Episode 64 - Think About Your Eyes - Dr. Jim Asuchak

Do you think about your eyes? If you don’t, your vision may go wrong. Harbir Sian’s guest is Dr. Jim Asuchak, the Owner and Optometrist at Optical Studio Lethbridge. Dr. Jim talks about the Council for Healthy Eyes Canada’s initiative called Think About Your Eyes. Its objective is to raise eye health awareness across Canada. They also help patients find optometrists near them for easy access. The council strives towards better optometrist engagement for 2022. Join in the conversation to discover strategies to grow your business from good to great. Tune in! 

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Think About Your Eyes - Dr. Jim Asuchak

I am so happy to have you all back again for another episode. Thank you so much for all the support. As always, I always have a request right off the top. If you get any value from this episode or any previous episodes, please share it. Hit subscribe and like. Leave a review and comment. All of that stuff helps so much. It means so much to me when you guys do that. Thank you so much in the past for all the support and all the support that will be upcoming. I am looking to bring amazing guests to the show who can bring value from a business and personal growth perspective.

I have Dr. Jim Asuchak, who is going to be able to hit all of those notes for us. Dr. Jim Asuchak graduated from the University of Waterloo in 1999 and opened the Optical Studio in Lethbridge, Alberta. The practice has grown to seven optometrists and they moved into a new space, which is 10,000 square feet. He has been fortunate to sit on the Alberta Association of Optometrists council and serve as the President of the association for two years. He is also the Acting Chair of the Council for Healthy Eyes Canada. That is something that we are going to talk about because that is such an important initiative that maybe not enough people have heard of yet. Thank you, Jim, for joining me. It is great to have you on the show. I am so glad that you agreed to do this.

Thank you, Harbir. It is a real pleasure and thank you for such a warm welcome. That was a great introduction.

There is a lot of information I didn’t share in the intro yet. I love it if you don’t mind me giving your introduction from your perspective of who you are, where you live, where you work and all of that.

It is amazing how fast time goes by. 1999 was when I graduated and how fast we’ve grown. The years go by pretty quickly. Coming home was great. We started on a 1,300 square foot building and then grew to a little larger space. We are in our hopefully final location lasts us a while. It’s been quite an experience and a journey to get here. It is amazing. It Isn’t something you envisioned when you got out of school.

‘99 doesn’t seem like that long ago. There are so many vivid memories from 1999. The most key thing was the whole year 2K thing. That doesn’t feel like that long ago. I graduated in 2010. That feels like yesterday. I shared something on social media about our new associates that started working at our practice. She observed and shadowed at our office years ago. It is crazy that years went by so fast that she is graduated. It was beautiful that it’d come full circle and she’s working at our office. It’s that time. I was hit in the face with that like, “It has been that long already?” 

When I was in the role of that past president, we had to bring on new council members and get a little more interest in there. A lot of the new candidates I was speaking to said, “It will be good to get some younger people on there with some new views.” I’m not younger anymore with new views.

Think About Your Eyes: Alberta has always been the push for historical perspectives.

As far as being on the association, I first met you as you were visiting DC because every year, presidents from other provinces come and speak when we have our conference. It was so good to meet you. Looking upon the stage, seeing somebody who is the president of an association for a province, there is immediate respect that comes with that from my perspective viewing you out there. You are a down-to-earth guy. If you could share, how did you get to that position? What came before you? You were part of the association and other positions, but what roles did you have as the president?

With the Alberta Association, I know it is a little different than a lot of the provinces. In some of the provinces, you can move through the chairs fairly quickly. Alberta has always been this push for historical perspectives. Once you get on council, there is a number of different roles you have before you start moving through the chairs. Once you make that commitment, you move through a treasurer chair for two years, then the president role for two years and past president for two years. I was on council for twelve years in total. By the time you start moving through the chairs, that is another six-year commitment. It is a long way through there.

