Episode 52 - Eye2Eye: The Ebb and Flow of Productivity

Listen to the podcast here

Since starting The 20/20 Podcast, I have wanted to take time to share insights from my personal experience and from the incredible wisdom my amazing guests have shared with me.

In this new solo segment on The 20/20 Podcast I will be opening up to share some of these deeper insights that I find myself discussing with friends, colleagues, and guests during more vulnerable conversations.

I hope you find some value in these thoughts and I hope they can help you grow and succeed in your journey as well!

In the first episode of Eye2Eye, I discuss something I call the ebb and flow of productivity. Over the years, I found myself going through these highs and lows of productivity and creativity. In the past, during the lows, I would often feel anxious and constantly be looking for ways to get back into a more productive state.

However, what I have found more recently is that there is value in leaning into the "ebb state" to learn more about yourself and your journey.

You can find more content at Instagram.com/harbirsian.od

Episode 49 - Creating Your Path with Dr. Mahnia Madan

Dr. Mahnia Madan is the Vice President of the BC Doctors of Optometry, a Fellow of the American Academy of Optometry, and she is blazing a new path in the world of dry eye treatment.

In this episode of The 20/20 Podcast, Dr. Madan shares how she had to create her own path, the value she sees in contributing to the profession, and how she balanced it all with her family.

Connect with Dr. Madan:

www.vancouvereyedr.ca

instagram.com/dr.mahnia.madan

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Creating Your Path With Dr. Mahnia Madan

Thank you again for taking the time to join me here to learn and to grow. Before we get started, don't forget to make sure you hit subscribe, like, and leave a review. Do all of those amazing things that help support the show. As always, I have a wonderful guest and am super excited to introduce to you. Her name is Dr. Mahnia Madan. She is the Vice President for the BC Doctors of Optometry, our provincial optometry association here in British Columbia. She is a fellow of the American Academy of Optometry. She has lectured and continues to lecture all across North America. She also practices in OD MD practice and in a busy private practice here in the Vancouver area. Dr. Madan, thank you so much for joining me on the show.

Thank you for having me. I’m super excited to be here.

Honestly, there's a lot of amazing things that you've been doing that I'm super excited to share with our audience. I didn't mention it for some reason in this little intro, but the subtitle of the title is Entrepreneurship, Business Life. It’s combining all these different things. Not just speaking about optometry specifically, but it's great that you had this rounded personality and profession and everything. You have so many different things that you can contribute here. The first thing I want to talk about is your position with the BC Doctors of Optometry. Congratulations on your re-election as Vice President.

Creating Your Path: We're not advancing in a linear fashion. There can be ups and downs in life.

Thank you so much.

It's so important to share the journey through this within the organization and what it means to the profession to be involved. If you could tell us a little bit about how long you've been involved and what that process has been like.

I've been involved with BC Doctors of Optometry for over three years. First, as a Board Member and got elected to be Vice President. It's such a neat position to be in. It opens up your eyes to the needs of the optometrist across the province. I've had the opportunity to not meet people just in BC, the various doctors and people on the board, but also across Canada. It's been fascinating to see how optometrists practice throughout Canada.

What are their challenges in the regions that they're in and what things they're facing versus what we're facing here? It’s bringing all of that knowledge together, collaborating, and always wanting to move the profession forward. It’s always advocating. There's so much behind the scene work that goes in these organizations. Until you are in that organization and see it, you don't even realize how many wheels are turning to make sure that we can practice the way we want to practice here.

That's such a great point to make. Often, we get busy in our day-to-day lives and practicing the way we practice. We forget that the profession didn't just show up out of nowhere and didn't stay here or grow by itself. It's growing because of the efforts of a lot of people and the advocacy and things like that that come through our professional organizations like the BCDO.

We’re like that. We find a profession and we want to leave it better for our children and the future. That’s what people did in the past for us. It's important to be involved instead of complaining.

I'd like to be a little bit blunt about this. First of all, we have to always remember that we stand on the shoulders of the people who come before us and the foundation that they've built for us. Be grateful and aware of that, so you're not like, “No, I did this for myself.” Where we are now is because of the people who came before us. That’s number one.

Number two, if you're going to complain about something, there's also the opportunity to do something about it. I want to say that because there are a lot of times people, and there are patients who complain, but people in all sorts of different professions who will complain about the fact that the profession is not meeting their needs or expectations. If that is the case, it's worth stepping out there doing what you've done and being in these leadership positions to make the change you'd like to see.

We've got a great board as well, so I'm excited. It's going to be positive. Things are going to be moving in a good direction.

I’m excited about the board that's been elected. If we don't mind, let's give each of them a quick shout-out. Dr. Shiv Sharma, Dr. Lili Liang, and Dr. Petar Prpic.

Those were the new electees and we've got our President, Dr. Errin Bligh, and past President Dr. John Lam on there. Dr. Brittany Rollett is in the interior and a young mom putting her time in contributing. It's wonderful.

Since you mentioned that, that was going to be a question later on, but I want to jump into that right now. You mentioned the mom thing. Many practicing optometrists and professional women are moms or want to have families. You, yourself, are a mother of three. I'd like to ask you, and it’s open-ended here, how have you found the balance and how did you approach this starting a family being a professional?

I feel like my 30s were a blur with trying to have three kids. After being in school, we moved back from the United States, working and setting up practices here, helping perhaps my husband set up his practice and building a home. There was a lot going on with having children. As women, maybe we even have our own internal battles going on. I went to school. I've got student loans. I want to be working, but here I am nursing and raising babies. Now that I am past my 40s, I found it’s okay to do that and step away from my career and take some time to raise my kids.

I heard a quote from Oprah one time and she said, “You can have everything but not all at the same time.” You want to try to have things that necessarily can't come back. We can't go back to our children's childhood, but I feel fortunate that I'm in a profession like optometry where I can take a pause and come back to it. It's still going to be here. It's still going to support me, and I'm still going to support it.

I feel like even though in the last few years, perhaps I took a break, and I wasn't so active because my kids were so young, I don't feel like I missed a beat. Whereas I felt like that when I was taking a break, I would sometimes beat myself over it like, “I started this job. I don't want to be taking time off. I want to be advancing in my career.” You can have it all, perhaps space it up and it's okay to do that.

That's a great quote and a great message. Leave it to Oprah to share these pearls of wisdom. You've answered a little bit already in that first part of the discussion. What advice would you have then for women who are in that position, maybe they are students, new grads, or whatever it might be where they're trying to understand how they might approach that?

One thing, for sure, you've got to figure out the profession and career you want. What do you want to get out of your professional life and your career life? It's okay that it doesn't have to happen right away. We've got to have patience and you might have children that you might want to take care of. You might have sick family members or maybe your parents that you might be taking care of.

Whatever the reason is, as long as you have passion. It doesn't usually go in a straight line. We're not advancing in a linear fashion and there can be ups and downs in life and that's what it is. Be clear on what you want out of life and your profession. You're going to be spending so many hours in it. Have that clear vision and they think things will fall into place when it's the right time.

I often like to highlight the fact that it's almost never a straight line. As much as we'd like to picture coming out of school, “This is my path.” It's almost never. I would imagine that it’s almost never going to be that way. There are always going to be twists and turns, so it’s being open to that. Understanding that you can have everything you want, maybe not all at the same time, and prioritizing those things.

Coming from my male perspective, I apologize. Optometry is a profession that at least gives quite a bit of flexibility in that versus maybe some others that are less flexible. Since we're on the topic, I've been fortunate to have many amazing women on the show who are professionals, successful in whatever areas they're in. I don't want to ignore the fact that there have likely been some additional challenges for these women to get to where they are based on gender inequality, bias, and things like that. If there are any experiences you've had that you'd be comfortable sharing, you don't have to, but more importantly, I'd like to know, from your perspective, do you feel like we are heading in the right direction? What do you think we need to see a bit more of that in our profession or across the board?

From my experience, I've been pretty blessed. I have a supportive husband that said, “It's your career. You tell me how to support you.” People I've worked with in the United States, the practices, and here have all supported the choices that I wanted to make. More than anything, it was probably my own internal battles. Maybe they come from what is expected of us and what society puts on us, even though people around me didn't enforce those expectations on me.

At some level, as a woman, you feel the mom guilt and the work guilt. You feel all these guilts. Perhaps we are putting it on ourselves, to maybe we have to start to change our own mindset and feel better and comfortable with the choices we're making and that things will be fine. No, I don't have a specific experience to share, so I feel blessed that it's been positive.

Not that there has to be one, but it's helpful when each person who comes on if they share their own story, someone out there will resonate with a piece of your story that maybe they didn't resonate with somebody else's. That's perfectly fine. I like to make these little segues where I can. You talked about the choices and the decisions that you made. We'll go back into your professional career now. You chose to do a residency. I'd love to hear a bit about your residency. What did you practice? Was doing a residency, in your opinion, the right choice for you? Would you recommend that to someone else?

My journey was a little bit different. I graduated from Pacific University, College of Optometry, a couple of years ago. I worked in Minnesota at a beautiful private practice. It was a multi-location private practice. They’re a wonderful group of doctors. I know that I probably would have had the opportunity to buy in at some point if I wanted to. It was one of those great high-end practices that I could see myself working in.

A couple of years into practicing, I realized that it's one of those questions that you have to ask yourself, “Am I happy? Is this how I want my career to go?” Anybody would have been happy. It was a great practice, but I felt like I was missing something, so I wanted to go back to school and do a residency. After three years of practice is when I applied for a residency.

It was in ocular disease. Being a Canadian, it's a huge step. If you're living in the States, you've got all this visa stuff to go through to be able to even get a residency. You're competing with all these wonderful new grads that are coming out. Not to mention, I was newly married, living comfortably and my husband was still going to school.

When I didn't match in Minnesota, I matched in Texas. That was another layer of, “Am I going to do this? Should I back out of it?” I decided that this is my career. I want it on my own terms. If I wanted to go to school and learn a little bit more about what my passion is, I want to do it. It was the most wonderful experience. We packed our bags and moved to Texas. You get to live in another great place.

My residency was at a large practice in Texas. It was a referral center for other eye care professionals who refer their patients for eye care. I got to work alongside four wonderful ophthalmologists trained in glaucoma, retina, cornea, and refractive surgery, be on call every other weekend, see 30, 40 patients, and be involved in the patient's care from start to end. You see newly diagnosed glaucoma to end-stage glaucoma, infections, cancer, everything in between. It’s a wonderful experience that is compact with learning that would take years to learn and see in private practice. All these years later, I still feel like that was probably one of the amazing experiences of my life and investment in myself.

It's amazing to know you had such a profound experience. To do it three years after already having graduated is a whole other story. Most people are thinking about doing it right after school. I'm going to take it that you would generally recommend new grads go into residency. Would I be correct about that?

Yes. It's such a phenomenal experience. No matter what you're interested in, if it's myopia control, ocular disease, contact lenses, do it. It's another year and you're going to make great connections and come up with a great experience. Even if it is a year or two later, it could still happen. You can do it.

That's a perfect example of the fact that just because it's not the usual time or whatever the time that most people do, doesn't mean you can't do it if that's what you want to do. Clearly, it was well worth it. After the residency, did you stay in the US for a while or did you come back to Canada?

