. You have a lease. You need to build the practice so you have CapEx investments. You need to keep your practice up to date, always beautiful, and showcase who you are. You need to maintain this practice. You need to have personnel and people working for you. It depends if you just want to be a doctor at just an eye care practice, or you’re also selling spectacle products out there. That situation is even more complicated. You need to manage a back office. It's not just about people, but you need to have also technology and instruments to manage the back office.

You need to have a website. You need to invest in marketing to be visible in the community. You need to have an HR and a system to let you manage the practice. You need to have an appointment booking management tool to make sure that you can handle your booking in a good way or in a seamless way. All these things are all challenges that when you are a doctor managing your practice by yourself can be a headache instead of joining a big optical retailer or a big organization like LensCrafters where you can have a lot of these things with a very affordable sublease contract.

You are already joining a company that has a strong guide within the community. You have a company that is already giving you a practice that is remodeled and fresh with equipment and everything. You already have a system and back office. Now, if you have any kind of equipment or instruments that is not working, it’s independent. It’s on the practice to make sure that this is working.

We have all back office, contact centers, and eye care operation teams that are making sure our doctor community can be always up and running in a good way. Nobody is perfect. You can have areas for improvement, but in terms of the operative model, we always try to serve our doctors in the best way possible, and the service level is pretty good.

LensCrafters: You can always have areas for improvement, but in terms of the operative model, we always try to serve our doctor to come in the best way possible.

You touched on the word corporate or corporation. That is the next question I was going to ask you. From when I was in school, and I know it’s from higher years as well, but the conversation starts to happen while you are in optometry school. It’s this division between independent and corporate optometry. I would like to hear your thoughts on what you think and if you could define each of those, and then where does the LensCrafters model fall in that?

What I’m going to say is pretty straightforward. It could be strong. This definition is one of the most confusing definitions in the industry. When I joined this industry, I'm a managerial engineer. I'm an engineer and I spend most of my life in consulting. During my professional life, I joined Luxottica, and then I start looking after this optical retail business, first in Australia and then here.

At a later age, I got in contact with this definition, and it's confusing because you have corporate and independent. Normally, what we mean by this is corporate are all the big operators of the optical retail chain. That's the overall definition that the majority of the people land on. We have the independent that is the single doctor with his own practice and so on and so forth.

It's a way to define something. If this is the definition, it's pretty clear. Where I focus on is what we want to mean with the corporate retail chain and independent. If all of us have the interest to define what type of eye care service we are providing to the community, so then it is worth understanding and clarifying.

For me, the important thing in any definition that we use is to make sure that the doctor is independent in the sense that he can manage and execute his profession in the best way possible without any condition. That's the way because you need to provide an eye care service to the community, and this should not be influenced by anything else. You should be independent.

Make sure the doctor is independent because he can manage and execute the profession in the best way possible without any conditions.

If instead you are employed in an organization, you should make sure that you are this independent. You are executing your job in a way that you are still providing this service to the community. In LensCrafters, to keep our life easy, we have both of them. The majority, more than 800 stores have this sublease model. What does this mean? For me, it’s one of the best ones because you have an independent sublease doctor that is operating in his own practice as an independent. He is not influenced at all by any sales coming from the product and material because he's not sharing any profit from the product and material. He's just operating next to LensCrafters.

It’s all the things that I told you before. He made his own decision and say, “I want to join LensCrafters. It's a strong brand. I can have traffic over there. They invest in marketing for me. They give me all these eyecare operation tools that I can operate in my practice. It's good to go there,” but he's independent. He’s got nothing to do with us. This is the model that we have in Canada.

In the United States, we have the majority of subleases but we have also employed doctors. When it comes to employed doctors in the United States, we strive for continuous employment, with continuous learning, with the processes and procedures to make sure that whatever is happening on the other side of the business, the doctor follows on the eye care. There is no difference in terms of equipment. The equipment is the same.

There is no difference in terms of the time that we dedicate to the patient in employed stores or in sublease stores. All the metrics and KPIs, when you look at it, are very much comparable. We are obsessed to make sure that these KPIs on both channels are very aligned because what we want is to provide high-quality eye care. Personally, the sublease model can remove any doubt because you are providing the best eye care backed by strong operators that can provide the best eyewear.

LensCrafters: The LES model can remove any doubt because you are just providing the best eyecare begged by a strong operator. So that can provide the best.

The definition is implying something, especially the way that it was always presented to us in school, and the implication is that corporate optometry is the less desirable route. The evil corporations will set you up that way, and the understanding or implication is that they are determining how you practice. They are determining how many patients you see. I know in some organizations, from what I understand anyways, that is the case. How many patients do you see? How much time do you spend on each patient? I would like to know your thoughts on that. Is that something that is generally the LensCrafters' perception of that?

I have to be very honest. I spoke with our independent doctors and then we look at our business as LensCrafters. There are two answers to your question. The first one is the availability of the doctor and the access to care. If you ask me, considering how important is access to the care, everybody, independent, corporate, hybrid model like LensCrafters, we have sublease and we’re corporate. Everybody should strive to increase access to care. If there is someone in the community that need an exam, he should be in the position and in the condition to have an exam.

Seven days, that's the goal where I try to strive to give access to care to the community as much as possible. Every day over the week. How we can achieve this is a little bit different because if you want to provide high-quality eye care, you cannot have a doctor seven days a week, ten hours a day. That's unfair. That's not good. This doctor is tired. He is not in the best position to provide a high-quality service. You need to organize your practice in a way that you can maximize access to care and make sure that you can guarantee your people a good work-life balance to keep them fresh and relaxed to provide the best service. One is access to care.

LensCrafters: Organize your practice in a way that you can maximize access to care and make sure that you can guarantee your people a good work-life balance and keep them fresh and relaxed to provide the best service.

The other one is productivity and the way you want to execute your practice. I think that we are pretty much aligned. There are practices that used to see 10 to 12 people on peak days, and there are practices that on average used to see from 5 to 8. At the end of the day, if you have a doctor in the room managing twelve exams throughout the day is a fair amount of exams to provide a good quality eye exam, and also manage the productivity to keep financial stability for independent practice. Between 12 and 15 is something that is very fair to manage.

You mentioned that you had spent some time in Australia.

I have been there from 2017 until 2020.

The big elephant in the room these days in Canada is Specsavers, and the splash they have made in the last several months or whatever it is since they have made their entrance here in BC. It wasn't directly because of Specsavers, but a lot of the impetus for this conversation and these conversations that we are having is due to the second order, third order effects that have happened.

Other somewhat organizations are recruiting harder ODs and staff, poaching ODs from other places, and things that are happening in response to these waves that are being made. A lot of ODs, all of us essentially, across the country are a little bit on edge like, what is this going to mean for the profession? What is it going to look like 10 years from now?

We try to look to other markets where changes like this have happened and where Specsavers has come in. They originated in the UK, but Australia was the market where we know that they made a big impression if we want to use a diplomatic word. I would like to hear your thoughts as much as you are comfortable sharing. From your time in Australia, wow do you know or what do you understand of the market changing in the period of time after Specsavers entered?

In Australia, I was looking after the OPSM chain. In Australia you have OPSM and you have two historical optical retail chains in this market. When Specsavers came into the market, I was not there. I came later on. What I have been told is that they made the promise to the market, “We’ll open 100 stores in 100 days." This was the call to action that they open in this campaign and this journey in Australia, and they made it.

They did a great job. They went there and they opened a practice. They respected exactly the timeline of what they did. About how they operate, I cannot comment. I cannot say anything. Everybody out there is trying to do their best or what they can. Any kind of effect that you may have from the coming of an operator like Specsavers into the market, this effect is completely in the hand of the doctor. The doctors have 100% the power to make this phenomenon a big disruption or nothing. Specsavers, like all of us, need doctors. The only way that they can be successful is if the doctor is going that way.

It's a little bit interesting the dynamic because you see doctors that are very scared about this. I don’t know if they would be successful like Australia, but in case they will be, that scenario would be exactly the doctor that will allow this. Isn’t it interesting, this stuff? The only thing that I can say is that the doctor has the power. They should understand exactly what they are going to do, and then make their choice. You cannot eat the cake and have it.

That's a fair point. The optometrists are demanding. We want the cake and we want to eat it too. That's the way we work. We have talked about the importance of the eye exam. One of the questions that I'm asking everybody is how do we create the perception of value through the eye exam service? How do we leave a patient feeling that the eye exam was worth the amount of money that they paid, hopefully, beyond or exceeding the amount of money that they paid? In your opinion, what have you seen on that side of the business in the eye exam? From the eye doctor's perspective, how do we create that value?

There are two key elements on this point. The first one, which is your first point, is perception. This is based on the awareness that the people have about the site and about eye care. In a world where the industry becomes a commodity, there are many operators that go in that direction. It's about price. It was about cheap. It's about the spectacle on the face of people because, with the price that they have, they cannot afford all the extra costs to provide high-quality eye care. The more we go into a world where the industry becomes a commodity, the more the customers don't see the worth of an eye exam.

LensCrafters: The more we go in a world where the industry becomes a commodity, the more we play and communicate as much as possible in the industry as a word of mind instead.

Instead, the more we play together and communicate as much as possible in the industry through word of mouth when a customer or a patient is in the doctor's room, or any magazine of the industry. How important is it to take care of your eyes? How much can you discover about your health testing and have an eye test? I don't remember, but it’s probably something like 80 or 90 different types of disease. You are a doctor, you know better than me, but how many can be discovered by just inspecting the eye? You can save lives by having an eye exam.

The more we are able to let the patient in their interest know that they should have annual exams. They know that it's important to have an annual exam for their safety and for their health, and they take care of their eyes like they take care of their teeth. You go to the dentist probably every month, every eight weeks, or every three months. There are many people that don't visit an optometrist every year. This is something that all of us need.

If we do a good job in letting everybody understand how important it is to do annual eye exams and how important it is to inspect your eye, not only for the good side, it is the main things, but for many other things, the more the customer has the attitude to approach the eye exams and strive and look for a high-quality exam. He’s also willing, if he has to pay, to pay more because he understands the value.

I have been in practice where the customer has been moving across pre-test and test, across 6, 7 and 8 different equipment without telling him anything. He doesn't see any value. We spend time in LensCrafters explaining what an optimal piece is. What are we doing with the vision fee? What does this mean when I'm doing the refraction? We spend time after the eye test. The doctor spends time with the patient to make him understand, “That's the overall situation. That's where you are.” Let him understand the situation regarding his health and his eye. The more we do that, the more he is willing to pay and so on and so forth.

The second question is the feeling. Do I feel good enough? Is it worth the money that I spent? Honestly, back to the first point. When you have a good expectation, then you can evaluate if this expectation is fulfilled, and then you can make a choice. It’s not only based on the price, “It’s a very good deal. I didn't pay anything.” You can make a choice on price and on service. You create the feeling later on. If you are in a world where everybody understands the importance to take care of their eye, so then people are willing and open to pay if you are a good operator in the community and you are providing a high-quality service. The competition then is on the service rather than on the price.

If everybody understands the importance of taking care of their eye, then people will pay. And if you are a good operator in the community, you are providing a quality service, then the competition will be on the service rather than the price.

Many of us understand or appreciate the fact that if it's a race to the bottom and if it's a matter of commoditizing and lowering the price, it's ultimately going to devalue the service or the perception of the service. On the flip side, I'm curious to hear what you think about if you do have a patient in front of you who values the service that they are getting. They understand that we can potentially find these multitudes of diseases.

The service provider or the clinic provides a very high-quality eye exam with all of the things that you mentioned like the technology and education aspect. On the low-end, you could go all the way down to $0 and give an eye exam for free, but on the high-end or the other end, it doesn't have to be at the very high-end. How much do you think a provider with that high-quality comprehensive eye exam should be charging?

Canada is a little bit different from the US with insurance. There is a copay. Even then, there is a world about the copay. How much should be the copay? How much are you charging? Even there, it depends. I give you an example of lawyers. With the same lawsuit, you can visit ten lawyers asking for the same service, but you can go from someone that is pretty much zero or very cheap to someone huge and super expensive.

They both have degrees. They both are lawyers. They both can practice, but you have a choice because you have a clear expectation. It’s the same thing when you go to a doctor or any specialist. There is any kind of price. I think that the price of a specific practice should be made by the doctor. He knows what he's offering and he is able to explain it.

With that said, let me give you an answer based on what I think, making the conversation general. How much you can charge? You have the best interest. You know what are you doing and the service you are providing. You can define a price, so you should be free to charge whatever you want as a doctor. I think on average, a pre-test is optimal. An eye test in the range of $100 is a fair price.

Your example of a lawyer is an interesting analogy. It is relevant because many of us have the perception that lawyers may be overcharging sometimes. We can appreciate that there is got to be a balance in there somewhere. Let's say I gave you the example of a lawyer, the same lawsuit as you said. One lawyer charges $50 an hour and the other charges $300 an hour. What would your perception of their work be?

On a like-for-like basis, let me say this. If you are providing safety, it should be like for like. If you get an eye test, you just go in for a pre-test, adjust refraction, and then you got the right test and you are out, you charge $50. You need to understand what are you buying. On a like-for-like basis with the same level of charge, you cannot grow 600 times, $50 and then you go to $300. That's unfair. This is not good. On a like-for-like basis, it's not acceptable. Most likely, the $300 doctor is not going to have a big following in the community on a like-for-like basis.

You need to understand what you are offering because, for $50, you are having a very basic exam. You are getting into the doctor's room for a very basic pre-test, and then you go to the refraction for a few minutes, and you get out. On the other side, if you walk through a deep pre-test examination, you go there, you walk through the visual field, you go to the outer refraction, you go to the optomap, you have an OCT, then you go to a slit lamp, and so on and so forth, you are having a comprehensive eye exam. I don’t know if you can reach the $300, but you can for sure double or $100 or $150 compared to the other one.

I used the lawyer example because I wanted to make it dramatically different. You are right. In an eye exam case, it wouldn't be six times the difference. More so the question was because you assume from the outside before you've met them or before you've gone through the due diligence that they provide a similar service. Would you perceive the higher-cost one to be potentially providing a more diligent and comprehensive service versus the one that's the lower fee?

It's back to the awareness. If you ask a potential patient what is an OCT, what is an optomap, what is a slit lamp, or what are the benefits of this stuff, we are not doing a good job. We are creating a good condition for the $50 and not giving anything. It’s commoditization. I totally agree with you. The patient is confused and the price becomes a key element to define where you go, but it's because of the industry commoditization. That's the main issue.

We need to spend time with the patient and the community. Let them understand what are you buying because otherwise, you are like the guy that is going around in Ferrari and the guy with the bicycle coming next to him and saying, "How much did you pay for this stuff to go around?" He said, "$200,000." He said, "How much do you pay for your stuff to go around?" "$200." The guy felt frustrated. He says, "How is it possible?" He didn't realize that this Ferrari is completely different stuff. You know what I mean. We need to work more.

We need to create more awareness about what a comprehensive eye exam is. What are the services that you should expect? What the different tests that you have can give to you?" When you go there, you don't see many steps of this journey. You don't see much information that you should collect. It's $50, but mainly when it comes to yourself and to the people you love, the $50, $100 or $150 is not a life change. If you can feel confident that your son or daughter is perfect, they don't have any issues. Awareness is very important. We need to make sure that we let the industry step far out from commodization.

We need to ensure that we let the industry step out from commoditization.

One of the things that you touched on right at the very beginning of the conversation that I was hoping to bring back to you now was technology. You mentioned telehealth. I would like to get your thoughts on what technology should we see coming forward, and how is it going to impact the way we perform an eye exam. How is it going to impact the optometrist's job and position as the eyecare provider?

In my point of view is the following. The current condition is creating a very favorable field for growth over tele-optometry. Back to what we said before. We have 1,700 doctors on the market. We have 1,016 that are leaving the industry because they are retired. There is a work-life balance. There are more doors and rooms coming into the market. The physical connection between a doctor and a room is going to be an issue. More rooms and fewer doctors. How can this happen? Technology is creating a highway, and I'm in favor of certain conditions that I'm going to share with you.

It is creating a highway to break this link between the physical doctor and the physical room. Putting a doctor remote that can cover more room. You are increasing access to the care. You are making this care more available to more communities. You are supporting the demand. The point is that we need to be very careful not to create a jungle because, in the world of tele-optometry, you can find lots of things.

This can be a tele-optometry between me. It's a video conference tele-optometry. In EssilorLuxottica and LensCrafters, we have the first chain in the group that we are testing this suite. We haven't created. We have built an end-to-end suite with all the equipment integrated into the same environment under a very restricted protocol that is very aligned with the comprehensive eye exams because this is what we strive for. Comprehensive eye exams, so in that case, the doctor is remote, but he has all the information to take and prescribe glasses or any medical decision.

How far is AI from taking over that? If via remote or virtual apparatus were able to collect all the data, how many steps is it until artificial intelligence takes that optometrist seat to compile the data and give a result?

We are in a situation where the doctor is remote, the patient must be in the practice. That's where we are now. If I understand what you ask, you say how far are we from both.

How far are we from the doctor potentially not being part of the equation?

That's impossible. I had the opportunity to spend a few years now in this industry, Australia and here. The eye is so complex. Not just these, you need to make sure that you are analyzing these patients and you are executing the subject interview with the patient by asking questions to him and interacting with him, and ask the following questions based on the first question that you asked him. Many venues can be open when you are doing the exam.

Only human beings have the experience that can reach this quality. We are all different from one another. Even if you are very close to another one, everything is different in terms of age or lifestyle. I strongly believe that an algorithm can never substitute a doctor. I don't think that in twenty years, we can have artificial intelligence that can substitute a doctor.

The other thing that we touched on earlier was the demand. We touched on that fair bit about the demand and the lack of supply of optometrists. Part of the impetus for this whole series of conversations was that there is a demand for optometrists. There's a mad scramble right now to recruit optometrists or new graduate optometrists. Part of that is some incentive programs that have been rolling out with certain organizations, whether it's signing bonuses or large salaries to work in certain locations or forgivable loans from some organizations.

It all looks very lucrative and glamorous for that new optometrist, but my question to you is based on all of that, do you think that that new optometrist is the person who would leverage looking at all of these incentives in front of them and making a decision based on those incentives? Is that new grad the person with the leverage or is it that these corporations are potentially clouding this optometrist decision and their career path and there could be long-term implications to those decisions?

I think that the market is in distress. There is a strong demand for doctors. Everyone wants a doctor. This is a general market rule. The more the demand is strong, the more the price goes high. We cannot do anything. It is what it is. It's an input for us. What we need to look for is a fair market value. When there is a fair market value, then there’s a fair market value to operate and that's what we have to do. Then there's the chain. The $50 cannot be anymore the $50. The $50 becomes $60, $70 or $80.

At the end of the day, it is a spiral that closes on itself. The more everything goes up, the more the service is going to go up, the more the people have to pay, and that's it. It is what it is. These are money. This is the market. This is a condition that it’s creating there, but how much this one can influence the decision of new grads? I don't see the risk because it’s the same stuff when the profession was much cheaper. You graduated yourself. I make it up. You can get $100. There is someone that can give you $120. You were moving from $100 to $120. Now, the situation is much worse. You start from $200, doubling. I make it up. You are moving from $200 to $250, but it's the same. The mindset of the doctor is exactly the same.

Money is money. These people are out of school. They have to repay the loan. They need to take the best decision in their interest from a financial standpoint. They need to repay the loan. They need to start building their lives. They need to grow and be successful in their life. I don't think that this can influence more or less the way our doctors used to make a decision and now they are making decisions. I make it up. If a doctor would like to be independent, and they were striving for this, he's going in that direction. No matter if before you could have $100 several years ago, and now you are getting $200. That's what you want to do. You go there.

I don't think that this is something different from what it used to be. If you are independent, you know that if you need a doctor operating in your practice, you pay more. You need to ask for more money. I don't think that this one can influence the way how would the doctor will operate. It's a market condition. It is what it is. There is no market that is only $100. An operator in the market is offering $500, so then yes. This can influence the potential decision of a doctor, but if everyone is on $500, you move from $490 to $510. It is what it is.

LensCrafters: If you need a doctor operating in your practice, you pay more.

Let's go a little earlier on in the educational timeline. If we rewind a little further to a student who is like how you were talking about earlier, potentially thinking about going into optometry or evaluating their options in the healthcare field. What advice would you give to that person regarding optometry?

Do it. At this moment, this is one of the best choices that a young student can do, 100%. There is no other industry so healthy as the optical industry. It's good for them. It's good for us. It's good for the patient. There is a strong demand there.

The last question I want to ask you is any other words of wisdom or any other thoughts or insights that you have regarding the profession or regarding optometry from your time in the industry that you would like to share with the audience.

The doctors in the optical industry are the main player. Most of the time, they don't come together. Listening to the view and the voice of the doctor sometimes is not easy. Instead, there are some communities, in a certain way, that should strive to make it easier to understand the need, and then all the operators can act in the direction to support them. They are amazing. They are the main player.

Without the doctor, the industry is not there. Everything starts with an exam. Everything starts from a prescription. That's what it is. It's the number one player in the industry. I personally have experienced being someone that wants to listen to the doctor play in my favor. Sometimes it is not easy. There are lots of different interests and you cannot go bold on a few things. You should do probably lots of more soft things in order to make sure that you can make everyone or as many as possible happy. I'm very happy about this kind of initiative. I can listen. I can learn which are the main concern. Personally, in my little space in the industry, I can take it into consideration, but then also the other can take into consideration all these needs. If we are all aligned, we are all moving in the direction that the doctor is looking for.

There are many different interests, and you cannot go bold on a few things. You should probably do a lot of soft things to make sure that you can make everyone happy as much as possible.

I appreciate that. That is one of the messages I'm hoping to share throughout this series of conversations. It’s that the doctors have the power and ability to make certain decisions. They have the ability to direct the profession the way we would like it to go and grow and thrive in the future. It's up to us to take that control of that. Take the reins and make those decisions and not leave it up to other players who may not have optometry's best interests at heart. I appreciate you sharing that, Alfonso. Thank you very much and thanks again for joining me on the show for The Future of Optometry series. I hope you get a chance to listen to the other conversations. They are going to be valuable if you get a chance to tune into those as well.

Please share with me everything. I can understand how far I am from the others.

That will be a good learning experience for everybody to tune into each other's conversations. I agree.

I thank you for that. Thank you for hosting me. I appreciate it.

My pleasure. Thank you, everybody. This is the fifth episode out of the six episodes in The Future of Canadian Optometry series here on the show. I will see you in the sixth and final episode.

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That was the fifth of the six interviews that I conducted for The Future of Optometry series, presented by Aequus Pharmaceuticals here on the show with Mr. Alfonso Cerullo, President of LensCrafters. As he mentioned, that means he oversees Canada, the USA and Puerto Rico, a very large demographic, a very large geographical area, and a very large brand.

I hope you were able to take away some useful insights from what Alfonso had to share. Whether you feel it's positive or negative, it's all very important that we take this information and we use it for the betterment of our profession working towards growing our profession in the long term. Don't forget, there's one more episode. This was the fifth. The last and sixth episode is coming up with Dr. Kerry Salsberg. I wanted to round up this whole series of interviews with a conversation with a successful and independent optometrist, and Kerry fits the bill. He will share some very candid insights into what we need to do as optometrists to make sure that our profession succeeds.

If you haven't heard some of the previous interviews, please go back and check them out. They are going to live on the internet forever. Whether you are on Apple, Spotify, YouTube, or wherever platform, go back and check them out, and please give me your feedback. I would love to hear your thoughts.

There's a chance that I will have some of these guests back on again in the future. If there's something you think I missed, I want to go back and ask them again down the road. As always, don't forget to share this with your friends. Send a text message, put it on LinkedIn, put up a screenshot on Instagram, and I will see you guys in the next episode.

Important Links

• LensCrafters

• Dr. Alan Ulsifer - Past episode - EPISODE 81 - DR. ALAN ULSIFER, CEO OF FYIDOCTORS - THE FUTURE OF CANADIAN OPTOMETRY

• Dr. Daryan Angle - Past episode - EPISODE 82 - DR. DARYAN ANGLE, VP AT IRIS VISUAL GROUP - THE FUTURE OF CANADIAN OPTOMETRY

• Bill Moir - EPISODE 83 - SPECSAVERS CANADA GM, BILL MOIR - THE FUTURE OF CANADIAN OPTOMETRY

• EssilorLuxottica

• For Eyes

• Alfonso Cerullo - LinkedIn

• Aequus Pharmaceuticals

• Apple - The 20/20 Podcast

• Spotify - The 20/20 Podcast

• YouTube - The 20/20 Podcast

Episode 84 - Essilor Canada President, Rick Gadd - The Future Of Canadian Optometry

In the fourth installment of The Future of Canadian Optometry series, Dr. Harbir Sian speaks with Mr. Rick Gadd, President of Essilor Canada. They talk about the fair amount and types of disruptions in the industry and the positive aspects they brought on. 

Going deeper, in this episode, Mr. Gadd discusses:

·         What he believes makes Canada a desirable market for private equity and foreign companies

·         What parallels he sees in Canada compared to the US market

·         The Essilor (the largest player in the industry) is doing to support optometry

·         How Essilor dealt with the conflict after acquiring Contacts

·         What is his organization doing to support optometry

Aequus Pharmaceuticals presents 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

Essilor Canada President, Rick Gadd - The Future Of Canadian Optometry

If you have been following along with this conversation about the future of Canadian optometry, then you know that these are conversations that I’m having and interviews that I’m conducting with leaders from various organizations within optometry in Canada and some of the larger organizations, FYidoctors, Eyeris, LensCrafters, and Specsavers, being one of the hot topics these days here in Canada.

The goal is to ask these leaders the questions that we would like to ask as optometrists, "What is your organization doing to support the profession? What is your organization seeing as the future of optometry in Canada? What do you as an individual see as the future of optometry in Canada?" Thankfully most of the guests have been very candid, including this episode's guest in the fourth installment of The Future of Optometry in Canada, Mr. Rick Gadd, President of Essilor Canada.

Rick being candid and open, does share a lot of insights from his perspective as the head of this gigantic organization. He has overseen so many changes within the industry, including one of the biggest pain points for us in Canada, especially in BC, the acquisition of Clearly contacts many years ago. He was very gracious in facing these questions head-on and giving the best answers that he could.

Again, looking at this from now a different perspective than some of the other interviews. For example, businesses like FYidoctors, Eyeris, and LensCrafters have storefronts and conduct business-to-consumer transactions. Rick is talking about the business-to-business transactions that he is in charge of on a day-to-day basis. He's bringing insights from his extensive experience working in the US and seeing consolidation, private equity, and foreign organizations entering the market.

What he sees in Canada as potentially similar experiences or parallels that are going on. Don't forget to share that we are having this conversation about The Future of Canadian Optometry with all of our colleagues across the country, take a screenshot, if you are on Instagram, throw it up on your Story. If you are on LinkedIn, put a link up there.

If you are not on social media, send a text message to a friend with a link to the episode or to YouTube, where you can watch these interviews in full but make sure we are spreading the word and helping our colleagues to be enlightened about this conversation and the important changes that are happening and coming for our profession in the future. Again, this episode is the fourth installment of The Future of Canadian Optometry series presented by Aequus Pharma with Mr. Rick Gadd, President of Essilor Canada. I hope you love it.

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Mr. Rick Gadd, thank you so much for taking the time to join me here on the show for this very important series of discussions on The Future of Canadian Optometry. Thanks so much for being here.

Harbir, thank you so much for having me. It's a pleasure.

A couple of months back, I put a call out on show or an invitation to various organizations that have a small or large footprint here in Canada in the optometry industry and the profession. Thankfully, people like yourself have stepped forward to answer that call and come forward and share their perspectives on where our profession's heading and what's happening now.

Since I put that invitation out there a couple of months back, I have been speaking to a lot of my colleagues across the country, Coast to Coast, in all sorts of different modalities to try to understand what are their concerns and thoughts about where we are now, and taking that national temperature of the profession. I don't like using the word average but I mean our mainstream middle-of-the-bell curve optometrists and colleagues, people who are doing their day-to-day work in their clinics.

The perspective that you bring and many of the other guests that I've brought on for this conversation is a very different perspective. You are the leader or the head of one of the large, if not, maybe the largest or one of the Goliaths in the industry here as President of EssilorLuxottica Canada. I would love for you to share as much as you can candidly from that higher or a different perspective than most of us optometrists would have. The first question that I ask all the guests is this, from your perspective, how would you describe the current state of optometry in Canada?

I'm still learning about the Canadian industry, to be fair. I joined officially leading the EssilorLuxottica Canada organization at the end of March 2022. I've had the opportunity timely as there were so many meetings going on. Everybody was getting back together to meet and talk to a lot of key opinion leaders in the industry, customers that were serving, and the associations.

I would put it into a few buckets. First is that the health of the industry is quite strong in terms of demand. We have a strong need that continues to be extremely relevant in Canada and across the country. Secondly, I feel it's an under-penetrated market relative to some of the under-markets in the world. That, to me, states opportunity.

Penetration isn't just necessarily a number of people who are wearing contacts or eyeglasses but the breadth of being able to utilize visual enhancement for different needs, whether it's looking at a computer screen, being outdoors or for protective purposes, and so forth. I feel like there is an opportunity in terms of penetration.

The third dimension, though, which I knew of but it's become quite clear to me, is that it's a very attractive marketplace. In the sense that you, the Canadian market has attracted a lot of players. Probably the number of relatively large players who have entered the Canadian market is quite stunning relative to others. I will reference the US because it's an easy reference that there are some similarities in the market. The last players have entered Canada from international destinations.

To me, that says a couple of things. One is that the barriers to entry may be lessened a little bit for the Canadian market but secondly, the socioeconomic landscape and the opportunity to market are very attractive. I always remind all of my peers that Canada is the tenth largest GDP in the world. The only thing that goes against that, perhaps, is that we happen to live next door to the largest GDP in the world. Sometimes that gets muted a little bit.

Essilor Canada President: Optometry has lagged in other industries in terms of the utilization of technology to streamline business and business models to attract, engage, and retain patients and consumers.

The fundamentals of the industry are powerful. What I see is that it's a very dynamic marketplace as a result of there being so many entrants into the market. That creates a new sense of competitiveness in the marketplace. It also creates, potentially, both opportunities and risks for others that we will all have to change our approach to not just survive but thrive in this very dynamic market.

You touched on it a little bit. I’m curious because I've heard this now a lot as I have been having these conversations like in Canada. For some reason, the Canadian optical market or eye care market is very attractive, whether it’s private equity or foreign organizations. What is it about Canada in particular that you feel like somebody else would want?

To point out the elephant in the room here, a lot of these discussions that are happening now are Specsavers coming to Canada and making a big splash. For better or for worse, that's the way it is. I'm asking a question Specsavers as well, “Why is it that you have been eyeing Canada for so many years?” Rick, from your perspective and the few months, that you have been back in Canada, what is it that you think is creating that desirability?

It comes back to the structural things and some of the fundamental characteristics of the market itself. Canada is very stable politically. It's a wealthy country. Uniquely healthcare in Canada is very unique compared perhaps to other marketplaces. The awareness is there in terms of healthcare. I view vision care as part of healthcare in many dimensions. That's an area that creates attractiveness but there's something that's fundamental that there has been a premium-ness in the market. We see it in our own numbers.

When we measure, Canadians, by in large, tend to shop a little more premium. I'm going to get specific about spectacles and apparel brands, and so forth. Canada is very premium in terms of its desire to look and feel good in what they are wearing. That in itself is attractive to many entrants into the market. The last thing is that when all of us benchmark the penetration in the market, we see that there is opportunity in terms of not just share grab but in fact, growing the entire marketplace. We see the regularity in terms of eyewear purchases relative to some other markets. I feel like that that creates opportunities. There are a number of different dimensions there. Hopefully, I'm getting to the core of your question.

There's no specific direction or answer that I'm looking for. You have that unique perspective from your position, and I would like to hear from that. When I ask that question to other guests, they will give me their perspectives. You mentioned penetration a couple of times. Do you feel like there's a large portion of the population that's underserved?

When I look statistically, there are gaps in terms of access. Canada has incredible density disproportion around urban areas but there are a lot of rural areas that are not appropriately addressed. That has something to do with the penetration, the regularity of comprehensive eye exams, and so many different dimensions. We can tie that back to healthcare and access as an opportunity in the Canadian marketplace.

Even in the urban centers, there aren't as many triggers in terms of that annual comprehensive eye exam that may exist in some other markets. That leads to penetration and regularity of purchase also. Finally, there are still multi-pair opportunities I'm speaking about from the perspective of a spectacle lens company at its root. We see that in terms of performance and situational as well as fashion opportunities. People don't have as many pairs of glasses in Canada as they do in perhaps some other markets.

With various forces coming in, whether it's internally or from other countries, there has been a fair amount of disruption, generally speaking. I'm curious. In your mind, how would you describe disruption in our industry or what forms of disruption you've seen?

There is the obvious one, private equity entering the market, and through consolidation, that creates one level of disruption. When I speak about that, we can go back to when this was purely in the independent marketplace in the '90s when it was largely speaking. There were no chains to speak of. I will start with the point fundamentals of our industry as a whole. Whether you are in Canada or the US, many other markets are very attractive. Private equity identifies markets where they think that they can create efficiencies for the benefit of their shareholders or themselves. I'm probably stating the obvious but it's a very fragmented industry historically that's created some opportunities that have been ideal for that.