When I first joined the council, it would have been 2009. I get on there and you think, “I am going to make a lot of change.” You are going to move things forward, but you won’t realize how much inner workings or what goes on behind the scenes to make an association successful and move stuff forward for the profession. There is a lot of learning experience before you get into that president’s role. It is amazing how much stuff you pick up along the way. It is fortunate a lot of people hear that commitment and it’s a tough decision to make to sit in that role.

With the amount of professional growth that comes from it and personal growth that comes from sitting in that capacity, I was fortunate to be given that opportunity. By the time you go to their provinces and meet people, the amount of information you’ll learn about from on the way and the type of people you meet. Meeting you when I was in that role and some other people I met along the way. BCDO has some phenomenal people in our leadership. Going to Saskatchewan and hearing some of the challenges they have and the people in their leadership and in Manitoba.

You learn a lot, but you make lifetime friendships as you go. That drives the passion for the profession and wanting to see it do well. Something as a new OD getting out of school, I’d encourage them to get involved in any capacity, whether it’s committees, association board, even with wisdom groups, the amount of knowledge to gain from others. Our profession is still small enough that a person can make effective change in their province. Something you can do to advance yourself is getting involved and making a difference. It was a great opportunity to have.

That is something that I have been echoing over the years. I have been involved in a formal capacity on and off like I was involved in some committees, I still am, but informally, I’m always trying to get wherever I can help. I’m always messaging people whatever different committees. The one thing is it’s a form of giving back. It’s a way of feeling more fulfilled. It’s a way of helping yourself build professionally and personally.

I tell a lot of people that most of the big opportunities that have come to me through my career have come because of some connections I’ve made through being involved in the association. I imagine you’d feel the same way. The amount of networking you do is valuable in building your personal professional development. You did it on this national level. I’m talking about here locally. What would you say are some of the couple of key takeaways that you could share with us from that experience?

Make lifetime friendships as you go.

Even in national, the amount of issues going on. Across the country, everybody faces different issues. There are different priorities. In other parts of the country, there is a little bit of learning you can get from everywhere there. The relationship you build is invaluable. Some problems are a little ahead in their scope. To see where things are coming and upcoming trends. Take those ideas, put them back and implement them into your businesses. It’s an unbelievable opportunity. One of the things, when I was president, was back in 2016 to 2018, a big push for our province was going through an operational board reached the board members were involved in the doing of everything.

Say the chair of conferences and special events would have to book the speakers, make the phone calls and set up a lot of the stuff like that. During that time period, we moved to a governance board. Looking at strategic planning 5 to 10 years out, APIs to do that and then putting in a business plan and entrusting a CEO to do that. Valuating the KPIs in how we can make strategic decisions based on our limited resources. Take that back into your business, the amount of growth that would fuel, and how you run things. Even dealing with staffing issues and how to manage people is a great opportunity.

Once you move to that governance model, you have this real corporate structure that you can learn from and implement into your business. We talked about the value of ODs being involved. It is a way of giving back, but also to help. If we want to succeed, our profession has to succeed also around us. Being involved can make a difference. There are some other initiatives out there that we can get involved with on our provincial or state level.

There are other initiatives out there that are broader and on a national scale. You have been involved in this one since its inception. I want us to talk about this because it’s so amazing. Full disclosure, I’ve been very fortunate to now be part of this initiative. I joined the board of the Council for Healthy Eyes Canada, which has this initiative called Think About Your Eyes. A lot of people have heard of this, at least peripherally or somewhere. Let’s start from the beginning. What is Think About Your Eyes? What is CHEC and how did it start? 

Way back, I was on the NPEC, National Public Education Committee. Back then, we looked at how to get a unified voice across Canada for optometry increased awareness, the importance of eye exams, comprehensive care and how it fits into the whole systemic health of the eyes or health of the body. At that time, optometry was funding the whole campaign. Down in the States, it was this rise about this Think About Your Eyes campaign. It was industry and optometry in partnership to grow eye exams and year-over-year increases. We looked at that no burden and said, “Why aren’t we doing that up there and getting the support from industry to help fund this education campaign?”