I stayed in Minnesota. We moved back to Minnesota and I worked at a large optometry-ophthalmology practice which is an integrated care model. I feel like there's a huge benefit in that care. I was working there for a few years before we moved back to Canada. That was a huge change. When I came back to Canada in 2013 or so, BC was just getting therapeutics or perhaps therapeutics to treat dry eyes and glaucoma right at that time. Coming from a state like Minnesota where you had the rights to even treat chalazion with injections and doing orals to coming back to the start of therapeutics was an interesting time to come back to BC.

I was grateful that the profession of optometry was advancing here and that was opening up, so that was wonderful. When I came back here, and with my experience in the States from the residency, I wanted to work with an ophthalmology group. I wanted to practice to the fullest scope possible of my optometric license. I felt this is working so well in the States, and I was happy there, and perhaps I can try that here. It was difficult. At that time, there weren’t any practices that were working with an optometrist in a fully integrated fashion.

I remember cold calling ophthalmologists, picking up the phone, and saying, “I'm an optometrist. I was trained in the US and I've done a residency. Here's my experience and resume. Do you think we can get together for a coffee and perhaps we can see if this would be a good fit?” There was a lot of pushback. Some of the ophthalmologists had a lot of questions. They're surprised that somebody would pick up the phone and call. That was interesting. Some of them said, “This is going to work, but good luck. See you around.” I finally found a group with Dr. Kevin Wade that we got chatting about it. He and I saw the potential in that, so we started working together back in 2014.

I didn't realize it had been that long.

It's been such a great experience. I remember when I first started working there, he said to me, “Mahnia, you wanted to work with an ophthalmology practice. You're here. Now what? What are we going to do? What kind of career do you want? What is your profession going to be like? What are we going to do here? What is it that you want?” That was a cool question that he asked me because we talked about how I could do pre- and post-op care.

He said, “I don't need you for that. We're going to do something bigger. That's the whole point of this. It's not this pre- and post-op care that you're talking about. What is that going to be?” That’s when I learned that what I want out of this profession is mutual respect for each other. I want us to learn from each other. I want us to both push our professions forward and provide this integrated care where we provide good quality patient care where he depends on things that I can do and I can depend on him for things that he can do. We all win in that situation.

A lot of credit to Dr. Wade for being that open. That's amazing on his part to be that open to that discussion with you and not like, “Here's the pre- and post-op.” That's the way in BC. Any OD reading in the US is not sure. Maybe not understanding the fact that here in BC, this OD and MD situation working together is rare.

In the cases where they do have that most often would think of them as more as pre and post, the few odds and ends at the MD maybe won't do. Not in a demeaning manner. I'm not trying to say that, but it's often the way it's set up, but for Dr. Wade to be like, “You do all of this and I'll take care of this,” that's pretty cool.

Creating Your Path: At some level, as a woman, you feel the mom guilt and the work guilt. We have to start to change our own mindset and feel better and comfortable with the choices we're making.

I said to him, “I do want to practice to the fullest of my scope.” He said, “You're not going to do that by doing pre- and post-op care. Let's figure this out. How can we move this forward? What is our goal here?” We've always had that in mind that we want to be at the forefront of that and maybe lead the way in that.

We're going to touch on something that you are leading the way, but I wanted to also give you the credit for doing the cold calling. This is something that I have stressed in various areas of my career. When I first started practicing, I took the non-traditional route of doing the same thing, cold calling optometrists and saying, “I like your practice and your setup. Can I potentially work there?” Having those conversations are uncomfortable conversations to have with people who are not expecting you to call them out of the blue. When I started my eyewear branding, I was doing the same thing. I was cold calling anybody I could think of that it might be relevant to. A lot of them were not expecting the phone call or that type of phone call. You’ve got to be willing to have that conversation. It’s cool that you did that.

It's amazing that you did that, too. There's so much learning out of that, but you're putting yourself in a tough spot. A lot of it is rejection, but when it's not, it's good.

You find opportunities that somebody else wouldn't find right through the traditional channels. You practice in a private practice as well as a big busy practice. We can touch on that a little bit, but since we're already talking about Dr. Wade's clinic and you having set this relationship up and trying to be at the forefront of things, you are doing a lot of dry eye treatment. That's your specialty. Within that, you're doing something that is much cutting edge, which is the PRP. We'll work our way down this. First of all, how did you decide that dry eye was your passion? How did you work on building that within Dr. Wade's existing practice?

It's always been a thing that I've always enjoyed treating. Dry eye is an optometry disease. It's something that we can manage fully. It is something that optometrists can take control of and be at their thing. It's something I've always enjoyed. In the last few years, as the practice was shaping, the dry eye area started to grow, Dr. Wade was seeing the benefits of me seeing those patients. From the patient's perspective as well, things were changing. That’s where we decided, “Maybe this is something we need to look into and make it a formal program.”

I decided to do a lot of staff training at the clinic to change the mindset because in Canada, especially in BC in an ophthalmology practice, we're in socialized medicine. There isn't a fee for service. There isn't,
“You've got to pay for something like this.” There's nothing wrong with paying for things. It's a mindset. It's not something that the patients and expecting, and not ophthalmologists are sometimes comfortable talking about because that's not part of the education. There was a lot of education that went along with that. I remember one of the simple challenges were things like, sometimes I hear one of the ophthalmologists say, “You could do lid scrubs with baby shampoo.” I have to knock on the door and be like, "No."

You’re barging into the exam and you’re like, “No.”

We've come to a point that the whole clinic sees the benefit of a dry eye program where patients are benefiting and the ophthalmologists see it. It's been wonderful.

Tell us the thing that you've posted about a lot on social media that’s got my attention and it's gotten a lot of key people's attention. For example, I don't know if you read the episode or not, but I had Dr. Richard Maharaj on. He's the dry eye Jedi. That's his specialty. That's what he focuses on day-in and day-out. He and I were chatting on that episode about the up-and-coming cool things that are happening and they're happening in Canada. Your name came up and your use of PRP. For the uninitiated in this topic, please tell us whaPRP is, how you make it, and how it has been beneficial.

PRP is Platelet-Rich Plasma. In simple words, it's your concentrated platelets that are within our blood. Our blood has many components and we concentrate the platelets and it's called platelet-rich plasma. The reason we concentrate the platelets is that platelets are the powerhouses for healing. A lot of studies show that they carry alpha granules and many other bioavailable molecules within our platelets.

In fact, 1,600 bioavailable molecules are within our platelets that come to a site of injury and rescue it. They are involved in wound healing, healing the tissue quickly. They're involved in reducing the osmolarity, which, in dry eye disease, our osmolarity is high. They can correct the osmolarity. They provide anti-inflammatory cytokines to help heal the tissue in the area. They also provide anti-analgesic effects to reduce the pain. There's some evidence that there is nerve regeneration that happens with our own platelets.

It's been fascinating working with platelet-rich plasma. The thought came from my husband. He's a periodontist. Dentists work with platelets. In fact, so many areas of medicine work with platelets. There's so much evidence in orthopedic care, dermatology and hair restoration where platelets are injected to the site of injury to help increase healing in that area. That’s where the idea came. We brought that into our clinic a couple of years ago and we've used it on so many patients. There's also a need for patients wanting to use more natural options.

PRP contains nothing else but your own blood and platelets, so there are no drugs, preservatives, and additives in it. We're all conscious of what we're putting inside our bodies now. Whether it's the food we eat or medication that we take, we want to try avoiding and doing as many natural things as possible. In that, it makes that part of the practice. Also, we've seen such phenomenal results with platelet-rich plasma. Patients use it four times a day, so we do the blood draw in the clinic, centrifuge the blood, concentrate the platelets, and put them in bottles for them to use as eye drops.

To me, it's mind-blowing that you've developed this whole protocol within the office yourself. Who does the process of centrifuging, bottling, and that type of thing?

I've got a medical technologist that comes in and does that. A couple of years ago, we did a bunch of research, looked at studies, optimal platelet concentration, different blood draws, and how much platelets are in people's blood. You need a certain volume when you need to have drops that have to last four months.

You need to be able to draw a certain amount of blood and get certain platelets out of it. You need to have a certain amount of volume. It can't be too thick. It's got to come out of the bottle. Also, retaining the bioavailability of these platelets so they're not degraded over time. A lot of studies or experimentation went into developing the method to make sure that we are getting good viable platelets.

Is it using a little dropper or is it coming out of a regular dropper?

Do you know those vitamin amber glass bottles with a dropper?

Yes.

Platelets stick to plate to plastic, so they have to be stored in a glass bottle. The amber color protects them from oxidation.

How do you prevent that from oxidation or other types of degradation over time? Does it have to be refrigerated? You said it's not preserved.

It's not preserved. It does have to be refrigerated between use and the bottles that are not being used need to be frozen.

Where would somebody need to look if they wanted to learn more about this? Should they reach out to you? Are there other resources that we could send them?

One of the other things I want to do is I want to make this accessible for other optometrists and for other patients. I've always reached out to other optometrists in this and said that this doesn't need to be any more complicated than writing a prescription for RESTASIS, Xiidra or any other eyedrop. You can simply write a prescription for PRP eye drops and we have it set up at our clinic where patients can come and fill that prescription. They don't need to see me. You are the managing doctor. You're managing their dry eye disease, and this is another tool in your toolbox. Should you want to use it for your patients, it's there.

That's a great resource to offer to people. Something you touched on and something I wanted to ask you about related to these types of dry treatments, whether it's IPL, radiofrequency, or PRP, there's a cost associated with it. The cost is one thing that tends to be a bit of an obstacle not just for the patient but for the doctor, even to have these treatments available to offer them to patients. How would you encourage an optometrist to approach this and how do you go about it? Is there any mentality or approach to this that you have that helps you look past that?

There's another quote that I love, “People don't buy what you sell. They buy what you believe in.” They often buy what you believe in, so you've got to believe. You've got to practice science-based medicine, so it's got to have some backing to it before we can prescribe it to our patients. When we do, we want to make sure that I would do something for myself or my mom and I would prescribe for my mom. I've got to get to that comfort level because people aren't buying what you're selling. They're buying what you're believing. If this is something that you believe in. If you've got compassion for it and the science behind it, that helps.

That's important. It's a great way to approach it. Let's touch on this. You do also work in private practice. I'd love to hear if you were able to list 2 or 3 pros and cons of each, the OD MD setting versus the private practice. If somebody is considering this or trying to figure out which path may be more appropriate for them, how would you separate those two? What are the pros and cons of each?

Every mode of practice has its pros and cons. I love working at the OMD practice. I get to practice full scope, for sure. There are so many things that come easy, whether it's ordering lab work or being involved in care for a chronic disease with another doctor. All of those things are easier or more speedy. It’s unfortunate that I say that because that should be easier in an optometry practice too, but perhaps, we're not there yet. Hopefully, we can bridge that gap and get there. It is heavy work.

You're constantly seeing sick patients, patients with real visual impairment. It can be condensed, fast, heavy days. I love working in a private practice as well, where I get to see families and you get to grow old with them, and you get to see their children. I love seeing patients that are my age who are young professionals and providing care for them and advocating for preventing eye diseases in the future. Whether it is to say, “We've got to start early on your dry eye stuff,” or whatever it is that they're going through.