The industry's fundamentals are creating a new sense of competitiveness in the marketplace.

What it means practically as far as disruption is concerned is that there are always two sides to every coin. On the one hand, it elevates awareness. We see more communication and advertising. It's more organized in terms of communicating more from a commercial sense is 0.1. That can elevate awareness. That can be a positive as far as the disruption is concerned.

There is the other side of the coin for an independent optometrist with their own private practice. The level of competition or their ability to compete becomes a more challenging environment in some cases. That in itself is one level of disruption we are going through that we continue to experience. The second level of disruption is technology.

I feel like optometry has lagged, perhaps in other industries, in terms of the utilization of technology to streamline business and business models to attract, engage, and retain patients and consumers. That level of disruption is accelerating as well too. We could talk about Teleoptometry and what role it will play going forward as an example.

Certainly eCommerce, in terms of the engagement in our industry, but now, very much a percentage, and I don't know the exact percentage that eCommerce represents as far as purchases are concerned in Canada but in the US, it's roughly around 10% now of eyewear purchases. That's another level of technology disruption but it's also following the path of what consumers are seeking in terms of choice.

I will speak from a company that is largely anchored on innovation, the other level of disruption is that we've gone from correction to protection, and then prevention, now to therapeutic lenses. The scope of the practice has also gone in terms of disruption to more medically oriented and integrated. What I'm speaking about very specifically are myopia and myopia management through therapeutic lenses, whether it's contact lenses, drops or spectacle lenses. Those are areas of disruption, and disruption doesn't necessarily always mean a negative thing. It means how do we adjust to either capitalize on the opportunity or in terms of minimizing the risk?

The word disruption tends to have a negative connotation, generally speaking. An obvious question for you, though, does it have to be negative or positive forms of disruption? How do we see it? How do we make it so the disruption can be positive?

It can be an extremely positive one, competitive, in general, always challenges all of us to up our game. We need to continue to innovate, whether it's how we are attracting and retaining our patients, the patient journey in practice or we need to change our scope of practice through innovation. I'm going to deviate because it helps me a little bit to rationalize what we are going through from a reference point. When I was growing up, my dad was a veterinarian in Toronto who's now well-retired. He was in private practice his entire life.

Innovation back then was when Big Box like Petco and PetSmart, came on the scene, which was hugely disruptive for them. They had to reinvent their practice because what was a key source of seeing patients attracting patients was an annual vaccination of the dog or cat. They had to find new ways of bringing new services into the practice to continue to retain and attract new patients and patients that had high value.

My dad, at 58 years old, went back to dentistry school because dentistry was something that they felt in the practice could be valuable. There was a disruption. They decided to change the scope of practice. They educated themselves and went back out, which was very positive and additive to the practice. It's super relevant in terms of disruption. By the way, dental has become a very significant part of their practice. The margins were way better on dental than they were on doing vaccinations. Pet owners oriented themselves to where they needed to go for the service that they wanted. That's an example of a disruption that can end up in a positive outcome.

Often the concern is when there's disruption, it's the sky-is-falling mentality that this is going to be the end of the profession but often we end up, as you said, pivoting, evolving or however you want to phrase it and hopefully coming out better if we are doing the right thing. You have this perspective from the US, you can make some comparisons with our industry in particular.

Essilor Canada President: My job is to create not just a product and service platform around eyeglasses but also find ways that we can help our customers compete in the marketplace.

Private equity, as you mentioned, is a big force now in Canada but it's not new in the US. You've seen various large organizations formed through private equity. Overall, in your opinion, as much as you are comfortable sharing, has it been beneficial for the industry? Has it been negative? Has everything come to some equilibrium after a few years?

What has been positive is that it has challenged all participants in the industry to evaluate our business models and find ways of creating new value. We serve the entire market as EssilorLuxottica, which evaluates how we can create value for each one of our stakeholders that's going to be meaningful for them. It's hard for me to speak in terms of our competitors and so forth but from our perspective, what we see is that every single year the industry continues to grow, and that's a positive outcome.

Secondly, with these well-organized businesses that are private equity backed and there are many different players, everyone from small boutique private equity players to large ones like Goldman Sachs, as you well know, MyEyeDr is a great example. If Goldman Sachs finds our industry interesting, that says something or KKRs and others. There are some very substantial private equity institutions that find it interesting.

In the net effect, there have been those practices and doctors who have found that the timing was good for them to exit their practice and play a different role. It created an opportunity for them, and that's stating the obvious. There are also some other doctors who have found that they are more focused on the clinical aspect of their practice, and it's where they want to focus versus the soup to nuts truly independent practice where they are managing all aspects of the practice. That has certainly been an opportunity that has also been addressed and has made it attractive to some.

Bottom line is that it creates choice overall. I don't mean to be ambiguous in terms of saying, "This is good or bad," Overall, it's good. It's a natural evolution of business. We've seen it in other industries, look at dental and dermatology, you can go down the list of other professional services and solutions that private equity has been active in. What I see is that a greater awareness by patients and consumers, in general, is a very positive outcome.

Where has it been a negative? "I want to stay independent. I want to own my practice." In the end, is that they need to seek help partners to help them succeed in a much more competitive environment. That's a reality. "How do I distinguish myself when I've got this marketing, prowess, and presence in the market? How do I elevate my voice as an independent optometrist?" These are all things that have a negative potential outcome for an independent but at the same time, there are means and ways to reinforce them. It not only just survive but thrives through specialization and differentiation.

I should clarify for people who are reading in case I haven't already. In EssilorLuxottica, your position is not consumer-facing. The other guests I’ve had are the head of FYidoctors or whatever. They have their banner stores that readers are probably thinking of, and your position is a bit unique in the series of conversations because your entity that you are at the top of is dealing with the businesses themselves on that side or EssilorLuxottica.

You have a very different and broader perspective because you are working with private practices, the private equity type of organizations, and these other large players to clarify for everyone who has been reading this. Rick's position here is not the head of LensCrafters stores. It's the other side of the business.

Thank you for the clarification.

We've talked about this before, and you are keenly aware of our feelings here, especially in BC of Clearly contacts. Several years ago, there was this big disruption and big deregulation here. Clearly essentially, they infiltrated the government and had things change to their benefit, which ultimately, from my perspective, was to the detriment of the profession. Some years later, Essilor had acquired Clearly for a large sum of money. First, I want to ask you, from your understanding and experience. What was the Canadian sentiment towards Essilor at that time, and then a few years later, do you feel that's shifted, and what is it now?

The fundamentals of the optometry industry are attractive, and private equity identifies markets that can create efficiencies.

I will give you my perspective. I wasn't involved in the transaction but I was with Essilor of America at that time when the acquisition was done. A lot of people might say, "Why did you do it?" It was not EssilorLuxottica, and it was not Essilor that did the acquisition. They had no eCommerce strategy but as a whole, we saw eCommerce starting to elevate. It was an opportunity that was presented. That's the background behind it.

Honestly, as a company, we felt that we could be good stewards. We thought about, "Where else?" because it was clearer that Clearly was going to be sold. We felt that we could be good stewards of that acquisition. One can argue whether or not we have been but nonetheless, our intention was to acquire this to start to learn a very basic sense of eCommerce and determine what our role should be going forward. That's the background.

My perception is that Essilor was viewed quite commonly as a partner to the Independent Eye Care Professionals. I'm going to assume that because I wasn't in the Canadian market at that time but I knew what our reputation in the US has been and continues to be as a partner for Independent Eye Care Professionals. I don't know that there was a reaction to the acquisition and that it was not necessarily a positive one.

There were some mistakes made along the way. One is that we should have clarified what were our intentions. There were commitments that were made around how we would behave in the marketplace, and certainly, that was our intention to do so. As I look forward, here's what I see, eCommerce is a reality. Our customers understand that it is part of the business model in the marketplace. Do they think that we should be participating? You will get as many answers as you will have from individuals who are in the industry. Some continue to find that unacceptable.

My response is that we have several lines of business. We are competing with our customers in eCommerce and own LensCrafters, that's another example. What we have tried to do is provide choice at the end of the day. My job is to create not just a product and service platform around eyeglasses but, in fact, to find ways that we can help our customers compete in the marketplace. That's what our intention is to do. We want to elevate the entire industry but also recognize that consumers will exercise choice as a vertically integrated player but as a single player.

Another thing about EssilorLuxottica, we don't have any other business. We are wholly into optical. If we are not successful in this business, then frankly, we don't have a plan B. We are in optical, and that's all there is to it. I've talked to people, including yourself. You started by saying we've had this conversation, and that's a point of stress in the relationship. We communicate regularly back and tell them, "Here are the things that are concerning to our customers very specifically." We try and act as good stewards to create that connection.

I, in fact, went to the president of Clearly and said, "Here are some concerns that we need to try and work through." If I can say anything, that's an open line of communication, and we are vested. We have to balance all of our business needs. It's an important and material conversation to have that, so we have a voice.

The second thing is that it's on me, my team, and my company to create value that's incremental to being a transactional relationship that we need to elevate and help you succeed in the marketplace. The second comment is that we work very hard on doing that, not just through the products and innovation that we provide in terms of the actual material itself but in the way we support the practices through marketing platforms, driving traffic to the practice, and so forth. Do I wish that everybody would love us? I absolutely do. It's probably my nature.

It bothers me when people have concerns about me but again, in a very pragmatic way, I take the feedback and try and direct it in a positive way that moves our business forward. I ask to be judged. The final point is that I feel that's a point of judgment and fair enough, then judge all of our competitors in the same way. We all have relationships in the industry. Some of us own certain assets that may be more obvious. At the end of the day, I would ask only that your readers judge us in terms of the value that we create. It's a very personal choice, and I completely respect that.

First of all, I'm humbled that after our conversation, you felt compelled to speak. I've seen that whole scenario play out from my own biased perspective of an independent practice optometrist or an optometrist based here in BC. The timing was very unique for me. I graduated in 2010, and as I was coming out to practice, that's when all of that disruption happened. It was very plain for me to see when it happened but over time, I've realized now, as we are talking, that there's the other aspect of your customers, as you've referred to a few times are optometrists and other eyecare professionals.

Essilor Canada President: What a patient recognizes as the quality of care is the interaction with the doctor and the staff. The comprehensiveness of the engagement, the utilization of the technology, and the instrumentation lead to a positive experience.

From that perspective, the acquisition of an eCommerce player, which is technically my competition, does seem like there's a conflict there. I can see how that would be difficult for people to reconcile it. It's a business decision. At the end of the day, you are running a business. It’s fine. There seems to be a conflict there. You are serving practice practitioners like myself, and at the same time, you own what seems to be my competition. How do you reconcile that, then?

A few things, one is that I reconcile it by trying to create value every single day to earn your business and to help you succeed in the marketplace. My sole motivation is to be a good partner to you. Secondly, as far as our participation in the market and, as I stated, we are a vertically integrated player in the market. We have been for a very long time. That is part of how we create value in the marketplace. Thirdly, we cannot ignore that consumers will make choices about how they want to purchase eyewear and contact lenses.

Clearly is a very big player in the context of contact lenses in Canada. In the sense that they are a relatively small player, and I don't mean to take anything away from Clearly or their success. It's just that there are multiple entities that are participating here because consumers, ultimately, are looking for choices. We feel that we need to be there for them at several different junctures. I will leave you with one thing. There are certain things that we will not compromise. If you look at any of our entities and our consumer or patient-facing, the one thing that's so foundational to us is that a comprehensive eye exam is what we stand for.

From a clinical perspective, reusing an old prescription and things of that nature are completely out of balance. We are committed to a comprehensive eye exam, not only refraction. It's the cornerstone of healthcare and something that we feel is very powerful and differentiating in optometry. It's a critical role that optometry plays in the entire healthcare system, not only in terms of eyecare but in disease states that are identified. It's fundamental to the company. It's not just me.

There are other players who are less concerned in the industry that may have eCommerce platforms that are less concerned about the starting point of a comprehensive eye exam, which is important. As we reinforce that, it is an opportunity to engage that customer or patient in your practice, wherever they may be. In the end, it's a balance, and I fully recognize that but we work very hard to keep the fundamentals front and center.

Speaking of comprehensive eye exams, in your opinion, what factors are involved in a patient's perceived value of the eye exam service? Before they walk into a clinic or after they leave it, what do you think helps a patient decide whether they received good value for the service they had?

The patient journey, in general, is differentiated in many different practices, retail locations, etc. The quality of care is the starting point. For all of us, it's the quality of care and the sense of quality in terms of that journey from the time that they enter the practice until the time they exit the practice. There's a high degree of variability that exists now but what a patient recognizes as the quality of care is the interaction with the doctor, staff, and the comprehensiveness, in terms of the engagement and the utilization of the technology and the instrumentation that leads to a very positive experience or not a positive experience.

Coming out with a diagnosis and a plan for their vision is how value is created on behalf of the patient, and ultimately, it's the patient's choice whether or not they act upon that like any aspect of healthcare. The additive there is that linking the conclusion of the comprehensive eye exam that is very clinically focused and then translating that into, "Here are my recommendations in terms of how to enhance, protect, prevent, and correct, and then ultimately, enhance your life through this set of visual solutions for you."

What role do you think price plays on that perceived value?

I'm not so sure that I am qualified to answer a price question other than to say that if the price is too low, then the perception of value goes down. If the price is too high, then it feels like access is being challenged. What's the balance in there? I won't put a dollar figure on it for you because I don't have a dollar figure.

Multiple entities are participating because consumers are looking for choices. We need to be there for them at several different junctures.

That was going to be my next question. The question I ask every guess is, how much do you think a high-quality, comprehensive eye exam should cost? I understand it's a difficult question, and it's not simply about the number. It’s about the conversation that happens after the questions are asked. How much do you think it's worth?

You put me on the spot. It's $150 or $175 for the initial exam itself, and then there's an adjunct on that as well. As you identify in the pre-screening, there may be areas that you identify that there are incremental tests required that should be incremental in terms of the cost associated with it. That's why I say it's a little bit hard for me to put an actual dollar figure on it because it can range.

If somebody is young, their health is good, you are less likely to find a disease state. It can be a more efficient eye exam. It should be a comprehensive eye exam and imaging associated with it to conclude that there are no disease states that are happening or that there isn't something problematic. At the same time, for somebody my age, my visual needs have changed over the years but also things that have been identified along the way. I've felt powerful.

My optometrist identified that I have macular degeneration, and it was horrifying to me but I'm glad he caught it so that I can manage it. What’s that worth for me? That's worth a lot to me because I can manage the state in itself at its very early stage. It's almost like I put a value on that's incremental, and had I not had that high degree of imaging, that would not have been identified. Until it was an advanced disease state, and then it's much more difficult to manage as it is. Preaching to the choir, you know way more about this than I did.

You touched briefly on Teleoptometry. That's certainly something I would like to dig into a little bit. As far as the implementation of technology in optometry, Telehealth being one, do you see other forms of technology being implemented that will change the way we perform an eye exam?

Yes. From an instrumentation perspective, imaging is an area that has so many possibilities. It's gotten so much better. In general, managing disease states and expanding the scope of practice is something that's a real opportunity for optometry. When I think about technology in general, the ability then to also be able to transmit that data in a secure environment, those images that are high quality, high-definition to get timely expert opinions or real-time as opposed to having to wait for an expert entity to be able to evaluate an image. Those are very positive progressions in terms of our industry and the possibilities to be able to address issues in a much shorter timeframe with a great deal of efficiency and also access.

That's the other area for me that's important. It's not accessible in the sense of being able to get an eye exam but access to a small pool of experts that can then be able to aid the local practice in terms of evaluation, recommendation, and the next steps. It's creating a pool and a panel of doctors that are more connected. In a very connected world, that seemed to me to be a super powerful opportunity. That in itself is interesting.

The second part of that is accessed, though. We start out talking about rural communities and the ability to access optometrists and where in some communities where they don't exist. The reach by utilizing technology, Teleoptometry being the discussion point, is super powerful. It can be enhancing for the doctor and patient. It opens up new doors in terms of regularity and interaction but it cannot be compromised.

It falls back on a comprehensive eye exam. I'm using my iPhone as I talk to you but I do not see a foreseeable future where that can replace a comprehensive eye exam. That is simply ludicrous. There needs to be that interaction or evaluation and recommendation in terms of expertise that cannot be replaced.

It's a very rich topic and one that I find exciting. It's being evaluated by different associations, and different recommendations across the country in Canada, the AOA in the US is also taking a position, and the CAO is also collaborating in the North America perspective in sharing data and taking a position. I had a comprehensive eye exam completed in a pilot that was being run in the US. I'm a high-touch person, so I like to see a doctor or an optician. I did not feel that I walked away from that having a bad experience. In fact, it was a good experience but as you and I are talking, the doctor was there. They were live.

Essilor Canada President: Technologies are very positive progressions in our industry and offer possibilities to address issues in a much shorter timeframe with a great deal of efficiency and also access.

The most important part of the connectivity through all of this was the ability that the doctor was in control of in this scenario. They were doing the refraction, looking at my retinal images, pointing them out, and walking me through, "This is what we saw. This is our recommendation." It holds a lot of promise but again, it was a live doctor, and that was the power. If it were something where that interaction didn't occur, then I would've seen that it was low value, and perhaps I would not have trusted it as much.

There are a lot of potentials, and we are in an industry that's growing. Although there's a lot of competition and need for optometrists. How do you efficiently have the optometrist in places where they are needed? There are a lot of things that can be done here to enhance the practice and enhance it for the doctors as well as the patients.

In that scenario where you had that exam, foreseeably, when it is implemented somewhere, is it a technician that's conducting the tests, and there's a doctor who's watching?

It was a pre-screen where a technician did the pre-screen, the way that you would have one of your staff members doing a pre-screen. I then went into the exam room. There was a technician in the room. The doctor was on the screen, and I was looking at the doctor in front of me but the doctor was remotely controlling the equipment. It wasn't the technician that was operating the equipment. They weren't saying to the technician to make adjustments. They were able to control it. That's what I found very reassuring.

Was the retinal evaluation primarily done with the photograph or digital imaging? Was there any form of lifetime active viewing?

There was lifetime active viewing.

As you stated already, our industry tends to be quite slow to move on to technology, generally speaking, Even if you won't agree with that. I will say that very bluntly when I do lectures on eCommerce and stuff like that, and we are slow to move on a lot of stuff. When technology like this comes around, where it potentially can improve and allow greater access to care, it still seems a little scary. There will still be some form amount of pushback, as I imagine you would expect.

For a couple of reasons, one is the potential loss of the accuracy or technical ability to diagnose. I know you will say technology is very good and it catches everything fantastic but the second one is the bigger one, as artificial intelligence plays a big role already in healthcare. There's a concern that "You got all the technology. You implement the little AI, then where does the optometrist come in on this?" Do you think that's something that we have to worry about?

It's something that healthcare needs to be cautious of. I use healthcare as opposed to eyecare because, at every intersection, there is always a risk of somebody who says, "AI can take care of everything." The training has certainly continued to be enhanced through the optometry schools. There's always a risk but that's the important role that the industry holds as a whole. The associations need to stand up for the right things when they are interfacing with governmental institutions so that the government understands exactly what they are speaking about and what the recommendation is and what are the risks associated with it.

That's where each one of the provincial associations of optometry or the Canadian Association of Optometry, that's the thing that they need to speak loudly and well-educated on. It can't be perceived as a fear of loss of revenue. It is about the sanctity and the importance of the comprehensive and the quality of the eye exam to make sure that it’s not compromised. As long as we are clear in what our commitments are and what could potentially be at risk. It has got to be fact-based as well, too. AI has a role to play, to be super clear but AI isn't replacing the optometrist. It enhances what the optometrist can do on behalf of the patient for the patient.

Optometry is very largely sustainable in terms of demand. We need more optometrists so long as we don't dilute the caliber of optometrists graduating.

As you may know, there are various incentives being thrown around, whether it's high salaries, signing bonuses or forgivable loans, to help attract these young doctors. Initially, I thought that was fantastic. I'm putting this out there as my thoughts, and I would love for you to share what you think of it. It's not exactly phrased as a question.

My thought was, "Is the young optometrist the person with the leverage and the power in this situation or do organizations know that the money will help draw them in a certain direction, and it may end up clouding their decision?" This may affect the trajectory of their career if they end up in a position where a few years from now, they are not so happy, not fulfilled or not doing something that's helping to help the profession grow. I had that conflicting thought in my own mind.

We see this not just in optometry but we know that their employment is not what it was. There's high demand and signing bonuses going on in multiple industries with different people with different backgrounds and so forth. It's not exclusive to optometry but it certainly amplified what we are seeing in terms of demand. What does that mean? I don't think it's a forever thing, to be quite honest with you. It's a now thing.

The sustainability behind those models gets pretty tough. We are not participating. I'm giving you a personal opinion. The long-term sustainability of that means that your cost structure goes up. How do you offset that? For the moment, there's a burst capacity need that's required by many others. How will that impact the graduates? I suppose it could influence them to maybe not sample the many options available to them. It may target them to stay within a certain model.

One of the things that I found interesting with some optometrists is that they've had different experiences throughout their life. They have been an independent private practice or associated with LensCrafters but still remained independent. They've worked in corporate. A guy that you and I both know, Dr. Howard Purcell at NECO, has done a lot of different things in optometry. He's the President of NECO. He was in private practice and an academic. Does that polarize someone to say, "I got to stay on this trajectory?" I don't know. Maybe it's possible.

I truly don't think this is a forever thing. It's like employment is in the world, in general, or certainly in North America. There's high demand for employment for certain capabilities. That is a competitive situation. Let me go back and see what I said. Optometry is very largely sustainable in terms of demand. We need to have more optometrists as long as we don't dilute the caliber of optometrists graduating because eyecare and healthcare still have so much potential. There will continue to be a strong demand there. We need to solve the demand side of the equation as far as people are concerned.

The last but very important question. The core of this whole series of discussions, when I put that initial invitation or call out is that you are throwing money out there to optometrists or doing certain things to help individual optometrists gain employment and to be financially secure. Ultimately, the question is, what is your organization doing to help support the growth and the strength of the profession of optometry in the long-term?

Thank you for the opportunity to state that. I feel very strongly about this. We are a company that is built on innovation. I joined Essilor in 2011, and one of the things that struck me was the depth of innovation that it created, and it was the same thing I felt about Luxottica in terms of innovation. Why is innovation important? It will perpetuate the industry. I didn't come from an optical background, so it was hard for me to imagine that eyeglasses that had been around for hundreds of years could have innovation associated with them.

Experiencing the continuous progression in terms of the technology, the designs, AR codings, and the fashion component of what we do. We have inspirational brands that make people feel good. They want to be associated with something that's very unique and special to them, whether it's Oakley or Ray-Ban. We have 30 different brands that we represent. Up and down the value scales as well too, from Prada, Vogue, Costa, and I could go on and on.

What we try and do is, first of all, create that consumer desire for great brands. When they enter into the practice, we want to make sure that they have a choice. We are known for Varilux, Crizal, and Transitions as key brands, and we are very proud of them but we serve the entire market at every price point in terms of lens technology. We constantly press on innovation. Our investments in myopia or presbyopia are continuing to find ways of developing therapeutic solutions, and that's all built on innovation.

Essilor Canada President: The sanctity and importance of the comprehensive eye exam and the quality of the eye exam are what the Canadian Association of Optometry should be speaking about loudly to ensure it's not compromised.

I was always proud to say that we spend between 3% and 4% of our top line as a company back on innovation every single year from an R&D perspective. That's huge. That's more than all of our competitors combined. We are committed deeply to innovation but it's not innovation based on product. That's what we are known for but it's innovation. I talked about having innovative solutions for practices to help them succeed in the marketplace, whether it's an integrated supply chain. This stars program that looks Luxottica or an EL 360 program that we've developed to help not only in terms of driving a good outcome with the patients in the dispensary but also offering incremental value to the practice to find ways that we can help them succeed again in the market.

That's where innovation is at the core of what we do. That's how we add value. Finally, we have to. That's at our roots. Our partnership with Meta on Ray-Ban's stories is the tip of the iceberg. That will be another wave of innovation that will come into the industry. We are deeply committed. How do we bring that to life? It's not like we are the first people who've integrated something into eyewear but what we've done is that Meta and ourselves have chosen each other as partners on this journey. A two very powerful brands with ecosystems. We are inviting everyone because we are an open network.

My closing comment is that while we show up in many different ways, we are an open network. Leonardo is a learning platform, which we are extremely excited about. It's open to all. We are trying to play our role, as you stated very accurately. We are one of the largest players in the industry that comes with responsibility. The responsibility for us is to give vision a louder voice, elevate the industry in ways that we can, create a demand, and constantly innovate so that we can progress the industry and create value for everyone.

That's how we try and do it and say it humbly. From the CEO's office and down, that's what drives us every day as they see more, be more, and live life to its fullest. It's generally our North Star. I am personally excited to be on the journey. I'm sure happy that in 2011, I made a decision to join the optical industry because it's an amazing industry, and I love being a part of it.

Thank you so much, Rick. Thanks so much for being here for answering the questions, even some of the more challenging ones, and being open to having that discussion. I appreciate you being on this.

It's my pleasure. Again, thank you for having me, Harbir.

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There it was. That was the fourth installment of The Future of Canadian Optometry series presented by Aequus Pharma. That interview was with Mr. Rick Gadd, President of Essilor Canada. As I mentioned in the intro, I'm sure you took a lot of insight away from that. Rick brings incredible insight with so much experience in the industry from the US to Canada. I felt like I took a lot of information there that I can use to have conversations with our colleagues and hopefully help guide our profession in the right direction, collaboratively altogether.

Don't forget we are having these conversation with six episodes or installments of this The Future of Canadian Optometry series. This one was the fourth. We have two more interviews to go. At the fifth installment is with Mr. Alfonso Cerullo, who is the President of LensCrafters in North America. The sixth then final installment is a great interview with Dr. Kerry Salsberg, who is an independent practitioner and optometrist, to talk about how we can, as independent and associate ODs, be successful and help to guide our profession in the right direction. Make sure you stay tuned.

Don't forget to share this on Instagram, LinkedIn, Facebook, wherever you live, and spend your time. Call a friend and let them know that this conversation's happening. As always, I'm very open to your feedback. I would love to hear what your thoughts are so we can continue to have these conversations and hopefully have bigger and better conversations over time here on the show. I will see you in the next episode.

Important Links

• Essilor Canada

• Aequus Pharma

• NECO

About Rick Gadd

Rick Gadd is President of Essilor North America and responsible for the company’s overall vision and planning, including all aspects of the business, mission and culture. A proven leader and advocate for Essilor’s mission of improving lives by improving sight, he is passionate about the customer experience and is highly regarded for delivering results.

Rick joined Essilor of America in 2011 as Senior Vice President Key Accounts. Most recently, he was President, ECP Sales and Services, and was responsible for developing and leading best-in-class teams to accelerate sales growth and customer satisfaction through ECP partnership and unique product and service innovation.

Prior to joining Essilor, Rick was Vice President of Sales for Motorola’s Mobile Devices business where he managed the wireless carrier relationship, demand generation and revenue growth for Motorola in Canada and the USA. He has more than 20 years of high-tech sales, marketing, product management and business development experience. Rick obtained his bachelor’s degree and his BBA in marketing and finance from York University in Toronto, Canada.

“I’m proud of Essilor’s commitment to our customers to provide innovative products and innovative business solutions. Innovation is our catalyst for growth.”

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

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.

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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.

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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.

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?

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?

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.

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.

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.

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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

• Aequus Pharma

• Dr. Alan Ulsifer – Previous Episode

• IRIS

• Specsavers Canada

• Essilor Canada

• Lenscrafters

About Bill Moir

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.

Episode 82 - Dr. Daryan Angle, VP At Iris Visual Group - The Future Of Canadian Optometry

Dr. Daryan Angle, VP of Business Development at Iris Visual Group, has seen many changes in the Canadian optometry landscape. He was heavily involved in many changes in Ontario in the late 2000s when the profession shifted away from the fee-for-service dispensing model. That (plus the fact that he has acted as chairman of the board for Iris and currently oversees much of their expansion) makes Dr. Angle an ideal guest to discuss the direction Canadian optometry is heading.

In this episode, Dr. Angle discusses:

•         his thoughts on significant shifts which happened in the past (such as the changes in Ontario and the deregulation in BC caused by Clearly)

•         what the current disruptive forces are in the profession

•         how to create value in an eye care practice

•         what is his organization doing to support optometry

•         where the profession is heading

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

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Watch the episode here

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Dr. Daryan Angle, VP At Iris Visual Group - The Future Of Canadian Optometry

As always, I am truly grateful for you taking the time out of your day to join me here to learn and grow, especially for this series of conversations that is going to be invaluable for us as optometrists in Canada, to understand where our profession is going, what we need to know that going well, what we need to be careful of, what we need to change, how we should approach the coming disruption and the changes that are inevitable and are happening.

This interview is the second interview in this series of The Future of Canadian Optometry with Dr. Daryan Angle who is Vice President of Business Development at IRIS, which is part of the larger New Look Group. In the last episode, I interviewed Alan Ulsifer who's the CEO of FYidoctors. We got a good perspective of this large organization, FYidoctors, what their presence is, what their plans are and what Alan being at the top of this organization sees as our profession in the future.

Daryan was no different in that being part of a larger organization, being in the leadership of this larger organization and having a very different perspective of the profession as a whole, where we are going and what IRIS is doing within that profession. Keep in mind that the point of these interviews is not to promote these organizations like FYi, IRIS, Essilor, LensCrafters or anyone else. The point is to ask the leaders within these organizations questions that we don't normally get a chance to ask. We will see a large organization making a move, an acquisition and say, “What was the point of that? What does that mean for me as an optometrist or a profession in the future?”

That is exactly what I'm hoping to achieve with this series of conversations, to have this show as a platform to ask hard and direct questions. What is your organization doing to support optometry? What is your organization doing to make sure the profession thrives and that future optometrists have a strong profession that they are passionate about and want to be part of?

What are you doing about these things that are maybe not so positive? What about this thing that your organization did that didn't seem like it was a step in the right direction? As I'm asking these questions, we are able to draw a lot of valuable insight, especially from guests like Alan in the last interview and Daryan in this interview who are willing to face the questions head-on.

They're not scared to take on those challenging questions. They invite them so we can learn about their perspective on the profession. This interview is with Dr. Daryan Angle and this is the second installment in The Future of Canadian Optometry series presented by Aequus Pharma. I hope you love it. Don't forget to share it. Put it up on Instagram or LinkedIn. Send a text to your friend. Let them know that this conversation is happening so we can all learn and thrive in the future.

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Dr. Daryan Angle, thank you so much for taking the time to join me for this very important and special series of discussions that we're having on the show. I appreciate you being here.

It's my pleasure. Thanks for having me.

As you know, I put this call out through the show to various organizations in the country to invite them on and chat about where we're heading and what the changes are that are happening in the industry. Since your response and others who have responded to me, I've been reaching out to colleagues across the country to get the temperature collectively. Nationally, how are we feeling? What's going on? What's on our minds? There are some obvious things. There are some elephants in the room and subtle things that are under the surface that seem to be very consistent when I'm having these conversations.

A lot of the questions, discussions and topics we're going to cover in this episode are those questions that have come from those conversations that I've had with our colleagues. Daryan, yourself and most of the other guests that we're going to have on for these conversations are in somewhat of a unique position. You're in a position that most of us are not. You're in a leadership position in one of these large organizations.

You've seen, if not been directly involved, in a lot of the change that’s happened in our country and our profession over the last decade or more. I feel like you and our guests that are coming on will have this perspective that the majority of us will not. I hope that we're able to have a candid conversation. You're comfortable with this. I hope you'll be able to share as much information as you can from his perspective that the majority of us do not have. I understand there'll be some things that perhaps you get to hold close to the chest but as much as you're comfortable sharing, we will all appreciate that. Let's start with this. From that perspective, how would you describe the state of optometry in Canada?

Optometry in Canada has never been so strong in terms of each province, the awareness in the public and the market share that's held. In the majority of provinces, optometrists have been very good in terms of entrepreneurs. There may be some exceptions there based on regulatory history but over the last few years especially, there's been a lot of strong leadership in a lot of colleges and associations.

We're seeing the dividends of that hard work. That's to say there aren't some headwinds coming that we have to be aware of but having been in practice for many years, I've seen a lot of change in a few years for the positive. That certainly makes me proud. Optometry is unique in Canada compared to the US and certainly as a profession globally. In Canada, in terms of all those best attributes you could have in a health profession, we're not just fortunate but we have to give ourselves credit for the efforts as a collective that we've done as a profession. To me, we're in a great spot at present time.

I'm glad to hear you have such a positive outlook. From this perspective of a 30,000-foot view that you might have that the majority of us don't have to feel that we're in a positive place is great. We'll talk a little bit more about where we think we're going and will be down the road but before we get there, let's talk about some of the other questions that are on our colleagues' minds. First of all, the common theme is a question about corporate versus private. If you could define for me in your mind, what is private practice optometry? What is corporate optometry? Where do IRIS and New Look as a larger brand fit within that?