Back in 2017, we met with some leaders of TAYE US and see if we could modify that and adapt it and bring it up to Canada. We are fortunate that they were collaborative, offering collateral and helping us get our feet on the ground and get running with it. We also had a number of industry partners. It was Essilor, Nikon, Shamir, Alcon and J&J who got on board and helped support the program. We started off as a very small pilot project in Alberta and it was an unbelievable success.

We formed the Council for Healthy Eyes Canada, which is the board whose sole purpose is to run the Think About Your Eyes committee, which develops and implements a whole marketing communications campaign. One of the big things about the TAYE campaign is data collection. In the past, you always looked at impressions and how many people it’s hitting out there for this campaign. The thing about TAYE is that we wanted to be smart about the dollars we’re spending, look at the data we’re getting from it, and then analyze it to positively influence consumer behavior to make sure we’re running an effective campaign.

Think About Your Eyes: Make strategic decisions based on your limited resources.

It was very cool collecting the data from it. Some of the stuff we even did was a football study where we used digital devices. People are served up an ad. We can track them to see if they visit an optometry office. We had a 12% increase in those who served an ad walking into an optometry office. It was a very effective campaign. For the 2018 year, we ran it in Alberta. For 2019, we had BCDO signup as well as Saskatchewan Manitoba. It was a Western campaign from the success we built on there. It moved to national. Unfortunately, in 2020 COVID hit. We had to put the brakes on for 2021. It wasn’t our ambition to take it national for 2021. We had all the Atlantic provinces and the Western provinces signed up.

You saw what was happening in the US and you thought, “Why not do it here?” It started small in Alberta, but there was such a recognizable increase. The goal is to get patients coming through the door across the board. It’s not to benefit one region or one type of practice. It’s across the board, increased comprehensive eye exams. That was a 12% increase. That’s pretty amazing.

An actual footfall traffic study. We’re still waiting for 2021. It’s exciting. The neat thing was we created all the bilingual collateral so that whole Canadian messaging has taken on its own.

In the short time I’ve been involved, I’ve seen some of that. Each part of the country has a different voice. In Canada, different languages are being spoken. Different key messaging will resonate with people in that area. I’ve seen that that messaging has been tailored to different parts of the country. We live in this time, it’s a little creepy, but we’re using this to our benefit that we can track people that closely. Other companies, businesses and industries are doing this where you click on something and that company is going to follow you and know exactly what you’re doing from that point forward, but we’re able to use it to the advantage of this industry and our patients’ advantage as well.

It’s the effective use of the dollars for the campaign to make it as useful as possible that is pretty significant. Another exciting thing, too, that we’re striving towards is a little better optometrist engagement for the 2022 year. We are looking forward to generating a whole tool kit that is available on the Council for Healthy Eyes website so that individual optometrists can go on there and use all the marketing collateral and make use of it on their website and social. Getting that better engagement is what’s going to drive 2022.

That is something I wanted to touch on. All this hard work is gone, and you’ve got multiple provinces involved. You have these key industry-leading organizations and companies involved in Al Qantas, Lauren and so on putting money and effort towards this campaign to ultimately get more patients in the door. This is to benefit any working OD in Canada. There is a lot of people behind the scenes putting in their time and effort.

Number one, I want to raise awareness for this initiative that has been around for a few years and it’s doing so well, but so few people are actively aware and taking advantage of it. Number two, how can people get involved to make it bigger? How can we spread the word? First off, there are resources for us to use. One of the first things that I remember you talking about when you were in BC was that there are all these resources like content and collateral that we can use on our websites. Where can we find that?

Your mission statement is your company’s guiding north star. 

Council for Healthy Eyes Canada is the one website on which all this information is. Under the member section, you click on there and there is a toolkit. Another thing is making your association aware that you want to use this information and even give feedback on what you want. Check the reason for existence is to increase awareness. Optometrists know what will increase their awareness. There are such regional differences in each area. We do have a group. We have the information. We have the collateral and the resources available at CHEC to help individual ODs out.