That’s fascinating as well. I love that balance of having both of those practices in there. There was a time where I felt like I wanted to be a business owner. That was when you came out of school and you've got these loans and whatnot. I thought, “If I can't do it my way, I don't know if I'll be happy.” I'm happy to report years later that I'm happy with my mode of practice.

I’m happy to hear that and that. If I can throw in my two cents here, many of us have this feeling, “I need to be a business owner to be successful, feel accomplished, or whatever.” Years later, for me, I can tell you that it’s not necessary. Does your husband own his own practice?

He does.

You've seen it. You've been involved in that, so you understand. Business ownership comes with its challenges. There are many challenges. There are many days where I'm like, “If I could practice optometry and help my patients and not have to also think about this other thing, life would probably feel a little bit more fulfilled.” There are pros and cons to both. Some people want some of that some people don’t. It's good to hear that you feel fulfilled and accomplished for a good reason in the settings that you're working in.

You're right. Being a practice owner, that's amazing too. I can't imagine the amount of doors that open for them and the connections that that draws in. In the end, you have to ask, “What kind of profession I want? That's an important question before we dive into and clock in our hours. You’ve got to decide what we want at the end of the day. I want to be able to look back and say, “Was I happy with that? Was that a good choice for me?”

It’s that old rocking chair test. You think about yourself as an 80-year-old or 90-year-old person sitting in a rocking chair.

What else is amazing is that that can change in a decade too. What I wanted years ago was so different from what I want now. That's self-evaluation from time to time. It's okay if we change the type of practice we want. Maybe in ten years, I'll be a practice owner.

Creating Your Path: We cannot control luck. The only thing we can control is hard work, so we’ve got to do what we can do on our part and hope for the best.

It’s not because you pick one path now, it doesn't have to be your path. If you've grown and changed, reevaluate. Thank you so much for all those amazing insights. I have a few Rapid-fire questions for you as we lead into wrapping up the show. We're going to do these. These are supposed to be short answers. One word to one sentence kind of thing. Whatever comes to mind. I want this to be quick, but the question itself might be a little bit long. The first question, if there was a dry eye war, like if you watched the Avengers, there's somebody coming from out of the planet and they're waging a dry eye war on us, what would be the one weapon you would choose to fight this dry eye villain?

IPL.

You’re going to Intense Pulse Light him into submission.

I feel like it's going to be cool.

It probably wouldn't be too. It's the brightest flash versus a lid scrub or something. It would be a lot harder to kill him. What is the biggest lesson you've learned through COVID?

What I learned is the growth that we can have when we're in such a different time. As an example, I started Instagramming, which I never did before. I never even thought about it, but with everything closed and not having the opportunity to connect with your peers and conferences, I felt that social media would be an avenue. It's amazing, different times and how they make us grow. When I think of COVID, I think of growth.

I'm glad that you think of that. Hopefully, many others do as well. There are easy negative takeaways, but if there's a positive like that, that's great. Who was the most influential person early in your professional career?

My husband.

What's the best professional advice you have ever received?

Reevaluate and align your goals with what you want out of your professional life.

I'll throw this last one in. Tell us a little bit about your kids.

I've got three kids.

The two final questions. If you've read a previous episode, you might have read this. There are two questions I'd like to ask every guest at the end of each episode. They’re self-reflective questions. The first one is if we could hop in a time machine and go back to a point in your life that was maybe a difficult time, what advice would you share with yourself? You could share that moment if you'd like, but more importantly, what advice would you share with yourself?

Some of the difficult times are often when we're conflicted within ourselves. This is Mental Health Awareness Week in 2021. Sometimes they don't have to be physical challenges that the world is putting on us, but our inner challenges are where we're trying to battle and we're trying to find our place of where things are in life, whether it's balancing career, life, and kids. Probably my hardest time where I battled with what my position was in life was probably in my 30s. Looking back and now looking into having things settle down, it's a way of life and growth. We learn from our hard times. We stretch and we look forward to being at peace with it.

The final question is, of everything that you've achieved and accomplished, how much of it would you say is due to luck, and how much is due to hard work?

Hard work is so important. Being open to rejection, picking up the phone and cold calling, knowing that 100 people are going to say no and maybe one will say yes, and putting yourself out there is all hard work. There's luck as well. It's a bit of both. The only thing we can control is hard work. We cannot control luck, so we’ve got to do what we can do on our part and hope for the best.

That's so true. For sure, putting yourself out there like you did. That falls under the hard work category. You wouldn't be where you are if you hadn't done that. Thank you so much for sharing that. Finally, how can people get in touch with you if they would like to do that?

You can get in touch with me on my Instagram page.

Fantastic Instagram page, by the way.

Thank you. It's a work in progress. I don't know how you do it, but I'm learning so much about it. My website is VancouverEyeDr.ca.

I have visited your website multiple times and I love the content on there. You talk about PRP and some of the stuff as well. If anybody's looking for some information. Reach out on Instagram. I find these days the easiest way to get in touch with people.

It’s a little bit more casual.

Thank you again, Dr. Madan. Thank you so much for being on the show. I truly appreciate all your insights and all the advice that you've shared. Thank you to everybody who's here. Don't forget to hit subscribe, like, leave a comment and a review. We will be back with another episode.

Important Links

• BC Doctors of Optometry

• Dr. Richard Maharaj – Past Episode

• Instagram – Dr. Mahnia Madan

• VancouverEyeDr.ca

About Dr. Mahnia Madan

Dr. Mahnia Madan is the Vice President of the BC Doctors of Optometry, a Fellow of the American Academy of Optometry, and she is blazing a new path in the world of dry eye treatment.

Episode 48 - Philanthropy and Mental Health with Christina Labarca

Christina Labarca is the co-founder of Giving Well, which is a company with a philanthropic focus that works with organizations to help them take a more conscious approach to corporate social responsibility.

In this episode, Christina helps us understand philanthropy better by clarifying some misunderstanding and busting common myths.

In addition, Christina shares a traumatic experience that she endured that lead her down the path of bring awareness to the discussion of mental health.

Connect with Christina:

GivingWell.ca

Episode 47 - How We All Can (And Should) Be Leaders With Dr. Richard Maharaj

One year ago, Dr. Richard Maharaj shared his thoughts on the psychological impact that COVID was having on those of us who define success through productivity. Today, we revisit that discussion of how we define success one year into the pandemic. Dr. Maharaj also gives us his thoughts on why it is so important for all of us to become leaders in our own way and how we can do it.

Connect with Dr. Richard Maharaj:

• instagram.com/dry.eye.jedi

• mydryeye.ca

—

Listen to the podcast here

How We All Can (And Should) Be Leaders With Dr. Richard Maharaj

Thank you again for taking the time to join me here. Before we jump in, don't forget to hit subscribe whether you're listening on Spotify, Apple Podcasts, or watching on YouTube. Leave a comment let me know what you think and at any point during this conversation or at every point during this conversation that you hear something valuable. There's going to be tons of value given to the guests that I have. Make sure you take a screenshot and post it up on Instagram and tag us both and let us know what it was that you found valuable and what you took away from the conversation.

My guest is a returning guest. It is his third appearance on the show. My mind was blown when thinking about that. He’s the first person to come back for the third time. He’s the Medical Director for eyeLABS Optometry and Center for Ocular Surface Disease near Toronto, Ontario. He is also the Cofounder of the Canadian Dry Eye Summit. He is none other than the Dry Eye Jedi himself, Dr. Richard Maharaj. Thank you so much for coming back on the show Dr. Maharaj.

Thank you very much, Harbir, for having me back. They say the third time's a charm.

If you count the first IG Live that failed, this is the fourth time.

Third on the record. Fourth in general. I'm happy to be here. Thanks for having me back. I'm excited. I’m looking forward to it.

This is the impetus. This is our anniversary episode. The first time we recorded an episode was at the beginning of the pandemic. It was the early days of the shutdown and quarantine period. You had some incredible insights to share with us. Before we go into that, I want to give you a chance to do a real quick intro for yourself in case I missed any important points there. Please let us know a little bit about what you're up to these days.

For those of you that don't know me and that didn't listen to that first episode, I practice outside of Toronto. As Dr. Sian mentioned, I'm practicing at a medical optometry clinic and my particular focus is on the ocular surface and dry eye disease. It’s what I've been known for over a decade or just there and about. A lot of the work that I do in teaching is focused on that as well. There are some changes in the courses. I've also joined an artificial intelligence company as the new Chief Scientific Officer, AI4Eyes. That's new and it's still in development, but that's probably going to set the stage for the next little while of my career. A lot of new things, a lot of old things but pretty much the same old me.

That's exciting, AI.

The cofounder is one of your colleagues out on the west coast, Dr. Henry Reis.

I was going to ask you if that was Henry's project because I know he has been working on something like that.

It’s exciting stuff.

That's the future for most industries. It’s some form of AI, AR, VR, and all sorts of versions of that type of stuff, so it’s pretty cool that you're into that. I'd love to hear more at some point in the future when you're able to share it and when there are more exciting things about that. There were some pretty amazing insights that you had shared with us on that initial IG Live that we did in April 2020.

A lot of that conversation was around what we were going through emotionally and psychologically. There's a term that you used that you had read or heard somewhere. It was The Great Pause. I definitely felt that it was that the world stood still there for a little bit but in that pause, people went a lot of different directions because of it.

If you could give us a little recap because one of the things that you were talking about was optometrists, maybe as other medical professionals, we tie our feeling of success or self-worth to productivity. If we're not at work, which we weren't at that time, it was going to cause us some grief, that was the word that you use. I wonder if you can give us a little bit of a recap and maybe bring us to now, and how you think things have come from there?

We talked and it was a wonderful conversation. At that particular time, when the shutdown happened, a lot of us, and I speak specifically to optometry, but I look at other disciplines and some of the people that I know, and I'm sure you did, as well, that stopped. That pause that we were forced to have, it's probably the first time and certainly in my life that anything like that has happened.

We're constantly on the hustle, trying to get something done and do work before workers due and get ahead of things. Our minds are constantly in motion and that pause either caused you to pivot towards pausing or towards the grief of losing our productivity. It was interesting when we did IG Live because I had asked you, “How do you define success for yourself?”

I asked you what I asked the audience and there are a bunch of different questions. A lot of people give an immediate response, “I define success as happiness and my family.” They’re virtuous answers. I'm not suggesting that they were false but they were quick answers. You took some time and you thought about it and you came back with this thoughtful question.

I hoped that a year later, we all thought about what success is and what it means. During that time, when we lost our ability to be productive, we almost lost a part of ourselves, or at least temporarily. We go through these stages of loss and grief. Elisabeth Kübler-Ross has the five stages of grief. There's denial, anger, bargaining, depression, and acceptance. We went through those stages.

In Ontario, at least, we were able to reopen but modified and suddenly, we were thrust right back into productivity but it was scrambled. It was disjointed and carried its own stresses of the unknown. Throughout the course of the year, we've been dealing with this modified productivity where we've had to put up PPE and maybe you've invested more in Telemedicine. We have more of those patients coming through depending on where you are, regionally. We started to now talk about getting vaccinated.

We're now dealing with whether our staff we're going to do that. There are all these new challenges. Almost every day has been a new challenge and. I don't know what your thoughts are on this but there was a fork in the road in April 2020 where those of us who felt not defined and tied to our productivity, were somewhat free to enjoy the opportunity that pause gave us.