I've never liked this binary labeling of private versus corporate. I never understood what corporate practice meant. There are some definitions thereof. Private practice to me is independently owned by an optometrist wearing all hats of all things in the practice whether that's marketing or HR. All are on the shoulders of the owner. That may or may not be affiliated with some buying group but in terms of the actual function of serving the patient, that's all on the individual.

Where IRIS sits, if I had to give a name, it would be more of a branded co-ownership model. Being part of a brand that's national and having all the tools that a large group can wield but having that ownership at a local level. Having some entrepreneurial abilities to maneuver in your present market as a local owner but using some of the tools that may be other competitors are only there for the benefit of a large corporate entity.

I feel we sit in the middle between what might be considered corporate. One way to look at corporate would be that the dispensary is 100% owned by a large company and then the optometrists have an exam service-only business either within the walls of that or beside. Under the New Look Group, we certainly have that model in some of our optical banners that are not IRIS. To me, that makes sense based on those two terms but IRIS to me sits firmly in the middle trying to grab the best of both sides.

Optometrists have full autonomy to practice to the full scope and even specialization based on their interests. So long as the brand attributes are maintained, there's some consistency across the network.

The thought here is that with corporate, there's this top-down. All of the directives are coming from the top and then there's a loss of autonomy. Whether that's true or not, that's where the negative connotation comes from. Generally, as we're having these conversations, there is a concern that that's going to be the direction that the profession may be heading to a point where optometrists are losing their autonomy and they're therefore wanting that distinction between what is each entity or corporation's perspective on that?

It depends on how you define autonomy. In our network, our optometrists have full autonomy to practice to the full scope and even specialization based on their interests so long as the brand attributes are maintained and there's some consistency across the network. For us, we've learned. We've been built on an optometrist and started in franchising and built up into a partnership model so we know the strength comes from the professionals that are in the clinics doing the work and treating the patients.

We've learned in the past that a top-down approach is a recipe for finding an organization in danger because the fragility of having to centralized approach is pretty apparent. You can see it in maybe other industries where you see large giants fall pretty easily based on some mistakes made by people that maybe are disconnected from what goes on in the real world and we understand that.

With our partners, we've never been more interactive in terms of hearing from them what it is that works and what doesn't work and getting their feedback and contribution on how we define the way we operate moving forward in our clinic. It's about sharing best practices but having consistent scaffolding. The best practices sometimes are hard to share if the way your clinics run is so different amongst the independent colleagues and things like that.

Yes, you can hear something from a colleague that's working but maybe your clinic isn't set up that way. With our network, that consistency makes it easy for us to grab a best practice and then roll out or share it with everybody. All the base things are similar so any innovations are easy to scale up. I was in DC meeting with our VC partners. I'll be also in Alberta and Ontario. That's exactly what our meetings are about.

It's looking at consistent information about the practices because that's the thing. Having tools that can gather data that may be an independent practitioner may not have or you may have the data but how do you crunch the data? How do you use the data to guide where you're going? How do you ask questions? How do you take information with conclusions you think you might have and get feedback from some of the smartest brains that there are in the profession?

Those are the ways that you build strength. To go center top down, any of us who is on Rogers can have an example of how being top-down centralized might put yourself in a much more fragile position than being able to reach into the minds of people that are practitioners who are skilled at what they do and see the effects of everything that you can bring to the table daily with each patient.

There are some consistencies or standardization. I imagine there has to be a model like that. What types of things are we looking at there that would be standardized? Only a few of them, if you want, off the top of your head.

We're on the same EMR model that we've designed ourselves on an iPad base. We have a seamless nine-stage patient experience where all the information gathered from each patient and every touch point is shared on the common platform so that a patient's never having to say more than once what their problem is. Once you intake them, they say, “I'm having trouble in the distance.” They're not going to get asked that same question five times. That information seamlessly flows from intake pretests to optometrists so that patient feels heard. “They heard me. They're a team working for me.”

That platform allows for that seamless communication. In the end, it's trying to increase the perceived value of the experience that a patient has. That's one of the consistencies we have to have because ultimately, that's the promise that our brand is offering to the public. When it comes down to location and the name of the location, we try to keep some consistency there.

There are variations based on whether we've acquired a practice that looks beautiful and we don't want to touch a beautifully renovated practice. Maybe we change some of the display items that are minor and the product mix. Although we do adapt the product mix somewhat to the markets, certainly, there are more consistencies across. Ultimately, what that comes down to is to a patient or a customer, consistency is more valuable even than excellence.

Canadian Optometry: Optometry is unique in Canada compared to the US and certainly as a profession unique globally.

We strive for excellence. That's in our DNA. Most optometrists are overachievers, in general, but it's very interesting to learn that consistency is something more powerful in a market than it is in excellence. That can be shown by a lot of brands that are successful and other industries that you’re like, “This place is crappy,” but you go there because you know what it's like. You expect it. It's comforting to you and humans like certainty. I practice in my partnership location out of Waterloo two days a week, in addition to my leadership roles. I see people migrate from all over the country to my location. They're from BC or Alberta and they moved to Ontario. They wander into a location and it's because they're comfortable there.

That to us is the power of our network. Do you give up some of the minutiae of variation? Yes, and some of the things there. You don't control everything as a partner but certainly, you control the quality of care you provide and how you provide that in terms of optometric clinical skillset and focus. That platform gives you so much more power to we're not worried necessarily about even HR, payroll, POS, inventory and some of the things that are not so much. Some people might find it fun. I don't find fun. I like patient contact and that one-on-one experience with each patient and making sure that you're doing an outstanding job.

One of the things that's on a lot of people's minds and I've heard you speak about this on perhaps another show or something, is consolidation. That's something that's been going on for a long time but it seems to be more prominent perhaps as the groups that are consolidating more and getting bigger. In your mind, being part of one of these groups, do you feel consolidation is necessarily inevitable? I suppose we can say it's inevitable. It's happening already but is it necessary for optometry in Canada to remain strong? Is it only necessary from a business standpoint? What is your perspective on that?

The pressures and economic forces are pushing us towards more consolidation. It's ramping up as challenges are out there. Other organizations are looking for expansion. We're a very attractive industry from a pure business standpoint. You look at the margins that I have. People in the financial or general business salivate because these are some good margins. They don't always understand what goes into getting those margins from a service standpoint but it's a very attractive industry for return on invested capital. There's that. With that competitive landscape, it becomes harder to do it on your own.

I'm not saying that the whole landscape will consolidate into a major group or brand. There's always room for very entrepreneurial and strong, independent optometry but there is certainly a lot more consolidation to come. It will certainly hit a plateau. I don't know what that will be but I don't think that it's always going to be 100%. You've got to be a part of one group or another. There'll be a significant chunk of the market like that. Also, for the strong entrepreneurial optometrists, they'll do fine but you'll have to be strong. There's no resting on your laurels. You're going to have to be a pretty smart business person, as well as a professional.

That's not always a hat that someone can switch up based on what you're trained in school. Maybe even how we determine who makes a good optometrist entering school. Is that the skillset that we're recruiting for? You can be very good in school and 90% in your classes but are you entrepreneurial? Can you take the pain of losing money for 3 or 4 years? Can you grind out for hours as you've never ground up before and do things you've maybe never done before, learn as you go and take the failure until you get the success?

That requires a special kind of grit that maybe doesn't even come from school. Maybe it comes from how you were raised or what. If you want to remain separate from a larger banner, that's the skillset that you have to have. More power to anyone who's got that because you'll make a pretty strong business for yourself. You have to love it, love every part of it and do it well.

That strong entrepreneurial person who's built a strong business can survive. What happens to everybody else? They either get taken up, fold or close the doors.

If you've got an existing practice, you've got lots of exit opportunities, whether that's with us or others. The exit strategy for existing practices is pretty robust. You've got lots of choices there. It all depends on how you want your legacy to look when you go, how that transition will look and what the timeframe of that is. A lot of new ODs are not necessarily looking for ownership right away. They want to have an environment where they've got a team or they're around people that can help mentor them. They may find themselves working in different environments to find what they like and go from there. That may be joining a strong entrepreneurial independent practice or joining us and going from an independent contractor into the co-ownership model.

If you're new to the profession, you got to work in a lot of different places to figure out where you like to be and you'll find it. There are always going to be different market segments served by different groups. To be independent, you have to find your niche and be a strong entrepreneur but those independent practices may be quite big and have a lot of associate doctors as well. It's an interesting demographic challenge as the Baby Boomers move towards retirement and we have the Millennials and Gen Zs come up and what that's going to look like. That's why we try to grab the best of both worlds. Lifestyle is also very important to a lot of people and hard to be an entrepreneur to have a balanced lifestyle.

It's not a balanced lifestyle thing if you're a strong, independent entrepreneur. That's where we come in and try to bridge the gap. To build some equity and some long-term value for yourself or retirement or for just having an asset that serves you over time with cashflow and resells value but also gives you a lifestyle so that you don't have to do everything all the time. That's where we tried to bridge that gap.

Being top-down and centralized might put you in a much more fragile position than being able to reach into the minds of practitioners who are skilled at what they do and see.

With this consolidation, I supposed one of the big concerns is that you have entities that are so large that they can affect change themselves. Is that something that you see as potential with some of the consolidation with the organizations that we have in Canada of creating change whether it's legislative or other forms that can affect the future of the profession or the direction that we're heading?

It's always a threat. No matter what, you can't rest on your laurels. We've worked very hard as a profession and in most provinces being independent contractors and always being self-employed. Never being an employee. I don't think there's any province that allows you to be an employee of a corporation. It's pretty clear in most regulations that it's a go-zone for everybody. That's important to maintain. To me, that is why Canadian optometry is awesome. Even if you're in a corporate setting for a year, you're self-employed. You got the tax benefits and write-offs of that. You get that extra bit of freedom and income that comes from that. You don't want that to change.

We need to always be vigilant about the regulations that over the last few years have been put in place in each province and make sure that we have a voice in government and at the table. Also, we're all aligned as much as possible. Ontario is a great example. When I moved to Ontario in '06, it was a mess but slowly over time, the leadership that has risen into the association of college and association with our coordinated action to renegotiate OHIP is outstanding.

We have 95% to 96% participation in the job action unheard of for many years. No one even thought it could happen. That’s aligned with everybody. All the bigger groups were like, “This is healthy for optometrists to do this,” but that's the kind of coordination we need to have to keep the momentum going in the right direction. We all have to be vigilant and get better at how we strategize those things. The Ontario examples are very good ones.

There's always going to be forced to change, especially when you've got bigger groups that have a benefit. We have to be better in that regard, whether that's through associations, colleges or even individual groups using their resources to make sure that we're defending the status quo from a structural professional regulation standpoint but allowing for evolution in the ways that we want through scope expansion and all that. That's critical.

I was looking at that. You're quite involved in those earlier changes that happened back in '06, '08 or '09.

We've made a challenge to some of the regs in Ontario. We responded to being taken to task for our business model in '07 and come to a settlement in '08 but then the regulations wound up changing on the books in '14 kicking off that revolution of regulatory change. 2014 in Ontario was a pretty big year to change and it created a lot of catch-ups.

If you look at markets that may be fertile ground for groups coming from outside of Canada to come in and scoop up market share, there is some risk in Ontario because optometry having been on a dispensing fee, no profit model for eyewear has shifted into either these side-by-side models or private practice, which required your eye exam fees to be sustaining income levels.

As a result, optometry doesn't own necessarily eyewear. There are a lot of independent optical chains that own eyewear. Eyewear, we're talking $3.2 billion a year in business Canada, which my estimate would be 4 to 5 times what your service revenue is in the country. That is the powerhouse. Having a piece of that is what allows you to determine your influence in a country and a province. That's where Ontario in 2014 changed but a lot of catching up has to be done for optometry to grab market share before somebody else comes in and takes it. That's where things get steered.

When the big dollars of eyewear are being captured by entities that can wield that resource in a way that maybe is not favorable to the profession, that's where the race is on. Other provinces have their challenges. BC is more of an open regulatory environment there. The best defense is an offense in terms of getting a stronger presence, being competitive and making it about eye care first. For instance, if you look at Quebec, they're protected by language but optometry has a significant portion of the majority of the eyewear market there. They do steer the ship and keep everybody out but they've got some advantages that a lot of us don't have from a language perspective.

Are you saying we should all start speaking French?

Canadian Optometry: Iris sits firmly in the middle, trying to grab the best of both sides of private practice and corporate optometry.

Maybe but there would have to be rules around companies.

You mentioned BC and some of the regulatory changes here. In that period when you were involved in those changes in Ontario, in that case, it was IRIS getting called out for the way that IRIS was behaving in that market that they were not supposed to but it worked out to the benefit of optometry. IRIS was doing something that generally was going to help optometry but a similar type of thing happened in BC where a corporation was doing something. They were getting called out for doing whatever or acting a certain way that wasn't according to regulations.

They took that to court and unfortunately, that's where the deregulation happened. It was performing in a way that they were not supposed to and they ended up getting the regulations to change. For someone who's practiced their whole career in BC, that's where my concern would lie if I'm going to make this a bit more personal. It is in the corporation where they come in and say, “These regulations are not working to my benefit.” The changes that they want to make are not to the benefit of the profession as a whole.

How difficult would it be to stop a large organization from making those changes? That was early in my career so I didn't see the inner workings of it but from what I saw, it seemed like a steamroll. There wasn't a whole lot of stopping that. How do we fortify ourselves? You mentioned the best defense is offense or however you said it but what do optometrists need to do to batten down the hatches and be prepared for potential regulatory changes like that in the future?

In BC, it was interesting and we could probably do a whole episode on it and dissect it but it was a political coup d’état. When you start to track the people, the players and where they were, they were in positions of political influence. There was a plan. It was not that they just came in there, went all willy-nilly and expected to win at the courthouse. They had their political ducks lined up. That's something the profession has to do as well. It's important to get yourself in those rooms and conversations connected to the right political people in various ways to be able to be there to effect change. I could tell you in Ontario, what happened is exactly that.

We were on our own in some ways because there wasn't necessarily the same push to allow optometrists to work with opticians and sell for retail in the colleges and maybe a bit more the associations at the time. Our strategy was very diverse in the sense that I had a lobbyist that I was working with who got me in to meet with some of the bureaucrats because sometimes, the politicians change but the bureaucrats stayed the same. They often hold the power of a file. You need to get to know these people, more than necessary, the politician in some respects. I don't want to speak ill of government bureaucrats but they like to be spoon-fed with information. They don't want to have to work for it.

You don’t go into government because you're a hard-working entrepreneur. You want an easy schedule. Both of my parents were civil servants so I can say that. If they have a file, they want someone to spoon-feed them in the framework in which they're working. If they've got a mandate, you've got to deliver the information that aligns with their mandate to make them look smart when they're talking to the politician or whoever's in their department. There's that aspect. Different regulatory arms are always gathering reports. You got to get in there, get those connections and deliver that.

It was a different media landscape when we were doing all this but we had a proactive PR strategy that was very effective at the time. The media is different now than it was back then. When we start to get into conflict, we were able to leverage the media to our favor and that's a particular skillset. It takes a lot of plans, coaching and the right thing. Also, through the legal aspect. The legal aspect is certainly the most costly. I have in my office volumes of our charter challenge litigation lined up. It's a point of pride.

It was a year of my life where you were researching down to building this legal case under the charter of rights. The legal landscape may have changed as well since that time. The bottom line is you need multiple strategies in the halls of power to even keep things how you've made them. If other forces are coming in, you got to get there. It's hard because the profession is not necessarily huge in terms of dollars to collect, this and that but also with the larger groups like myself and others, working collaboratively together in some aspect is important too.

In Quebec, they are more organized in that way, in which a lot of the major eye care groups are competitors in the marketplace but they're like, “We got to make sure that they don't go too crazy and make it hard for us to operate our businesses. Let's all get together and have some common things that we want to make sure that the government is not going to hammer us or surprise us with.” That's a model that we should be looking at in other provinces too if we want to be more effective. The government also likes alignment. They don't like an anti-competitive activity necessarily. In the eye care industry, it'd be like, “All of us want the same thing here. This is what we want. We're all aligned. We have all this mobilization.”

It’s like with the Ontario Association doing their OHIP negotiation. “We're all aligned. We can't divide these people. We're done. We can’t do anything. We're going to have to go to the table. We can't split them up and make that person want something different and upset.” That alignment is very powerful and that's going to be incumbent on us to set differences aside based on our different models if we want to keep eye care as it is, which I believe is in a very healthy place on the regulatory level.

Build value that far exceeds the dollar and reap the rewards.

With potential forces entering the market and looking to make those kinds of regulatory changes, it is one thing to look at the large entity but then I'm always curious about the optometrists that choose to work with those entities. I'm not picking on anybody here but speaking about us being collective as a profession, wanting to strengthen our profession and do what's best for the long-term for our profession, what would you say to someone if you were talking to somebody who was working at one of these places? It’s all theoretical, Daryan.

I certainly don't judge anyone based on where they choose to practice. You always got to go where your values are aligned. You need to look inside yourself and say, “What values do I have? Also, what long-term future do I see for myself? Is where I'm at contributing to that potential future?” Certainly, if the future puts you less in charge of your life, less self-employed and maybe an employee working not with your autonomy or the scope of the practice you want to, then you got to think about the long-term. What is going to support that level of autonomy and practice? Decide what environment you want to be in that does that.

It's tough because you come out of school with lots of debt. You got a lot of bills to pay and not necessarily looking to go further in the hole to start a business. Not everybody. Some people do and more power to them. It's about aligning yourself based on values. To me, that pretty much gives you the answer. If your values are short-term, I'm going to earn a lot and the profession is damned. It doesn't matter what five years will bring for me. I'm going to make hay while the sun shines. If you do that, you may reap the results of that. We all have to think long-term. It's one thing for us to be in a great place but we want to be in many years in a better place or at the very least the same if it's great now.

When I was young, I came out on my own. I didn't know anything. I was like, “I want to learn the business.” I practiced in so many different environments to find out what I liked to be. Finding a mentor that would fill a gap that was left with school and by sampling different places, I landed where I wanted to be and that evolved too. In my experience, I was like, “This is a pretty cool environment. I like these people.” I found a mentor in Francis Jean, the Founder. I played it cool for a while and practiced not full-time.

I got inspired and learned more about where I was. My career took a trajectory that was natural, exciting and felt like fun more than it did work. The key here is to get on these journeys but think about the long-term. “What's going to give me the best opportunity long-term? What's going to put me in the best position of autonomy long-term?” To do that, you're not alone because there are lots of market forces and groups coming in. What situations are going to make me happy in this situation? I'd hope that it would be in the one where you have some freedom to practice.

That question was off the cuff. I had questions related to that for later in the conversation but since we're on the topic and I derailed myself, I'm going to move on to the same topic. With new grads, you mentioned coming out of school with a lot of debt. That's nothing new. The debt may be a little higher now than it used to be but that's always been the case.

One thing that's different to me anyways and maybe you can confirm or deny this is there's a lot more demand for ODs with the growing organizations, the consolidation or whatever it might be. Also, the salaries that they're being offered or the signing bonuses. There are forgivable loans that are being offered as incentives to try to draw primarily new grads in but even other ODs. They try to sequester these ODs so they can have the manpower to run these businesses.

There are 2nd and 3rd-order effects on other businesses and practices when that thing is happening but specifically with these new grads, do you think that they're in a place of power and leverage because they're getting all this money thrown at them? Do you think that they're perhaps being influenced, almost blinded or at least obscured a little bit by the money and their path maybe potentially be negatively affected by what they're being offered? They're not seeing past that because of the simple math of, “I have debt and I need money,” and that thing happening.

It is tough when it's a mix of both because there's a lot of demand in remote areas. If somebody wants to live or practice in a major urban center, there's no shortage of other optometrists. The market is more saturated. As soon as you go outside the city, the demand is huge because those populations are usually underserved and it’s harder to get optometrists to be there. In those two remote areas, there's more demand than there is supply. That is a power position for a new grad or young optometrist.

When it comes to all the bonuses and things like that, it's getting pretty tough out there for that. We've certainly kept competitive in the market when it comes to some of those things but I like it. For us, it's always about culture, fit and values. It starts to make us feel uncomfortable when we start to lose or an optometrist takes another position because they got a bigger signing bonus or something like that. We're like, “We could pay for that or try to bid outbid but what kind of person are we getting that this is the start of our relationship?” It's a bidding war to get you into our relationship.

We've always been about, “Do you feel that there's a fit with our culture? Do you share our values and passion? Do you like this environment or this family feel that we have? Is that something that you're going to feel good about in 5 or 10 years?” We want that alignment. It sucks when you're out there with all those money being thrown around and we're like, “It doesn't even feel that great as an investment.” If you put yourself as a person who's like, “I'm going to the highest bidder,” then how long are you going to stay until someone else throws some flashes of money?

Canadian Optometry: The strength comes from the clinics' professionals doing the work and treating the patients.

In the end, how long does that last? Maybe the dynamics change and suddenly, you've taken a couple of great exciting bonuses and forgivable loans but then maybe the dynamic changes in the market and suddenly, you’re like, “Who is going to be in a position to have a good spot?” It's somebody loyal, fits with the values of the practice and hasn't taken a silly advantage of this point in time.

Now is one thing but what do 5 to 10 years look like? Money doesn't necessarily buy happiness. It looks great in the beginning but ultimately, you've got to feel like when you get up and go to work every day that you're not even working but having fun. That's sustainable. Being paid a large sum of money, not being happy and being miserable is never a good trade.

That was a question that I was asking myself. I was like, “How long will this last?” It seems to have happened very quickly. I wonder how long this little blip will last and then what it's going to look like on the other side for ODs and the market in general when all this money has been thrown around and people are put in positions that perhaps they're not happy. I wonder if there's a correction, what that looks like. I guess we'll have to wait and see. Unless you have some foresight on that, I'm happy to hear it.

I wish I did honestly but it's like anything. It's going to have to correct at some point because it's not sustainable. Nobody can keep paying these things out indefinitely. Ultimately, there will be a return to maybe, “I shouldn't be going to the highest bidder or going into the environment that I want to practice in.”

The pendulum always swings. Perhaps, it's on one side and maybe it'll go the other way when people are not looking for money. I don't know if that's realistic but they're looking for an enjoyable workplace setting. It'd be interesting to see how far it swings back.

Our strategy has always been the same in terms of creating an environment and values that are clear so that somebody knows what they're getting into or feels a particular way in our locations and is in alignment or not. That was always put in there from the beginning. The pendulum swings all the time and the market does crazy things. If you're not consistent, you can get yourself tangled up. We've always tried to keep this straight and narrow. We've got to sometimes remind ourselves, “This is our identity and who we are,” so that there's not that variation and we attract those that have that similar DNA or depth.

You mentioned the perceived value of the services that we all provide. It's one thing if a patient is in the office already and you've got your pathways all set. You know that you have great service and that kind of thing. The patient feels that value as they're going through the process but what about a patient who's not yet in the office and still choosing where to go? To the public in general, how does that person in the public determine the value that this optometrist will perhaps provide? How does the optometrist try to show the public that they're going to provide the most value?

Perceived value is always where the customer or the patient feels they've received more than they've paid for. You need to always deliver more than what the dollar sign at the end of the day shows and that's increasing perceived value. We were like, “Maybe that was expensive but that was amazing.” You don't feel bad about it. You're like, “I felt like they treated me well. This was great. My doctor spent time with me and answered my questions. They have great equipment. They listened and solved my needs. They got great pair of glasses. I'm happy. The dollars didn't matter because they over-delivered what I expected.”

Execution in your location with the idea of that person must feel like they received more than they've paid is critical. It's better to do that by increasing what you deliver instead of decreasing what they pay because that'll get you in some pretty tight spots although that is a segment that doesn't require some lower costs options. In terms of getting out there, word of mouth is still number one. You could spend infinite amounts of money on marketing. There is no shortage of places where you can blow money in marketing. Focus on what you're doing every day in your location first because that person will talk about what their experience is. If it's great, then that person will bring more people in.

That's critical. If you want to keep your finances tight, don't overspend on marketing. Make sure you have an amazing outcome for every one of your patients. Naturally, things like Google Reviews and stuff will flow from that. Focus on the patient. Give that patient an amazing experience. Secondary to that, it becomes a game of how you get exposure out there in a noisy place with devices disrupting attention. It is tough. One of the reasons why we aligned around a brand is that brands are simpler when you build them up. They're addictive. They cut through the noise.

Once they've developed a trust level in the perception of the market, it becomes easier because people are like, “I know this place. I'm going there.” We're bombarded with all these things. Other than that, I don't have the recipe when it comes to marketing. We're still working through and it changes. The landscape has changed in the last few years where you could put millions of dollars and when it's going to yield. We're constantly revising strategies all the time because it's not always certain what's going to work and different markets have different things that work for them.

Humans need to feel they're cared for or listened to, trusted, and not judged. That's the key to building a long-term relationship with a patient or anybody.

Getting out there is tough. I don't think it's any easier if you're in a large group. You've got more money but you could waste that money easily if you're not smart about it. The core always comes back to word of mouth. It is always the most effective advertising that you can have. The rest of it is a learning process and I wish I had the secret sauce because that would make my life easier too.

Let’s say in a place where potentially there's going to be a lot of talk about lower costs of eye exams. A potential patient is standing there looking, “This place is charging me $50 for an eye exam. This place is charging me $150.” How do you think that patient's going to make that decision? Is it going to be based on technology? Is it going to be more so on word of mouth? Is it going to be certain patient going to say, “I don't have more than $50. I have to go to this place?” Is this going to be a mix of all of those things?”

It is going to be a mix of all those things and it depends on what population your practice is positioned to serve. If you are positioned to serve a lower-income population, you're going to have to get competitive on your pricing because that's one of the biggest determinations of what some people have in terms of what their ability to pay is. That's the reality.

If you're positioned for trying to get somebody who's maybe a little more after a client or someone that at least is desiring a good experience, then it comes down to the game of word of mouth and the game of reputation. One of the advantages an independent has too is you can get out in the community and meet a lot of people. You can be a social butterfly in your community and raise yourself to a pretty well-known presence there. That's also very helpful.

People see you around and you're committed to local community stuff. That's always great, for sure but it's tough. If somebody only has a price at which to make their decision, they may start at the lower price point before they realized, “I didn't feel very good. They didn't spend very much time with me. These glasses are crappy. They're falling apart.” It does initially when you get a wave of low-cost options. There are a lot of people that try it out and it may hurt short-term for some people.

Some of the patients or customers say, “I didn't like that experience. I’m going to go back to where I'm used to. I know why I pay more there.” You've got to justify it. That's the thing. That's why I come back to the experience that you give in your practice because if you are charging $150 and that patient didn't feel like you listened to them, that you explained everything or that they got good value for that $150, then you're at risk to lose that person for a $50 exam.

They're like, “I'm not paying $150. This was a terrible experience. I didn't feel important at all. I’m out. I'm going to try a cheaper next time.” I'm not trying to critique anybody but I dare say there are probably practices where the $150 exam is like a $50 experience. Yes, you and that practice are at risk. You got to up your level of experience and the location so that people know what they're paying for. Short-term, there's always disruption when a big player with lower pricing maybe comes in, people get curious and then they go out there. It's coming upon us to tighten up our ship and do better.

With your vast experience here across the country, how much do you think a high-quality and high-service eye exam should cost?

That's a difficult question because there are a lot of regional differences. Our pricing is different per province. The dollar sign doesn't matter. It is the value that you can deliver that exceeds that dollar sign and that's not an exact science. That is like, “What is it that we're able to do for each of our patients and customers? If we charge X, do they still feel that’s worth it?” There's a bit of calibrating that happens there. You introduced some new equipment into your practice and charged for it 100%.

Since the beginning of my career, you charge for what you're worth. You invest in equipment and in yourself to be at the top of your game clinically. Your time and expertise are worth something. You charge. Don't ever discount the services you provide but you got to explain that value to the patient in a way they get it. You got to be a good communicator and figure out how to take your brain from optometry school level science into lay-person. Maybe cuss words if you're working in a stressful environment.

It is about adjusting your communication style with your patients and the way they connect to you. It's a tough question for me to answer because it's like, “If you can deliver a $300 perceived value and only charge $200, then your exam should be $200.” How do you deliver that value? That's the ultimate challenge and the journey that you're on. If you want to keep your prices healthy and high, you got to go, “We've got to deliver more than that.”

Canadian Optometry: We need to increase the perceived value of the experience that patient has.

All of us go on vacations. If you pick a luxury hotel or resort, there are little things that they do that may not cost them very much that you're like, “They treat me like a queen or king. “ You're like, “This is awesome.” The per night charge is not low at all but because they've been able to give you this experience, you're okay with it. There are many examples in many industries like that where little things here and there build value that far exceed the dollar and they reap the rewards.

We can all learn from that. I believe it's a strength and not a weakness. Optometry has got a lot of private revenue into it. To me, that's exciting because you have a green field in terms of what you can do to increase perceived value and revenue coming into your location. While if you're always having to ask the government for fees, it's tough to evolve.

This is a part of the reason why I wanted to do these things recorded one at a time and not put them all out. This is one of those questions that makes everyone uncomfortable. Let's say you read one of the episodes and you’re like, “He answered like that. I got a better answer.” I don't know if that would happen but that was part of the reason why I did that.

With this one, I'm not exactly looking for a number, to be honest with you. You said it yourself and I love that you said it. In your own words, you said, “It's about us as the service providers making sure we value our services and charge accordingly for them.” If somebody is coming in and deliberately lowering the cost of their eye exams, it's not only de-valuing the service of that particular provider but of the entire profession and all other providers by saying, “We are technically providing an eye exam and charging half of what the other people are charging.” Every hotel is giving you a bed to sleep in but the experience of that hotel resort is different. It leaves you feeling like a king or a queen and they charge accordingly. That's how we should look at our services too.

Thank you for answering that. Whether you put a dollar number on it or not is not important. Here’s one of the direct questions that I wanted to ask everybody and I put that call out into the world with IRIS, FYi or whoever. I see that you are providing opportunities to optometrists or new graduates. You are opening these doors of consolidation but what is IRIS doing to make the profession better in the long-term?

We've always been about raising perceived value in eye care services specifically. It's interesting because we talk about a divergence between optometrists and business people. Since the very beginning of IRIS, I've always been encouraging our optometrists to charge more. You're worth more. It's usually optometrists that don’t necessarily want to go there, at least historically.

For us always, we've promoted quality eye care and always been about ensuring that the public knows that that's worth something. It's worth paying for a quality eye care experience, quality technology and product. We are messaging in a way that is always educational and about assigning a high value to your vision and eye care.

In terms of the impact on the market, you can even see it historically. When I came to BC in '01, 60% of ophthalmic lenses sold were uncoated or something like that. It was a high number. We went to fully-coated lenses. That was our thing. On a very odd occasion, we would sell uncoated lenses but we went crazy in terms of 100% fully-coated and reflection coating is better for vision.

We hit that message hard and did it in our locations. We have a significant presence in BC. A few years later, overall in the industry, it was easier for everyone to sell reflection coating and it raised the penetration of that significantly. As you know, as an owner of a practice, coated lens, the price point is more and you do better with it.

Maybe some people reading this are like, “Uncoated lenses, what are talking about? What is an uncoated lens? Why would you sell them uncoated lenses?” Back in the day, you did and we pushed it. We’re fine. We brought the industry up because we were like, “We'll always be willing to push if it benefits our patients. We’ll put our machinery behind it and everyone will benefit.” We'd rather have the general value of eye care go up in quality because it makes it easier for us too. That's always been what we've done.

In terms of equipment too, we like to be scaling up on our equipment. We're rolling out our OCT program. We're doing innovations like teleoptometry in underserved areas. On a technology level, we've been involved in some AI projects as well. We take our resources not only in terms of improving the perception in the marketplace but even on the technology side. We've got some relationships with some schools that we'll be announcing coming up.

Human connection is always going to be priority number one.

We're giving back to education and the technology research side that benefits everybody, ultimately. That's good. We'd rather have everybody doing better than us to have a divergence in the market where people are pulled in different ways. Perceived value is everything. The public will always look at you differently if they see you as, “That person is an optometrist. They help people see better. My eyewear and my eyes are so important. That is worth something.”

When you charge for your services, people respect you and your profession. It all spills over into all these different elements including what we talked about in terms of being politically active and things like that. If the politicians or the bureaucrats who are members of the public perceive the profession highly, then when they meet with you, they're like, “I meet with an optometrist. This is good. This is somebody I should listen to.”

With IRIS being part of a larger group, do you feel that the same mentality and progress are going to maintain over the long-term? Is there a chance that being part of a larger entity will change the course of the way that IRIS is placed within the profession?

No, I don't think so because we occupy a pretty interesting niche in the Canadian landscape. We are unique globally. What we do has been well-recognized in other countries. It is pretty outstanding, even when it came to things like the fully-coated lenses. We moved to that model where we were pretty much 99% or 99.5% fully-coated. That resonated globally. They are like, “This group is doing what?” For us, that's the attractiveness of our group. We've always been this forward-thinking fusion of business and optometry.