Any feedback you want to give us will help create the collateral to do that. When COVID first hit, there were a lot of people asking for different things to help them out for their office. We created a lot of COVID material when it first happened. There is a lot of resources that we can provide. We are more than willing to help out with that. Manitoba is one where their members were asking for things. The association relayed it back to us and we are more than happy to create collateral for that stuff.

What is the website?

CouncilForHealthyEyes.ca.

Visit that website, go to the member tab, look for the content there. Once you have gotten up to speed on what CHEC is, therefore, speak to your association to let them know that this content was valuable or maybe you’d like to see. CHEC is working in concert with our provincial associations to help us succeed.

It is about leveraging the member dollars. The associations are supporting it through their members’ dollars and then the money they are providing is being leveraged with the help of industry. It is a great value. You see value in it is a huge thing.

That answers the second thing I was saying is how can people get more involved? Would you say that is it to give feedback, talk to your association, or do more others?

We have a committee on there. The TAYE committee is the one that deals with the marketing company and provides feedback on where the direction the campaign wants to go. Anybody who has an interest in this area with social media, we have some great OD members on there. Some of the provincial associations have their communications marketing people on there. We are getting great feedback from that. The CIO has a marketing person who sits on there who is fantastic. Having associates input individual members’ input is huge. Anybody who wants involvement, we are more than open to that.

Think About Your Eyes: We're striving towards better optometrist engagement for 2022. 

As a professional, we want to continue to grow. I can only do so much as an individual, so get involved with your association. Knowing that there is something on a national scale to help across the board is valuable. I would love for people to learn a little bit more about CHEC. If anybody follows me on social media, feel free to shoot me a message. If you are looking to get more information on how this initiative works, I’m happy to chat with you about it because this is something that we should all be more aware of. Let’s narrow the scope a little bit.

We went from provincial to national. We are going to come back down to the Optical Studio, this fantastic clinic that you’ve built. You moved into your new space. 10,000-square feet is mind-boggling to me. I’m trying to think about what you do with 10,000-square feet, but I’d love for you to tell me. I know you said it’s been a long road there. There are a lot of things that happened that you can’t exactly remember. How did you get here? What do you think you did to take whatever it was in 1999 to where it is?

The book we have been reading is Good to Great and talked about that flywheel. You start off pushing the flywheel and how difficult it is, but once you get it moving, there wasn’t one push. It was a number of different pushes. Along the way, a lot of little things built up to it. From our last location, our clinic patient-facing is probably about 6,500-square feet. The staff area is about 3,500-square feet. At first, they look at that and like, “We need a boardroom this big doing this many admins off.” It has been a huge thing.

That was one of the things I started noting and seeing the value in. I always have the right people on the bus and the proper staffing there. We’ve found that we empower our staff and do the things that they do best. We have a boardroom for staff meetings. It’s no longer huddled in a lunchroom that’s a multipurpose room and a bit of a mess. We can have proper functioning meetings where we have boards that track our KPIs and strategize on improving things. We can have Zoom meetings with reps, especially with the way things have been.

Those in-person visits have been a little more limited in the last couple of years. We found that facilitated moving ahead and following through on our strategic direction. Admin offices to make sure our accounts receivable is up to date, make sure we are in the right inventory to have meetings on the right frame selection is on the board. We found that it made a big difference to make sure all the things that happened behind the scenes happened.

That has been a huge change for us and a part of that growing-up experience and making sure people aren’t caught in the whirlwind. They can concentrate on growing the business rather than being caught down and growing the business in between, running around and getting all the things done down on the dispensary or the exam rooms.

Investing in technology builds loyalty from your customers. 

The phrase, working on your business versus working in your business. That is a tough distinction to make like, “If I’m not seeing patients, my business is not growing.” If you’re only seeing patients, your business will also not grow the way it needs to. I’ve had a challenge seeing things differently that way. I’ve always been that go in there and do the work person. Fortunately, I have a business partner who sees things that way and can help me understand that side of the business a little better. You are talking about the governance model that you were talking about with the association and you bringing that in it clearly is beneficial to you.