Perhaps, those of us that are maybe more tied closely to productivity might have spiraled a little bit more. I was talking a lot in 2020 about how it has affected our mental health. That's a big question and I don't hear it enough amongst our colleagues. Some of us are having these conversations but I'm kind of curious about how to have this conversation about mental health in optometry more.

That's definitely a conversation that needs to be had a lot more often. It's always been a difficult topic of conversation for anybody. That's something that you've probably heard of. I'm working with the Lensbox Foundation and definitely one of our mandates is to bring awareness to that topic and provide resources to our colleagues because it is so important. There's a lot of people who are going through some difficult, challenging times, regardless of COVID, they have before COVID, and of course, people during COVID.

To touch on what you were talking about that fork in the road, I envied those people whose happiness and success were not tied to productivity. I was keeping myself busy. I was doing IG Lives, webinars, and things. I was like, “It's my way of being productive.” It was much later that I realized there was a lot more going on in my mind, where I was not comfortable because of the situation and it took me many months to get comfortable. Fortunately, I worked my way through it but I can see what a lot of people probably were going through. I feel this conversation that we're having here is so important.

I'd like to take a quick second to encourage anybody who has been feeling uncomfortable or doesn't know how to vocalize the way that they've been feeling to take a second to give your friend a text, a call, or give one of us a shout. We're on Instagram. It’s easy to find us. Honestly, I'm saying it with a smile, but I'm not joking. Give us a shout. Reach out to someone to say, “What's up?” Have a little conversation. It will help you feel better.

Becoming Leaders: When we lose our ability to be productive, we lose a part of ourselves, at least temporarily.

In your experience, what has helped people like ourselves, optometrists, maybe business owners get through this? What do you see that optometrists and business owners may have needed to do? What pivot would we need to have made in the last little while to get through this and now to continue to succeed moving out of this?

I look at my own experience. Let me set the stage and say that I'm certainly not a perfect example of a person that has been able to separate productivity from success but I'm mindful of it. That's the work. The job is constantly being reflective and mindful at the moment. As you said, as business owners, employers, optimistic physicians, what are we doing to exemplify, the right decisions, the day-by-day moments?

There are a few things, but it boils down to leadership. If I could stress this, it's not to suggest that you need to be in a typical leadership role. We are leaders in every aspect of our lives. You're a father. I'm a father. I have a business as well. I do things in my community. We all have influence over somebody, whether we want to or not. What are the key ingredients, if you will, of being an effective leader at a time like this, where there's so much change constantly being thrust at our feet? How do we hoist that opportunity to be compassionate and vulnerable?

There are these key things that are important for leadership. One is, stepping away from being the know-it-all from having all the answers to pivoting towards a sense of being more vulnerable and having questions yourself. Also, showing your staff, your team, and the people that look up to you, perhaps with people that are around you that the right leadership and moves are asking the right questions, as opposed to saying, “I know the answer.”

I'll give you a quick example. I have a team and staff that I work with. I call them my team because I feel we're all in the same water in different boats. The question as to whether or not they're going to get vaccinated comes up. We all have different feelings about this and how to implement this to our staff. I'm certainly advocating strongly for each and every one of my team members to get it but there have been a few that have been a bit hesitant. That could be because of fear because of the unknown.

Instead of admonishing them, the approach that I chose to take was, “What are the questions you have? You say you're scared. Please tell me what you are afraid of happening?” I encourage them to ask those questions. I created this environment. It's important that we try to create that environment around us where asking a question is not a negative.

In fact, it's a trait that I look for. If you come into a job interview and you don't have a question for me, unfortunately, I'm probably not going to hire you. You could probably have the best resume and you could have it knocking it out of the park, but if I don't have a question from you, if you know it all, then I got nothing to teach you.

That's one of the things. The other thing too is about exemplifying accountability. Going back to what I said about being vulnerable, and not having all the right answers. We'll talk about this vaccine. Instead of shaming them and blaming them for not getting the vaccine, it goes back to a place of empathy and accountability. As your employer and my management team, how can we understand that it's coming from a place of fear and not from a place, “They don't want to get the vaccine because they want to make our lives hard?”

That trickles down to even our patients. When our patients say, “I'm not going to get this anti-reflective coating that you've recommended for me. I'm not going to buy this bottle of drops that you want for me.” Instead of shaming and blaming them, maybe we need to do a better job at understanding, what's our role in that? In relaying that information, that diagnosis or that treatment plan, what role did we have to play? Let's learn to be empathetic.

The other last part, managing perception. As a leader, the last thing you want to do is to fool anybody into thinking that you can manage another person's perception of yourself or your office. That's a fool's errand. It becomes important to recognize that being steadfast and stoic, means being vulnerable. You're not there necessarily to be liked, you're not there to be loved. You can try to have a laugh and if they don't laugh at your jokes like most of my staff, they don’t. They are a bunch of dad jokes, it's fine. I'm there to take a swing and if I miss, I miss.

I'm there to be vulnerable but I'm not in charge of anybody's perception. I don't let that shame set in that you might feel around staff not doing what it is that you want them to do or a patient not following your instructions. Those are the three things that are important and that have been important for my office in the last few years, in my office, my family, and everything that I've done. I've found those to be critical.

Super valuable insights and applicable outside of work for sure in the community with your friends and family. Generally speaking, trying to take that objectively. I'm into stoicism. Anybody who follows me on Instagram sees my daily stories. I'm posting pictures from a couple of books that I read. Ryan Holiday’s book, The Daily Stoic has a passage. It’s a great book. It was about the observing eye and the perceiving eye. The observing eye is what you're seeing is seeing a situation for what it is.

Somebody said they don't want to buy the eye drops. They don't want to buy the eye drops. It doesn't say anything about you, personally but that's the perceiving eye. That's our perception of that scenario. I love that rather than taking that perception and turning it on the patient, maybe turn it on yourself. Understand what maybe you did in that scenario or what you want to do differently. It’s important.

With everything during 2020, whether it was the Black Lives Matter stuff, COVID, and all the misinformation around these different events in our lives, it's been so easy for people to turn that perceiving eye on others like, “Look at you, sharing this information. Look at you, anti-masker or anti-vaxxer or pro this or that.” There has been so much of it.

It's crazy. When it comes to untying success and productivity, that's where the work is. The work is in the perception of this situation too. If you're going to break that down and distill it, what do you think are 2 or 3 qualities? If we want to be a leader, what would those be if you break them down into a few words?

The first one is being vulnerable and asking questions. I don’t know if you listen to Brené Brown, but she's great. She talks a lot about this. There are a couple of shows where she dives into this, but I'd say being vulnerable as opposed to knowing it all and being empathetic, as opposed to avoiding tough conversations. You commented on, worrying about the perceiving eye, being mindful of the environment that you're in and being an observer.

You have to recognize that we're all in the same water but in different boats. a lot of people say, “We're in the same boat.” We're not in the same boat. My boat looks different than yours, but we're definitely in the same water. Waves are hitting our boats at different times, but we all need to open the sail. We all need to let the wind carry us through the tough times. Be mindful of controlling other people's perceptions. We can do that.

It's amazing that we have within our profession, within our group of colleagues, somebody like yourself who has these amazing insights because otherwise, we're sometimes afraid to go looking outside of our profession. I would love for you to see if you're other things you'd like to share other lessons that you think we could take away from the year that we've gone through.

Some of the stuff that you posted that you shared in your show resonated with me. We probably aligned on a lot of these things. What's relevant for optometry and I've talked a lot about this. It's understanding Optometry Psychology. We are who the optometrist embodies from a personality standpoint. There are five main personality traits. There's agreeableness, neuroticism and there are a few others.

There was a study done in 2003 and we might have talked about this as well where the generalized personality of an optometrist was for the ISFJ personality, which is an agreeable and likable person almost doing for others in excess at your own demise, in some cases. We’re the helpers in the room. That's the ISFJ. The ISFJ comes with a lot of built-in empathy but that empathy sometimes can create a bit of cognitive dissonance in terms of what we do.

For instance, charging for a service, having a high-end frame gallery, for instance, or charging for in-office dry eye procedures, which are in the thousands of dollars or any specialty for that matter. There's a bit of dissonance with it when it comes to charging for a particular expense or deemed expensive service. Our own ISFJ personality, being able to make that recommendation guilt-free. That guilt sometimes ends up resulting in us withholding the recommendation, for instance, because we don't want to come across as, “I don't want to tell this patient that this is how much it costs. I feel badly about it.” I hear that a lot.

That’s one of the things that I hear a lot about amongst my colleagues. The one thing I answer to that is we have to make sure that our own narrative and frame of mind are not bleeding into the patient experience. It’s not confounding that experience. I would hate for my patient to not have the right treatment because somehow, I felt guilty about recommending the right treatment. Forget about the reason why maybe it's cost. There could be a number of reasons but if cost is the thing that's holding me back from recommending it, they don't get it and get worse. All that patient's going to know is that they came to see Dr. Maharaj. I didn't make them better.

They're not going to know your inner narrative. It's important for us to reflect on our own narratives and what we bring to the table and to leave it there. Be reflective and mindful of our own biases because it's much there and it spills into our practice. It creates a lot of stress because we're trying to do two things at once. We're trying to be likable and we're also trying to recommend, prescribe or have our patients consume a product that costs X amount of dollars. There's this dissonance and that stress makes work stressful. The need to be liked can sometimes be all too consuming.

I could go on all day about my experience of going through that process of struggling with the price versus offering the best service and that type of thing but I can tell you the short version of that story. I completely agree with you. For me, it comes down to wanting to offer the best options and services to the patient, the price, stuff, and conversation that will happen later if it has to. I can't have a conversation with the Dry Eye Jedi and not talk about dry eye.

Becoming Leaders: There was a fork in the road in April 2020 where those of us who felt not defined and tied to our productivity were somewhat free to enjoy the opportunity that pause gave us.

We've been investing in some new equipment in our offices and starting to bolster our dry eye stuff. It’s so exciting. I love it. I look forward to offering these treatment options services to our patients and seeing the results that we get. You talked about one quick thing already, the AI4Eyes. It’s super exciting and up-and-coming technology in the dry space. Any other things that you could share with us or things that we can look forward to?

I will happily share a couple of quick things but I'll say congratulations. I know you guys invested in the InMode RF System. Everybody's talking radiofrequency these days. It's an exciting technology that bridges aesthetics and optometry but in dry eyes specifically. It is an exciting area. We have a new handle. I've been working with InMode to bring an eye-specific handle to the InMode platform, so it's called The Forma Eye.

It's a much smaller handpiece than the traditional Forma. It's bipolar, so it'll fit nicely in the periorbital region. I'm excited to be working on protocols as we speak but that's the newest thing. We're the first in Canada to have it so. If I'm not mistaken, I believe that it is commercially available as of now. That’s exciting. I'm looking forward to it.

The day I texted you, as soon as I heard I started texting anyone, I could find an InMode and be like, “Put my name down. I'm getting one. Hurry up.”

It's pretty crazy. I'm excited for it. It's nice to have options in the marketplace and it helps us learn. The more tools we have, the more we're going to learn what works and what doesn't work. Being able to have a hand in this as well is kind of rewarding in and of itself. That's amazing. The other thing that's not new, but it's new for 2021, we opened up sales for the 2021 Canadian Dry Eye Summit. We had you as part of our faculty in 2020. You attended and, and that was a bit of a different experience because it was all virtual.