We're known in terms of the financial community as strong operators. As long as we can continue to cultivate good leadership and partnerships in our group which is the perfect fusion of optometry and business, we will continue on that path because that is what we are. Changing what we're doing doesn't make any sense because it's always been somewhat looked at globally as a leader position. It would be very weird for someone to say, “They're doing all these things that no one's doing. Let's change it.” It doesn't make any sense.

In terms of our financial ownership structure, it's all financial. It's nothing to do with the operation. The consensus in the larger business world is, “If I'm a pension fund and I want to invest in a good business, I don't know anything about this. They're good. Let them do their thing.” That's what we've always done and that's part of also being decentralized as partners too. It's a bit of insurance because if ever something crazy happened on a central level, partners could be like, “I'm not doing that.”

You have an ownership stake in a local corporation with rights. It’s pretty tough to go against that if something crazy was happening. All these things are decentralized. The whole company could collapse under bankruptcy and our partners will be fine because that company is insulated from everything. They would wind up owning 100% of the practice for cents on the dollar if something were to happen. That's why I like our system because it is anti-fragile and decentralized. For those of you who follow the financial markets, those are things that a lot of businesses talk about because we've seen the impact when you're fragile and centralized a lot and it's not good.

The overarching concern there is a large organization perhaps deciding that they want to change not a business model but perhaps the market's not quite working the way they want it to. They want to change something about it. It's not aligning with the profession. It’s the concern that maybe I'm trying to express with you hear. On a local level, it's great that the optometrist can do what they want to do but it's that larger entity with the potential power to change things in the industry that is more the concern. What do you think IRIS or New Look looks like a few years from now?

We certainly will have a more significant presence in each province in the country. With IRIS, it's about gathering partnerships with optometrists and opticians through mergers and acquisitions. The other banner is the same but more on the market segments that they service. We will certainly have significant growth.

As we get bigger into a market and more financially benefiting, some of the things you and I talked about are things that we want to do like more political activity to ensure we keep the industry and profession strong because we believe it is strong. That's why everything has been built on this strength. We cannot see that go down and we do talk a lot about how would we ensure the future long-term. We also look out for the demography of things and how we service populations.

As we get bigger, we'll have more resources to do more things and we are optometrist-centered. That is the core of what we are and we need to always do things to strengthen the profession. Your track record is there. When I challenged the regulations in Ontario, it was not an inexpensive endeavor. We spent a lot of money to do that and it benefited everybody. That has always been the ethos of the organization. Otherwise, our business model doesn't work any other way.

Canadian Optometry: We need to gather partnerships with optometrists and opticians through mergers and acquisitions to achieve significant growth.

A cynical person might say that it benefited IRIS so it made sense. IRIS had the power and the funding or money to do something like that whereas others who might've wanted to do the same couldn't do it. It's wonderful that it benefited the profession as a whole and that's always what we want to see but the concern going back to what we talked about is if those goals don't align with the profession and that individual entities don't align, that's where things could get a little bit scary and where we need to be more cautious.

I'll get you out of here on this Daryan. I've taken up a lot of your time and you've been very generous with answering all these questions. You've told me what IRIS was going to look like years from now. What do you think the individual optometrist's job is going to look like years from now? Is it going to be the same walking in, doing refraction, doing a health check, going outside and buying glasses or is it going to be remote in some capacity? Is there going to be some other technology you see down the pipeline that's going to change the way we practice dramatically? Feel free to be as dramatic as you want. What do you think that looks like?

I do think that there's certainly going to be a lot of delegation, whether that be to technicians or AI in some ways too. Ultimately, you'll wind up an optometrist breeding a lot of data being processed by artificial intelligence to deliver you a probability of something. It's up to us to make our judgment call based on these data inputs. It's going to be like that. It's all ready when you look at an OCT, especially over a couple of visits in history.

You are looking at trends, graphs and things like that. As AI is able to reach into more data sets and compare, it'll make it very interesting because we'll look at all this information. We'll have to draw our conclusions and communicate that to the patient. We may be less in terms of our physical like doing the exam and more about reading the inputs from all of these scans and different instruments that we'll be using.

Teleoptometry will be much bigger because there are a lot of underserved communities and it's tough to get people out there. There should be a strategy amongst schools to recruit optometrists from remote communities so that they return to them because that ultimately is better. One of the other aspects of what optometrists should be doing is a more expanded scope of medical things. You may find yourself doing a lot of emergency or more medically-based treatment as well. You need to have some physical presence in these locations and being remote isn't going to cover all the bases yet.

Maybe they'll have some robotic arms that you can use through the metaverse to be able to pull up foreign bodies or do some invasive procedure. The demand for our medical side is going to be continuing to expand because there is less ophthalmology. Like you’re doing Oklahoma with being able to do YAG caps and things like that, it's the natural evolution of what we'll be doing. It's pretty exciting as a profession that there are all these interfaces with technology and things that will move forward. That’s the way I see it.

I feel like the human connection is always going to be to me priority number one and that's what all optometrists should realize. They need to be able to listen to a person, explain complex things to them, put them into context and address their needs. The communication and the psychology in that aspect of things are going to be probably even more important as you're able to use technology to do some of the diagnostic. You need to be able to break it all down, be a human and build that connection with people. No matter what, humans are humans. They need to feel like they're cared for, listened to, trusted and not judged. That's the key to building a long-term relationship with a patient or anybody.

Thank you very much. Any final words before we wrap up?

No. We've covered a lot of territories. Thank you for having me. I certainly had a lot of fun.

Thank you, Dr. Daryan Angle. Thank you so much for being here, answering these questions and being part of this conversation, which is going to be an important big conversation across the country. Thank you to everybody who has been reading this series, The Future of Canadian Optometry on the show. I will see you again in the next episode. Take care.

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That was the second installment and interview in The Future of Canadian Optometry series presented by Aequus Pharma here on the show. I hope you're able to take away a lot of insights like I was from Dr. Daryan Angle here who was very open to answering a lot of these questions and facing them head-on. Don't forget to share these insights, videos or audio with your friends and colleagues across the country. This is a conversation all of us Canadian optometrists need to be part of.

Take a screenshot, throw it up on Instagram, put a post on LinkedIn or send a text to your friend. Maybe, more importantly, send the link over so they can read it or watch it on YouTube. Don't forget to send me your feedback. If there are other questions that you want me to follow up with or other questions that we should be asking, I'd love to hear them so we can continue to challenge the status quo and make sure that we are all involved in the direction that our profession is heading in. Remember, we will be releasing new interviews and episodes that are part of The Future of Canadian Optometry series presented by Aequus Pharma. I'll see you in the next episode.

Important Links

• IRIS

• New Look Group

• FYidoctors

• Aequus Pharma

About Dr. Daryan Angle

Dr. Daryan Angle was born and raised in Edmonton, Alberta, and graduated from the University of Waterloo School of Optometry in 2001. He joined IRIS in British Columbia in 2002 practicing as an independent contractor, which eventually lead to co-ownership in 2 Vancouver area locations.

In 2006 he relocated to Ontario to serve as Vice President of Professional Relations (2006-2013) during which time he successfully led a political and legal challenge to the regulations governing the business practices of optometry in Ontario. The challenge eventually led to changes to allow open collaboration with Opticians and corporations, as well as the freedom to brand, advertise, and dispense eyewear at retail pricing.

Following that appointment his role became national as Executive Vice President and Chairman of the Board from 2014 to 2017, concluding with the sale of IRIS to New Look Vision Group Inc. Dr. Angle is an active, practicing Optometrist and co-owner of an IRIS location in Uptown Waterloo (since 2007).

Currently he serves as Vice President Business Development and Partner Relations at IRIS the Visual group (a division of New Look Vison Group). In this role he uses his extensive management experience in store operations, regulatory/legal jurisprudence and in mergers/acquisitions to grow the network of IRIS locations, while ensuring current and new partners are engaged and successful in their practices.

Dr. Angle currently resides in Kitchener, Ontario with his wife Jill and 2 young children. He enjoys Les mills fitness classes, stand-up paddle boarding and watching multi-season TV series such as Peaky Blinders and Ozark.

Episode 81 - Dr. Alan Ulsifer, CEO Of FYidoctors - The Future Of Canadian Optometry

The Future of Canadian Optometry series on The 20/20 Podcast is a series of 6 interviews with leaders within various organizations in the Canadian optometry landscape.

The first interview in the series is with Dr. Alan Ulsifer, CEO of FYidoctors.

In this interview, you will hear Dr. Ulsifer discuss:

• valuable market insights into the four main types of consumers in eyecare

• what he sees as threats to the profession

• what FYidoctors is doing to support the long-term success of the profession

• what the future optometrist's job looks like

The Future of Canadian Optometry series is presented by Aequus Pharmaceuticals.

Stay tuned over the next three weeks to hear and watch all six episodes.

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Listen to the podcast here

Dr. Alan Ulsifer, CEO Of FYidoctors - The Future Of Canadian Optometry

I'm truly grateful that you would take the time to join me here to learn and grow. As always, right off the top, before I get into it, I always ask a quick favor. If you've been getting any value from previous episodes or upcoming episodes, which I am very confident you will, please share it. These next few conversations I'm going to go into are going to be extremely important for us as Canadian optometrists. Please do share this. Send a link to your friends and colleagues. Text it, put it on Instagram posts, LinkedIn posts, whatever you can do.

I promise you I will be truly grateful every time I see that. Our colleagues across the country will be better for it, and be grateful that you have shared this content with them. The next six episodes are going to be part of what I call The Future of Canadian Optometry, presented by Aequus Pharma. The future of Canadian optometry is a series of six conversations with six leaders in the industry.

They are leaders from different organizations within the industry that are going to help us shed light on what is the current state of optometry in Canada. What is the future for optometry and Canada? What do we have to look forward to? What do we have to be careful about? What information can we learn and glean from people who are at the top of these organizations and who are making a lot of the decisions that are essentially determining the direct direction that our profession is going in? That is what The Future of Canadian Optometry series is all about. It's 6 interviews with the following 6 people, which I'm sure once you read the names, you'll understand why these conversations are going to be so important.

There's Dr. Alan Ulsifer, who is the CEO of FYidoctors, Dr. Daryan Angle, who's the VP of Business Development at IRIS, part of the New Look Group, Mr. Bill Moir, who is the GM of Specsavers, Canada, Mr. Rick Gadd, who is the President of Essilor Canada, Mr. Alfonso Cerullo, who's the President of LensCrafters North America, and round off the conversation with Dr. Kerry Salsberg, who is a successful private practice independent optometrist based in Ontario, who truly understands what the sphere of optometry is now and what direction we're going in. He is somebody who is at the cutting edge at the front of the curve here as to what is the leading technology and what we can expect to see in our industry moving forward.

After having these interviews, I am confident that you're going to walk away from each one of these interviews with a different insight, with a different outlook on the profession. Some cases are positive, and some cases maybe not so positive. I'm grateful for the guests who have come on and who have been mostly candid and open to answering the questions that I've asked direct questions that we, as optometrists, should be asking. Most guests have been open to answering these questions head-on. Once in a while, you'll see a guest give a more corporate answer that dances around the question.

Every guest, with all of their answers, will speak for themselves about where they stand and what they think of optometry in Canada. We're going to start with this episode, which is with Dr. Alan Ulsifer, the CEO of FYidoctors. This is a great episode to start with because Al is very candid and open and even says it right off the top. He's not the best at being secretive or sugarcoating or answering in a corporate way.

He likes to be himself and answer very openly, which is fantastic for us, as the rest of the optometrists in Canada, trying to understand what a large entity like FYidoctors is doing and what they see as the future of optometry in the country. Without further ado, here is the first episode of the future of Canadian optometry series presented by Aequus Pharma. This interview is with Dr. Alan Ulsifer, the CEO of FYidoctors. I hope you love it.

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Dr. Alan Ulsifer, thank you so much for joining me here for this special conversation about the future of Canadian optometry. I appreciate you being here.

Thanks so much for the invitation, and I look forward to our chat.

As many of the audience will know, I put out a little bit of a call-out to some of the larger entities and organizations in the industry here in Canada, asking you and others like yourself to come on and share your thoughts on where the profession was heading and some of the changes that are happening now. I do appreciate you taking the time to come in and join this conversation.

I know that that initial call-out may have seemed to feel a little uncomfortable for some people, but I know that you are not afraid to tackle these types of conversations. Thanks for coming on to do that. In quite a unique position, being the CEO, being the head of FYidoctors, this large entity in Canada, I imagine you've seen a lot of change if you haven't been involved in the change yourself directly.

I imagine that you're privy to a lot of conversations that many of us are not. Whether you're able to share some of that information publicly or not, I expect that that unique perspective will be invaluable for the masses. The average optometrist is wondering what's going on in our country and in our profession. I hope you're able to share as much as possible, as much as you're comfortable sharing, and hopefully, we can have a candid conversation about that.

I'm comfortable sharing most things. I do have NDAs, but my reputation in the company is my idea of keeping a secret is telling one person at a time.

Let's start with this. From your perspective, how would you describe the state of optometry in Canada nowadays?

From a clinical side, it's a very exciting time with advances in technology and drawing new treatment methodologies. Our importance as a profession in the community is as high or higher than it's ever been. The state of the profession for what we do and how we help people has never been better. If we look at the more industrial approach, the commercial, our profession or industry has been an area of interest to a lot of people outside the immediate community for a long time. I talked early days, years ago when we formed FYidoctors, a lot about consolidation is coming, private equity. I talked about Specsavers at that time and the impact that they had on the market.

I've talked over the years about how other markets have been disrupted. We have a lot of outside people looking at the profession, looking at the industry with lots of money that they want to put into this industry. Not for the sake necessarily of investing in the profession, but more of how they get involved in what they see as a very lucrative opportunity and profession. Money is a key factor, and we're seeing in BC with the injection of cash that Specsavers is making, even the $10 million in advertising for a market that size, no one's ever done that in the history of our profession in that particular area. A lot of entities are looking at this as an opportunity.

What would you say is the opportunity they see in the profession and Canada in particular?

There's an opportunity to, in their mind, make optometry practices more efficient by consolidating a more efficient supply chain in all areas. This was a big part of why we formed FYi in the early days. As independence, you're paying more for everything from a supply chain perspective. Even now, from a marketing social online reputation management, all those things are more and more expensive for an independent. They see utilizing capital to consolidate as an opportunity to drive very high returns.

Independent Optometrist: Consolidations happen in a lot of industries and usually been great for optometry.

You're one of the founders of FYidoctors. It's been well over several years. Some would consider that you have amazing foresight to think that consolidation was important and to come together as a group. Do you feel that consolidation is the only way for the profession to survive? Is private practice still going to be a viable way to practice?

It wasn't about survival. When we formed the company, we had a couple of mantras. One was consolidation is going to happen regardless. It's a reality. Why can't a bunch of doctors do it? That way, define what an eye exam looks like. Create a different narrative in the marketplace around what eye care should be. We have this tagline called, "Doctors defining eyecare." It was much less about consolidation as the savior of the profession, but consolidations happened in a lot of industries, and it hasn't necessarily and usually been all that great for the profession. That's the reality. I'm not talking about optometry. I'm talking about all kinds of healthcare disciplines where in the United States and abroad, everything is being consolidated.

There's more capital on the sidelines than there's ever been in history, and health is seen as a safe haven and a great opportunity to deploy that capital. It was less about saving optometry because we knew there would be consolidators and competitors, but we had an opportunity to drive our destiny. Capital and money are important. By working together and making some compromises, we've been able to do things we wouldn't have been able to do on our own.

What would you say are some of the upsides and downsides of the consolidation? You mentioned that it's not always positive for the profession. What would be some of the negative things that you see potentially happening in optometry or in other industries?

The biggest negative is that people other than optometrists get in the exam room. Did they decide your hours? How many patients do you need to see? What procedures do we do or shouldn't be doing versus procedures that we shouldn't do? What's the feeling around investment in technology? Is that seen as an opportunity? Is it seen as simply standard of care, the right thing to do? Is it financial engineering methodology where if it makes financial sense, we do it, and if it doesn't make financial sense, we don't? Those are the big pros and cons. If the answer to the first part is yes, now we have more capital to invest in those things. Let's face it. It's costly to be state of the art in our industry.

If by getting together, all of those things are aided, then it's a great story. If, on the other hand, that money is not going back into the exam rooms and to technology, and it's about driving the behaviors of the optometrists, then you have some pretty significant negative potential. If we look at even South of the border, some of the optical entities where there are quotas for optometrists in terms of how many patients they have to see an hour, I don't see how that can be good for the profession.

Sometimes when you mix financial people and healthcare practitioners, there is misalignment. That's always the risk that's going to be out there. Whether it's a private equity, a corporation, or even another optical entity, those are the questions we have to ask. Is this helping the profession be better than it was on our own? Is it a way of financially engineering the business for the sake of maximizing profitability? Can it be good? Yes. Can it be bad? Yes, as well.

Would you say you've seen examples of that? You're mentioning down in the states, you've seen specific examples of that type of thing happening where that financial entity is dictating some of the things that are happening within the exam room and the way the doctors are practicing,

Ultimately there's a management team that executes. If it's a majority ownership situation, that management team is set to execute the vision and the strategy of the owners of the business. Sometimes that may misalign with what's best for the patient. I've seen all kinds of examples, and I'm not picking on private equity. There are some fantastic private equity roll-ups in healthcare, whether it is all about high-end clinical care doing the right thing.

It's those entities that have seen the value in that brand so that Mayo Clinic and Cleveland Clinic approach healthcare. We'll talk about money at some point a little bit more later. That can be a good story. Are they telling people in their marketing how important healthcare is versus the spray and pray marketing message of cheap eyewear and pretty people wearing glasses? It's all in the messaging, but there is an opportunity to be profitable and high quality. Give the best patient care. Let the doctor do their thing however they want to. There's value in that. Some investors see that, and some don't.

On that value side of things, it's creating the perception of value, at the very least, to the patient. If you have a patient looking to go to a service provider or an optometrist and want an eye exam, how does an optometrist, clinic, or brand create that perception of value? When a patient is selecting a clinic that they want to go to, how would they say, "This one looks like they're going to give me the best eye exam?" How do you think that we would do that?

If discussions about competition lessen, eye care in the Canadian market can become stronger, and developing better doctor training will be much easier.

First of all, it's understanding the consumer. One of the advantages of having a minority partner is they do a ton of market research. We've always done market research, but we've never done more than what we have. I have done a presentation or two on some of the results, and there's some brand new stuff that we got out of Canada. The reality is we need to understand the optical consumer. Out of the studies, we have very different mindsets of the optical consumer. McKinsey broke it down into 4 or 5 categories of consumers. Years ago, Luxottica did research on this as well. It's funny how the categories were pretty similar, with one exception.

If you indulge me, I'll jump into that. That will be a better framing for answering the question about what an optometrist does as an independent to win and survive in the marketplace. First of all, the independent can do well and has done well in markets where even over 50% is a value-driven market. The first thing the research showed us, similar to the Luxottica research of years ago, was they broke it down into four categories. That budget-conscious person who doesn't care about looks, fashion, and as much about eyecare wants the cheapest possible glasses. That's all that drives them. On the other extreme, you have the quality seeker who wants good quality eyecare and a good quality product.

Brands might be important or might not be important. If they are perceived as quality, that's the quality seeker. There's the doctor-loyal patient. That's about 30%. No matter what, they're going to buy from the optometrist and see that optometrist for all services. The other category that McKinsey identified is tied to some of the disruptions that are going on now. They call them the style seeker. This is a person that wants great fashion. They might want to own a couple of pairs, 3, 4, or 5 pairs of glasses even. They like how they look in eyewear but don't want to pay that much, so they're very value-driven. They've identified that it is about 16%, 17%, and 18% of the market.

The purely budget seeker is around 20%, even up to 25%. You've got these different competing segments with value and price being more important than what it was in the old days with the Luxottica study where they said 18% of people was budget price. They didn't have a style seeker component because, if we think about it, it probably didn't exist. We had value, but we didn't have the Warby Parkers. The Bone looks, the Bailey Nelson's, and the Oscar Wylee's that have this cool vibe appeal to the Millennial generation. It's not seen as poor quality. It's seen as good value. A lot of the research is showing that they are gaining traction as much as the story, where sometimes old people will try them, and they always come back. That's not what the data says.

We, as traditional optometrists, somehow aren't capturing that image for the new young consumers. When we go back to how optometrists succeed and do well in markets where over 50% are in the UK and Australia, there are not nearly as many independents. In the UK, the top three biggest chains make up 80% of the market. Look at the United States, where Vision Monday top 50 biggest optical entities. Years ago, if you added the top 50 together, it was about 24% of the market share. Now it's in the low 30%, so there is more consolidation, but North America is still very much dominated by independence, more in the United States where the numbers are in the low 60%. In Canada, it's 50%.

How do you win? Be mindful that you have to execute and invest in your practice. Give amazing service. A lot of these studies talked about loyalty as well. As you can imagine, style seekers and budget-conscious consumer is not loyal compared to optometrist loyal consumer who is loyal. Loyalty is driven more by emotional factors. That's the primary target. You look at other things like price, selection, technology, and all those things.

The one great thing in the Canadian market is that quality eyecare technology and knowledgeable staff are hugely important, more so than the same consumers in the United States. There's hope. Execute well, invest, and be conscious of styles. One thing that was shocking to me in these studies is the difference between that brand-consumer in eyewear and that they want to brand. Study after study both in Canada and in the US show that segment is shrinking dramatically to the extent where I've often felt like optometrists have felt like, "I got all the brands. I'm going to be safe."

That's less of a story, according to the research. Optometrists have to think about having an affordable offering for patients, especially in this world where there's going to be more noise. Like it or not, on TV, radio, and social media, there's going to be more about price. People don't necessarily want to buy inexpensive frames, but they want to know that they're getting good value and have a choice.

Execute, invest in technology, and make sure you're talking about what you're doing so that the patients understand the test you're doing because the category of expert is, in any industry, a huge term to own. Independent optometry has the ability to maybe not own the expert category but certainly be up there. In those markets where it is 80% chains, independents have done very well by sticking to what they're great at and doubling down on being a great doctor and having a great staff and great technology.

Market research is important. One of the things is that smaller clinics, independents, or the average, don't have access necessarily to that information. Not at their fingertips, at least. To be able to share it and let our colleagues know what types of consumers are out there is very important. Where do you think the price comes into all of that? Let's say I'm executing. I'm being an expert. I'm offering the latest technology, but a patient walks up and sees X number of dollars for an eye exam. Do you think that plays a role in their decision to come in?

It does play a role. The consumer research is very clear that price is important. If we look at the style seekers and the budget-conscious consumer and add those two together, we have something in the 40 percentile where the price is a big factor. Does that mean that they're avoiding the optometrists? It appears that nowadays, no entity has captured that. Eighty-five percent of those people seeking value are seeking it in multiple places. They've not identified a brand or banner that owns that. I do believe that will change and is changing. It will continue where you may have an entity that goes after that to own that. Can they own it from both a budget and a style be seen as both? That remains to be seen.

Independent Optometrist: An optometrist’s loyal consumer go to professionals they trust without thinking about the price of the product.

The opportunity for optometrists is to break the perception of being expensive. It's interesting in the market research for years. Despite FYi, we own our supply chain. We have a private label, two pairs, which are very inexpensive. People still saw us as expensive. We had to tell how we create both that high quality but not also the add-on expense expensive. There are ways to tell the story where you can say, "We can do that too, but here's where we thrive and excel. Here's the difference between a personalized lens and not, and why the measurements are so important."

It's a bit of work to tell that story, but it is a compelling story. If you can get the consumer to think that you're not expensive, that they can get value, but you have different products that others might not be offering, that's how you beat the story. Do people look at that, and if you don't give a different narrative, they're going to assume optometrists are expensive. The research is loud and clear forever on that. Even when in Ontario, where there was a fee for service, by far, optometrists were less expensive than competitive optical because of the fee-for-service model. People still thought they were expensive. It is very much a perception play for the consumer.

That part is more on the product, the glasses, that eyewear type of thing. How about on the service side? An eye exam costs X number of dollars in one clinic plus whatever in another clinic. If a consumer sees an eye exam at $80 versus seeing an eye exam at $150, do you think they perceive one to be better than the other? Do you think they'll say, "They're doing the exact same thing, but this other guy's charging me almost double?" Do you think there are other ways for us to display that?

If we look at the optometrist loyal consumer, which is about 30%, it probably doesn't matter much. They're going to go to optometrists they trust, and they're not thinking about the price. Those who don't have someone they're loyal to might ask questions about that and want to understand the difference. There's a segment of the population when things are less expensive, and that's a deterrent as well. They automatically assume that it's less value. To answer your question, up to 40%-ish of the population is going to be driven by that. Unless they're told otherwise, they're going to assume it's the same.

If the dollar value is material to them, they're going to pick the lower dollar value. The goal is to get a chance to tell them the story. In a lot of cases, we don't necessarily get that chance because they've already made the decision based on that price. If we're lucky enough that they phone and ask, then that's our opportunity to say, "Here's what's included in a comprehensive eye examination."

From your perspective, as an optometrist and an owner of an organization that's optometry first, how much do you think a high-quality, comprehensive eye exam should be in Canada? Give me an average number.

In FYidoctors, our doctors set their fees. I don't think anyone in our organization does it for under $100. Probably the norm is around $150 for a full comprehensive, which probably includes an OCT in that examination is typically what we would see out there.

I know that's an awkward question. Because it's awkward, that's a question we should ask each other. I know we can't exactly say, "This is how much you're supposed to charge." Here's some understanding of the value of the service that we provide. We go to school for these number of years. We get all this training and this expertise in this area. There's got to be some return on that to some degree. If we're offering that for free or at some discounted rate, we're not doing ourselves a service as individuals and as a profession as a whole. I am curious to get the feeling from others when I interview them to understand where they stand on that. I know some may not want to answer that question, so I appreciate you being open to it.

The reality is it's not a bad thing for an optometrist to make a decent income. They deserve it. It's seven years of school. It's not an income that's out of control with other professions. In fact, it's significantly inferior in some ways, for the most part. You will hear a noise out there about optometrists taking advantage of you. There are groups already telling that story to politicians and anyone who will hear the story like, "We're going to save the eyecare industry. People aren't getting their eyes checked off enough because of the expense of it. We have a study to show that." This is the thing that's going to be happening in the marketplace now and be set in a way that we've never experienced.

If you think we've been fighting to make sure that our services aren't devalued, and Ontario certainly is going through the wringer here, that messaging is going to be amplified in a massive way going forward. How do we know that? You look at what's happened in other markets and other areas. You learn about the conversations that are already happening. That's going to be the challenge. We're going to have to justify more why an exam should cost this amount of money.

In some of those markets, the cost of an eye exam starts at two for certain optometrists who went to that high tech and invested in their clinics. There are consumers that will pay that for value. It's just there is going to be potentially a larger group than there is now that's more price conscious because of how much noise is going to be made in the market. Let's face it. There's already been lots of noise about prices in the Canadian market going on for a long time, and we've weathered the storm. I do believe that's going to continue and continue to put pressure on our fees.

The eyecare industry has an opportunity to utilize technology to create a better experience for patients while keeping the importance of the doctor.

This is the message that I've been hoping to share with a lot of our colleagues. Not putting names on this. There's another low-cost budget player in the market. It's all good. The trouble is there are entities that have the ability to lobby in government or to go to insurance companies and show you don't need to be reimbursing this much for an eye exam and lowering our compensation, whether it's through our MSP or through what the third-party insurance providers are giving us.

That's where, in my opinion, some of the bigger concern is because that affects us broadly. It's not another competitor down the street. We're getting paid less overall. I'll step off my soap box. I don't know if you agree with that, Al. I feel like you did already say some of that. It's a matter of us all getting together to understand the importance of making our profession stronger.

You mentioned sharing the market research, and I'm happy to share the market research with anyone because it makes us all better and helps us understand. We've never looked at buying groups or independent optometrists as competitors. That's never been a philosophy of our organization. It comes down to what are the things that are important that competitors can agree on. What's important to the patient is the most important thing. It would be interesting if we talked less as competitors and tried to outdo each other on price and everything else, but how do we make eye care in the Canadian market stronger and better? How do we better train our doctors? What are the things that we should be doing from a scope of practice perspective?

There are lots of things that we can all agree on out there that are good for the patient, but our industry classically hasn't behaved that way. It's, "Our company's the best, and we're going to do it our way and not talk to anybody." Maybe those days are possibly changing now, but we have a very noble profession that cares for its patients and wants to do the right thing. We do tests and procedures that don't make any money because we want to look after patients. That's important to us. How do we make that better? How do we make that better for optometrists when it comes to doing those things? That is important.

How would you define a private practice versus a corporate one? How would you define those two things? Where would you say FYi generally falls into that? Is it its own separate category?

The word corporate optometry is funny. I've always been scratching my head on it. Most of us have professional corporations. I had five partners in my practice before FYi. It was a corporation that had five people under it. What is corporate? When you get to more than ten, is it corporate? What actually is it? I've always looked at corporate optometry as tax planning. There are partnerships. We have space-sharing arrangements in optometry through partnerships.

If there's going to be a definition of corporate versus not, it comes down to who's in control of the patient care experience. For us, it's always been critical that even though I'm an optometrist, if I dared to suggest somebody should see another patient that day or something like that or suggested how they could be more efficient in their examination process, that would be blasphemy. We have the biggest practice in Canada by volume. It's considered taboo in our organization.

I've coined the word independent optometry. Corporate optometry or controlled optometry where the doctor isn't in control sounds corny, but in FYi, I call it dependent optometry. We're dependent on each other, our size, and our scale. We wouldn't be able to do the things that we do without all working together. You make some compromises. In our organization, we have a board that's more financial and budgets and that thing. The group that decides what happens in our organization is our advisory committee, which is anywhere from 14 to 18 optometrists where, "What are the things that we can do together? Why do we want to do that? What's the advantage of doing it?"

From a day-to-day operational perspective, it's those doctors that are weighing in on what we do and what we don't do. Management not from a patient care perspective, but from an operations perspective, we'll have all ideas. That's our sounding board and decision-making board to say, "We make a case for why this makes sense to do it." It's doctors that decide if we're doing it or not. They're speaking on behalf of the other doctors in the organization. When I look at, "Are you big? Are you small? Are you a corporate or not?" it's more around governance, "What's the governance of the organization? How are decisions made with respect to the practice of optometry, the operation of the organization, to investments that the company makes?" To me, that's what defines the difference.

As independents, you get to do whatever the heck you want. The disadvantage is pricing, and it's getting harder and harder to run a practice. Let's face it. I didn't have to worry about online reputation management, digital marketing, Google reviews, and all these things back when I practiced. Now, these are all things that are an extra burden to the optometrist. By making some compromises and doing some things the same, I won't call it standardization, but maybe that's as good a word as any. We do have some standardization on backend systems, even electronic medical records.

By standardizing, you can automate. That's a lot of what we're trying to do. It is to create the systems, automation, and investments that enable the doctor to execute patient care and feel proud of their practice. They still think of it as their practice. They're making the decisions around. We support HR, but they pick who they want to work with. They pick the hours they want to do, pick the procedures they want to do, but they have support in a whole bunch of areas that they wouldn't have as independent. Corny or not, it's dependent optometry within FYi.

Independent Optometrist: Automated systems and investments allow optometrists to execute patient care flawlessly and feel proud of their practice.

The concern with the word corporate, or at least the interpretation of it, is a top-down structure where essentially all of the mandates come from above, and that's what everybody has to follow the marching orders. At least that used to be the way it is. Now, perhaps there are versions of it or evolution of that.

There is a top-down. Look at the new world of business. The goal is to be flat or that word servant leadership or stewardship. If you have a team that thinks that way, that's very different from a traditional hierarchical organization where the decisions are made top-down, and management is like, "This is what we want to do, and go make it happen." That exists in all industries. That exists in ours. The hierarchical institution is still alive and strong, but all of the best management gurus are how you create a servant leadership culture where we don't use the word head office. We use the word home office.

We have a patient pathway, which is something we have worked on for years. Here's the ideal patient experience. It's every touch point in the whole journey we've defined and have a training program on. We also have a home office pathway because of the people in the lab and Calgary that aren't in clinics. What's our pathway? How do we create that great experience for our doctors and their staff? We have that spelled out, and it's a training program that has to be renewed every eighteen months. We have a job to do in supporting the clinics and having them see the value. The big question to ask anybody in any of these settings and that I would challenge new doctors people thinking of selling your practice or whatever is ask what's it like. I'm always shocked by how people will sign contracts without asking questions.

We give a list of all of our doctors. "Do you want to see what it's like in FYi? Phone anyone you want. I'm sure somebody and they're going to tell you the good, the bad, whether it was a good decision or not." We don't do that. That's the best way for a person to figure it out. Ask those hard questions of any organization. For new entrants, what's it like? How do optometrists work in those other settings? There are lots of answers out there. We just have to ask the right people the right questions.

If there's any overarching theme here other than supporting our profession and making sure it stays strong is asking questions, that's something that we're going to get to. When we talk about new grads and students and that type of thing, asking questions is something we don't do enough of. It's something that I'm getting better at because I have a show, and I need to ask questions, but we don't ask enough questions.

We're uncomfortable. We don't want to make the other person uncomfortable. We don't want to look bad or whatever it might be, or we don't want to look stupid because maybe there's a stupid question, but there are no stupid questions. Whatever endeavor you're embarking on, whether buying a business, selling a business, or a new grad, you need to ask the questions. Don't be afraid to make someone uncomfortable by asking the right questions.