What would you say out of that? I’ll use myself as an example. We have a practice that’s about 1,400, 1,500-square feet. It’s fairly new. Two exam rooms, it’s starting to slowly get busier. We have a lunchroom where we hold our meetings. We don’t have a boardroom. How does someone look at it working on the business? Off the cuff, I know we didn’t have you set up to answer this question, but whatever you could think of that might be helpful.

It’s dedicating that time to do it. It’s always putting that time aside to get it done. You always think, “I see 2 or 3 more patients in a day.” The biggest thing we did was come up with what is our why, sitting down and discussing it. As an association, that was one of the things that were at the mission statement. It’s your guiding North Star to look at. It was creating that memorable patient experience. How do we do that throughout the whole journey throughout the office? Taking time aside, we have weekly staff meetings and have those staff meetings. It’s not just used to be where my business partner and I dictate, “This is what we want to do. This is how we’re going to get there.”

We are not always the front desk realizing there are pinch points there and how they can create a better experience. It was transferring that power over to them to make it happen. Some of the stuff they bring to us are pretty unique and different. We have upstairs a call center, taking those phone calls coming in off the front desk. When people come in, somebody can greet them rather than being on the phone. That was one of the huge things that made a more memorable experience for patients coming in.

We have a concierge at the front door to greet you. Sometimes people don’t need to talk to the front staff to greet them and say, “I need my glasses adjusted.” The concierge can take them right over. Someone who might take a little more time or getting their glasses edged while they wait can bring them coffee, juice, or little kids get snacks. That is where there is a lot of input and what they see going on. Empowering staff, getting the right people in the right positions and a strong org chart to make sure everybody knows their role made a big difference for us.

So much of what you shared is going to be instantly applicable for me in our practice. I’m sure others are reading. I’ve read that book, too. It’s a great book. Having the right people in the right seat position on the bus is important. There are a lot of good lessons there. Thank you for sharing that. The other thing I wanted to ask you about your practice is specialty care. Do you offer different specialties? Which ones do you offer at this time?

We had seven optometrists. One of the ones we brought on has taken an interest in specialty contact lenses. It’s a niche area that we do that will hopefully grow quite a bit in the next few years. Another one I’ve taken a big interest in is dry eye. That is a big growth area. I’ve been fortunately part of a wisdom group with some real go-getters out there. A lot of mentors in that group have helped steer me in that direction. Some of the exciting things are having a little more room like that has given us the opportunity to have dedicated rooms for certain things. Our dry eye rooms are a little more spa-like. You throw that specialty wallpaper up, a little nicer cabinet.

Good to Great: Why Some Companies Make the Leap and Others Don't

We have the massage chair, a flat table and an RF center sheriff in there. The Lipiflow is something we had a few years ago. We brought in a skincare line. We’re trying to differentiate a little more. Our IPL showed up, so it will be up. Another big thing we’ve done is TVs in every room. We have a 42-inch TV in every exam room. We’ll be implementing it right away, which we’ll have ads running on what we offer.

Some of the time, patients are looking for services, but they don’t know what you offer. We’ve got 5 or 10 minutes where they’re waiting for you to pick your head in. We are serving them based on the demographic and why they’re there. We can put ads up there for them and let them know what we offer.

Specialty contact lens, dry eye, what else? Do you do any myopia control or has that been integrated generally?

It’s a little bit of dabbling. Some specialty lenses, a little bit of ortho-K with our new fellow, joined on with us. We’ve been lucky. One of the other optometrists that joined us did a little more vision therapy where she came from her last practice. We’re excited to get that up and go. Hopefully, once she gets settled into place, we’ll be doing a little bit more of that, specialty areas to people who know what they’re doing. Dabbling isn’t always the best, so I was glad somebody else came on with a little better grasp on that stuff.