In 2021, the Canadian Dry Eye Summit will be a mixture of virtual and real. It is contingent on the state of affairs in Ontario when it comes but on November 13th and 14th of 2021 will be our Canadian Dry Eye Summit. We're excited about that. We're building out the program as we speak, but ticket sales are open now. If you go to www.DryEyeSummit.ca, you can register.

For those that want to attend a live meeting, should we end up having to forgo the live meeting for provincial lockdown reasons or any other, your ticket will automatically be transferred to a virtual ticket. We're trying to be mindful of making sure that no one kind of gets left behind but that we are still able to have a robust meeting. If our virtual meeting last year was any indication of what we can do virtually, the experience is going to be even better.

You guys crushed. Thank you for having me. I was humbled. I can't even tell you. I was presenting alongside Dr. Art Epstein and Dr. Laura Periman. I'm like, “What am I doing here, exactly?” It was pretty cool. The way he presented it was so cool. I love that talk show type of setup where you guys were in the studio and throwing it back to people. You had a little cut out of Trevor there and that was all awesome. I love the way you guys presented it. If that's what you do virtually, I can't wait to see it in person. If it's in-person in 2021, I'll be there for sure.

It was great having you there. You said that you didn't feel you were needed. You weren’t worthy of being in that position but that's one of the great things. The Canadian brand of education is unique. That was our third Canadian Dry Eye Summit. In 2021, it will be a fourth but we've had our first-year attendees became faculty in 2020 and that's important. If there's anything that your audience can take from this, the brainpower that we have, the Canadian optometry brainpower is phenomenal. I love it.

I see Mahnia Madan, who's doing a bunch of work on PRP. Clare Halleran on the East Coast does fantastic work with Scleral. We've got such talent in this country and I love seeing it. Just because we don't get the wide-open stage that some of our US counterparts have, don't sell yourself short, there's a ton of good brain power here and I love wonderful conversations. There's a pleasure having you and I look forward to more of these types of conversations at the summit.

Thanks for taking the time to create the platform for Canadian ODs to show that talent and knowledge as well. That’s awesome. I’m Looking forward to that. What are the dates again?

November 13th and 14th, 2021. It will be two full days.

Early registration is open. If you do early bird registration, you get a phone call with Dr. Maharaj. What is it, one-on-one?

I'll put Dr. Diana Nguyen. She was our clerkship student. She's now full-fledged. She's going to knock it out of the park on social media. There's also our parent company MyDryEye.ca which is a patient education physician education portal so, check that out as well. I'm going to the show a little bit from you if you don't mind.

That’s okay.

I've had some burning questions that I've had for you.

We're going to flip the script here.

I'm going to grab the mic and I'm going to ask you some questions. What do you think? You okay with that?

Let's do it.

I know you've been doing this very silently and I've often thought of you as a conscious entrepreneur. Tell me about your Oxford & Kin eyewear. How did this happen and how does one even do this? You have your own line of frames and you reach them out in your optical? How did that come to be? Tell me a bit about it because it seems like a fantastic thing that you've done here and you've done it so quietly.

You're good at this already. I'm afraid you might be taking over The 20/20 Podcast here.

Not at all. It’s all yours.

The Oxford & Kin was a passion project of mine that I started years ago. I did give the longer version of the story on Instagram when the company was acquired. I've always had this itch or passion to try to do more outside of the four walls of the office and I had this epiphany and inspiration. I was seeing companies like Warby Parker and the like.

I'm like, “Why aren't there people within our industry taking advantage of these potential opportunities or trying to at least put themselves out there in these positions?” “Why is it people from outside of eye care coming in and taking these opportunities?” I dug into it, researched, Skyped, and cold calling people in different countries. I went through this long process. I often joke that if I'd known how much work it was going to be, I probably wouldn't have done it. There's this certain amount of naivete that you need. When you're starting something like that, I think it's actually a good thing to have.

I went through the process. I didn't know how to draw or do any kind of design. I worked with the manufacturers. We did back and forth on designs. They sent me prototypes, samples, and ultimately landed on a small boutique collection, just a few pieces. The goal was for it to be primarily eCommerce. Yes, we had some in the optical and I distributed to a few stores here and there but I didn't want to have to hire manpower to oversee all of that.

Becoming Leaders: Be reflective and mindful of your biases because they can spill into your practice.

It was primarily eCommerce and the backbone of that was the giving back portion of it. It was this one for one like Toms Shoes kind of model. Before I started it all up, I called Optometry Giving Sight. A pretty big organization that does a lot of fundraising for eyecare around the world, whether it's building schools or providing on the ground services, that kind of stuff. I called and chatted with them about partnering. Basically, we set it up. Every pair of glasses we sold through Oxford & Kin, was going to be the equivalent in the form of a donation, the equivalent of a full eye exam, and a pair of glasses for someone in the developing part of the world.

That was the core of it, to be able to reach and help more people than I could possibly help by working 9:00 to 5:00 in my office. That came from some of the volunteer work I'd done with OneSight and stuff like that overseas. That was the shorter version of it. Eventually, after plugging away for a few years, a company named Lensbox has been building up some steam and momentum. They wanted to have some boutique collections of eyewear as part of their platform. They approached me to acquire the company.

That's phenomenal. I love the genesis of that idea. It sounds like you weren't setting out to take over the world. It was this passion project and look at where it got you. That's amazing. That's also nice that it ties back into optometry, but it's also part of that greater good. I often talk a lot about things that are positive-sum and things that are zero-sum. That positive-sum game, when everybody wins, there's such a good feeling in that. It's very rewarding, but moreover, it's not a personal reward. It's the reward to many. Good for you.

Thank you very much. If anybody wants to learn more, you can go to OxfordAndKin.com or message me on Instagram. It's always the answer to everything.

I flipped the script on him, everybody. He didn't know that. I figured, “We're talking now. We're both busy guys. This is the time to talk about the things we haven’t.”

It's been a big part of my life but it's been behind the scenes for the most part. Aside from learning, I can't tell you how much I learned. I couldn't even try to quantify what I learned from as far as connecting with people. Networking, learning eCommerce, learning digital marketing, all this kind of stuff. I had to learn it all by myself because I didn't have the money to hire people for it. It’s a pretty crazy experience.

It sounds like a great learning experience and hopefully, for some of the younger readers that are out there, there's a lot of entrepreneurs and people that want to become entrepreneurs, especially those that are fresh out of school. All they hear about is the hustle and grind. Hopefully, you hear a little bit about the realism in building something in your bootstraps. That's exciting stuff. If you're okay, I know every time you do this show, you got two questions, and I've been dying to ask you the last two questions. What do you think?

Let's do it. You've already answered them, so I suppose that's fair. I've thought about someone asking me and but it actually makes me a bit nervous about having to think to answer them now.

I bring the pain. I keep it real. I like to dive into people's minds a lot. That's my little magical power there. Question number one. Was there ever a time in your life, if you had a time machine that you would go back to and change one thing or a piece of advice that you give a former version of yourself? Whether it was a stressful time or something like that, what would it be? Tell us about the advice.

I don't know if I could think of a very specific moment, but it would be, “Don't worry about pleasing other people. Don't put so much emphasis on that.” I did that for a lot of my life and it makes you do weird things. They’re not crazy things but you act weird when you're constantly trying to please people. Whether it's pleasing your friends or lay trying to please a girl, like trying to get a girl interested in you, or it's business related, trying to impress other people. Try not to focus so much on impressing other people. I'd say, “Just focus on making yourself the best version of yourself that you can be, whether that's spending a little time on education or spending more time on personal development and not worrying about what other people think so much.” That would be it.

That's beautiful. I can see that. I like to say, “Pivot towards valuing the mind over the muscle. Peace over hustle.” Those are the two things that I used to say. I had a similar answer. It was like, “Learning to say no, and to be quiet.” That was a key thing. Great answer. I like that.

Thanks.

Next question. You've accomplished so much. You've got this fantastic show, The 20/20 Podcast. You've got your Oxford & Kin line. You've got your practice, profession, family, and all these great successes. How much of it is due to luck and how much of it is due to hard work?

It's so funny to have these questions asked to me. This one I've thought about over the years randomly. This is a little existential but I'm taking this from a different conversation somebody was having in relation to understanding time, like, “Now doesn't exist, there was a moment that just passed and the moment that's coming.” He was saying, if you're on a beach and stand at the edge of the water, your feet are in the water, but you're on the beach.

You're neither in the water nor on the beach, or it's both. I feel like that's how I think about this luck and hard work thing. It's got to be both. When you're standing there on the beach, you’re both on the ground and in the water and it's both hard work and luck. Quantifying how much water there is versus how much sand there is, that's hard to do. I feel bad that I asked this question and forced people to make this binary decision.

My answer this is, it's a lot of luck. It’s not luck like dumb luck. I hate the word luck because I've been told I'm lucky a lot of times. In fact, my roommate in Boston in optometry school goes, “Harbir, you just fall ass-backward into luck.” I was like, “I studied for that test. I don't know what you're talking about.” It's always had this negative connotation to me. By luck, I mean fate, or I use the word grace that Tony Robbins uses. It's the universe, bringing things to you.

I couldn't control who my parents are, where I was born, that day decided to move to Canada when I was young. I have this large family here that's a support system. I'm very fortunate to have that. It's extremely important to me. That's luck and for me, that's probably 50% of it. If I didn't have that support system, I wouldn't be able to work as hard.

Becoming Leaders: The more tools we have, the more we will learn what works and what doesn't.

I know a lot of my colleagues and a lot of people I have on the show will say 99% hard work, and I get it because the eyewear brand, two companies, two optometry clinics, two kids, and all this stuff at the same time, it's hard work but I wouldn't be able to do it without all the family support and everything I have. I'm going to say 50/50 is my short answer to your question.

That's a good answer. I gave it 80/20 last time. You definitely bring up one of the most important things, which is not to forget the context of the world before us and what we were graced with, to be fortunate to be born, I was born in Toronto, and to be in this country. That alone puts us in a stratosphere of wealth that other countries can't even dream to have. If you're earning $60,000 in Canada, you're earning more than 80% of the global population. That alone puts us in a different position, so I respect that.

That doesn't discount the work and effort that we put into it. Again, what part of that was choice, and what part of that was ingrained in us, in our families and cultures? I can see how the sand and the water are very much all there at the same time. That's a great answer. Thank you for letting me take the mic for a moment.

No problem. That was an interesting experiment. I feel like I spilled my brains out here. I’m clearly not prepared for that. I should be by now after all these episodes but thanks for the suggestion. I appreciate it. Dr. Maharaj, any last words that you'd like to share about how it's been for you?

Personally, it's been challenging. It's had its ups and downs. On the family front, I'm fortunate to have my great family, and they've all been healthy. We've lost a family member on my wife's side and that was challenging. What stood out the most is our ability to navigate through tough times. We forget ourselves. As tough as 2021 has been, and I said this last time on the show too, I still have my practice. My dry eye patients have needed me now more than ever. Looking back, it's been crazy.

Despite three months of income loss and then a trickle back over the course of 2021, we've ended off the year doing okay. If 2021 taught the human race anything, it’s the story of resilience and how resilient we are and we forget it. We hear the government shutting us down again in Ontario, and schools being shut down, it immediately takes us to a place.