Speaking of an uncomfortable question, here's another one. You mentioned FYi owns a supply chain, and I know there have been some pretty significant acquisitions over the last little while. If I'm not mistaken, there was a frame line or manufacturer. For somebody who's not part of FYi, how do you think that is perceived? Is that perceived as you as the new Luxottica Essilor in Canada? How should people see that?

We're doing deals, and we'll continue to do deals. We're well capitalized. A quote I use in about all of my presentations is, "The only way to predict the future is to have the power to shape it." We will continue to be bold in our actions. When FYi first started, we were the evil empire, a bunch of old guys that we're going to sell out and cash out. Many years later, what have we done to the market? Have we gone to predatory advertising? Have we ever spoken poorly about independent practice? Have we not supported the school? We're making acquisitions, but we're also making the Waterloo Institute happen by giving them millions of dollars. We are doing the same thing in the School of Montreal in terms of the innovation lab.

We are using technology and investing in that to train better students. You did ask what are some of the things that we've done. We supported the schools unlike no other organization out there. What have we done in the profession? We have OCTs in all of our locations. We will have wide-field imaging in all locations by the end of 2022. We're investing in protocols. We build the dry eye protocols. We built a turnkey operation. We often see in private practice where we buy a machine, and we don't know how to implement it to make it work for the patient and train our staff. We're investing in all of those things, like dry myopia control protocols. We're getting stronger.

There's no question we're growing, but is that good for the profession or bad for the profession? Since we've done marketing and market research, we are trying to tell the story about how important patient care is. We're telling our database. We're talking about things that others aren't talking about. I believe that we've elevated the quality of eyecare in Canada by making these aggressive investments and that others are doing the same because that's now becoming the standard of care.

Sure, we're growing. No, we're not quite as big as Luxottica Essilor. We're a tiny little mouse compared to the size of that organization, but we will do smart things to benefit our practices and make us more competitive. To be able to afford technology, the economics sometimes isn't there from what you're able to charge the patients to be able to continue to do that because we've made other smarter investments.

Money will play a major role in the evolution of optometry, whether money is taken out to profit takers or reinvested.

I honestly don't believe that it's been to the negative of the profession. It's the opposite. Have we supported independents? Will we continue to support independents? I'll be honest. In the early days of FYi, we would have regular meetings with the two of the big buying groups. I tried to say, "Here's an opportunity for us to truly do something together." We offered the buying groups to have ownership in our laboratory, which was fledgling at that point in time. It was not in the interests of the buying groups at that point in time to do anything with FYi or with each other. I like to think there's still hope that we can talk about the things that matter. We've created an organization that can be very helpful to independents if they have an open mindset to it.

You touched on it a little bit in there. As far as supporting the schools, there are only two Canadian schools for anybody who's reading from outside Canada. There's Waterloo, the English-speaking school in Montreal. The University of Montreal, the French-speaking. I imagine that will change at some point in the future. A cynical person might say that these contributions, as significant as they are, may not be entirely altruistic. The presence that FYi will have in the schools will lead to the potential of these students choosing that as their career path. How would you respond to that?

Is it the driving force for why we're doing it? No. Has it made a bit of a difference with respect to some students thinking differently about FYi than they would? Probably, but we're talking $7 million to $8 million in pledges between the doctor's personal pledges, my personal pledge, and the company itself. The scale is, if you did the math on it, it's not very good math. There's a sense of pride in our organization about that. We were lucky enough to be able to get together for our AGM, which we typically do every year. We have the directors of the school stand up and be so thankful and recognize people getting out of their own pockets significant amounts of money because they believed in the profession that got them to where they were. They want to give back.

Do we get some people that join us because of it? Absolutely. That's great. I don't make any apologies for that. This is about giving back and doing the right thing. That is the primary reason that all the individuals and the company itself had given. If you think I didn't have to do some convincing at the board level to spend that money, that would be an understatement even to the advisory committee. We did it because we care about the profession. The innovation labs we funded in Montreal and Waterloo were game-changers in the education of optometrists in Canada.

Staying on the note of the students and new grads, I've never seen in my career the demand that doctors are in now, especially new grads coming out of school. Some organizations, including yours, are offering various incentives for these new grads to join, whether there are large sums of money, big salaries or signing bonuses, or whatever things that might be happening or forgivable loans.

Do you feel that these new grads are in an advantageous position, a position of leverage and power? Are they perhaps being taken advantage of because they're in debt? I heard the amount of debt students are in these days is incredible. On this one, I'm going to give you my personal opinion now. It potentially can blind or obscure the path that a new grad takes and perhaps gets tied to a mode of practice that is not in the long-term beneficial, maybe for the individual or the profession as a whole.

We launched our incentive, but sadly that's what the market is becoming. There is going to be more competition. There is more competition, and dollars are going to be thrown around. Dollars are important. A lot of people coming out how they practice is also pretty important. For us, we didn't want to be ruled out because of an incentive. We frankly are in a position where we can do that. We have the capability. I feel bad about it because most independent optometrists aren't going to be in that same position, or it will be a bigger stretch for them to be able to do that. I do feel bad about that.

Having said that, I also feel bad about more commercial entities where the control of the doctor isn't in question, grabbing up new graduates. It comes down to asking the right questions. To all new grads, ask the hard questions of everyone. Validate the answers to those questions. Talk to people that have been in the situation.

Fortunately for them, there may be a financial tipping point. When all things are created equally, and there's a financial advantage, probably they're going to go to the financial advantage, but new graduates want to do the best they can for their patients. This is a wild new world for us in Canada. It's pretty new for us. It would be interesting to have this conversation a year from now when we have some data, and we can see the actual behaviors of the new optometrists. Is this making a difference? Where are they going? The answer to those questions is still unknown.

Speaking of thinking forward, imagine, if you haven't already, FYi develops a pair of glasses that lets you look into the future, Al. In the future, what do you see for optometry in Canada? Imagine an optometrist going to work. Assuming the optometrist is still doing the eye exams, what does their job look like?

With the sheer numbers, optometrists are probably going to do more delegation. It's an amazing profession. Those new graduates coming out, good for them. It's an amazing profession where you can make such a difference in people's lives. Technology is probably going to change some things. One thing we know is patients don't like the experience of booking an appointment, getting their eyes checked, or picking out glasses.

Independent Optometrist: The quality of eyecare in Canada has been elevated because of aggressive investments. This is becoming the standard of care.

It's a highly stressful experience that people generally don't like. We have an opportunity to utilize technology to create a better experience. Delegation is going to be important, whether that delegation is through staff or some remote technology. That's going to be a reality of our profession in the future, but that doesn't take away the importance of the doctor.

We have to think of ourselves more as healthcare providers than refractionists or test-doers. With limited numbers of optometrists, there is a supply and demand. It's either going to be we keep doing things the same way, and there's going to be more and more schools and graduates, or we find ways to be like, "How can we utilize technology to allow us to focus on what we're good at? What's important to the consumer that can't be replicated by another person or another technology?" The future is bright. It depends on a few things, such as who's playing and where the money goes. I hate to say it, but money is going to play a major role in the evolution of our profession.

Whether that money is taken out will have one negative role to profit takers, or if it's reinvested, that would have another outcome. You're going to probably have entities that do both, and that's going to be a big driver of the future. With the scope of practice, other specialties, other treatments, not just the same eye exam we've been doing all these years, there's an evolution that's going to happen much quicker than what has happened over the years.

What advice would you give to someone staying on the student track here and considering going to optometry school? Not yet in optometry, but maybe someone considering optometry as one of their professions? Be brutally honest here. Would you encourage them to follow this path? What would you say to them? If you encourage them, what caveats or other disclaimers would you give them?

I love the profession, but we got some strange stuff going on now. I don't mean to end on a negative. We have an opportunity for people that come from other countries where they've been fresh out of school and done a three-year program in optometry and challenge examinations and have the same privileges and title as an optometrist who's taken a minimum of seven years of training.

That's a reality and a threat now. If I'm a young optometrist, I'd be pretty concerned about that if I'm a recent graduate or someone in Waterloo or Montreal, and I'm finding out people can be brought over from the UK or Australia on a three-year program. I don't know. To invest seven years and go into all that debt when in such an unfair situation.

I would get students to make a lot of noise about that. Maybe that's not the answer you were looking for, but it's probably one of the most unfair and scary things in our profession now. I'm hoping that the right thing will be done, and invariably in that arena, I'm not confident, but I'm hopeful. Having said that, assuming we continue to grow our scope, the opportunities are great, and our ability to help people and fix problems almost instantly in a lot of cases is unprecedented in healthcare.

It's a rewarding future. A lot's going to be determined by their decisions. What do you choose? Are you asking the right questions? What's important to you? That's the beauty of the people going in. They're going to be the ones shaping the future and having the power and ability to do that. That can be in a negative or a very positive way, depending on the stand they take, the questions they ask, and the choices they make.

I wasn't expecting anything specific. I appreciate the honest answer. If it's negative, it's negative, but at the end of the day, the point of this series of conversations is for us to be as candid and open as possible to understand where we are and where we're heading. If something needs to change, if we need to change course a little bit, the only way it's going to happen is if we are aware of it. Thanks for giving that answer versus some other sugarcoated potential answer you could have given. I'll give you a chance to take a minute if there's anything else you'd like to share regarding this particular topic, where we are, what we're doing in optometry and our profession in the country.

First of all, thanks for the invitation to speak my mind. I know I'm a big advocate of having hardcore conversations. I love it when people ask me tough questions because it shows courage and respect that they would do that. I very much appreciate the opportunity. We have to ask hard questions of each other. We need to be careful about the sugarcoating and the storytelling and trust our gut. Remember that if something sounds too good to be true, it usually is. We have some challenges ahead of us, and we need to have frank conversations. I applaud you for putting this together. I'm interested to see all of the episodes. Thanks for the opportunity to give my point of view.

Thank you so much for taking the time to come on. I'm excited to see how it all turns out for all these different perspectives that we're going to bring together here. If you're reading, don't forget to share this. Throw it up in your Instagram Stories, and share it on LinkedIn, wherever you can. Tell a friend. Let them know that we're having these hard conversations about the future of our profession, and make sure you stay tuned for the next episode. Thanks again. Take care.

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That's the first episode of The Future of Canadian Optometry Series presented by Aequus Pharma. I hope you found that as insightful as I did. There are so many things I took away from that conversation with Al that helped me change my perspective of where we are with optometry, where we're going, and some of the things that I'm going to need to think about. We should all be thinking about moving forward.

I hope you found it useful. I hope you share this with our colleagues across the country so we can all understand where we're heading and share these same insights that we all took away from reading this episode. Remember, there's going to be a new episode, a new interview that's part of the future of the Canadian Optometry Series presented by Aequus Pharma. I'll see you in the next episode. Take care.

Important Links

• Aequus Pharma

• FYidoctors

• IRIS

• Specsavers

• Essilor

• LensCrafters

• Dr. Kerry Salsberg

About Dr. Alan Ulsifer

Dr. Ulsifer graduated from the University of Waterloo as an optometrist in 1990, where he was acknowledged for several awards in clinical achievement, including the Ontario Association of Optometrists Award for Excellence in Patient Management.

After graduating, Dr. Ulsifer became one of the founders and the managing partner of Northern Vision Centre, which developed into one of Canada’s largest independent optometric practices. Dr. Ulsifer has also been involved at the executive level with various not for profit Boards including: Alberta Optometric Association, Rotary, Optometry Giving Sight, the Alberta Freestyle Ski Association and the Grande Prairie Chamber of Commerce.

In 2008, Dr. Ulsifer oversaw the creation of FYidoctors, which still stands as the largest business merger in Canadian history in terms of the number of companies involved. He was awarded the Ernst and Young Emerging Entrepreneur Award for Western Canada in 2008 and the Top Canadian Entrepreneur Award in 2012. Dr. Alan Ulsifer has served on many Boards over the years and has an ICD.d designation. He currently serves as CEO & Chair of the FYidoctors Board of Directors.

Episode 80 - Europa Eyewear Creative Director Nico Roseillier On Manufacturing And Developing Creativity

There’s more to just manufacturing in a company. Opening your eyes through showcasing diverse ethnicities and backgrounds can be achieved through developing creativity, which makes a difference in your company. As the Creative Director at Europa Eyewear, Nico Roseillier is responsible for the creative direction and frame design for State Optical and American Optical. In this episode, Nico shares his creative process and ways that he can maintain his creativity. Tune in to this episode as Nico draws his expertise from the frame!

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Watch the episode here

Listen to the podcast here

Europa Eyewear Creative Director Nico Roseillier On Manufacturing And Developing Creativity

Thank you so much for taking the time to join me here to learn and grow. As you know, if you've been following along with the show for a while, I like to bring on guests from different industries or even the optical industry, and different areas within the industry to help us learn about the different aspects of the industry and get different insights. I hope we'll be getting some creative insights from my amazing guest, Nico Roseillier. He is the Creative Director for Europa Eyewear, which includes STATE Optical and American Optical. Thank you so much for joining me on the show, Nico.

Thank you so much for having me. This is great.

I'm super excited because I've been out there to visit you in Chicago. I've seen the manufacturing facility and your workspace. I've talked to you in person. I'm excited for us to share that and try to bring that into life here, but also because you're a super energetic and entertaining guy to talk to. It's going to be a fun conversation.

You came here and saw the behind the scene. You know everything now.

I was trying to take pictures, but other people wouldn't let me.

There's still some secret stuff that's cooking here.

That's good to know. For too many people, frames and eyewear are too commoditized. We think it's just a piece of plastic and there are so many frame companies that all must be the same. It's cool to hear that there is still a secret sauce or secret recipe happening that's making high-quality designer stuff that's not the same as everybody else's.

We always talk about storytelling and the way we design the product. When you came here, you saw the factory and you saw it's real. We make products from scratch here. We're open for anybody to come and visit. We do tours twice a week of the factory. It's important to understand where the product comes from, the way it's made, and the way it starts. There is a secret sauce in terms of the way we treat products that is probably different from some other companies out there, and the way we design this process and thought off. You came and it was great. You came in and saw the behind-the-scenes and the way my brain works a little bit.

I assume there's a method to the madness there because to me it looks like a bunch of pictures. We'll get into that in a little bit. We'll also talk a little bit about manufacturing because there are some things that I would like to share my thoughts on what I saw and the impression that it left, but not the secrets about the manufacturing process. Let's rewind the clock a little bit. How did you get to this position as a Creative Director and what does that exactly entail?

I will try to make a long story short because it has been twenty-plus years now since I moved to this country. Some people may still need subtitles on the bottom of the screen for some stuff I'm going to say. I'm from France. I studied Micro-mechanics and Engineering. I went to an Art school in Paris. I studied different types of art. I then went to study Architecture and Industrial Design. I moved here with a friend with two suitcases and $600. That is what we had when we moved here. I worked a lot on different projects and met a lot of people.

I moved to New York first. I was in New York for ten years. We did art installations for some advertisements and designed booths for trade shows. That's how I started to meet people from the eyewear industry. I worked a little bit with Bevel or Spectacle. I worked with a company that doesn't exist anymore. At the time, it was called Dada from Los Angeles and SCOJO Vision.

I worked with a lot of different things and then they decided to close the company. I got a phone call from my friends who became my dear friends and family at MODO. I went to work with those guys for four years designing and creative direction over there. I then moved to Los Angeles for another ten years. I worked there for REM. Now, I'm on the sunny side of Chicago.

You've moved around a lot. I don't think I knew the two suitcases and $600 thing. That kind of stuff is always so intriguing to me. Being also the child of immigrants, my parents moved out of India. They moved to the UK at first with a similar story, with not a lot of money in their pocket and some hope that they'll be able to make it. I find that story so inspiring.

If you work too hard on something, it won't feel natural.

I'm used to hearing it from the previous generation. Somebody who moved in the '60s or the '70s or something like that. For someone like yourself who moved in the early 2000s, that's still so inspiring to hear that there's still that motivation and hunger for someone to leave their country where they're comfortable and come somewhere new. If you don't mind sharing a little bit more about that. What did it feel like? Were you scared or excited? How did you even go about the first couple of things like finding a place to live?

I was young so I was naïve. I think that does help a lot. I didn't speak a word of English. My friend who became my business partner was French. We met at the architecture school and design in Paris. She lived in the US for a bit. She worked for an eyewear company doing sales. She lived in New York for a few years. She was not going to move back. She and her wife were living in Brooklyn. She wanted to go back to school. That's why she moved back to Paris for a short amount of time. That's where we met and started to work in design together.

When I came the first time was during Thanksgiving, which is why I love Thanksgiving and the idea of sitting around the table, eating and drinking all day. That's from my French side probably. We came here because at the time I designed new concepts for lamps. It was a lighting design. I got the opportunity to show it in the gallery in Soho. During that week we spent here, we met so many people. It was inspiring to meet people, the energy in New York, and the way everything was moving so fast compared to what I was used to.

When we went back to Paris, I was in school and also designing for a company doing lighting design for different hotels and stuff around the world. It was so inspiring and she wanted to move back to New York. I was like, "I'll go. Let's do it." We were roommates too in Paris. We sold everything we had. It was two suitcases and $600, and we moved to New York. I could not even go to the deli by myself because I didn't speak a word of English. It was crazy.

We slept on a few of our friend's couches for a few weeks, then we found a loft that we could afford the first month off in Brooklyn in Bed-Stuy. We lived there, and then I learned how to be a bartender. I was babysitting. That's the way I learn English. It’s through babysitting kids because they're very patient and they talk slower. Bartending was a great job to meet people and learn the language. Some people know me for making cocktails. That's where I got the love of that, but it was humbling.

That's what it was. You’re moving somewhere. You have no idea about the culture and do not speak the language. It took a lot of work and patience. Would I do it all over again at my age now? Probably not. It was the perfect time to do it. I do remember my dad being like, "Why are you going there? You have job opportunities in Paris which were great.” I decided, "It was the right time and the right moment." I followed my guts.

It is also interesting to hear you talking about it from the aspect of your parents. We came back from a trip to France and I brought my kids to let them see where I grew up, the school, and everything. It occurred to me that's interesting to see it from their perspective too. They know I have an accent. They got used to it. It's a great experience. I do believe that things happen for a reason in life. Good or bad, it's always a learning experience from everything. That's the way I see it.

Not a lot of people would be open to that dramatic change. It's scary and intimidating. I didn't realize you didn't speak any English to come to New York and make it happen. Of any place for you to go, New York would be the place where you're thrown into the fire and you get to figure it out. It's the melting pot for North America. If you moved to Montreal or something, it might have been a little more cushy and easy for you.

It's so funny you say that because that was my plan before I met my friend. My plan was to move to Montreal. I was like, "It’s easy. I don't have to learn English," but life decided otherwise.

The word I keep saying there is inspiration. That's inspiring in one way, but for your actual work, when you're trying to come up with new designs and trying to keep things fresh, where does that inspiration come from? Where do you find that inspiration to come up with new designs and colors and all these different things every year and every season?

Over the years, they have changed. It's interesting. Due to social media, the internet, and everything, things have changed very differently. It's still based on travel and people I meet and the places I go. I never look into our own industry for inspiration because I'm always afraid that if I look too much into it then there's a lot of repetition. I feel like everybody in my job does that. We're all going to do the same thing all the time and it's going to get boring.

I always look a lot at architecture because it's still one of my passions. I do look a lot into textiles and patterns. In all the trend boards I do, It’s always based on that kind of thing. There are ways colors and textures are mixed together. I'm a very visual person. The way I do it is it's basically a segment of six months where I grab pictures. It's a constant saving of pictures mainly on my phone now these days. At some point, things started to develop. It's almost like developing a picture back in the dark room where layers start to make sense, and a bigger picture or feelings start to appear a little bit more.

Developing Creativity: It's important to understand where the product comes from and how it was created.

That's the way I work. From there, that's where the direction goes to storytelling. It's a different process now that I'm with Europa versus my life before. At least the ten years in LA were a little bit different because I've done fifteen years of licensing. When you work for a license and you design for a brand that is a bigger brand, I worked for Converse and John Varvatos, it's going to be different because you take your aesthetic or design and then try to apply it to what the brand's direction is going.

In some way, it's a little bit easier to develop the film because you have more guidance. The reason why I moved here to Chicago was not for the weather. It was for the fact that Europa is an independent brand that has no license and I was able to get that freedom of creating the story as we go. In terms of designing, it's the main thing. To give you a little bit of an idea as much as trends are everywhere, this is what it looks like. There are a lot of textures and patterns, depending on the season and things change. That's the way it goes.

If you got a sec, go to YouTube and watch this because you want to see Nico's background with all the pictures and stuff, but also these trend boards.

It’s a storyboard. It helped me guide where the collection is going.

Can you walk me through that a little bit? Are you trying to find things that are similar in some aspect? There's some consistency or throughline or something you're seeing in each of these. The colors on one trend board look like it's blue-gray. One of them looked like it was more of a different color. How does that become a frame?

This, for example, is one of the latest. This is 2022 for STATE. It’s a lot about the textures, but it’s a lot about the color association and the way things go together. There is a genial feel to it or the genial finish to it. That helps tell what the story is going to be.

That in itself looks like a piece of art or a work of art. That was so cool.

I'll do that first. We have a system and then a business to fulfill. We look at how many styles we want, what material, what's doing well for us, what we need, what's missing, etc. We do a roadmap of where we want the collection to be in terms of purely physical frames. From there, I go and I'll start designing products. I do all the designs by hand. The two tools I use are a pencil and a whiteout. I do the drawing by hand and then from there, I will put it into a computer then I send it to the factory. That's the nice thing about being here. The factory is two doors down.

I have a rule of three which I don't know why, but I became like this over the years. After three modifications, if it still doesn't feel right. It goes out and I keep moving. If you work too hard on something, at some point, it doesn't feel natural. That's the way it works. From there, I'll get the final drawing, then we'll go and make a 3D print.

For example, we're making a 3D print of what the frames are going to look like. It's pretty straightforward. There's no InDesign I think. This is more for us to put it on to see if the proportion is right, then we'll do modifications on that if needed. We're going to make one final frame. Meanwhile, I go back to that board and I go to the color room where we keep all the acetate, metal swatches, etc. From there, I go back and then I work out the big boards where there's the model and then start applying colors.

I designed a year ahead. The idea is on that board. you're able to see the underlying story of how the colors are mixed together, how the material is utilized from one model to another, and how things flow together. It helps on not repeating things and a lot of different things. From there, we do full-color samples. In general, I will design double of what we need. I always sample more colors than we need. We then have a meeting and we're down exactly where we want the line to be. That's when there's some passionate argument about what people like. Those are fun meetings to have.

You guys do get together and say, "I like this one. I don't like that one." There's some debate about which ones to keep. That's good to hear. For a lot of people, it feels like perhaps, "Draw this one. Next one." It's more like a production line type of situation. For you guys, there are a lot more passion and creativity involved. I liked the rule of three.

Things happen for a reason in life, both good and bad, and it's always a learning experience.

That's what makes it different from some companies out there. We love the product. We love the process. There are two main ways to do products these days. There are more complicated lens-wise, development, and the time-consuming of doing it from scratch, and then there are some companies that pick from existing stuff.

We believe in the quality of our product, but we also believe in bringing something different and trading and creating those stories. I see my job at MODO as a storyteller at this point more than anything else. I used to go to trade shows and then come back from trade shows and be like, "Why?" There are so many companies out there that do amazing jobs and then you're like, "How many more frames do you need?"

There are a lot. When you think you've seen them, you realize you've only seen a tiny fraction.

The one that you’ll remember is the one that had a point of view that has a story to tell. It does not necessarily mean it's good for your consumers in your practice, but that story to tell is very important. You got to create those stories that fit with wherever your practice or stores are. I still go to shows and I look at stuff around. After a week or two after the show, I'm like, "Those guys are so good."

What I came away from Europa when we visited there is it made me realize that there is a big difference between certain brands, the way the product is manufactured and the story they tell. I was already on the trajectory but since then, when I came back to my office, I was like, "I need more brands that tell stories. I need my team to be able to tell a story." Not just say, "This is XYZ brand” or that mainstream that you've heard of before. We need a few of those, but we need some of those that are like, "Let me tell you about how this one is made, what the shape means, what the color is," and so on.

Things like that resonate with some people. Some patients come and say, "Show me the brand name," but there are some people who want something different so they can go tell their friends the story. They can be the interesting person in that circle, and it keeps trickling down. There's a lot of value to that. It's incredible that you guys are doing that from the ground up like from scratch. You're drawing on your piece of paper and making that come to reality. That to me was all super cool.

I want to quickly go back to the rule of three because that's a valuable thing to have in life, in general, because you don't want to get bogged down. I'm one of those people who believe in that phrase, "Perfection is the enemy of getting things done," or whatever. I'm one of those people who is like, "Let's keep moving forward. If this is not going to work, let's put that aside. Let's go to the next thing."

I would rather keep making progress than be sitting here over and over trying to perfect something and then it never gets done. That's a good way to put a tangible structure to it like the rule of three, "I've tried this thing three times or I've given it a good effort a few times. Maybe this is not happening now. Maybe we'll put that aside. Let's go work on the next thing." That can be helpful in business. It can be helpful in creative endeavors. However, you came up with it, I find that super valuable so thanks for sharing it.

I used to work with somebody in one of the brands I used to design. She was the one that brought up that rule of three. I remember the first day she brought it, I was like, "That's interesting." I realized that it's a natural thing to do. It doesn't take much discipline, but it helps on not getting cut off with sometimes the things we do.

For me, it's looking for shape and redesigning, then it never comes out right. The frame comes out in a sample and it's not right. Do you want to keep on spending more time? Doing that rule helps simplify the process and then keep moving forward. There's always the next shape, product or project. Even now, when I go back and look at old stuff that I designed several years ago, I'm like, "I would change this and that." You can keep going on forever, but it's not good because it's not productive. I also don't think it's healthy.

The saying is, "Perfection is the enemy of the good," or "Perfection is the enemy of progress." I could go back to the first couple of episodes that I did and be like, "It's not very well produced. The interview was not very good," or whatever. I was stuttering constantly. I still do that anyway. It's funny because we talked about this before the start of this interview. I'm comfortable with stumbling on my words and stuttering a little bit. I'm good with that and keep moving forward because if I had to go back and edit every time I slipped up or if I had to make sure that I never slipped up in an interview, I would never get it done. It's super valuable to have some limitations on that, and then you can keep moving forward.

You can apply this in life and in everything you do. We can all thrive for the better but sometimes we have to accept that it is what it is and keep moving forward. That's the way it is.

Developing Creativity: Showing what's happening in the industry is not about the brands but putting everybody together.

We touched on it a few times already but talked about some of your processes at STATE. When I was there, it was amazing like soldering on the nose piece or the bridge, or the way the hinge is assembled, and all the crazy amounts of machines you use to acetate the fronts and all of that stuff. It’s incredible that it's all done on-site. Why do you think it’s important that these frames are manufactured there where you are in Chicago in the US?

It has surprised me over the years doing this job that the amount of people that do what I do in some different perspectives have never been to a factory or have no idea the way the product is made. When Europa started the factory, it was the same thing for our customers. We've been dispensing eyewear for many years and have never seen the way the product is made.

It's not the reason why the factory was made. The factory was made to bring back the manufacturing of eyewear in America when it was gone for decades. It’s the idea of the craft, doing a beautiful product, and bringing that knowledge and know-how back here. It has been interesting to hear the different stories of people who have come and visited and be like, "I had no idea that's the way you make a frame."

I visited factories all around the world. I went to a lot of different countries to see how the product is made. I was amazed when the first time I came here. Scott Shapiro and I knew each other from the industry. He called me one day and he's like, "Do you want to come over?" I was like, "Sure." A dear friend, James, from 2020 was like, "You got to go and see the factory. Even if nothing happened, at least go check out the factory." That was the deal.

I remember the first time I came in to see the factory. It was half the size of what it is now that you saw. I was blown away not just by the idea that they're making products here, but the fact of making the product right, and caring about every single step. All those little steps in between that do make a difference when you hold the product.

There are beautiful factories all around the world. I want to believe that is not so much about the country of origin. It is about the craft and who is able to do that. We're lucky to have this beautiful factory here. I was lucky because I was not here at the beginning. I came here in the middle of the road and it's already amazing. It's only getting better every day. This has been getting way bigger over the last four years.

Something I love here at Europa and all the other brands is the idea of transparency. We are not hiding anything. This is why we're giving tours to our customers and to the consumer who bought a pair of STATES or American Optical. If they want to come, they can schedule a visit to see how other frames are made. There is this idea of transparency. We will show you how things are made. We're not hiding anything. We start with sheets of acetate and from there, we draw all the way through the process.

Now, we're doing metals with the acquisition of American Optical. In the last few years, we've been adding metal factories here as well. That's how we doubled up the size. It's really cool. To be honest, I forget sometimes. I'm here in my office or I’m on my way and doing stuff. I go two doors down and I'm like, "I forgot there's a factory here." It's not what the format has been over the last decade.

That's funny that you could still forget that there are tens of thousands of whatever square foot factory in the back. We touched on this briefly when we were talking before. It’s about you being in your flow state. When you're in the zone, you probably forget that anything else exists. I imagine that's probably pretty important for a creative person to get into that flow. Do you find yourself getting into those zones where everything else disappears?

Yes. I work on a lot of brands. I dedicated days for different brands and then some days, it's not flowing. It's that rule of three. Don't force it if it doesn't come out. I find myself in some days or weeks where it's not working. I'll go work on something else. That's fine. You got to change the scenery and go for a walk or whatever it is to get inspired. It's part of the process. I've learned how to not try to force it because if I forced it, I'm never happy with the end result. I rather have to work more hours at some point versus trying to push it and it's not working.

It's good having that flexibility in your overall schedule and your productivity is important too. Some days may not be as productive. Some days you'll be super productive and you get to work longer hours to maximize that productivity. Having that flexibility is important. Let's talk about Vision Expo. You do a lot of stuff at Vision Expo. There are some pretty cool installations that you're responsible for. The next one coming up in a couple of weeks here is Vision Expo West in Vegas. Do you have anything specifically going on that you are part of that you’re doing?

There are a lot of things at Vision Expo. I'm always looking forward to seeing all my friends. We've created a museum with the Heritage Optical Museum in Southbridge in Massachusetts where the American Optical factory used to be. I worked with those guys. They're amazing people over there. They've been a tremendous amount of help on my side to do research and be able to understand and learn the brand and re-educate myself on American Optical when we did the acquisition.

If your work doesn't come out, don't force it.

For the last few years, we've done the museum that you saw that is now in our office here. It's retracing the story of the brand from 1833 to today. It has been a great success. People enjoyed it. I don't know if we're going to be able to tap that. I've been working on the new exhibit for our booth that will be shown for the first time in a few weeks. The idea is to represent our factory. As we're talking about manufacturing, that's the idea. We're all bringing small vignettes of our process and showing the process of manufacturing into a more art installation kind of set-up.

I can't tell you too much about it. There's not so much secret sauce here more than I'm working on it every day to get this thing together. It's pretty exciting. It would be great. For people who cannot come and see us or the people who are still doubting that we're making products here, we'll be showing what we are so proud of, our craft, and our men and women doing what they do best. We'll be showing that in terms of the acetates factory and the metal factory. We'll have that.

That's going to be at the STATE or Europa booth at Vision Expo.

I've been working on a project for years. I'm super proud and happy that we were able to do the first edition, the last show in New York. For the people that haven't been there, it's a trend that’s showing what's happening in the eye industry in a very democratic way. It's not about the brands or how big or small your company is. It's putting everybody together for what we do which is making and designing eyewear.

We have a committee that we change every year. That includes people from the press, tailors, freelancers, and different people. For New York, we came up with four different themes that presented the direction of the eye industry. We're able to show that there. That was the first edition and the second one would be New York. It's a couple of months from now.

It's crazy to think because it's like, "It's next year," but it's not that far away. It must be nuts for you because we have Vision Expo West coming up in a few weeks. As soon as that's done, you're going to be like, "Let's get ready for East."

It’s pretty much right away, but I'm very happy. It's going to be a new committee. We are also going to be growing. We're looking at doing some new programs and competitions. Those are the parts of the Vision Expo that are going to be growing. I'm very happy with it. It's what the industry needed to bring everybody together on one platform and show up.

You mentioned four categories or whatever of that now. Can you tell me what those were again?

There was something about diversity and inclusion. One was about environmentally friendly, and then fashion and technology. It was interesting as we went through it. We got 160 frames submitted which were fantastic. Going through all of that and understanding the product or what categories. We're able to identify some categories that were going across some others. There are categories that are great to see that is growing. The fashion side is the obvious side.

I like the diversity one. I liked that there were designers from different backgrounds and ethnicities. I have never thought of it that way. I always think of frame manufacturers as a company, not the fact that there's somebody from this heritage or background who is the designer or the owner, and the inspiration or their story that they've brought into that design or frame. I thought that part was super cool. That part of the exhibit was great.