I do not put my hands anywhere near specialty contact lenses or buy ocular vision-type stuff. That is not because I don’t think it’s important. It’s because I don’t know it well enough that I don’t want to mess around with it. Dry eye and myopia control, I’m happy to give those a try. Would you say that those have been important areas of building your practice as well?

Dry eyes make you think, “You want to make this investment in the technology.” When you start, you’re a little apprehensive. “Do I recommend this and the costs involved with it?” There is no better feeling than you always having those patients say, “Have you done your hot water?” “No, but my eyes hurt.” It gives them something that can give them some relief. 

It’s a way to build the practice and loyalty to the practice and word of mouth. That has been phenomenal. We have probably been running it for maybe 4 or 5 months. The growth we have experienced there and the confidence you feel. When you have a passion for it, it’s exciting to go into work and you got something new and different that you know you feel confident recommending. That has been a huge growth area for us.

You create your own luck. 

This is a question that I ask a lot of ODs who have these special types of equipment. You have the RF, which is a fairly expensive unit, your IPL. It’s a big investment for you, but it’s an investment for the patient. You’re charging $1,000, $1,500 or $2,000 for a set of treatments. Do you get a lot of pushbacks? If you don’t mind sharing, how do you overcome that or present it to the patient to make it feel like that investment will be worth their time?

It’s having a passion for it, knowing what you’re recommending and getting confident in it. Having the information that goes behind it. It is one thing to say, “We are going to try this or we will try this.” If you feel confident, you have the knowledge. I found it’s been an easy transition. I’ve been lucky to be part of a wisdom group that is probably early adopters of a lot of this technology. I have been hearing about it for quite a while.

I had the opportunity to attend the Dry Eye Summit out in Toronto. I feel confident with the information, science, technology and studies that have come with it. When you are making that recommendation, you’re not selling the patients something, but you’re making a recommendation about which you can feel confident. That comes with confidence.

In your case, that confidence comes from knowledge, science and feedback expertise from your colleagues. Even before you’ve had the machine in your office or only you’ve had it there for a little while, you feel like that information you’ve obtained from other sources brings you enough confidence to share it with your patients.

It’s been in the office a while to see the results of it has made a difference. It’s not just the doctor’s recommendation. It has to be that whole journey throughout the office as well. Everything has to be cohesive. Your website has to display the information that you know why it’s going to work. Your staff has to have bought into it, why it works, be knowledgeable and the information you send out to the patient, that follow-up care. What we’ve found too is the baseline measurements as well.

There are a couple of computer programs that report all the dry eye treatments. We use one CSI dry eye. Even the baseline measurements. A lot of people are familiar with the OSDI, speed and DQ, but a lot of the other things to look out for, we have the LipiScan to look at the structure of the glands, MMP and we have the eye pen to measure osmolarity. The noninvasive tear breakup time is getting all those baseline measurements and then showing the patients after the care. Sometimes it takes a little while for the symptom to resolve, even though you’re noticing the signs are improving. That helps quite a bit as well.

That has been a consistent theme amongst colleagues I speak to who have this equipment, more importantly, having success with the equipment. It’s having those baseline measurements, myography and the noninvasive tear breakups. These things are key because, a lot of times, the symptomatic relief is delayed. It’s not right away. There are times when it feels worse because the corneal sensitivity is coming back. If you can show them, this looks better than it used to, at least. Patients feel good about that. When I tell them, “I know you don’t feel necessarily better, but it is looking better.” That is enough for patients to feel good about what they are doing and then stick with it.

Dabbling is difficult. It’s an investment in technology, but once you have it and have the confidence to show the results, that was a huge step forward for us.

Think About Your Eyes: Grow for what you want to become: increase your stuff and buy equipment. 

Before we move on to wrapping up with a couple of last questions, I would love for you to share if there are any topics in general that you would like to talk about? More importantly, if people wanted to get in touch or learn more about your office, where could they do that?