Let's not forget our resilience and ourselves, and let's keep forging ahead. This is not to say to create more busy work for yourselves but to create more time for you. That has been the most important thing that I've done this 2021 is to take back some of my time. I took it back and I'm not giving it away again. I would encourage everybody to do the same.

Thank you for being a leader in this regard, in many ways, and for sharing these insights, because I know that they're going to be valuable for a lot of people. They have been for me as well. Where can people find you?

On Instagram, @Dry.Eye.Jedi, and www.EyeLabs.ca, that's another way to find me. There are a few different avenues, or as you can call me up on my cell phone.

Perfect. Thank you again, Dr. Maharaj. I appreciate it. Thank you to everybody who's reading. Thank you so much for taking the time. Don't forget to take a screenshot, post it up on Instagram. Tell us what you took away. I know Dr. Maharaj dropped some pretty solid knowledge that you guys will all find valuable. Give me a shout and let me know what you think. Thank you again. We'll see you again soon.

Important Links

• Spotify - The 20/20 Podcast

• Apple Podcasts - The 20/20 Podcast

• YouTube - Dr. Harbir Sian

• eyeLABS Optometry

• Canadian Dry Eye Summit

• The Dry Eye Jedi: Dr. Richard Maharaj - Previous episode

• AI4Eyes

• Lensbox Foundation

• Instagram - Dr. Harbir Sian, Optometrist

• The Daily Stoic

• InMode

• www.DryEyeSummit.ca

• Dr. Mahnia Madan

• Dr. Clare Halleran

• Dr. Diana Nguyen

• MyDryEye.ca

• Oxford & Kin

• Optometry Giving Sight

• Lensbox

• @Dry.Eye.Jedi - Instagram

About Dr. Richard Maharaj

Dr. Richard Maharaj is well known in optometry as being one of the leading names in specialty dry eye care. He is a co-founder of the Dry Eye Summit, which is a highly regarded conference targeting dry eye diagnosis and treatment. In this interview, we discuss how Dr. Maharaj became a big name in the dry eye space, recommendations he has for those of us getting started, and where he sees the profession heading.

But, perhaps more importantly, Dr. Maharaj shared incredible insights into the psychology around productivity and how our need to be productive may be leading to anxiety during this time of self-isolation.

Episode 46 - The Dry Eye Master aka Dr. Laura Periman

Listen to the podcast here

Dr. Laura Periman is a successful ophthalmologist based in Seattle, Washington. She is the founder and clinical coordinator of the Periman Eye Institute and she was recently named as one of the top 100 most influential women in ophthalmology by The Ophthalmologist.

In this episode, Dr. Periman shares he passion for dry eye, approaching patient care with a heart-centred approach, and her incredible personal journey.

Connect with Dr. Periman:

instagram.com/dryeyemaster

dryeyemaster.com

Episode 45 - creating a fulfilling career

Listen to the podcast here

No matter what profession you are in, one thing I have seen in high achievers across the board is the desire to have a greater impact on the world.

In this episode, I share 5 recommendations I would make to any person at any stage of any profession that can help them build a more impactful, fulfilling career.

Share your thoughts! Leave a review or shoot me a DM at instagram.com/harbirsian.od

Episode 44 - Progress Not Perfection: Dr. Ritesh Patel

Dr. Ritesh Patel is the owner of an award-winning, multi-location practice in the Toronto area. He holds the unique distinction of being the first practitioner in North America to implement LipiFlow into a dry eye practice. Oh and, by the way, he was formerly the official optometrist for the Cincinnati Bengals.

In this episode. Dr. Patel shares his experience building a successful optometry practice with multiple sub-specialties including dry eye, myopia control, and specialty contact lenses.

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Listen to the podcast here

Progress Not Perfection: Dr. Ritesh Patel

Thank you so much for taking the time to join me here. Before we jump in, don't forget to always subscribe. Please leave a comment and review. Whether you're watching on YouTube, listening on Apple Podcasts, or Spotify, I always appreciate all the feedback that you guys provide. I have an amazing guest here. Dr. Ritesh Patel from See & Be Seen Eyecare in Ontario. They have two beautiful locations. I'm not just saying that. If you guys check it out, it’s amazing décor and beautiful locations. Award-winning practices voted top three optometrists in Toronto for more than five years running.

Dr. Ritesh Patel also lectures to family practitioners on the Ontario Pharmacy Association. My favorite fact about Dr. Patel is, he was the official optometrist of the Cincinnati Bengals from the year 2008 to 2010. If you know me, I'm a huge football fan. I got pretty giddy learning that fact. Thank you, Dr. Patel, for joining me here. I appreciate you being here on the show.

Thank you so much for having me and the audience for reading. Dr. Sian is an amazing showcase of optometry and young entrepreneurship. I'm thankful to be here and for you for having me. I look forward to sharing some of these thoughts and ideas. It's Super Bowl Sunday 2021, so the football note is relevant, so thank you.

Thank you, Dr. Patel. I appreciate the kind words. Why don't we jump right in? Tell us a little bit about your practices, so you have two locations in the Toronto area. How do you feel? How would you describe yourself as an optometrist? What do you like to do? What's your favorite part of the practice?

I've been one of those lucky few that someone knew that I wanted to be an optometrist since I was a young child. Breaking glasses every other visit, my parents dragging me in going through the process of what it is with a minus five with high astigmatism type of kid and rambunctious enough to break my glasses constantly. It was one of those things that I figured, “If I can't beat them, I’ve got to join them.” The only way it would make sense is if I had the ability to be able to yield and harvest my eyewear.

Fast forward following my passion, the lines it takes to become an optometrist, I was fortunate enough to be able to do that. That's planted an important seed for me early on in terms of following my passion. When it came to a point where after graduating from school in Boston, I practiced in Cincinnati, Kentucky, and was one of the doctors from the Cincinnati Bengals, it was pretty cool. Part of all those experiences taught me what it was like to be able to care for people.

It dug deeper into what allowed me to follow my further dream to be more focused on dry eye. For us having our own practices in 2013 was pretty incredible. We were able to help people for sure, but then diving deeper into some of the passions of optometry, dry eye, and investing in technology, which I'm sure we'll chat about a little bit more like LipiFlow and IPL. That's been the fun part for sure.

We're definitely going to jump into that. I also want to give a shout-out to NECO as I have a fellow NECO alum here on the call. Go NECO. I had Dr. Howard Purcell, who's the President. That was a bit of a rah-rah conversation too like, “Yay, NECO.” You mentioned dry eye. That's going to be anybody who follows me knows that I talk a lot about dry eye these days. I have tried to document my journey into the dry eye sphere as a beginner. What were my steps? How do I get into it? I'd love to hear your version of that journey. When did you feel dry eye was a specialty you wanted to go into? Were there certain triggers, moments, or milestones however you want to put it that you feel that you are along that path?

Absolutely. I vividly remember the point, and we all do where we got our first hug from a patient and it was an incredible feeling for me. This goes back to when I was practicing in the States. It was in Kentucky and I had a patient that was impacted greatly by her dry eye. I was fortunate enough to be able to help her out and get her started on a treatment protocol. I remember seeing her 6 or 8 weeks later. She came in and before she said anything, she gave me a big hug. It was her being genuinely thankful for someone to be able to help her.

In her own journey, she had gone through different practitioners and came up with the same roadblocks and the same end result of not feeling necessarily any better than she did before. Quite frankly, I didn’t do anything special besides listening to her concerns and coming up with a plan. That helps people who are not being hopeful get them on the right track and to be able to get there. That was a vivid memory. That does not happen to be my first hug from a patient but happened to be a dry eye patient specifically.

At that point, it was a big seed that was planted in me in terms of the true nature we have as physicians and doctors to be able to help somebody. It happened to be one of the few months that I had graduated. It was much aligned with right after finishing school in NECO and being able to have this experience with the patient and in terms, to be able to take that a step further, continuously help people. That was an important thing that drove my passion for dry eye.

Few hugs are going around these days, unfortunately, but other people are appreciative and not. It’s definitely a special feeling when a patient gives you that acknowledgment, praise, and love that you've given them some relief that they haven't had before. They'll definitely encourage you to pursue that path. When you dive deeper into dry eyes, what was the first that you would consider an advanced piece of technology that you brought in? What convinced and encouraged you to go that step to bring that instrument in?

When I moved back to Toronto, I was fortunate enough to practice alongside an ophthalmologist who was in refractive eye care. One of the things that I was brought on for was to develop a dry eye clinic. Fortunately, enough, we were the first. I was the first practitioner in North America to utilize LipiFlow.

That's a pretty big and unique claim to have as well.

Health Canada approved it before the FDA, so we had access to it. It’s the same story in terms of being passionate about dry eye. I was a symbiotic fit for myself and the practice I was at. LipiFlow was the cornerstone of dry eye care for many years, and quite frankly, still is. For anybody who's been around for more than ten years of practice or longer, for many years, you had no choice. It’s like, “Here's a drop and see you in a year.” That was pretty much the end of any dry eye care that you have for those patients. Now, I'm seeing patients and I'm like, “If I did that, I would feel like it'd be malpractice.” We're fortunate to live in an age of technology.

Building Progress: There's no harm for young practitioners to test different waters. You have so many different types of patients, knowing and understanding their solutions allows you to choose your own adventure.

Unfortunately, we know that there is still a good portion of practitioners who don't care to dig into dry eye all that much, so that is what they do. They’re like, “Here's a drop. Take that. I'll see you next time.” The goal of this is to encourage our colleagues who maybe are not that comfortable with dry eye treatments yet to get into it a little bit more and know that there are some options for them to treat their patients even more in-depth. We would love for those people to come on board.

The water’s warm. The idea here is that there is a lot of technology in the realm of let's call it LipiFlow, IPLs, and BlephEx but quite frankly, there's not always a complete need for those things, so something as simple as warm compress and nutraceuticals go a long way. To your point, that’s a great idea that we can practice however we feel comfortable but at the same time know that these different technologies, vitamins, or therapies exist in various formats that whatever realm that you want to practice in, it's nice to have that option. Whereas not only that long ago, it wasn't an option. To have that flexibility of technology, both in terms of a practitioner in whatever level that you want to go at and to know that if there is an X that you want to rotate, the sky's the limit, at this point, which is great.

Let's step away from dry eye for a moment because there are a few other things that I want to touch on and we'll come back to dry eye with a few other things. You also do myopia control, you fit specialty contact lenses, and all these other things at your practice, See & Be Seen Eyecare. I don't do all of those things. I do some of them but I find that if I want to get into it, then I'm afraid that I might be taking away from some other ability to do other part of the practice. You do all of those. Do you recommend somebody who wants to get into all of those different things? Should they dabble a little bit with each thing? Do you think they should go heavy into one, get that set, then go into the next one and get that set, and so on?

There's no wrong answer, per se but I do find that the old saying, “Ten thousand hours of doing something makes you get that level of expertise.” There is certainly a value in terms of going a little bit heavy on something that you hopefully feel passionate about. Sometimes, as you're an early practitioner, you don't know what you truly are passionate about, so sometimes dabbling in those things so you can understand your passion is one of the biggest things.