It's about business but also purely design. The frames are designed differently depending on the facial structure. We're all different which is what's beautiful about it. How do you adjust your design to fit different people? I was happy to see that there are more in that category. I was afraid that category would be too small in our industry. Thank God that diversity and inclusion as part of the industry have been changing, finally, over the last few years. I'm very happy about that. I was happy to get so many submissions and see that becoming bigger. It's time to think about it differently and reopening people's eyes to it.

I've been doing a lot of work on that. A friend, Tarrence, and I worked together very closely a few years back. We started this auction a few years ago. He and I talked one night and say, "As designers, we all want to have one piece of one-of-a-kind thing that means differently." I was like, "How about we put an auction together and raise some money?" We raised quite a bit of money in the first auction. We did a second one a few months ago.

Developing Creativity: The designed frames are in different ways, depending on facial structure, and they're all different, which is what's beautiful about them.

Tarrence pushed the whole idea and put it together to create the scholarship, Opening Your Eyes. It's being a part of a lot of things of what we do. The collaboration I did with Maxwell was a part of that as well in supporting the scholarship. Diversity and inclusion were a big theme and it's still remained very important. I'm so happy to see that we are making tremendous progress.

It's important to see these different ethnicities and diverse backgrounds get to be showcased. They're making their way in an industry that for a long time seemed a bit bland or dominated by a couple of big players or however you want to phrase it. It's cool to see that's where it's going these days. As I was saying, we like to be able to tell a story of, "This is where the frame comes from. Here's what the designer was thinking or the owner is doing." The more of that, the better. The more we can share those different stories, the better. That's cool that you're helping to highlight that. Nico, anything else you want to tell me or tell us about yourself or about STATE or Vision Expo before we wrap up?

There is so much we can talk about. We can talk all day. For the show, I'm very excited. We're bringing some new products. We're going to be showing a lot of new stuff. American Optical is growing very well. It's part of the new secret. We are going to be launching soon a part of the collection. That's exciting. We're bringing some new products to show at the exhibit. We want to see all of our friends. It's a great time after being in a pandemic. We have the opportunity of seeing each other and then being able to share stories and experiences. We're joking about the secret sauce and the design, but the bottom line is we're all one big family. That's the way I look at it. We all have our stories and that's what makes it interesting.

Where can people find you or learn more about yourself, STATE or Europa?

It's STATEOpticalCo.com. For American Optical, it's AOEyewear.com. For Europa, EuropaEye.com. If you want to see more behind-the-scenes stuff, it's usually my Instagram which is my name, Nico Roseillier. That's pretty much where you'll see a little bit of everything.

You'll catch Nico hustling around during the expo. He's always going here and there.

If it's your first show, wear good shoes.

That's a good call. Thank you so much, Nico. I appreciate it. It's always fun talking to you. I always learn something new every time I talk to you. That's always great. Thank you, everybody. I look forward to seeing you guys again very soon.

Important Links

• Europa Eyewear

• STATE Optical

• American Optical

• Vision Expo West

• Opening Your Eyes

• Nico Roseillier - Instagram

About Nico Roseillier

Born and raised in Normandie France, Nico studied architecture and industrial design in Paris before moving to NYC. While in New York, he started his optical career designing eyewear for Modo.  After ten years in NYC and four at Modo, Roseillier switched coasts to Los Angeles, where he became Creative Director for REM eyewear which then became Derigo. In that decade of inspiration, he spearheaded brands as diverse as Lucky Brand, Converse, Tumi and John Varvatos. 

4 years ago Nico reestablished himself in Chicago, where he now delivers full design expertise and creative direction on the powerful and independent entities of State Optical, American Optical and Europa Eyewear.

Among his accolades, Nico has won the Vision Expo awards for best booth design and best brand activation as well as an Accessory Council Design Excellence award for his collaboration with 3 time Grammy award winner Maxwell. Nico Roseillier is also responsible for the vision and conceptualization of the new NOW trend pavilion debuting at the VEE 2022 in NYC.

Episode 79 - Pharmaceuticals In Dry Eye With Dr. Bruce Jackson

July is Dry Eye Awareness Month! To commemorate and help raise awareness for the disease, Harbir Sian is joined by no other than Dr. Bruce Jackson. Dr. Jackson has a long list of accolades with his research interests covering bacterial and viral infections of the external eye, new antibiotics, antivirals, and ocular surface disease, especially dry eye disease. In this episode, he educates us on the history of the condition and the development of the different treatments for it. Dr. Jackson also discusses the different diagnoses associated with the disease and how to approach them with your doctor to develop a dry eye plan that works for you. Tune in for a very insightful and informative episode.

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Watch the episode here

Listen to the podcast here

Pharmaceuticals In Dry Eye With Dr. Bruce Jackson

Thank you so much for taking the time to join me here, to learn, and grow. As always, I am truly appreciative of all the support. Everybody I speak to who gives me feedback on the show, all the comments and reviews online are incredibly supportive. I always ask a little favor right off the top. If you do get some value out of the show from any episode that you've read, please do share it. Tell a friend, throw it up online on social media, wherever you can.

Again, I appreciate all the support. It has really been helping the show grow and helping me bring on amazing guests like our guest, Dr. Bruce Jackson. Before I get into the introduction for Dr. Jackson, if you didn't know, July is Dry Eye Awareness Month. We are going to do this show digging into the ins and outs of dry eye to commemorate this special month. I didn't know that until recently. I want to make sure that we do this Dry Eye Awareness Month justice here.

Dr. Jackson is the perfect guest for this conversation. He obtained his MD in 1967 at the University of Western Ontario, and he completed his residency in Ophthalmology at McGill University in 1972. In 1986, he became the Ophthalmologist in Chief at Royal Victoria Hospital, which is the hospital at McGill University. In 1987, he became the Chairman of the Department of Ophthalmology.

Since then, there has been a lot happening in Dr. Jackson's career. In particular, he started the Excimer Laser Program at The Eye Institute in 1992, carrying out clinical research in the treatment of myopia, myopic astigmatism, hyperopia, hyperopic astigmatism, and PresbyLASIK from 1993. His research interests are in bacterial and viral infections of the external eye, new antibiotics, antivirals, and ocular surface disease, especially dry eye disease.

Dr. Jackson has a huge list of accolades. I want to mention a few of them because it's important to recognize these types of achievements. Here are a few of them, the Eye Physicians and Surgeons of Ontario Lifetime Achievement Award in 2017 and the Canadian Ophthalmological Society Lifetime Achievement Award in 2012. The Ottawa Life Sciences Council Career Achievement Award in 2006, the Queen's Golden Jubilee Medal Recipient in 2002, and a few more. I feel like the only thing that's missing, Dr. Jackson, is the queen tapping you on each shoulder with a sword here to give you a knighthead. What do you think? Is that due at some point soon?

No, I don't think so.

Thank you, Dr. Jackson, for joining me. Honestly, it's truly an honor to have you. I have had some pretty special guests but to have someone as distinguished as yourself is wonderful, especially when we are going to be talking about this condition, dry eye that you are truly an expert in. Thank you for taking the time.

I'm delighted to.

Dry Eye Awareness Month is in July. Why don’t we start with a little introduction for yourself from your perspective of who you are and what you do?

I started in ophthalmology. In fact, I thought that I would probably not do much in the way of clinical but be more on the research side. However, once I got into the program and then did a fellowship at the Proctor Foundation in California, I returned to McGill. I enjoyed the practice, teaching residents, and ultimately starting a fellowship program.

I tried to get involved in research but it was when I moved to become Director General at the University of Ottawa Institute we had a chance to develop a good corneal unit with basic scientists and also be able to start the excimer laser program. At that time, that was the most controversial of anything to have a new Eye Institute start into something that was only in the private world.

The question was, "Does it work or not?" Our research for all those years was to show that it was a great benefit, and there was a tremendous amount of spinoff that we got learning about dry eye, ocular surface disease, and refractive changes. It was a great tool for training residents, fellows, and ophthalmic technicians.

You have this amazing experience in the research realm but also refractive surgery, dry eye, and ocular surface disease, and all of that does come together in many of our patients. I was interested to know the perspective on treating dry eyes in preparation for refractive surgery. Is that becoming more important over time? How important is that now?

It’s always nice to have options.

Let me take you back to 1995, when we started to do hyperopic PRK. What we soon saw was that these patients, who were perimenopausal women predominantly who wanted to get rid of their glasses so that they could put on their makeup more easily, basically had a fluctuating vision after surgery. If you put in an artificial tear and had them blink a few times and read the chart again, you often got 1 or 2 more lines of vision.

We realized that by steeping the cornea, these eyes were drying and had tear instability. That was the first recognition that refractive surgery could change the ocular surface. We started to look much more carefully at patients preoperatively to make sure that they did not have a rapid tear breakup time and didn't have corneal standing or other signs of dry eye.

That's a lot longer ago than I expected. 1995 is taking me back to high school. Since we are talking about its history of it, is that when we started to recognize dry eye more? Was it an earlier stage when the medical community as a whole recognized dry eye as an actual disease?

When I first did my training, we looked at the dry eye as a lack of tears or an inadequate volume of tears. We understood that Sjogren's syndrome was autoimmune and that there was T-cell infiltration that shut down. The lack of accessory lacrimal glands in this group but we didn't recognize this as an inflammatory condition.

Allergan did the clinical studies with Restasis. The associated research after that showed that we were dealing with an inflammatory ocular disorder. By 2007, the first Dry Eye Workshop included that this was a multifactor disease of the tear film ocular surface, and so it took that time for us to realize that it wasn't an adequate number of tears. It was the composition of the tears and that this was an inflammatory process that was driving this.

When was the Allergan study conducted?

The Allergan study was done around 1998 in that realm. We took part in that at McGill. Fortunately, we had a number of patients that did well in that study. The government gave us this special access program so that we could continue to use cyclosporine or RESTASIS on these patients. The supply was come and go. Sometimes we have it, sometimes not. Some of these patients would be doing great, and then we couldn't get it for two months. You could see the regression that occurred. When they got back on again, they were happy with the symptom, signs, and improvements.

It drove home the point that properly selected patients did improve on anti-inflammatory treatment. Cyclosporine was the first one that we had. Up until that point, we used some steroids for severe cases but they had to be short-lived because of pressure and cataract concerns. When cyclosporine came along, we had a safe drug that we could use long-term.

Dry Eye: We looked at the dry eye as a lack of tears or an inadequate volume of tears. We didn't recognize this as an inflammatory condition.

I'm a little bit of a historian or at least I enjoy learning about the history of certain things. A couple of my questions have been like, "When did this start?" Where did cyclosporine even come from? We are saying that perhaps doctors or the medical community started to recognize dry eyes toward the late ‘90s as an actual inflammatory type of condition. Was it being used somewhere else where they said, "This could be reapplied on the eye?"

There is a spontaneous dry eye that occurred in dogs. I'm not quite sure why the veterinarians got involved but they started to use it. We picked up on it. One of the chaps in New York, Hank Henry, and myself started to formulate cyclosporine and try it on some of the dry eye patients. It was interesting that the discussions with Allergan and Paragon chairlift at Snowmass Colorado prompted them to take a real serious look at what cyclosporine might be able to do in the treatment of the dry eye.

From that, we've learned a ton of information regarding this inflammatory cycle. Again, we are recognized for refractive surgery and its importance, and then cataract surgery became a refractor procedure. With premium IOLs with toric lenses, we realized that we had to have accurate keratography. If you took topography, for example, you could see some patients with severe dry eyes in the images. It became an important part of patient satisfaction and getting a good post-op result.

The other interesting thing was that there was a study called a PHACO study. Although it was done in 2013 and 2014, it didn't get published by Will Trattler until 2017. What was interesting in that study was that about 60% had no symptoms when they were going for cataract surgery or dry eye but in fact, about 63% had a rapid tear breakup of less than five. Fifty percent had central corneal staining, almost 3/4 had some form of corneal staining, and close to 20% had decreased Schirmer's.

That put a perspective of what problem they had in patients going for cataract surgery, who are older may not have symptoms but do have evidence of ocular surface disorder. You compound that with patients who are on glaucoma drops with preservatives. You have the perfect storm, where you might get toxicity from the preservatives in the glaucoma drops on top of a dry eye. This is why it has become so important if we are going to have patient satisfaction after cataract surgery.

Circling back to that initial question, especially when it comes to, and I lumped them together, to be honest, laser surgery, cataract surgery or refractive surgeries, as far as I’m concerned. Surgeons can have fantastic visual or refractive outcomes with cataract surgery if it's all done well. That's why it's so important. Often the patients who are getting cataract surgery have this perfect storm of the deteriorating ocular surface plus the medications, oral and topical medications that can cause more dry eye and all of that needs to be addressed. You are telling me that Restasis came into eyecare because of a conversation that you had on a chairlift.

Yes, we were pushing them to take a good look at it. Fortunately, they did. We didn't understand a lot about the symptoms and signs of dry eye in those early days. When you look at those early studies, they were aimed at more severe patients. They were using Restasis twice a day but with no other drops. There was no other therapy. We know you can't treat dry eyes with cyclosporine twice a day. It's multiple treatments to achieve a good result.

The fact that they could demonstrate improvement, and it took until 2003 for the FDA to approve it in the states based on increased year production. Canada didn't accept that. It took a subgroup analysis to show that both symptoms and signs improved. It got approved in Canada by 2010 but again, properly selected patients were the key. When it first comes out, everybody gets on it, and then there are failures. You say, "Why didn't this patient improve?" You then have to look, "What these patients do benefit from anti-inflammatory treatment?

We're getting much more efficient drug delivery to the eye.

Early in my career, I felt some of those failures as well because I thought, "This is the magic drug. I'm going to put every dry eye patient on." That's not how it works. Since we are doing the history of pharmaceuticals here, Restasis was the first one of these pharmaceutical agents to treat the inflammatory side of dry eye. What came after that?

Interestingly, Restasis was approved in 2010, and seven years later, in 2017, lifitegrast or Xiidra was approved in Canada. This was a little different immunomodulatory drug. It acted differently than cyclosporine around the LFA-1 to ICAM binding but it acted on the T-cells, decreasing recoupment cytokine release. It did help a number of patients with their symptoms more than signs.

I call it my love or hate drop, either patient loves it and will hug you for putting them on it or else they will return the box and say that the side effects were too bad of the dysacousia, the stinging, and the blurred vision that they couldn't continue with it, even though it might have made a little improvement. I found it more useful in the evaporative dry eye than the deficient dry eye. Again, more for the symptoms.

In 2021, CEQUA by Sun Pharma was approved as a new formulation of cyclosporine. The exciting part is that it's almost double the concentration at 0.09%. It's like using Restasis four times a day when we only have to use it twice a day. The formulation is novel where they use this nanomiceller technology to encapsulate the cyclosporine as a core with a shell of a water-soluble polymer such that it gets into the tear film much more quickly. It looks like it penetrates the cornea and conjunctiva considerably faster.

We are getting much more efficient drug delivery to the eye. We've started to use it. I certainly have had a few patients now that were unable to use Restasis. They are finding it more comfortable and showing some good results. It's always nice to have options. We did have another one. Santen had Ikervis, which is now approved for vernal, which is Verkazia, and it was also 0.1% cyclosporine but again, an emulsion, a little different vehicle. That didn't get approved by Health Canada. At this point in time, CEQUA is our newest one to use.

You mentioned with Restasis and any of these medications that you can't simply use the medication on its own and expect that to fix all of the symptoms and everything that the patient is dealing with. Usually, there's a multifaceted approach, as we know from the DEWS definition. It's a multifactorial disease. We will get into that a little later about what would be the holistic approach.

Speaking about the pharmaceutical agents, you touched on it already but what would be the benefits of CEQUA versus the traditional cyclosporine Restasis of 0.05% versus 0.09%. You mentioned the higher concentration. Are you finding that patients are tolerating it better? Are they not getting as many of those symptoms or the side effects that they were getting with Restasis?

It's pretty early for me to make a comment. The ones that I have put on at this point are patients that have failed on Restasis. For those that are doing well on Restasis, I leave them on it but for those that have failed, I have had to discontinue. I'm having some good success in getting them started on CEQUA. For some of the new patients coming in, I will put on CEQUA. So far, they have been doing quite well.

Dry Eye: The different formulations may make a big difference.

The different formulations may make a big difference. Another point to be made is that generic cyclosporine was approved in Canada. To a lot of people's surprise because we have no idea what the emulsion is. I had a number of patients that were switched by the pharmacy and came in, and they weren't doing as well and had a lot more symptoms. I then realized that they were on the generic form, not on the brand name form.

Once we switched back to the brand, they improved. There is a group that may not do as well on the generic. I just point that out when people say they are on cyclosporine, and what they are on is important. Allergan has a multidose bottle. That one is not genericized. That is one that can be prescribed and not get the generic for.

That's an important point to confirm if your patients are not doing well on Restasis to confirm whether they are on the generic or the branded one. Is the multidose available in Canada? I didn't even notice that.

It was around 2018, it was approved. I was on the advisory for that and we thought, “This was going to be great,” that patients are going to love the multidose one bottle that they can carry around and use for a month. Interestingly enough, patients like the vials. They could carry them around. They could leave them all over the place, in the office or at home so that they didn't forget them.

A number of them did vial spare, so they could get more out, whereas there was enough for one month in a bottle, especially when patients didn't have insurance and we are paying for it. I have a few of the multidose but I must say that the majority are still back to the minims, and that's the way CEQUA is as well.

I've got similar feedback from a lot of patients when I'm trying to switch them over from the single-dose or single-use preservative-free drops, whichever preservative-free artificial tears, over to a multidose. Initially, they say, "That sounds like a great idea, except I like to keep a couple of my pocket, a couple over there," and then reuse them so they get a little more out of them. That does make sense. That would be a common issue there.

We are moving on and understanding that this is a multi-factorial condition that we are talking about. You and I talked in the past and wanted to stress the importance of recognizing the relevance and the role that lid disease has to play on ocular surface disease and dry eye. I would love it if you could go into where blepharitis and other types of lid conditions come in and how we can recognize them?

One of my mentors at the Proctor Foundation, Dr. Richard O'Connor, used to give a lecture. He starts on blepharitis by saying it was poorly diagnosed and treated, and it's still exactly the same now. If a patient comes in with crusted eyelids, scurf, and debris sleeves on the lashes, we recognize that as blepharitis. We know that cleaning the lids using an antibiotic, occasionally an antibiotic steroid, will settle these down. That hasn't changed much over the years for interior blepharitis. In adulthood, you get a history that as a child, they had crossed either some styes.

Patients look for that quick relief or improvement and when it doesn't come then they quit.

It really did change with meibomian gland dysfunction. We did recognize the role of the meibomian glands, especially when patients came in with frequent chalazia and you could see obstructed glands. I used to remember at the Royal Vic, patients would come in, and we would do meibomian gland expression after warm compresses and put these patients on tetracycline, for example. We didn't recognize the role of lipids in the tear film. In the same way, as we did eventually how lid disease probably accounts for 50% or 60 of dry eye with the tear instability. Only about 10%, 15% have an aqueous deficiency, and the rest are basically a mixture.

We now know a lot more about the role of meibomian gland dysfunction, and also the role that rosacea plays within this, and atopic dermatitis are all added risk factors for it. It's that tear instability that starts this whole inflammatory cycle. The lids play such a major role. I remember, at one point, we used to talk about conjunctivitis and meibomian. Conjunctivitis from the old days where the eye would get red and inflamed a bit, and you would look and find nothing, except that there may be a few little changes on the lid margin. We didn't recognize that there was that inflammation that was going on that was the cost of this.

That's such a key factor. For so many patients, the underlying issue is this meibomian gland dysfunction, leading to the tear film instability and then the inflammation. This is a conversation I have so many times every day with patients. They come in, and their complaint is they are getting a sharp pain a few times throughout the day. I'm like, "Let me rewind the clock here and tell you how this all started, and then it got to this point." I try my best to show them visuals and all these things but they will be like, "No, it just started a couple of days ago." "Trust me. This has been going on for a long time. Your symptoms started a few days ago."

It's interesting to know that physicians at that particular time connected the dots but now we know that it's so vital. When we talk about a more rounded approach to treating dry eye, what would you say on the average patient that you've seen who has these mixed causes of dry eye, the aqueous and evaporative? What treatments are you seeing most commonly for these patients?

At the moment, I'm practicing in a community. We don't have a lot of some of the new technologies available. We are back to almost where we were. We have been able to show that warm compresses are done effectively, lid massage, keeping the lid margin clean, and now we have pre-moistened wipes and some with tea tree oil if we suspect Demodex.

We've got the use of antibiotics but azithromycin, a lot of the staff are resistant to it. I tend to use Fucithalmic or fusidic acid for some of these patients and a discussion on Omega-3s. We also have eye drops that have oil in them to help the tear film. We used to use lid-scrubs with baby shampoo but I worked out better ways to do it than that, so I discourage that.

If you look at the combination of things, including the artificial tears, I have a discussion on the omega-3s with patients, we know some do well on them, and others have found no effect. I give the patient the choice of using a medical-grade one to see if that will make a difference for about three months. In about 80% of patients, that alone will make an improvement if they do it. What happens? It's like flossing your teeth. They start to feel better and then gradually drop off. Men don't like doing warm compresses, so I have them do it in the shower and let the warm water hit the closed eyelids and massage in the shower. That's a little bit better way for doing that.

That's the basic treatment that we need, and then depending upon whether they have more rosacea, I will often put these patients on doxycycline or low-dose doxycycline. It's amazing some will improve with that. Their symptoms of dry eye almost completely disappear with that as an anti-inflammatory. In some patients, it doesn't seem to make a difference. For those unable to take tetracycline, I use azithromycin, and occasionally, you can use compounded azithromycin on the lid margin to help as well. That, to me, is the basic approach to the lids.

Dry Eye: We didn't recognize the role of lipids in the tear film in the same way as we eventually did how lid disease probably accounts for 50% or 60%, of dry eye with the tear instability. Only about 10%, 15% have an aqueous deficiency and the rest are basically a mixture.

We will then get into those that don't respond to that. For that group, we've got a lot of new technology. The first one was the LipiFlow which showed thermal pulsation. If you warm those lids up to about 42.5 degrees, you were able to express the meibomian glands that these patients did have symptomatic improvement. We did see parameters change in the tear film. The problem is it was expensive, and it didn't last. It wasn't a permanent cure.

Other procedures came along like that. For example, for rosacea, we have been using intense pulsed light, and dermatologists have for many years. That has an anti-inflammatory effect and Demodex. That shows improvement. I gained not a cure but often has to be repeated and/or combined with meibomian gland expression.

We have a number of these techniques where we are trying to warm the lid, essentially expressing the meibomian glands. We know that meibomian glands get keratinized, so therefore, there are a number of procedures to try and debride the surface, whether it's mechanical, and even gone to the point of Maskin developed little probes for meibomian probing.

I did spend a few hours probing meibomian glands but decided this was not going to be a procedure that I was going to continue with. It goes back to that same concept. We've got to warm up the lids, try to open up the meibomian glands, express them, and then hopefully change that LipidFlow, so we got better stability of the tear film. At the moment, things like doxycycline and azithromycin are certainly ways that seem to alter the meibomian gland function.

If you wouldn't mind sharing the mechanism of action for something like a doxy when you give somebody an oral doxy, what do we understand is happening?

I tell patients, and they are always concerned. I said, "We are not using it for its antimicrobial effect. In the low dose, it probably does have a little but it inhibits MMP-9. MMP-9 is a product of IL-6, and it is responsible for causing apoptosis and corneal cells. I use it pretty extensively on patients who have a corneal disease because it does inhibit the MMP-9s. On patients with lid disease, you could do the InflammaDry and show that they are positive for MMP-9.

Using doxycycline reduces that. I use it as an anti-inflammatory, and then I try to use it in a lower dose as possible. Certainly, Apprilon is a good one for those that have insurance. For those that don't, I will take doxycycline, use the pill, have them cut it in half, and take half a pill a day. That's often enough to maintain their symptom-free level of comfort.

There are other conditions that will mimic a dry eye. We call them a masquerade. In different areas of medicine, we will have Masquerade syndromes or conditions. Are there some for dry eye, and what types of conditions are they? How do we distinguish those from your typical dry eye type of condition?

If you're treating dry eye, you have to spend the time with the patient.

I have a fun practice because I get the referrals of the patients who've not done well on a lot of the routines. It's interesting that when they come into me, they have all been advised by their eye care provider to use all of the things that we've talked about and the warm compresses and everything but by the time they get to me, they've forgotten all of that. We are starting back from scratch. I always look at each one of them from the point of view of being a detective. "What can I find that's really going on? Why didn't they respond?" You go through everything and look.

I have had a number that have an anterior basement membrane dystrophy or epithelial basement membrane dystrophy. They come in with symptoms of fluctuating vision. It's not an obvious one but when you put fluorescein in and they have to have enough fluorescein, and then watch the epithelium breakup time, you start to see the lines. For some of those patients, that's the cause of their tear instability. I've done some of them a superficial keratectomy to relieve their symptoms.

Same thing as for Salzmann's nodular dystrophy. Treating that made the world of difference and made them comfortable because it altered tear distribution. That is what leads to that tear instability. Conjunctivochalasis is the same, and that's inflammatory. That's usually inferior, and we have SLK, Superior Limbic, both friction-related disorders but also in the superior limbic can gets filaments. By identifying that you are dealing with SLK that you can treat that one and conjunctival resection for both of those tends to work well.

I have had a number of patients with Floppy Lid syndrome that have been referred in. The realization that those are lax lids, and when you elevate the upper lid, it flips over, and you see that papillary reaction. A lid shortening procedure and a lot of these patients who have sleep apnea can make the world a difference. I have had a number with Mucus Fishing syndrome where a little bit of mucus and then they start going after it. They start this cycle.

I had one young lawyer who would take her finger and go right into the upper and the lower fornix to remove it. It's the most dramatic you have ever seen in a video. She's coming in with symptoms of dry eye but until you asked, "You have mucus but what do you do?" They then show you and you say, "I didn't realize that people were doing this," whether it's Kleenex or their finger.

There's a lot, even things like the epiphora tearing. I get a number that is referred and isn't dry eye with reflects teary, and that gives them epiphora because we know that tearing is a part of the symptoms of dry eye or is it punctal stenosis or nasolacrimal duct obstruction. What drugs are they? Is it toxicity from a medication they are taking? That's the cause.

A lot of these patients with keratitis, and it looks like dry eye. The other thing that I've done is check for corneal sensation. That's something that we've neglected to do. I have been surprised at the number that has reduced corneal sensation. We know this can be on the basis of dry eye. For example, the Sjogren's is a very severe disease. They almost have no symptoms and yet complete corneal staining. There's an element of neurotrophic there in a number of our dry eye patients. Recognizing that, changes a lot of our treatment approach.

Those are a few of those masquerade ones. I have had a couple that has been essential like blepharospasm, that I have been referred in because of frequent blinking due to dry eye, and they are basically blepharospasm patients. That Botulinum will make a big difference. I always try to put on my detective hat and see if I can find something that's there that has been missed that we can address.

Dry Eye: They've taught us to recognize conjunctivochalasis as a cause of symptoms where we looked at it as almost an aging process and ignored it as a cause when it can be significant.

There's a lot. I was thinking that you might give us 3 or 4 but there are 10. There are probably others that you maybe see a little less frequently. The conjunctivochalasis, I feel like I see many in the aging population. If I see a little bit, should I refer it out to see potentially if it could be repaired or improved? Does it need to be like hanging out over the eyelid? In your opinion, as a surgeon, how soon would you want me to send that over to you?

I'm in exactly the same position as you are. Some patients can have a lot of conjunctivochalasis and have no symptoms. Some patients have a very mild amount and have a tremendous number of symptoms. It's interesting that if you do an InflammaDry, a lot of them will have a positive MMP-9. That gives you an idea that, for some of these patients is more of an inflammatory process. What I've done and others have taught me is that if you have patients that you've done everything else, they have conjunctivochalasis and are not improving. One of the simple things you can do is cautery virtually at the slit lamp and basically shrink down the conjunctiva. That can be a very simple procedure.

On the other hand, you can do a resection, and a lot of times, with glue, you can seal these up very quickly. It's a minor procedure, and they do well. We are always surprised at how much improvement when you finally make the decision to do something that they get. We are under-treating but no one knows how to predict which is going to do well and which is not.

It is tricky in that sense but I have one small comparison that I can make, which is when I was doing my clinical rotation in my fourth year, I was at an ophthalmology clinic in Florida. This is maybe a distinction between Canada and the US. If they saw a little bit, they were like, "We are going to fix that," and they will do a resection like this.

Here, I've sent patients over to the ophthalmologist and they say, "We are not going to touch that." I remember seeing not that much conjunctivochalasis before when they were doing the surgery in the US. There's an obvious distinction there. I still have those thoughts in my mind that maybe the surgeon will go ahead and repair this but they are not as easy or not as open to invasive procedures here.

I agree. They've taught us to recognize conjunctivochalasis as a cause of symptoms where we looked at it as almost an aging process and ignored it as a cause when it can be significant. What's interesting is that when an SLK, Superior Limbic Keratoconjunctivitis, where you get that loose conjunctiva up above, what amazed me was that they had been resected. The next day, the patient feels comfortable, and yet you have this bare area up above. You flip the lid, and there's still a papillary reaction. They should be more uncomfortable but they said, "At last, I have relief." That always amazed me as to what symptoms they can get from that redundant conjunctiva.

Dr. Jackson, if there are three words that make me uncomfortable, and I'm sure many other people frustrated, who are treating ocular surface disease, it's a pain without stain. We have a lot of patients coming in. There are no obvious signs or staining, there's nothing showing up under the slit lamp but they are complaining constantly of this pain.

Whether they've maybe had laser surgery or cataract surgery, perhaps they haven't and are still constantly complaining of this discomfort. Some of them come in with pretty severe pain. This neuropathic issue, how do we pick it up? How do we treat it? Help me with this because I have a bunch of patients who could benefit from me learning a little more about this.

Dry Eye: Those with chronic pain syndromes, fibromyalgia, osteoarthritis, diabetics, atopic, or any of that group, even those with migraines can have an exaggerated ocular response and you don't see anything.

I can't agree more. Returning back to my days of refractive surgery and I was referred to patients that had perfect results but were in agony. When you looked, there were no signs of ocular surface disease, and yet they would be crying because of the discomfort in the waiting room. We soon learned that this was a nerve problem. It's not an ocular surface problem but it may start as an ocular surface problem.

In other words, these patients may be in that pre-sign stage of dry eye, where they have hyperalgesia. Their corneal surface is sensitive to wind, cold, and light, and yet you see no signs. Ultimately, they develop more of a dry eye. In that group, if you put in a topical anesthetic, they feel comfortable but when you get into the true neuropathic pain patient, you put in a drop of anesthetic, and they don't notice any difference. I say, "I'm putting a drop in to see if it makes any difference." They think I'm putting an artificial tear in. If they say, "That feels so much better," we are dealing with something on the ocular surface. If they say, “It didn't make much difference,” then this is neuropathic pain.

We do know that a number of patients have an exaggerated response. Those with Chronic Pain syndromes, fibromyalgia, osteoarthritis, diabetics, atopics, or any of that group. Even those with migraines can have an exaggerated ocular response, and you don't see anything. There is this discordance that occurs with that. When you get a patient, and you suspect that they have neuropathic pain and may or may not have other risk factors, you have to go through the whole gamut of dry eye treatment. I look at the lids and the surface. I try them on various things.

It's only at the end that you can sit down with them and say, "We've tried everything from drops to cyclosporine to serum tears, and none of it has made a difference. Sometimes a scleral lens or PROSE type of lens can make the difference too but in the end, it's a pain management. Sometimes, I referred them to a psychiatrist, and I have had amazing results with a few of the psychiatrists treating these patients over a period. They've come back and have been smiling in the office where they were crying before.

It's one of the pain management but it's recognizing and they need reassurance. They've gone to see five other people, and they have all said, "I don't see anything wrong." They think they are crazy but you have to reassure them. You know what's going on, "This is a problem. We don't have effective treatment for it.” It's to manage pain is the key.

In many cases, we can say, "Here's an eye drop. Here's a pill," or whatever. For this, there's not really anything that we know works. I've read different things about serum like autologous serum drops or an amniotic membrane, even something as simple as Omega-3 potentially helping. Would you find those are more for the ones that respond to the anesthetic that you know it's more of a topical or surface-level thing or would you think those potentially could work for the deeper neuropathic type patients as well?

I have been fooled on both. I go through it for all of them. I don't usually go for the amniotic membrane but I go through to the rest, the serum tears, even cyclosporine, can increase nerve growth in that. There may be some function for it as well. I try all the things but I tell the patient up front what is going on. If they are willing, we will go through it and try this. I have had some patients that do find some relief. We haven't cured them but are able to function. While there are a few patients after refractive surgery, some have gone on to suicide. It could be like the zoster or postherpetic neuralgia. It couldn't be that severe.

Before I go to my last question, I wanted to go back to the Omega-3 thing. You mentioned a medical grade. I was curious to know what type of Omega-3 if you have something specific that you recommend, and what dosage? How many milligrams of Omega-3 are you recommending daily for patients?

Dry Eye: The studies have shown some have had benefits and the more recent ones show that it didn't. It's a hard thing to assess. Patients should at least be given the option and the knowledge of the types of omega-3s out there.