For me, I was fortunate that dry eye was something that hit me early on in my career. It was something that I continued to follow through it. Whether it's Scleral, which was a byproduct of dry eyes so for my patients that want to continue to wear contacts, Scleral happened to be an organic fit in that direction. Part of my refraction, when I spent my years in the laser clinic, focused on dry eye. There are some patients that weren't suited for laser. To know that they wanted or required a non-surgical option is what stemmed into myopia control/more so than it is myopia control of my practice.

These slight movements branch off from the trunk of my tree and it happened organically. To me, I decided that I'm enjoying it, so I'm going to dive deeper into it, go to certain conferences, learn about specialty contacts, and keep going forward with it. I was fortunate it happened organically but to your point, considering something where you may want to test the waters, and dip your toes in, there's no harm in that. For young practitioners, when you have so many different types of patients that you're hopefully seeing, knowing their solutions or understanding their solutions to those various things allows you to choose your own adventure.

I like that. Choose your own adventure. That's a great advice. Thank you, Dr. Patel, because I still feel I'm in the early stages of these things. We're getting more into myopia control, probably a little more into dry eyes than myopia control right now but want to start to do Sclerals and these types of things. It's good to know that a young practitioner or even a more veteran practitioner could dabble a little bit, see how it works, whether it works for them in their practice and start to implement one or the other a little bit more heavily. It reminds me of a quote from a book. By any chance, have you read Good to Great by Jim Collins?

Yeah.

One of his theories was to fire bullets, then cannonballs. I don’t know if you remember that theory, but that completed that quote. You shoot little bullets. Let's test this theory. Let's test that little practice. If it works, you shoot the cannonball in that direction. If you haven't read Good to Great, get out there and check it out. It's a good book if you're into business and entrepreneurship, which you probably are since you're reading this. I digress. Let's get back to dry eye a little bit. How do you feel about offering more advanced dry eye treatments and things? Has it helped build your practice, with patient retention and those types of things? You can give some examples of how you think that it has.

When you're in the case of a dry eye, or anytime you're helping a patient, and somebody sees, “I was feeling one way and now I'm feeling another. I have been listened to. I have been cared for. I'm in the right hands,” that person is going to be a loyal patient. It doesn't necessarily mean that you have to be specialized or have the fanciest equipment, that person just need to feel they've been heard.

Fortunately, if you do have the options for having equipment like LipiFlow, IPL, and so forth, I feel we've taken steps along the way that when LipiFlow first came out, being one of the first practitioners of having that was the only thing I had my eye dry practice for 5 or 6 years. It wasn't until newer technology came out like BlephEx. It was like, “That sounds like a pretty reasonable thing for me to have.” You realize, “There's a whole subset of patients that I could be helpful for that.”

It wasn't until that was like, “Scleral lenses. That seems to make sense.” As much as we sometimes need to have this drawn-out plan about what the next thing I should get or the next piece of equipment I need to invest in, sometimes dipping their toe in first and realizing how many patients you can help and let that organically grow as time goes on.

I know you're out in BC and I'm here in Toronto. There's a company called Strategic Coach and this is coaching for entrepreneurship. It’s right down your alley. One of the things they always talk about is progress, not perfection. As much as the idea that you want to be perfect for that person, for that one patient, or for your practice, the reality would be, as long as you're making progress. In this case, whether it’s the use of technology or growing knowledge or learning, then that progress is going to help that patient move further.

What's interesting in the example they give is a flight from Toronto to Vancouver, let's say it is off course 95% of the time, and there are constant course corrections that happen along the way. I take that much at home when I'm thinking about practice and even my patient care. It’s like, “One, I want to help this patient. I want them to be perfect.” The reality would be as there are probably certain things that I'm going to help them feel better. Those incremental improvements for those patients with potentially the technology I have are not with my knowledge or all the above allows that person to get incrementally better as time goes on.

When the next technology comes out, you have the option to see if that's something that you want to invest in or if there's a subset of your patients that have benefited or not. That's an important one to keep in mind. As long as you're making progress within your own practice and with the patient, that loyalty for that person and how they're able to build your practice, sharing that same type of experience with your friends and colleagues and family is organically going always to help your practice grow. No matter what, if you take a digital approach or not, word of mouth will always be the best way for you to grow your practice.

You can give people those experiences like you're talking about. Patients want to give you a hug because you change their life basically. They're going to be able to bring new people in, they're going to share that experience with other people and bring new people in. I like that growth mindset. That's so important. I've definitely been guilty of it too, where you get caught up in wanting to make it look perfect before you put it out there.

It's about being open to learning, growing and failing, frankly, sometimes so you can get better over time. That's great. Tell me about how you made the jump. You had IPL. I still can't get over that you're the first optometrist in North America to officially use IPL. You had that for a bunch of years. That was your mainstay. How did you make the jump to IPL? When did you do that? What was your impetus there?

Being first in LipiFlow and in turn, having that base of patients that we were helping along the way and quite frankly, some patients were not eligible for LipiFlow even if they wanted to. We were always looking for the next technology as it was coming out to be able to offer to nonlinear or subsidiary patients that weren’t on LipiFlow or haven’t benefited from LipiFlow but certainly from those that didn’t.

When IPL came out and it was Health Canada approved, we jumped on it. We were looking at a few different devices and finding something that was going to, of course, have the clinical papers to prove that this is beneficial for dry eye. There have been some off-label treatments for it with IPL for some time but we were waiting for that approval.

That was big for us and looking at something that especially in the demographic that we're in, but quite frankly most people, that if there was some potential benefit from me going into dryness treatment, then combining those two things into one almost beauty standpoint we were excited about that. In this case, we were the first in Canada to have the E>Eye IPL and we've had it now for more than six months and it's been incredible. We've been able to help patients. I don't know about yourself, but I've never seen so many styes in my career. It’s non-stop. Almost 80% of my patients right now will have some experience or story about styes. It's unreal.

We were fortunate in the timeliness of it. Being able to help those patients with dry eye and have a gamut of different things that we can utilize technologically, whether it's IPL, LipiFlow, BlephEx, plugs, Sclerals, warm compresses or cleansers. There's such a wide range of things you can do, which is awesome no matter what range of practitioner that you are or want to be.

You're right about the stye thing. There's something about it because people are home more. I don't know what it is, but maybe they're on their screens, more than rubbing their eyes, whatever it might be. It’s also one of those things that when you start looking for something, all of a sudden, you start to see it so much more and that's something I tell people about dry eye too.

Before I got into this sphere, more than a few years ago, it's not that I brought in a bunch of new patients in that period of time, I have been seeing pretty much all the same patients that I've been seeing. All of a sudden, a giant proportion of them have MGD or whatever because I started looking for it and it wasn't before.

One of the first investments I made even prior to LipiFlow was an interior set camera. The interior set camera was a game-changer. It still is to this day, because it's not something that's common. The retinal camera is amazing. When people say, “That's my retina. Never seen that before in my life,” in theory, that’s not necessarily the newest technology, but people are still wowed by it. It still is foreign.

They'll say, “Is that my eye?” It can be anyone's eye retina wise but when somebody sees the front of their whole eye, one, they don't know it's their eye in terms of their color and so forth. When you show them any MGD, any blepharitis, they're automatically thrown back. They’re like, “Is that my eye?” They're also offended by the fact that their eyes look potentially a certain way. Even basic things like pinguecula we’ll say, “This is UV damage,” and how that links to many other conditions potentially in the eye.

Interior set cameras are probably one of the best investments I've made in terms of patient care. It's neat to be able to see this case. I'm more than thirteen years out but going back a few years ago to see before and after images, whether it's again you've done treatment with BlephEx or having to go home and do treatment with cleaning their own lids.

Building Progress: Planting a seed early in a patient during treatment is important. Later on, they remember something you mentioned and come back because they're ready for it now.

To be able to see before and afterward not how they're physically feeling, a lot of times, even if you're physically feeling the same, but it looks better automatically, mentally that person feels a lot better about it too. I want to share that with your audience. An interior set camera doesn't have to be expensive. It goes a long way.

That’s fantastic advice. Thank you. I've tested out a couple of different ones. I don't have one that we're using. I do use a smartphone sometimes to take a photo if I need to but I often will use those generic images. When I did have a camera or I did take photos to show the patient, it's way more relatable for them. They recognize their eye, their iris, and everything.

They know that there's a bit more of a connection to it than a generic image or the retinal image that they've never seen before. A key point for somebody who's getting into dry eyes is to have imaging like that or some basic diagnostic stuff like that without going super high-end or complicated myography and non-invasive tear and stuff like that. Getting imagery is super key for getting patients on board.

Also, compliance helps in terms of the person seeing. We do a lot of lid cleansers, even if that person does not need any secondary treatment like BlephEx and so forth. I try to have the patient relate to any build-up they may have on their lids because you know that in one way, you're educating that person in terms of what you're seeing clinically. When they see for themselves, it does matter what I say. They see for themselves.

You're planting the seed like, “In terms of a compliance level, if you do this home therapy, the need for me to be able to do some incredible things. They may not be necessary.” If you don't, then at least I'm going to send you information and, in turn, at least let them know that they have technology there because patients want to know.

They may not need it right away, but they certainly want to know, “You told me about it.” Most of my dry eye patients are astute and sharp. We're probably about 65/35. We have 65% of our patients that are referred, so they tend to have some baseline knowledge of it. There are family practitioners or optometrists already educated with but they've gone home. Ten minutes of a Google search on dry eye and you can learn a lot. They're coming in with direct questions and different therapies that they've done research about even before I told them.

Having those different things that you have access to and the imagery for before and afterward keeps that person on the ball as well but what I found is with any of these treatments is that planting a seed early in that patient is important. I have patients that I may have said something years ago that are now finally coming back. It’s like, “I remember you mentioned that thing, LipiFlow, IPL, or whatever you want to call it, I’m ready for it now.” Don't be afraid to necessarily, not only educate that patient in the niche but realize that may not germinate those seeds or those seeds may not mature until a bit later on but it's okay to plant them early.

That's also good advice. Don't get caught up in the fact that maybe those patients aren't converting into your advanced treatments right away because the fact that they know about that information, the fruits of that might show later on. I wanted to ask you a little bit more about the IPL. You have the E>Eye from I-MED. Is it IRPL? Is that correct? Is that a little bit different than a standard IPL? Would you be able to distinguish the difference there?

It is. That's the IPL that I have for I-MED. What the researchers found is that the IRPL has a little bit of pulse therapy that allows it to go a bit deeper into the tissue and they’re five sub-pulses within the pulse itself. We were debating between the I-MED or the E>Eye versus a couple of other instruments. A combination of One Health Canada approval right off the bat, which is great having the history of the studies that they've had, was a pretty big distinction factor for us so again. We've been happy.

One of the biggest things for us was the ability for that specific IPL to treat some of darker skin tones. With anybody who's familiar with IPL, then there's a little bit of limitation as we get to some of the darker skin tones and this was one of the only ones that had some flexibility in terms of getting to even my own skin tone for that matter. To us, that is one of the 3, 4, or 5 different key things that allowed us to say, “This is the right one for us.”

That's awesome. That was something I was going to ask you specifically because we've been looking into these devices for our office and I understood that when looking on that Fitzpatrick scale of the skin tone, there was a limit. I've spoken to some practitioners that say, “If you are experienced with a certain type of device, maybe you can push that a little.” It sounds like you have that ability with the E>Eye. That’s good to know. Are there any other words of pearls of wisdom you want to share on the dry eye? You've already shared a lot, so it's come out organically. Is there anything else you'd like to share? I want to talk about football for a second.