When I first heard about Omega-3s, I must say that I wasn't very convinced that that would help. A number of studies were published. The first one, a medical-grade one, was PRN which I was introduced to. The difference between an ester and a triglyceride, in other words, most of the lower priced ones that you can get are in the ester form to take out impurities but they are not very efficient and not well-absorbed. You can get that fishy taste. If you go the extra mile, you convert it back to a triglyceride. That's the medical-grade one.

With that, somewhere around 1,500 to 2,000 EPA DHA seems to make a difference if you look at the blood levels and the thing that people have done. Systane makes an omega-3 PRN. There are a number of them that make a good run. I tell patients to use it if they would like for about a three-month period and see if it makes a difference.

I have had patients that have faithfully felt it did and stayed on it. I have others that didn’t. I have a lot of patients come in and they say, "I'm taking an Omega-3." That's where we have a little discussion and say, "You can continue. That's fine. If you want to see if it makes more of a difference, then there are options to upgrade what you are taking and see if it does make a difference." The studies have shown some have had benefits, and the more recent ones show that they didn't. It's a hard thing to assess. Patients should at least be given the option and the knowledge of the types of Omega-3s out there.

Education is where it starts. I have a similar conversation as you with my patients, educating them on the difference between ethyl ester and a triglyceride and roughly recommending about the same amount dosage-wise as you do as well. It's nice to see that patients when they get the education, they understand why you are sharing this information, and a lot of them do come onboard with it. Especially these days, many patients are looking for more of a natural approach versus a pharmaceutical necessarily or other invasive processes.

If they can do a holistic approach like taking an Omega-3, that's systemically going to be healthy for them and open to that conversation. This is going to be my last question for you. This includes myself. I find a lot of eye care providers or optometrists are hesitant to maybe prescribe or maybe unsure even to how to prescribe or if they should prescribe something like CEQUA, for example. Are there any words of encouragement or anything that you might want to share that might help someone like me to become more comfortable with prescribing these medications?

It's interesting because a lot of my referrals come from optometrists. They will put patients with dry eye or a fairly severe dry eye with keratitis on a topical steroid for a few weeks, one of the FML or fluorometholone, and notice some improvement or maybe not notice any improvement and then refer the patient. They stopped short of putting them on anti-inflammatory, whether Restasis or CEQUA.

I look at those drugs as being the safest. They are steroid-sparing. I tend to use them with induction with steroids. A 2 or 3-week induction with steroids, sometimes if the severe ones that I see, I will start them on a topical steroid 3 or 4 times a day. After a week, I will add Restasis, CEQUA or cyclosporine, and then taper off the steroids. They get an initial good improvement with the steroid because we know that it's going to take 2 or 3 months for cyclosporine to have its full effect. As far as a safe drug, it couldn't be a safer one, much safer than steroids. No hesitation there.

You have to warn the patient of the side effects that it will sting and burn. We haven't been able to get away from that. If they put it in the fridge, sometimes putting it in the cold helps. Ten minutes later, they put in an artificial tear that can be very helpful. I would tell the patients that they are not going to notice an immediate benefit. In fact, when you back and see me in 2 to 3 months, you may not feel much better but if it's working, I will notice an improvement on the surface. Gradually, there will be some improvement but patients look for that quick relief or improvement, and when it doesn't come, then they quit.

Dry Eye: It's the technicians and the help that can go over how they use the drops, what to use, timing, all of that, that makes a real difference in whether there's good compliance or not.

One of the ophthalmologists used to say, "I make them swear that they are going to use it for three months or I won't prescribe it," because you've got to give it a chance. From the point of view of safety for spending a few minutes talking to the patient and if it's purely an evaporative dry eye and they got tons of tears, then I don't go that route initially. I will look at other things to try but for those that have that mix, they have some decrease in tear volume but also have some lid disease, then certainly, I will go to that when they have corneal staining.

Oftentimes, it will be part of your initial dry eye plan to start them on a drop like that.

By the time I see the patient referred to me, they usually have had a lot of the basics but they have stopped whatever. We go over that but then this is what I will add next. If they don't have much keratitis, then I may wait and reinforce a lot of the other things, see them back again and how much improvement we've got from that alone, and then start them on the drug. For those that have severe keratitis and have been struggling, that's my next approach.

Thank you so much, Dr. Jackson. There was a lot of valuable information here, whether it's the history of dry eye, refractive surgery, and pharmaceuticals or your more practical advice on a clinical approach to treating dry eye. It has been helpful for me in this conversation. I'm going to go back and read it again because there are parts I can implement right away in our office. Any other final words of wisdom? Any other thoughts you would like to share before we wrap up?

If you are treating dry eye, you have to spend the time with the patient. The chair time is important because most of the time, they are given drops and then out the door. It does take time. As providers like ourselves, we only need 3 or 4 minutes with the patient to assess where they are. It's the technicians and the help that can go over how they use the drops, what to use, timing, all of that, that makes a real difference in whether there's good compliance or not. That's the big thing that I find. Make sure the patient feels that you understand their condition and can inform and give them a rationale of how you are going to approach treatment. See them back 2 or 3 months later to follow up on that. I find that this goes a long way in getting compliance from the patients.

I would have to agree with you on that one. In fact, for that reason, I find there are more than a few practitioners out there who choose not to dive into the dry eye because they know how much chair time, handholding, empathy, and all this that it requires. That's fine if they choose to practice a certain way but those of us who dive into it, learn pretty quickly. That's a big part of it. Thank you for that.

Thanks again, Dr. Jackson. It's a pleasure to have you on. I'm excited to share this with everybody, and don't forget everyone, July is Dry Eye Awareness Month. Make sure you get out there and spread the good word about treating dry eye and its importance of it. Thanks again for reading. If you got some value out of it, don't forget to share it with your friends. I will see you again in the next episode.

Important Links

• Bruce Jackson - LinkedIn

• Allergan

• Sun Pharma

• Santen

About Dr. Bruce Jackson

Dr. Jackson obtained his MD in 1967 at the University of Western Ontario and completed his residency in Ophthalmology at McGill University in 1972. After a fellowship in Cornea and External Disease at the Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco in 1973, he returned to the Royal Victoria Hospital at McGill University in Montréal, Québec where he was geographical full-time at the hospital, involved in clinical care, research and teaching residents medical and surgical cornea. He developed a Cornea and External Disease Fellowship Program, graduating twelve fellows and initiated the McGill Low Vision Clinic.

In 1986, he became Ophthalmologist-in-Chief at the Royal Victoria Hospital and in 1987, Chairman of the Department of Ophthalmology at McGill, Program Director, and Research Director, a position he held until he moved to the University of Ottawa in1991 where he became Chairman of the Department of Ophthalmology and Director General at the University of Ottawa Eye Institute, The Ottawa Hospital until the end of his mandate, in June 2008. He started the excimer laser program at the Eye Institute in1992 carrying out clinical research in the treatment of myopia, myopic astigmatism, hyperopia, and hyperopic astigmatism and PresbyLASIK from 1993. Over his academic career he has trained many residents, fellows and technology students.

His research interests are in bacterial and viral infections of the external eye, new antibiotics and antivirals, and ocular surface disease especially dry eye disease. He has led and been an expert consultant on teams formed to investigate clusters of endophthalmitis cases following cataract surgery and helped develop best practice strategies for prevention.

Dr. Jackson moved from Ottawa in December 2014 and continues his subspecialty consult practice in Cornea and External Disease with an emphasis on ocular surface disease - lid disease and dry eye and new therapies at the Peterborough Clinic in Dr. Kylen McReelis’s office. He is a participant on several pharmaceutical advisory boards and presents clinical and research studies at major meetings. He has published numerous peer reviewed articles and chapters related to refractive surgery, dry eye disease blepharitis and new therapies.

Episode 78 - Become The Disruptor With Dr. Brianna Rhue

There’s so much room for optometry to grow yet. So how can we take control of that future and become disruptors that will change the industry for the better? Here to talk about that is Dr. Brianna Rhue, CEO and Co-Founder of Dr. Contact Lens, an online platform that makes ordering and purchasing your prescription lenses easy. She joins Harbir Sian to talk about how optometrists and professionals in the industry can better care for their patients by also focusing on the business side of things. Technology is not a bad thing, but we should have a say in incorporating it for the benefit of patients and doctors alike. Listen in to hear more!

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Watch the episode here

Listen to the podcast here

Become The Disruptor With Dr. Brianna Rhue

Hello and welcome back to another episode of Canada’s number one optometry podcast, bringing clarity to optometry, business and entrepreneurship. Thank you again for taking the time to join me. I am always so grateful for all the support, all the comments, the reviews, and all the people I connect with in person who tell me that they tune in to the show. It means so much and warms my heart. It energizes me to come back to create more content and reach out to more amazing guests such as my wonderful guest for this episode, Dr. Brianna Rhue. If you have not heard of Brianna, I am sure you will soon because she is everywhere for good reason.

Brianna is Owner/Partner at West Broward Eye Care. She is the Cofounder of Dr. Contact Lens and TechifEYE. She is the mother of two boys. Her son, Dalton, was the inspiration for you to lean into the whole myopia control side of your business. I would love for you to tell me more about that. Thank you so much for joining me. I am super excited about this conversation. We are going to have an energetic and passionate conversation here. I am excited to have you on.

I am excited to be here, Harbir. It has been a long time coming, especially after meeting you here. You really are tall.

I am tall. I lost count on the first day how many times people say, "You are taller than I thought you were." You cannot tell when I am sitting here but it is all good. It is better than the alternative of people telling me that I am shorter than I look. I will take the taller version for sure. There is a lot for us to talk about. I’ve condensed your bio here. I would love for you to fill in a couple of the gaps. Is there any important information you want to share with the audience before we dig in?

I grew up around optometry. I got my first pair of glasses in second grade. My father had two optometrists that were mentors my entire life. I always loved the optometry side and also the business side. That is where I have been able to merge these two passions between optometry and business, hence why these other businesses have been started. My dad was a furniture builder my whole life. I saw what small business ownership looked like. Some of that got ingrained in my brain from a very young age and that is where we are now. I met my husband when I was doing my rotation at Bascom Palmer. I’m very versatile on all the medical side of things. I then went into private practice and became a partner/owner, and then Dr. Contact Lens and TechifEYE emerged from those.

I mentioned in the intro there, “Bringing clarity to the optometry and business.” Entrepreneurship is the big thing that I like to talk about. I know the audience loves it too because when I go back and look at the stats of the podcast and downloads, it is always those conversations about business and entrepreneurship that seemed to be resonating with people. I love that myself, having dabbled in the entrepreneurial space. I find that it is such an exciting place to be when you are able to start something from scratch and have a guest like yourself, who is not only a partner in a brick and mortar business but also has started this technology company yourself with your partner. I am excited to dig into that. My first question to you is, in your opinion, what is the definition of an entrepreneur?

This is what I live my life by. Being an entrepreneur is you can wake up every day and build your own dreams or you can wake up every day and build your own. Entrepreneurship can take on many different levels. You can be a small business. You can be a technology company that reaches multiple businesses. You can be a consultant. It is what you make of it and it is messy. You can laugh and cry and go through all those emotions in one single day. It is little things of starting with why and what your purpose is.

We all have to understand that in optometry, we are small business owners first. We are all wearing that entrepreneur hat because we did create it. We have created multiple things from scratch. It does not have to be a company that you start. It is your own practice. In our practices, it is not only us being small business owners first that happened to practice optometry. We are optometrists first that happened to be small business owners. That is where the big disconnect is when we are looking at things. We can dive into that deeper.

I did not realize that your answer was going to go that way. It is so important to think of it. I was thinking entrepreneur in the way you initially described it. It’s either helping someone else build their dream or building your own thing. If you own your own business, you are doing that. We are trained that way in school though. We learn all the medical and optometry and then it is like, "Here is a little bit of business on the side for the few of you who want to go into that direction." It is ingrained in us that you are an optometrist first and a business owner second. It has to be the other way around, at least if you want to be successful in that. What do you want our mainstream optometrists to know about leaning into that entrepreneurship role that they should be in?

You can wake up every day and build your own dreams, or you can wake up every day and build your own.

It is continuing to broaden your horizon and learn different things. Just like we learned optometry, the eye, everything that is connected to it, and the importance of yearly eye exams, it is also not hard to learn the business side. We read numerous books and made numerous note cards. I found my notecard book and I am like, "I cannot throw these out because there is so much connected to it." Just like we invested in that part of our education, you have to keep investing in the part that is going to help you pay for that part of your education. Picking up a business book or listening to things like this can take you from 0 to 1, and not get stuck at level 0.5.

We are talking about, “Is it a podcast that you listened to? Is it a book that you read? Is it tracking certain metrics?” It is also about working on your business and not in your business all the time. Those four little walls, as you said in your amazing TED Talk, are not just saying one or two. There is a lot that comes behind that. That also has to extend out so that you can be able to say one or two. If you do not have a business, you do not get to say that. If you do not take care of that side, you are fully not taking care of your patients to the ability that you can be. If you do not have the money to invest in new technology and invest in your staff and invest in your patients. You are doing them a disservice. That is how we have to flip it.

Zero to One by Peter Thiel is a good book. We are going to get into the business type of conversation. When it comes to numbers, I am savvy with the metrics. I love talking about that stuff. I love learning about it but I am still not an expert on it by any means. When I have someone like you on, I am like, “Tell me more.” Tell everybody else what KPIs and whatnots we need to be looking for. I want to talk about you more personally first. One thing I already got from you before we met in person and from seeing you online in all these different forums and platforms was the energy. It is amazing. You are everywhere.

I mean it in a good way. Sometimes people say that to me like, “You are always showing up on my feed.” I am like, “I do not know if that is good or bad. I cannot tell by your tone.” I mean this in the best way. It is incredible knowing that you are a business owner, entrepreneur and mother. How do you find the energy? Where does the energy come from? Where is the inspiration? What is getting you out there to do all these things? We were on a webinar together and your talk was incredible. I love the enthusiasm you put into it.

A lot of people come on and be like, "Now we are going to talk about this thing," but you are like, "Look at me. I am doing this. I am the queen of my castle." I loved it. I want you to know that I love your energy. Tell me, if you do not mind, where do you think that comes from and where can people tap into that for themselves too?

I have many nicknames surrounding my energy, from Energizer Bunny to Pop-Tart because I would pop tart out of bed in the mornings. I have always been a cheerleader. It is my nature of being a dancer, gymnast and cheerleader. I am everybody else’s cheerleader too because it is what I love to do. I could be doing backflips and standing on my head for the rest of my life, and that would be my super happy place. I get energy from feeding off a good circle of people. It is important to find your core group on what keeps you motivated. I have always been coachable and I love people coaching me, and me trying to help other people through stories and content like this to help us to get that dream.

Not only to the "be happy" part. Happy is used in the wrong term in a lot of ways. It’s like, “I will be happy if I get this. I will be happy when I do this.” “Happy is always moving,” I heard that and I cannot remember who said it but it is replacing the word happy with joy. These things bring me joy. My practice and my patients are different parts of it. The business side is what accelerates all of this and sharing that with people that had been my mentors forever.

Become The Disruptor: Continue to broaden your horizon and learn different things.

I feel like I am expanding on the universe and what is in front of us to be our own bosses, be in charge of the industry, and drive the industry forward where it has been status quo for a time. Become that disruptor because I feel like we are all being disrupted. We go to so many years of school, and give up our entire 20s and our 30s to become doctors. What is driving me here is I am sick of the doctor-patient relationship being cut out of the equation. If we keep doing that, everybody loses, from industry to patients to us. We have to be advocates for the future. There are not enough of us standing up for that. That is what gets me up every day.

I knew this already but the things that we align on in that mindset of advocating for the profession, "Let's get up and move this thing forward," is something that I can get real fired up about every day any time of day. Let's get into that. I have heard you say this before. The first time you said it to me, it felt like a light bulb went on. It made so much sense. We are so used to being disrupted and being the disrupters. How do we become the disruptors? How do we leverage and take advantage of the disruption ourselves? Why cannot we be doing that from the inside versus what some external forces do? I would love to hear your thoughts more on that, and then share with us what you are doing to be one of the disruptors from within.

That came about with Dr. Contact Lens. Jenn Tabiza and I went to school together. We both bought private practices close to one another. She is in LA and I am in Fort Lauderdale, but we closed the deal together. We had conversations time and time again about what was happening. We all have that reaction when a patient sits down in your exam chair and says, "This is the best eye exam that I have ever had. Your staff is amazing and all the equipment that you have. Can I have a copy of my prescription?" That hurts all of us because we have not gotten a raise from one of these vision plans in a very long time.

I know in Canada, you operate differently. In the US, it has been that same amount for a long time. How we take care of our businesses and how I am able to invest in my patients is by selling what I prescribe. That comes to glasses and contact lenses because we know it is medical devices at the end of the day. That is how we take care of our patients and figure out if they are diabetic or have glaucoma and get them back in for their yearly exams. It is tying part of the refraction to the medical diagnosis and what it should be. Dr. Contact Lens was born out of that feeling of always playing defense, "Please order for me. I have your rebate. I have your vision plan." It is not a good place for you to be as a doctor and it is not a good place for your staff to live.

We wanted something that was like, “Perfect, I have uploaded your benefits. Your rebate is loaded and you can download and print your prescription so you have access to your record 24/7 or you can order here in one click.” That is why this was created. It is playing in giving the patient that little bit of control that they are asking for. I am not a huge advocate for saying, “If a patient asks you for a PD, that patient is way out of your door already." There is nothing that you are going to say that is going to recapture that sale and make you feel good at the end of the day. You got to meet them where they want to be met. If you do that and you make it convenient, then everybody wins. We just have to give them the opportunity.

There are differences as far as the vision plans that do not apply in Canada, but there are other analogous things going on. If you replace the word “vision plan” with whatever our government healthcare pays, there are some analogies there in a way. Where I live in British Columbia, there was huge deregulation a while back. We are required by law. I know certain things like this are starting to happen in the US. There are whispers of the FTC regulations changing, but this has been the case for us. By law, we have to provide the prescription with the PD written on it. It is not a matter of the patient asking us anymore.

It has to be given. If you do not give it, the patient can take some recourse but usually, it is nothing like that. We have had to try to adjust that. I have been in that and everybody else has been in that awkward position of almost begging the patient to stay, "Please look at some glasses here. We will match the price on the contact lenses." I have been there. That needs to change. How long is that going last? How long are we going to want to grovel for our patients to purchase from us? Why not accept that this is where it is at?

We have to be advocates for the future

Meet the patient where they want to be met. This is a lot of what we were talking about. You and I did this eCommerce type of webinar. A lot of the stuff we were touching on is like, “This is where people are living. Why don’t we just go to where people are living and meet them there, rather than trying to force them to meet us where we are?” A lot of our colleagues are struggling with this mentality of this switch. What is the roadblock there? What is stopping them from taking that step?

You uncovered something here. There are a couple of things that play here. One is that everybody can say that they have ordered something online that has been delivered to their door. What makes this box of contact lenses or potentially a box of glasses different from that box that somebody ordered? When we walk into our practices and open that door, for some reason, we forget that we were a consumer before we hit that door. It is calling them now, which everybody else is calling our patients healthcare consumers. They are there. They are allowed to have access to their care. I am having a new infant. Some of my purchasing is happening at 2:00 in the morning. For most Amazon purchasers, you can tell if somebody is a new mommy because stuff arrives at 2:00 AM.

There was something done in the ‘80s and ‘90s that was saying, “You want your patients to come back and pick up this box of whatever it is because you are going to show them and sell them another thing.” Looking at that and saying, “No, they are not. They are trying to get to daycare at 5:00 PM because now they are being charged $20 for every minute that they are late or they got to get home and get dinner on the table." We are all busier than ever trying to get home. I do not have time to go back to my optometrist and pick up my boxes of contacts.

Your staff is not showing them that frame that came in because they are going through the same thing. You have got to get this direct ship-to-patient model going. I am over 95% direct ship-to-patient in my office. We do that by providing free shipping on anything. You can play with this and there are ways there to make money off of that, but it is meeting the patient where they are. The number one reason that something is abandoned online is that there is no free shipping attached to it because that ship sailed 5 or 6 years ago.

Definitely, during COVID, free shipping is an expectation now. That is the standard. It is no longer like, "Cool, they threw in free shipping," You have to have that minimum. It is such an interesting point that you make. I have done these lectures. I have given these lectures on behalf of a contact lens company, introducing a product or talking about the increase in touchpoints. When a patient comes in to buy their contact lens or comes to pick up their contact lens, there is the increased touchpoints, therefore more opportunities for sales.

In theory, that makes sense. Maybe it did up until a few years ago. After COVID, that does not. Let’s think about what the average person is trying to do. They are trying to get from point A to point B to point C to home. Unless they have a real appointment set where they are going to come in and spend time in the office, they are coming to grab the contacts and then, “I will see you later.” Meeting them where they are and having them deliver it to the house and using that. When you have a box of contacts shipped to a patient, is that an opportunity to provide messaging to the patient within that box? Are there other contents being delivered that remind the patient, "Do not forget us at West Broward Eye Care or Clarity Eye Care."

It is not about touchpoints anymore. It is about creating raving fans and raving patients. If you can meet the patient and send them a link where they can download and print or order their contact lenses in one click, you are going to go from a customer service experience from a 5 to a 10 because you met them. You had free shipping. They got their boxes and they do not have to go back. Not only is it a different type of touchpoint, but you are also elevating that patient experience versus them coming in at 5:00 PM, and Susie behind the front desk has four other people to check in or check out. They have to wait ten minutes to get their box.

Become The Disruptor: Just like we invested in that part of our education, we have to keep investing in the part that will help pay for that education.

Think of that customer experience that you want to create and set, and how you can look high-tech for these offices. Especially since it is being jammed down our throats with telemedicine and like, “Order your contacts here and order your glasses here.” We already have the brick and mortar. We already did that. We did the hard part of this. Now we get to do the easy part, which is the eCommerce side. It is not about touchpoints anymore. It is about meaningful touchpoints.

You know this more than I do, but there is so much resistance that we meet when we talk about eCommerce, getting online, and digital marketing. Is it a fear of the unknown? You could everybody some numbers like the value in switching to a platform like this whether it is Dr. Contact Lens or something else. The numbers speak for themselves. The dollars and cents are there, but there is some other mental block. Is it too much on the training side or educating the staff side? Is it like, “I do not think it is going to work.”? Is it too much of an upfront financial investment? From your experience, what has the pushback been for the most part?

It has been interesting being an optometrist and then coming to the sales side, and trying to get us out of our own way for making money. We have been taught to save money for some reason. That is not where the opportunity lies. It is looking at true ROI. We are good at doing it with machines. I buy a digital camera. I know that I am going to charge XYZ for it and make this much and pay it off in this amount. That is a hardcore value that we can measure. When it comes to the online world, it is all trackable if you look at it. All of us have built things in our platforms to do this. It is understanding that even if you are doing good with your annual supply rate and your capture rate, there is still so much leaking out of your practice.

For instance, if you have 1,000 contact lens patients in your practice, which is normal for a 1 to 2 doctor practice, and your capture rate is 80%. That means 800 patients ordered something from you and 200 walked out of the door. If you captured 5% of those walking, it more than pays for the cost of a service. If you take that a step further from the 800 that ordered something if your annual supply rate is 50% and mine is 40%, and I built a system. That means 400 patients need to reorder from you. If 200 walked and 400 need a reminder from me, that means 60% or 600 patients walked out of the door that I was never able to try to do business with again. I hope that they call me in six months to order from me, which they will not because it is at 9:30 at night when they throw out the last contact lens that they want to order.

It is understanding that the $200,000 is low hanging right there. Invest a little bit in a process and going from paper to EMR, we all did it. To come back to your question, it is a lot of staff and changing a process if you stick with something for a year. I hate the word “try.” We tried it and it did not work. Implementation for some of these processes can take a while, but we are there to hold your hand. If your staff is excited about it and we are not meeting a dead wall, we are here to be an open book. If you go in cross-armed, you are going to get out what you put in.

We sold an account. The doctor was super excited about it. She came back the day before we were going to implement it. We had already pulled in all of her information. We showed her where $257,000 was hiding. She was like, "We are not going to move anymore because my staff voted." "Here is your money back, but I want to show you what you are leaving here.” I am not there at this point to sell her to stay. That is not what I was there to do. It’s to educate her and say, “I get it. You are up against the staff here but at the end of the day, you are a business owner. They cost you potentially $257,000. I am not sure if you wanted your staff to vote in that case.”

It does not sound like a staff voting type of situation to me. That is insane when you have those numbers in front of you. I am guilty of this too. If I am not showing those numbers, I am out of sight, out of mind. I will assume everything is working. Once you show me, "How do you like them?" I will be like, "Let's do it. Let's go." When it comes down to those kinds of numbers, that is not a vote that the staff gets. It is like, "Here is the plan moving forward." It is crazy.

You have to meet the patients where they want to be met. If you do that, and you make it convenient, everybody wins.

On the implementation side of it, anything takes time to implement. We are trained medically so when you bring in a retinal camera or you bring in an OCT, you already know how you are going to implement it. It is going to fit into your patient flow like this. When you start talking about technologies like, "Who is going to be running it? Who is going to be implementing it?" That is extra work for me to monitor now. A few of those people and patients captured automatically pay for this thing, and then it is off to the races from there. What are we going to do? We have to get out there and yell from the mountain top. We got to get on to more podcasts and do more webinars. We got to get in front of more people and say, "Come."

“It’s fun on this side of the fence.” I do not like living in doom and gloom like we’ve been taught. You do not have to live there. Our most valuable patients, because I know this side of the industry so well, are really our contact lens patients. We are all trying to drop vision plans or get into my opiate management or scleral contact lenses or dry iris prosthetic, where you find that clinic and the clinic of your dreams not to just be busy but to be busy with the right patients is your contact lens patients.

That minus three mom, 34 or 35-year-old that has been wearing contacts is your dry eye patient that walked out of the door that potentially went online to not renew from you. That is her kids that are potentially myopic that you are trying to build in myopia practice. It is also being laser-focused. You can only focus on so many things. I get it. The medical side is easy for us to focus on because that is what we know. That is what I can control in my practice.

It is funny about this slide that everybody has referenced me as the Queen of my Castle thing. I got this from Susan Resnick. She is like, "As much as I say that I am the queen of my castle, some the days, I am not. I depend on other people to help me and pick me up." That comes to your office manager and it comes to having that cheerleader in your office. They do not care, at the end of the day, if you make more money. They do care about taking care of the patient like you do. If we word some of this differently with our staff, then we are keeping a clinic healthy and that is what we are there to do.

We use this analogy in so many other cases. It’s the oxygen mask on an airplane thing. You are going to put yours on before you can put it on for the person next to you. The business owner’s business has got to be breathing and successful, then you are able to help your staff and help your patients. You have to have the energy to do all of that. Sometimes we look at it the other way around as if the patient has to provide you with the mask when it should be the other way around. We will go back to the whole cheerleading thing before we wrap up.

Let’s talk more about some of these metrics within the office. One thing you touched on is that the contact lens patient is most likely your most valuable patient. A lot of times, ECPs worry that if a patient buys an annual supply, then they are not going to have as much money to spend on something else. There are surveys or studies that have been done that show this. My personal experience shows me as well that those patients will still spend the money in all those other places. We have the 40-something who buys the multifocal contact lenses, but then wants to get the dry eye treatment.

We have the radio frequency and the IPL and they are willing to invest in that, and then they still want to buy the nice frames because they know that they got to wear the glasses. They are not going to wear contacts all the time. Usually, it is patients in that age group. The 40s and 50s have more disposable income as well. It is not like where we are closing our other opportunities by selling these contact lenses. We should be looking at it as opening a door to all these other revenue streams within our practice as well. Is that something that you would experience as well on your site?

Become The Disruptor: If you don’t have the money to invest in new technology and your staff and your patients, you’re doing them a disservice.

A hundred percent. Those are the patients that come back more often that do have more disposable income that is open to what we prescribe. There are a couple of bad words in my practice. One is calling a vision plan insurance and asking, “How many boxes do you want?” Box is a bad word. The word “follow-up” is a bad word in my practice like, "We will see you back for an eye problem evaluation or a dry eye evaluation," because follow-up condones free. I am not about to give my service away for free. You start to get on that path and not recommend but prescribe. It’s not, “I am recommending this contact lens for you?” It’s, “I am prescribing this contact lens for you.”

If you can start to change one little word, it makes a difference to the patient. They came to you because you are an expert and they want to hear from you first on new treatments. They do not want to see an ad on TV and then come in and ask for it. That is what I have always been an advocate for. We are always learning. We are physicians. We are supposed to always be learning. Just like we learned this side, we can learn metrics, business, ROI and little business words. The big word now, I do not know about this in Canada, that nobody knew about years ago was EBITDA. Earnings Before Interest, Taxes, Depreciation and Amortization.

If you are looking to increase that, you can do something as little as investing in a process because that is what these people are coming in to do. They are putting processes in place that are broken, just like the contact lens ordering process is broken. It is a 28-step process from start to finish for a box when it is shipped back to your office. We cannot be having our staff do these mundane tasks anymore to save $5. It is also about patient information. We are all giving our most valuable intellectual property away for a 2% rebate. What do I mean by that? You are going to give whoever it is a 2% savings.

If you order 100 boxes of contact lenses and you save $2 a box by doing the 2% rebate, you save yourself $200. What you could have done was get a contact lens patient back that is valuable to your practice at $350 or $500 or $700 depending on where you are located. I lost money by trying to save money and not giving your intellectual property away for a 2% rebate. TechifEYE was born to show us these things because this is what we have been up against as a tech startup and helps doctors evaluate certain things.

That intellectual property thing is something that went over my head. I did not realize it. I even asked you like, "Who is taking my data?" I want you to share that if you do not mind. For the different companies and manufacturers that we are using, I said, "I do not give them any of my information," but there is still information being shared regarding our patients. What is the value of us holding that data versus giving it to a big corporation? Can you explain that a little bit more?

When you are giving someone access to your records or if you are putting something in as far as a rebate is concerned, they are capturing the patient’s first name, last name, what they ordered, and their zip code where they can look a lot of stuff up. They are putting in their email address for marketing. Are they using it in this form? Maybe not right now but who knows where that could be driven in the future? This is a statistic that is outdated. I found something that was saying that one patient is worth about $1,500. That is way underestimated, especially if you are looking at the LTV or lifetime value of a patient.

If you are seeing a patient that spends on average $500 a year in your clinic, they come back every two years, and you see them for the next 30 years, you can figure that out quickly. These companies all have that. That is fine. That is not what I am saying. Do not stop doing that but I want you to empower yourself with the data. I want you to understand and use the data that they are, and the way that they are using it because it is fun over here. It allows you to spot check things. For instance, I was in my clinic. I spot checked a patient within Dr. Contact Lens. I realized there was something that was not billed. It was $70 that got missed and was not billed properly. Let’s round this up to $100 because I could easily go into my practice and find $100 a day that was not billed properly. We can all do this.

There’s a place for telemedicine, but there’s still something to human connection. That’s what we’re all about.

At $500 a day for 5 days a week, that’s $2,500 a week. If we push that out, what does that equal here? That is $130,000 that I found in one click. It is not about being happy with the wage that you are making and we cannot blame that on anybody else. It is finding little tweaks that make a huge difference on that backend.

Those are all the things that technology now allows us to do. The reasons why you, in particular, are out there sharing this message and almost being evangelical about it, “Everybody come on board. There is so much here for us.” It can be that simple. It might sound like an exaggeration for somebody who has not looked into this type of stuff but this technology is there for us. I love that I have an optometrist. I have started a series of these. I had another interview with an optometrist in the UK. He is an entrepreneur and started his own company. He is doing well and doing big things. Now I have you. I feel like I am going to start a whole series on entrepreneurship and eye care.

It is inspiring and hopefully, it inspires others to step up. Let's be the disruptors from within. It does not have to be that something is always knocking us sideways from the outside. Let's be the ones that grow the profession and take control of that. On that note, I want to get your thoughts on where do you think eye care is going? Do you think there is going to be more of these disruptors from within? Do you think we are going to continue to get disrupted from the outside? If you can look at this both ways, what is your blue sky, best case scenario 10 to 20 years down the road? What do you hope to see? If things do not go so well, where could we potentially end up?

What I hope for the future is I think there is a place there for telemedicine and do not get me wrong, but there is still something to human connection. That is what we are all about. That is about listening and being compassionate. That is why we became doctors. In order to get to do that, we have to be the driver of that and show what is wrong. This brings me to our EMR companies, our Electronic Medical Record companies. They have been the ones inhibiting innovation. I cannot tell you how many conversations I have had with these people where they are like, “We are not going to integrate with you.” I was like, “You made a decision for 10,000 of your users that did not know that you said that.”

We have to be the ones that are seeing the future and coming at it and pushing these EMR companies forward to open up access because it is not their data. It is our data that we should be able to get to use. Fast forward when I am 70, I do not want a computer taking care of me. I want the computer to help take care of me. I do want someone with that knowledge and that compassion to look at me from head to toe. How many tumors have we all diagnosed? How many diabetics have we all diagnosed? How many connections are you making within a community? All of that is the driver to being here on this earth.