To your point, especially when you're earlier on in your career, as probably a lot of your readers are, don't be afraid to try something. It's one of those classic lines, “You miss 100% of the shots you don't take.” If we're always looking or we're potentially concerned about maybe not doing the right thing, that patient as long as you're describing to them, what your plan is and executing on that plan and what that person should expect in terms of a timeline. They're going to be happy that you have a plan for them. That would be one of the big things. Sometimes we limit ourselves. We're a bit afraid or concerned not necessarily to take that additional step, so that’s one thing.

The other thing there would be is starting off and realizing don't be intimidated by technology. There is a lot of stuff in the dry eye field out there. We named a few. Corneal Images, LipiFlow and IPL. You're talking about a lot of potential financial outlay but for me, I started off with a pretty basic slit lamp camera and trying things. It grew from there and your patient base will grow along with you. Don't be afraid to try those things and you'll need all these fancy tools. They help but they certainly are not a complete necessity a lot of the time. Spending the time to be able to educate yourself and your patients goes a long way.

What great advice. Thank you very much. The show that I released prior to this one was my entry-level beginner's plan, if you will, to get into the dry eye space. This is a perfect discussion for us to have as a follow-up to that. Learning from someone like yourself who's in a much more advanced and experienced position using these types of treatments and I feel good that you're echoing some of the advice that I hadn't given in that show but giving now your own spin on it.

I haven't practiced in this field for a little bit longer. Thank you for that feedback and that information. Tell me about becoming the optometrist for a National Football League team and what that experience was like. You were with the Cincinnati Bengals for a couple of years. If you don't mind, share how you got in there and I know you told me it was pure luck but I doubt that's all it was. What was the experience like being in optometry exactly?

It's awesome. To a certain point, I was lucky, for sure. Luck plus circumstance goes a long way and just being ready for it. I was fortunate enough that I was practicing with another practitioner who's, historically, been the eye doctor for the Bengals. Seeing a lot of the, of the players already and it organically led into we're a good fit for each other symbiotically. The practitioner was happy to have been doing it for some time. He's like, “I've had my fun. It's your turn now.” It was pretty awesome to be able to meet some of these players and they're big kids. They're nice people and you get a chance to see a practice facility. At some point, in the NFL, it is next level.

Some of the stuff that these guys have access to, it's as you can imagine, they're superhuman, in many ways. Probably one of the things that amazed me the most was many of these offensive linemen. For anybody who watches football, their whole world is arm's length away. Many of them are -1s and -2s. That's how they play the game.

You imagine, “What are you doing downfield? How do you see somebody who’s 100 yards away?” They don't bother? That’s interesting. One of the most incredible things was there were a couple of famous wide receivers there at the time. One of the most famous at the time was monocular. As you can imagine, a wide receiver needs to see depth, distance and be able to catch a ball literally while jumping in the air, even potentially seeing the spin on the ball to understand that.

I'm examining this guy and I’m like, “You know that you don't see your one eye. How are you doing some of these incredible things that I was watching him do on TV?” I was blown away at the fact that without having both eyes, he would have judged depths. There are other cues shadowing, size, and so forth. For the viewer to understand that the skill level, as you can imagine, is incredible. Your brain is able to adapt accordingly for that.

While you were there ‘08 to 2010, I'm trying to think about who was the quarterback and who were the big-name players. Are you allowed to say who was one of the more famous players that you got in touch with or in touch with?

The quarterback was Carson Palmer. Ochocinco was another big guy who was there. He’s a wide receiver. Some of these guys are super talented, potentially Hall of Fame status and quite frankly nice guys. They’re human.

That's amazing. To wrap up, there are always two questions I'd ask every guest. I wanted to pose those questions to you a little bit off-script from what we've been talking about. The first question, Dr. Patel, is if we could hop in a time machine and go back in time to a specific point where in your life, any time in your life where you were struggling, you're having a difficult time. You can share the moment if you want but more importantly, I'd like to know, what advice would you give to yourself at that moment in time?

Building Progress: Don't be intimidated by technology. Start simple and grow from there and your patient base will grow along with you. You don't need all these fancy tools, they help but are not necessary.

It’s funny. It combines a few different aspects of life, including practice. This was vivid almost to the month. Years ago, we found that we were pregnant with our first child. We had opened the practice not too much longer before that, so we're still in the opening phases of that. I'm a big sports guy, so I was playing basketball and broke my leg playing basketball. It was a pretty bad break. If any of you are sports fanatics, it was like a Paul George break. It was not fun.

I had a combination of all these different dates. What my goals were with my practice, so there's some uncertainty there. My wife was expecting our first child. I couldn't walk for about three and a half months. I was in a wheelchair. It was the whole nine. It was surgery. It was a pretty potentially dark moment in my life but certainly, most importantly, probably the biggest learning to your point, as you say and they always say, “If you want to be successful, fail faster.”

This is not quite a failure, per se, but certainly a little bit more of a challenging time. I told myself this more than a year ago, “Staying calm in rough waters is an important part of life in general.” Why I told myself this was the start of the pandemic in 2020. I did remind myself about that. Ironically, it was five years ago at that point. We had opened the second practice and we had a second child.

All these things were coming to a head and certainly the whole nine, uncertainty, financial, family and health. You name it. What I told myself then and I'm thankful I did, especially with the fact that I'm spending time with my family. Relax. This too shall end and it'll pass. Although it's taking a little bit of time for it to pass, the advice still stays valid. It’s making sure that when the waters are rough, be calm.

Especially if you are a practice owner or not, or a leader in your practice in some way or the other, making sure that the captain steers the ship a certain way is important for the team and the rest of your people around you to see that. That’s continued advice that I have given myself and make sure that the younger practitioners and family people are not or both of the above or none of the above. I know that with personal experiences.

That's an incredible experience. That’s scary to even think about. I can only imagine how difficult and painful that was. Thank you for sharing that moment with us. I know sometimes people don't like to share such painful memories but thank you. That's amazing that you got through it. I get stronger because of it too. The last question I like to ask and we've already touched on this, quite a bit but I'd like to pose it to you but more directly. Everything that you've achieved so far in your career and your life, how much of it would you say is due to luck, and how much is due to hard work?

I'm not sure if I've defined it that way. I would define it as a combination of gratitude. Being thankful and generally speaking, you get more of what you're thankful for. I’m a believer in that. Certainly, I joke around and say I'd rather be lucky than good. I always say that. I've been fortunate in terms of being pretty lucky but I like to think of myself as pretty good. Also, being thankful. Gratitude goes a long way.

Depending on how you want this show to go, before this show, we do a Sage cleansing of our clinic and we do this every quarter. We have a lot of energies that are coming in and out of our space, so we do like to be able to do that and study some of the energies, so I'm a believer in that. A combination on some of the traditional ways of thinking goes a long way. Certainly, luck. However, you want to define that. Gratitude is one of the biggest things for me.

That's amazing. First of all, I like that you went off the board there. I gave you luck and hard work, and you put gratitude but that's great. I appreciate the humility. Honestly, you're doing amazing things. Being that humble, to put it that way, is incredible. Sage cleansing of your practice. We're going to have to talk about that a little bit more offline because that sounds like something I would definitely into doing in our practices.

You're right. There are so many energies coming through daily. It's no surprise that sometimes your own energy could get thrown off and the wind can be affected. That's cool. Thank you, Dr. Patel, again for taking the time to join me here on the show and sharing such incredible insights about your practice as a whole on dry eye specifically.

Thank you for having me. You're such a great showcase for young entrepreneurs and young ODs. Thank you for having me and thank you for sharing your voice and your ideas and thoughts with the rest of the community. It's awesome and good luck to you.

Thank you so much. I want to say thank you to everybody who joined us in the audience. Whether you're watching on YouTube, listening on Apple Podcasts, or Spotify, make sure you go check out Dr. Ritesh Patel. Check out to See & Be Seen Eyecare and learn a little bit more from them there. Thanks again for joining and I will see you again soon.

Important Links

• YouTube - Dr. Harbir Sian

• Apple Podcasts - The 20/20 Podcast

• Spotify - The 20/20 Podcast

• See & Be Seen Eyecare

• NECO

• Dr. Howard Purcell - Previous episode

• LipiFlow

• BlephEx

• Scleral

• Good to Great

• Strategic Coach

• 5 Step Plan To Implementing A Dry Eye Practice - Previous episode

• YouTube - See & Be Seen Eyecare

About Dr. Ritesh Patel

Some people grow up wanting to be a famous athlete, an astronaut, or even the Prime Minister of Canada. Dr. Patel’s childhood ambition was to be an Optometrist. His dream leads him to live and practice all over the world, but his heart has always been in Toronto.

Dr. Patel was born in Toronto and grew up in the Markham area. After completing his Bachelor of Science in 2003 from the University of Waterloo, he went on to study at the prestigious New England College of Optometry in Boston, MA.

Having earned his Doctorate in 2007, Dr. Patel moved to Cincinnati, Ohio, where he practiced for three years in a variety of settings: surgical, and private practice. He was also part of the medical team that performed examinations on the Cincinnati Bengals NFL team.

Dr. Patel moved back to Toronto in 2010 and became the Lead Optometrist of The Herzig Eye Institute. As director of the Dry Eye Clinic, he was the first practitioner in North America to use the Lipiflow Thermal Pulsation device. His dream of owning his own practice led him to open See & Be Seen Eyecare in 2013.

Dr. Patel works hard to stay at the cutting-edge of eye health. He regularly attends continuing education seminars and, as a leader in the optometric industry, has consulted for companies such as Allergan, Shire Pharmaceuticals, Bausch & Lomb, and Tear Science. He is also a regular lecturer for the Ontario Pharmacy Association as well as the Ontario Medical Association. Dr. Patel has been voted Top 3 Optometrists in Toronto in 2016, 2017, 2018 and 2019.

Dr. Patel’s passion for giving back has led him to participate in volunteer missions with Optometry Giving Sight in India and VOSH in Nicaragua. He was on the board of directors for the Ontario Association for Optometrists (OAO) and served as the association’s communication chair. Dr. Patel lives in Liberty Village, Toronto with his wife and two young children. In his spare time, he enjoys listening to old-school hip-hop, exploring the city on his bike, traveling and cheering on his beloved Toronto Raptors.

Episode 43 - 5 Step Plan to Implementing a Dry Eye Practice

Listen to the podcast here

Over the past 18 months, I have had the opportunity to chat with experts in the field, test a variety of devices, and implement strategies/technologies in our clinics that have helped us jumpstart the dry eye side of our practice.

In this solo episode, I share what I call my 5 Step Plan to implementing a dry eye practice for someone in the early stages of their journey.

Give me a shout at instagram.com/harbirsian.od to let me know what you think!

Episode 42 - Dr. Harbir Sian on the YVR Business Den Podcast

Listen to the podcast here

Let's start 2021 with a little re-introduction!

I had the pleasure of being a guest on The YVR Business Den podcast with Vishal Gill and Harvir Mann.

We dive into all sorts of details from undergrad, to optometry, business, and launching my own eyewear brand.

The unofficial theme of the interview was the power of taking action.

Hope you enjoy it!