If I look at it from the other side, technology is going to help us be better and catch things sooner because healthcare is not circular. You are going to this doctor and they have records here or this doctor and they have records here. It is not all together under one umbrella. That is going to be here sooner than we think, which will be great. It is a whole cohesive person and being integrated into that care versus being stuck in a dark room all day. We have to be the ones that are saying, we need this to better take care of our patients so we can be on the offense. It is all integrated.

Is the future of our profession looking bright or dim?

Become The Disruptor: It’s not just about touchpoints. It’s about meaningful touchpoints.

I think it is very bright because a lot of us are starting to wake up and take action. We need that to happen sooner than later. It is getting to conferences, coming out, talking and having these connections and these conversations that we have been able to now have. I can reach you from here to Canada to the UK to South Africa. We are all connected now and that is cooler than ever. In the past, we never would have had platforms like this.

We are starting to understand the business side and share it. That is where we get to have fun to invest in the medical side of our practices to better take care of the patient. A patient, when they say, "Doctor, you have all of the craziest and coolest equipment I have ever seen." I say, "You invested in me, so I was able to invest in you." That is how I thank the patient. It hits home with them saying, "I did help her buy that to take care of me." It is a roundabout way. I am all about planting little seeds. For some reason, they all like to sprout at the same time. It is the little words that we use and chooses to use that can make a huge difference.

We hear that in our office as well. I am sure many of our colleagues do. Those of us who are trying to stay up with technology, and we do get that. Patients will say, "I have never had that. You invested in this. I like that.” It is because the patients have invested in us. That is very good. There are two questions for every guest on the show before we wrap up. Before we get to those, please share how people can find you. Where would you like people to go?

They can find me on LinkedIn, Brianna Rhue. They can visit DrContactLens.com. You can reach me there. My email is BRhue@doctorcontactlens.com, and then like, share, post and comment. We are all part of this. We are all learning from each other. That is all part of the engagement.

The last two questions. You were at the Vision Summit in New York, right?

I was.

That is funny because one of the ladies that was speaking who was an entrepreneur said, “I do not like when people ask me what advice would I give to my younger self?” That is the first question I usually ask my guests here. I will say, "If you could go back in time to a point in your life where things were a little bit difficult, what advice would you give yourself?" After she said that, I was like, "Maybe I will not ask that anymore." The questions she thinks that is more relevant and that I started asking now because it is a cool question. It makes people think quite a bit. What would your 10 or 15-year-old self say to Dr. Brianna Rhue now?

It’s little words that we use and choose to use that can make a huge difference.

I have never given up. You all get knocked down. Having been bullied in middle school and I could have chosen to live there or I had a huge support system to get me where I am. Be careful with who your top 5 or 10 people are that are in your life. I was able to be steered in a way that was very positive. I always never heard the word “no.” I always hear, “Not right now.”

You talked about that right off the top too when I was asking about your energy. You said it comes from those key people that you spend time with. I found that in my own life that is so important. The older you get, the more you realize it because your circle gets a bit smaller. You filter out. You do not have as much time for so many people, so you end up filtering down to the key people. That is the answer that I give to so many people when somebody asks me, “How do you have time to do all these things?” I do not necessarily think that I am doing more than anybody else but somebody asked me that question. I am only able to do the things that I am doing, whether they are more or less than what other people are doing because of the people around me. My wife, for number one, is able to support me in all the different ways that she does. My parents and my family and my close friends give me brutal and honest feedback when I am not doing something well.

That stuff means something and it is extremely valuable. I wanted to say that earlier but since you brought it up again, I will 100% agree with you on the importance of that circle of friends. That is so key. The last question is in everything that you have accomplished so far in your life, in your business life, professional life and personal life, how much of that would you say is due to luck and how much is due to hard work?

There is a bit of luck. Right place, right time and seeing the vision. A lot of it is hard work and energy and getting knocked down but getting up again. One of the stories in the Dr. Contact Lens venture as we were at that point was somebody knocked us down real hard and we had two paths to take. One was to give up or one was to figure it out and move forward. I am glad that we chose to move forward with it.

Hard work or luck or both? How much of each?

I am a true believer in you have to find signs in the universe that you know that you are on the right path. A lot of the time, you can get into a dark place, especially as an entrepreneur. It is hard work but the right work. I am a huge believer in the book, Traction. It is being that visionary and finding integrators in your life where you can live where you want to be living to keep creating and focus on the work that you want to do.

People ask me all the time, “How do you do all of this? You must not sleep.” I am like, “I sleep pretty good.” It is being focused. In the book, Deep Work, it is not having a hive mindset. It is being laser-focused and coming up with that five-year plan, your one-year plan, your 90 days, and then breaking it back out into weeks. That comes down to daily habits and daily goals that you set for yourself. It is hard work but a little bit of luck.

Become The Disruptor: We have to be the ones saying, “we need this to better take care of our patients,” so we can be on the offense.

They are both necessary. It would be nice to sit in a room and wait for luck to happen but you got to get out there and do it. You are doing it. Thank you for doing everything that you are doing, especially being this voice and this advocate for growing the profession to take it to different levels and different heights, and encouraging our colleagues to be the disruptors from within. We need that. That voice is rising up and it is nice to have you at the core of it. Please keep doing it. If there is any time you need somebody else to shout loudly with you, I am happy to join you whenever you need.

One last note there, optometry is super bright. You can have a career, a husband, a baby, another baby, and build businesses. There is more to optometry than just the exam chair. That is what makes you your money but if you tweaked little things, you can build the life of your dreams. It is important to find people that are doing it like yourself and others in the industry and collaborate.

Anybody out there who wants to get out there more or feels like some of the messages that I am sharing or resharing sharing are resonating with you, get in touch. Dr. Brianna has got her contact information here. You know how to reach me on Instagram at @HarbirSian.OD. Thank you again, Dr. Brianna Rhue, for joining me on the show. I appreciate all your insight. I am excited to watch you continue doing your thing out in the world.

Thanks, Harbir. It was my pleasure.

Thank you everybody who is tuned in to Canada’s number one optometry show. I am super excited to bring you more and more amazing content. I will see you in the next episode.

Important Links

• West Broward Eye Care

• Dr. Contact Lens

• TechifEYE

• Zero to One

• Brianna Rhue - LinkedIn

• BRhue@doctorcontactlens.com

• Traction

• Deep Work

• @HarbirSian.OD - Instagram

About Dr. Brianna Rhue

Brianna Rhue earned her undergraduate degree from the University of Arizona before earning her Doctorate of Optometry at Nova Southeastern University. She completed her residency at the Bascom Palmer Eye Institute in Miami and is a partner at West Broward Eyecare in South Florida.

Dr. Rhue is passionate about health care technology, myopia management, specialty contact lens fits and practice management. She enjoys sharing her love for technology and myopia management through speaking engagements to help optometrists understand business, technology and new areas of care to help all parties involved.

Dr. Rhue is the immediate past president of the Broward County Optometric Association. She is the co-founder of Dr. Contact Lens, TechifEYE and Myopia Patrol. Outside the office, she enjoys spending time with her husband and two sons, playing tennis, standing on her head in yoga and traveling.

Episode 77 - Dr. Harbir Sian On The Power Hour

How can you build your personal brand while remaining authentic? Join Dr. Harbir Sian as he takes the hot seat opposite Dr. Bethany Fishbein (CEO of the Power Practice) of the Power Hour Optometry podcast. Together, they discuss how to build a personal brand and why it is important for professionals in all industries. Dr. Harbir shares the story of how he started sharing and building a community in optometry by educating his audience about the industry. Be re-introduced to his mission and his purpose for the podcast. Tune into this episode and learn more about the voice behind the show.How can you build your personal brand while remaining authentic? Join Dr. Harbir Sian as he takes the hot seat opposite Dr. Bethany Fishbein (CEO of the Power Practice) of the Power Hour Optometry podcast. Together, they discuss how to build a personal brand and why it is important for professionals in all industries. Dr. Harbir shares the story of how he started sharing and building a community in optometry by educating his audience about the industry. Be re-introduced to his mission and his purpose for the podcast. Tune into this episode and learn more about the voice behind the show.

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Watch the episode here

Listen to the podcast here

Dr. Harbir Sian On The Power Hour

Thank you so much for taking the time as always to join me here to learn and grow. I am truly grateful and appreciative of all the support as the show has been growing. I have been connecting with people and learning about who is reading, what they like and when they are tuning in. All these things have been incredibly humbling. Thank you for all the support. As always, I would ask you to please continue to support. If you like the content and find value, please share it with someone. Leave a review, a comment and a like. All those amazing things that you have been doing, I truly appreciate all of that.

For this episode, I am going to share an interview that I did on another show called the Power Hour, which is one of the longest-running, most well-known optometry-related shows. It is something that I have been listening to for years. I was honored to be on the show and speak with Dr. Bethany Fishbein who is the CEO of The Power Practice, an amazing and well-known consulting firm in the US. We talked about building a brand and the value of building a brand for an optometrist and healthcare professional and how I went about building a brand for myself and our clinics.

What I wanted to share here was a reintroduction of myself to the readers of this show. By sharing this interview, you get to learn about me. For all the new readers or the people who have joined in over the last couple of years reading this show who do not know me that well, this is going to give you a chance to meet me and learn about me and how I got into optometry in the first place. I hope you love it. Please do check out the Power Hour. They put out amazing content. Stick with us here at the show. We are going to come out with amazing new interviews. I hope you enjoy this one. I will talk to you real soon.

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At Power Practice, we talk a lot about helping optometrists achieve their dreams. When we ask clients or potential clients what their dreams and goals are, typically, people give us their goals for their office like, “I want to have a $3 million or $5 million practice. I want to collect this much, net this much and have this many staff.” We try to get people to think about their goals beyond the office, not only for what they want their practice to be but what they want for themselves, their contribution to their profession and the world. It is always a pleasure to talk to somebody who is making a big impact beyond the exam room.

My guest is Dr. Harbir Sian. He is an owner of 2 practices in British Columbia, 1 private practice and 1 sublease. He is a podcast host of The 20/20 Podcast, has done a TEDx Talk, author of many articles and has appearances on TV. I learned that his most important job of all is being a dad to his two daughters. You are making it happen. Thank you so much for taking the time to talk in this episode.

Bethany. thanks so much for having me. I appreciate it.

To people who are thinking about creating content in some ways, often, we create our own barriers.

It’s my pleasure. I got to know about you through LinkedIn where you have a very active presence. In this episode, I want to talk about building that personal brand. Before that, I am interested to know about your path. How did you find your way initially to optometry?

How I found my way into optometry is not that exciting. People ask that question because a lot of times, we like to hear these stories that have some passion behind them. My mom’s vision was terrible. I wanted to go into this field to help people with that. Towards the end of my undergrad, I was trying to make a calculated decision about which profession would suit me best. I volunteered or shadowed a bunch of different professionals, including optometry, pharmacy and MD. Optometrists seem like the profession that aligned with my personality the best. Speaking with the optometrist, they tend to be laid back. None of them were that type A, which I am not.

One optometrist in particular, Dr. Amrit Pawa here in Vancouver, when I sat in the exam room with him, it was such a cool experience. It did not feel like the doctor-patient. It felt like two people connecting and conversing at the same time. One of them happened to be helping the other person with their vision and eyes. I felt like that interaction resonated with me. It was not a very clinical experience but more of a personal experience. That is what I like to try to emulate at work as well. When I was applying to optometry school, there is one word that sticks with me. I do not know where it came from but when I was filling out these applications, I would always write that I want to be an advocate for the profession or an ambassador for the profession.

I am not sure how I knew that when I was 21, still in undergrad and doing undergrad things. Somehow when I came out of optometry, right away, I started writing blogs, which I had never written blogs before, and emailing friends. They would send those emails to their friends because it was a fun fact about eyes. I kept that up for a couple of years and then I started making YouTube videos, Instagram and then the podcast. It snowballed and grew.

The underlying theme from all of it has been to somehow advocate for the profession, educate the public and let them know that as an optometrist, I am not simply spinning dials and giving you a pair of glasses. There is so much more to what we do on the health side of things and the education side of things. That has been the driving force behind some of the things that you listed off the top of the TEDx Talk, the podcast and everything else.

When you started doing that and you are writing these blogs, did you have a practice at that time that you were promoting?

No. At that time, I was working as an associate.

Were you doing just blogging personally or for any promotion? Is this a personal passion that you had?

Personal Brand: It's just simply for the sake of education and for the betterment, hopefully, of the profession because there are a lot of forces out there that are creating friction or difficulty for our profession to move forward.

Yes. We talk about personal branding. Looking back on those years, I was personal branding before I knew what it was. I was writing these blogs simply from Harbir to the world about eyes. I look back and I do not know for sure but perhaps I thought that it was going to help me gain more patients somehow. I was doing it to educate. That was the number one driving force.

That genuine desire comes through in what you do. People are hit with so much self-promotion from all over, which is disguised as education. People can see through it. One of the things I have noticed about the articles and the TEDx Talk is you are putting information out there in such a genuine way that it builds trust. It is not something you intentionally came to because of how it started and that is who you are.

I am glad it comes off that way. If there is some other ulterior motive, I try to make it clear if I am speaking on behalf of a company or something like that. Otherwise, it is simply for the fact of education and the betterment, hopefully, of the profession. There are a lot of forces out there that are creating friction or difficulty for our profession to move forward. Some things are happening here in BC that we are not necessarily fighting but we are trying to rally the whole profession to make sure we can still stay strong in the long-term and not let these other forces diminish and devalue the profession. That is where most of the energy comes from.

When you were in school, you came to the profession thinking, “I met this optometrist. I like this optometrist. I could be him.” Where did you start to realize that the public had this misperception or would benefit from this additional education on what it is that we do as ODs?

It was right before I officially graduated. In May of 2010, there was a big thing that happened here in BC, big deregulation of eye care forced by an online company called Clearly.ca. They are a BC-based business but they are huge. They forced the government to make a change where they deregulated everything. People could go online and buy glasses or contacts without a valid prescription. Without seeing an optometrist, they could go ahead and do that.

That is the biggest thing that our industry has faced out here. It shook the whole profession and everybody was nervous and anxious. That was the impetus for me to get out there. I was trying to figure out how I could contribute at that point as a student or a very new grad. I thought that putting the word out there and educating the public was the best thing I could do. That is where it started.

You intended to go back and practice in Canada all along. You are from British Columbia and went all the way across North America and down the country to go to New England College of Optometry. Did you intend to go back and practice in BC?

Yes, 100%. There was never a doubt in my mind. I skipped residency for that fact because my singular goal is to come back to Vancouver and open my practice. I did not need anything else to get in my way. As far as moving to Boston, geographically, the closest optometry school is in Oregon, Pacific University. I was accepted there. I am a city guy and I did not realize it until that moment. I went down and was like, “This is a very nice campus but tell me where the stores, pubs, bars and nice places are.”

“The obstacle is the way.”

They are like, “You have to drive 45 minutes to Portland for all of that.” That was not my jam. In Canada, the only English-speaking school is in Waterloo, which is also a fairly small college town. It then came down to between Chicago and Boston. I loved Boston sports and everything. Something resonated with me there.

When you started with these blog posts, what content were you putting in there? Was it thought out and strategized or was it, “This is what is on my mind this time?”

It was the latter and that is how I live my life. I am not the most strategic person and a person who plans a whole lot. Although as you get older with businesses and family, you are forced to. I like to do a lot of things on a whim and off the cuff. That is what the blog was like. I would say, “Every Wednesday, I am going to release a blog.” Tuesday night I would sit down and say, “What am I going to write about?” I did not realize how much I enjoyed writing or trying to express myself through writing.

I tried to make it relatable and fun. A lot of times, I try to bring pop culture into it. There was a rap lyric from a Lil Wayne song or Snoop Dogg that said something or a hockey player got hit in the eye with a puck. I would write about these types of things and how they are relevant to eye care. I would try to make them fun like that. That resonated with a lot of people and it was fun for me too. I was not writing dry.

Did you work to build your audience or did it build organically because people were interested in what you were doing?

It was organically. I did not do any promotional stuff other than I did send these out in emails but I did not work to necessarily grow my email list. Naturally, those emails were getting forwarded from people on to other people. You could see the numbers on the blog increasing month after month. Certain blogs got a lot more attention than others but it grew naturally. I was doing it without thinking about its growth. I was doing it to put the education out there. I could have leveraged that growth more and use it for other things or actively grown it but I let it do its thing.

The podcast evolved from there. How did it happen?

Personal Brand: If there's an obstacle that you perceive to block your path, don't try to go in a different way. Let's just find out what that obstacle is and figure it out.

There were a few steps in between. The blogs led to YouTube videos. I am fortunate to have good people around me who give me honest feedback or good advice in general. One of my closest friends said, “You should be doing YouTube.” This was back in 2012. YouTube had been around for a few years but had not blown up yet the way it has. I started making videos that I found fun and interesting. I started making these videos. I created an alter ego or a second character that I called Dr. Eyenstein. He did not talk but he was dressed up professor-like with glasses, a bow tie and a white coat. I had me who was doing most of the talking most of the time but he was the comedic relief in those videos.

One thing I have known for a long time is I like video and editing videos. I learned that many years ago and I have loved it. It gave me the chance to be more creative there and do these side-by-side types of editing things that were exciting for me. As anybody who does YouTube will attest to, it takes a lot of time to film and edit. As soon as we had a baby, I was like, “I cannot spend six hours creating this video. I have a business and a child.” I dropped off the YouTube video thing for a long time. It naturally led to podcasting. It was getting big. I was trying to see what other way I could create content.

One thing I would like to share with people who are thinking about creating content in some ways is often we create our barriers and reasons why we think, “I do not have the time, resources or finances to do these things.” When I was looking to create this podcast, I wanted it to look polished and professional but it was going to be just me doing all of it, filming, editing and posting. I thought that if I am also doing a video with it, I am going to need a good camera, lighting and microphones. This was pre-COVID so I tried to have as many guests in person as I could. I needed microphones for the guest as well. I put it off for a year, maybe more.

One day, this thing is nagging me. It will not leave me alone. The same as when I started my YouTube videos, I kept having this thing that was nagging me and not leaving me alone. When the YouTube videos happened, my fiancée at the time went out and bought me a nice camera for my birthday. She was like, “Here. Shut up and make these videos. You keep talking about them.” The same thing happened with the podcast. I was like, “How much do lights and microphones cost?” The lights were a fraction of the cost of what I thought they were going to be. I could buy these little clip-on mics that plug into my phone for $30. I was like, “I can afford this.”

I finally reached out to a bunch of people that I knew and said, “Would you mind coming in for a podcast?” I recorded 5 or 6 episodes first to make sure I felt like it was something I wanted to do. I then went, “I am going to do this.” A lot of times, we create these barriers and obstacles in our minds. I am into stoicism. I read a lot of this stoic philosophy type of stuff. One of the biggest ancient stoic philosophers is Marcus Aurelius, Emperor of Rome, thousands of years ago. One of his key theories or dictums is the obstacle is the way. If there is an obstacle that perceives to block your path, do not try to go differently. Let’s find out what that obstacle is, go that way and figure it out.

For me, these obstacles were imagined and not real. When I went that way, I found that I could continue down this path. It has been amazing. I love doing the podcast. It is another way for me to creatively express myself but most importantly, help amazing people and experts have a voice to continue to promote, advocate and improve our profession. That path has been winding like many paths are but it has been fun for me as well.

Talk about your podcast, The 20/20 Podcast. What is it? Who are you speaking to?

The 20/20 Podcast: Bringing Clarity to Business, Entrepreneurship and Optometry is the full title. Years ago, I launched my eyewear brand. It was an eCommerce company. Through that, I was exposed to a lot of people in different industries as I was trying to grow the brand like entertainers, athletes and business people. I was networking a lot trying to grow the company and build its awareness. I met such amazing people like these celebrities to different levels and other people. At the same time, I was speaking with students or new grads through social media about how they can build their influence and personal brand and become better at business.

Most people are pretty happy to share their stories or contribute and help others if you give them a chance. 

I thought, “On one hand, I have these amazing successful people that I am speaking to through my online business. On the other hand, I have these young people who want to grow their business and become successful. How can I bring them together?” That is where the impetus for the podcast truly came from. I reached out to those people that I had known through my eCommerce brand and said, “Would you mind sparing me an hour to talk about how you became this television personality and this super successful business person?”

One thing I have found over the years is most people are happy to share their stories or contribute and help others if they can and you give them a chance. The podcast was an opportunity for those people to share their side of the story, their struggles and successes. One common theme is that everybody has struggled. You could read an episode from a successful hockey player and you will say, “I have been through that myself. I remember being in a certain position like that myself.” Knowing how they got out of it, you’ll learn the next time you go through that same rt, how you can work your way out of it and come out better.

The goal of the podcast is to share those stories. Somebody said that it is more like a success podcast. I do not think I would use the word success but it is not your standard clinical type of conversation for the most part. Half of my guests are from eye care and the other half are from other realms. My favorite guest was Hayley Wickenheiser who is unanimous. She is the greatest women’s ice hockey player of all time.

She has got multiple Olympic gold medals and World Championships. She is one of the grittiest people I have ever spoken to or met. After her hockey career ended, she went and finished medical school. She is in the process of finishing her residency. It is crazy all of the stuff she doing but it is more about how or what her mindset was going through all of those things. I love to share that. That is the core of the podcast.

My husband is Canadian and is very determined to raise our children that way too. My son growing up, one of his favorite books is called Z is for Zamboni. It is a little alphabet of hockey. I forget if Hayley Wickenheiser is H or W but she was in there. That is how I knew her name. How did you get the TEDx Talk? How did that happen?

It is funny how you hold certain thoughts in your mind and somehow, they come to fruition. It is hard to say exactly how it happened but I have envisioned myself doing something like that for a long time. I have even gotten to the point where years back when I was doing my YouTube videos, I was like, “How can I recreate a TED Talk?” Not to say that I am doing a TED Talk but I want to recreate that entire stage and environment and make my series of talks. I was going to call them TOD Talks. TED stands for Technology, Entertainment and Design so I was going to make it Technology, Optometry and Design.

I was like, “Where can I get the big red letters made? Who is going to film this?” I was planning this whole thing out. It became too big. I had this vision in my mind that I was going to be on that stage somehow. I thought that if I could recreate this and have optometrists come and speak on the stage, I thought that would be cool but it was too big of an endeavor for me.

Personal Brand: When potential customers or patients see your videos, they can learn your personality and build that trust with you before they've ever come in and seen you in person.

Many years go by, I threw all the networking that I have done. Through the passion that I exude or express when I talk about optometry, eye care and eye health, it ended up being someone that I know happens to know the organizer of a TEDx event. That organizer happened to express that they were organizing an upcoming event and actively looking for speakers.

Our mutual friends said, “You should talk to Harbir.” That is what it came down to. I believe other things were happening in the background. I do not know how many people think about things that way about the universe and how energies work but clearly, something happened along the way that made that conversation happen. The organizer got in touch with me.

Initially, the talk was supposed to happen in 2020 and then COVID shut everything down. At that time, they said, “What would you talk about?” I spat out all these ideas of, “I love philosophy and stoicism. I could talk about the mindset and all these things and then my podcast. I have learned about these things.” They are like, “Many people talk about mindset in TED Talks. What are you bringing as an optometrist? That is what we are interested in.”

I showed them some YouTube videos that I had made. I call it Chiasma. A chiasm is a place where the two nerves come together at this junction. For me, it was this theory of bringing optometry or eye care and philosophy together. I am big into philosophy. I do these short one-and-a-half-minute segments. It is like a Jay Shetty talk, bringing in philosophy and then how that relates to our eyes, how powerful our eyes are and how much of our brain is taken up by our vision and the visual system.

I made 5 or 6 of these videos. I showed them and they said, “We want you to do this on stage because this is different. It is poetic and philosophical but you are talking about eyes. There are a very few TEDx speakers who have spoken about eyes.” That is how it all came together and it became a roughly ten-minute talk. I would love for everybody to go and check it out. There are things I could have done a little better but I am happy with the way it turned out. The message is conveyed fairly clearly that our eyes and eye health are very important. We should make it a priority in our lives.

In private practice, we get caught up in getting through the day sometimes. You’re like, “Here we are at work. This many patients are going to come in. We are going to do this and this. There is an emphasis on making money.” It was a good step out to get that 10,000-foot view on, “This is important to life, health and sight.” It was a good perspective. I would recommend everybody to check out that TED Talk video. You have done other cool appearances too. On your LinkedIn, you have got links. You are the go-to expert on TV when they are looking for someone to talk about eye stuff. Did you actively seek those out or did that manifest itself as well?

I was a bit more active in pursuing that one. I tend to deliberately put myself into uncomfortable situations so I can grow and get better at them. My family would laugh at me for saying this but I was not the most comfortable in public speaking. They know that now I am okay with it but in the past years I would say, “I would like to be comfortable with that. I want to be that guy on the stage. How would I do it?”

Trust is what brings people in. 

The only way to do it, in my mind, was to get on stage somehow and look for those opportunities. The same went for these TV appearances. I saw people on TV and thought that would be cool. I aligned not just simply to be on TV but with my goal of becoming that advocate and ambassador to be out there to want to share the important messages.

One of the key things I share with everyone or young ODs who are trying to build themselves up in the profession and build a presence is to be involved with their association, provincial, state or whatever local association. It is called BC Doctors of Optometry. It is our association. From day one, when I graduated and became an optometrist, I was a member and then got involved on committees. They started sending out emails like, “We have this opportunity. Is there anybody who would like to go on the radio or TV?” I would instantly respond as soon as I saw it and be like, “Yes.” They realized that I was interested and then comfortable enough doing it so they started to reach out to me.

We have a small group. There is a handful of us in BC that when our association needs someone in a certain region, they will reach out to us. It is cool to be that key person. It was something that feels right to me to reach out to express or advocate and be an ambassador for the profession as a whole. Being involved in the association is the number one thing I have put on the top of the list for any time I am talking to any OD.

If you are wondering how you could be out there more, that is the best thing to do. Many opportunities have come to me as an optometrist as far as public speaking because I have known someone through our association who needed something and they reached out to me for it. I would highly encourage people to do that.

These things are out there enough that have turned around and helped your practice. You started with this vision, “Maybe someday patients will want to see me because I do this,” but it was not the primary driver and it sounds like it has never been for you but how has it affected your practice that you are being this person and advocate?

It has impacted the practice for a few years but I have not looked at it and quantified it. I was not looking for it to be that for me. People are more comfortable sharing certain things. In the past, people would say, “I found you online.” They would not say anything else. I did not probe a whole lot but then people are openly saying, “I saw you on TV or Instagram.” Instagram is a big one. “I saw this video that you did so I thought I would come to you.” It is being shared.

Almost every day I go to work, there is a patient that says something like that. It has become a more common thing and it is helping the practice but I am also a little awkward when people say that to me. I am sitting in the exam room with them and they say, “I saw you on Instagram.” I feel like I have to be that Instagram person, “Which video did you see? What was I talking about?” I am trying to bring that same energy here in the eye exam. It is helping the practice grow, especially since we are doing more specialty stuff.

Personal Brand: If your leading motive is to bring value to the person on the other end, that's how you bring authenticity.

We are doing a lot with dry eyes, radio-frequency, IPL, iLux and more myopia control. When I talk about those things, I know there are going to be people who see me locally who would be more interested in learning more and come to see me in person. I know that my videos are being seen across North America. I am getting messages from ODs in Texas saying, “Tell me about your radio frequency.” Patients in Toronto are saying, “I would love to get this treatment. Where can I go?” It is broadly being shared for everybody’s education but locally, people are going to come and see us because they see that I have this technology that could benefit them.

Not only do several new patients come in to see you but the thing that happens when someone has seen you speak and has come in because of that is they are coming in with a level of trust that you have to work for with somebody who truly saw you online and picked your name off a list. The patients who are coming in are primed and ready for what you are presenting because they have already heard it and liked it.

In my podcast, I am doing a series on marketing. I have a few guests coming on who specialize in personal branding or online digital marketing. That is one of the key messages that they are sharing in this series. Video is the number one way to get out online to share your personality. When potential customers or patients see these videos, they can learn your personality and build that trust with you before they have ever come in and seen you in person. That is where being online and building your brand is so important. I did a COPE-approved lecture at the beginning of 2019. The concept of personal branding was still new to a lot of people.

I did this lecture and was surprised at how many people showed up. It was personal branding and online marketing. At the end of the lecture, an older OD put his hand up and asked, “Why are you doing this lecture? What is the purpose?” Either my whole presentation fell flat or I am ahead of the curve and these guys do not know why this is important yet but I hope most people know why it is important.

I was trying to show that if you get out there, you can build this trust. Trust is what brings people in. Building trust is so hard. If you can do that before someone even sets foot in your office, that is a huge win. That is why I keep encouraging ODs to get out there. Start to do this type of thing, get on video and share.

I have heard a couple of good solid pieces of advice here. The things that I am taking are one, do it for the right reasons. Do it because you want to and you have something that you want to contribute, not going in with the intent to monetize it or, “I am going to do this to get patients.” Do it because you have something nagging you that you want to put out there. The second is, do not let perfect be the enemy of the good. If you have something, do it. It does not have to be the perfect setup. You can start and improve from there. Do things that make you uncomfortable. That is a big one.

I am hearing that personally. Video is important and I am dragging gills to the ground like, “It cannot get you there.” Also, a bit of, “Just do it.” The young ODs are coming into this profession having heard podcasts, followed ODs on Instagram and have favorites they watch on TikTok. They are coming into this thinking, “How can I be that?” Any other advice to give?

You have to think of yourself as not just the person putting out content but as the audience as well. 

In that lecture and in general, I share the three pillars of personal branding. It goes for online and offline but we are talking mainly online. Number one is to bring value. If your leading motive is to bring value to the person on the other end, that is how you bring authenticity. Value goes in a few different ways. In my opinion, education is the easiest way to bring value because we are all experts and professionals. We can talk about an eye drop, a technology that we offer or something in the eye. We can educate the public. We might think that it is mundane information but there are a lot of people out there who do not know this information.

The other ways you can bring value are comedy, humor and telling passionate stories, however you can integrate those things. The Singing Dentist does these funny songs where he makes up his words to a song and they have nothing to do with dentistry. He is so popular on YouTube. If you have a hobby or something that you are good at, that can be the value that you bring. Number one is value.

Number two is engagement. When you are online, actively engage with people. Let’s say you put up a post and someone comments, “That was funny.” You respond to that. That is the simplest way to engage. “Thank you. I am glad you enjoyed it.” It is like a Google review, make sure you respond and engage when you get a Google review. The other way to engage is to actively go out there and find people to engage with.

You have to think of yourself as not just the person putting out content but as the audience as well. Go find people who are relevant to you in the community you would like to be part of. Go comment on their stuff. Go reach out to people. In-person, that would be like going to an event and networking with people. If you are going somewhere, you are going to shake hands. “What do you do? That is interesting. I would like to learn more about it.” That is essentially doing that online. If you use hashtags, you can search #Optometry or #EyeCare and comment on relevant posts.

The last one is consistency, which means two different things. It means posting regularly but people get too caught up in that. The second type of consistency is posting on different platforms where you have the same voice. Instagram is my primary outlet but I post on LinkedIn, Facebook and other channels. TikTok, not so much but I will post the same video or post on all channels. Different people will see it but they will all hear the same voice. Consistency is important.

On that note about getting comfortable, at the end of 2018, I decided I was going to make a dedicated effort to become more comfortable online. I told my wife, “You are going to see me on Instagram way more. Do not make fun of me. Let me figure this thing out.” I decided that for 30 days, I am going to go on Instagram and do a story. On Instagram stories, they only last for 24 hours and then they are gone.

I felt like, “Good. It is not permanent. Even if I say something silly, it will not be there forever.” You can always take it down or edit it. I thought, “I am going to do 30 days of stories. This will help me be consistent and comfortable.” It was always a video. I am holding the phone, looking at it and talking about something educational or informational thing. It ended up running for over 100 days straight. My second daughter was born and then that day or the next day, I had to stop because I had other priorities.

What you see is a result of getting comfortable. I would highly encourage that if somebody is looking to get out there, start like that. Those videos are maybe 1 minute or 30 seconds. Get comfortable with looking at the camera, saying stuff to people and educating. Eventually, you can pick up your phone in public and be like, “I am here. Look what I am doing.” That was uncomfortable for me for a long time. It still is a little bit but that consistency of doing it regularly is what is going to help you get better.

It does not take long. Many people say, “I do not have the time.” If you go sit in a room somewhere, open your phone and talk to the camera, “I wanted to tell you about near-sightedness, which means you cannot see far away.” End of conversation. That is all you need to do for 30 days. You will slowly start to build the other things on top of that.

That is a good way to get started. It’s super interesting to learn about you and hear your story. This is terrific. Harbir, thank you so much for taking the time and giving time to me and my readers. Everybody out there, thank you for reading.

 Important Links

• Power Hour

• The Power Practice

• The 20/20 Podcast

• TEDx Talk - YouTube

• LinkedIn - Harbir Sian

• Clearly.ca

• Hayley Wickenheiser - Past Episode

• Z is for Zamboni

• BC Doctors of Optometry

• The Singing Dentist

• YouTube - Singing Dentist

• Facebook - Harbir Sian

• TikTok - Harbir Sian