Feel free to email me anytime. It’s JimAsuchak@Gmail.com. I’m more than happy to have a conversation with anyone about anything. I’m a big advocate for joining their professional association. We have always been very fortunate in Alberta. They are all volunteers who want to make a difference and make things better. A lot of people are like, “I don’t have the experience or knowledge.” Everybody has experienced knowledge. It’s your profession. You also develop a big passion for it when seeing what you can do to advance the profession. As I’ve seen, the change while I was on the council was significant and can have a big influence on that. It will expand your passion for it.

I don’t think it can ever be overstated how valuable it is for the individual and profession when people get involved. If you’ve read the previous show, you might know this already. There are two questions I ask every guest at the end of the show. The first one is if we get a hop in a time machine and head back in time to a point in time that was difficult, perhaps you were struggling in some capacity, feel free if you would like to share that moment that comes to mind. More importantly, what advice would you give to yourself at that time to help him get through that point?

Everybody experiences difficulties with growth and finances. It seems like I’m always delayed. You are growing for what you want to be, so you increase staff or debt and buying equipment. You are always behind. Financially, there always seems to be a lag until things catch up. I always get distracted and start on a new project. You never seemed to get caught up. I probably wouldn’t do anything. I am very happy with where I got to. If anything, I wish I had gotten involved in the networking aspect sooner. The associations, the wisdom groups, sitting on boards, I waited probably ten years after I graduated to join in on that stuff. That’s huge. The camaraderie that comes from charity organizations that you join from board work to you do and the amount of knowledge and stuff that comes with it, and building those friendships and the network is huge. I wish I would’ve done that stuff earlier.

That is still super valuable, even though you say you are happy with where you ended up and I wouldn’t change anything. That’s something to give people some advice on what they could maybe do better. The lag is so true. I’ve shared that with so many people. You do something and we live in this place of this instant gratification in our society. It’s like working out. If you exercise for a couple of weeks, you are not going to see a difference, but it is making a difference.

It is going to be months until you see it. The same thing happens with business. It goes the other way, too. You worked out for a long time and you get fit and then you stop working out. You’ll still look good for a long time because of those effects, but you know you are heading in the wrong direction. It can be deceiving if you get a little lazier or complacent. There is that lag period that discourages people sometimes. The last question I have for you is, everything you’ve accomplished, president of the association, this big part of CHEC, your success in your practice, and everything else, how much of all of this would you say is due to luck and hard work?

People create their own luck. You have to get out there. You got to meet and talk to people. You got to always be looking for opportunities. I’ve been very fortunate with who I’ve been associated with. I’ve been lucky with my business partner, the people I went to school with, and the friendships I’ve had. That has helped to drive me to where I am. You can’t get too far without those networking opportunities. You got to go out there and create your luck.

Thank you for sharing all that information about CHEC. Everybody who is reading, please look into it. All our Canadian colleagues look into the Council for Healthy Eyes Canada and Think About Your Eyes. Get those resources. Reach out to your association to give them some feedback. See how we can make it better. If you have any questions for Jim, all his wealth of knowledge, feel free to reach out to him as well. Thanks, Jim. Much appreciated.

I appreciate it.

Thank you, readers. Once again, if you got any value from this, I’m sure you got multiple pieces of value from this. Please do share it, take a screenshot, throw it up on Instagram, hit like and subscribe, do all those things. I will be back with another episode. Take care.

Important Links

• Optical Studio

• Council for Healthy Eyes Canada

• Think About Your Eyes

• Good to Great

• JimAsuchak@Gmail.com

About Dr. Jim Asuchak

Jim was born and raised in Fort Macleod where his parents still operate a small farm. He later attended the University of Lethbridge and then onto the University of Waterloo to earn his Doctor of Optometry degree. Jim returned to Lethbridge in 1999 and opened Optical Studio soon after. The practice has now grown to 7 optometrists and recently a new building as well.

He has been fortunate to sit on council for the Alberta Association of Optometrists and serve as President for 2 years. He has also been acting as chair of the Council for Healthy Eyes Canada since 2018 and on the board since it was founded.

He has enjoyed his time volunteering for Canadian Vision Care and attended mission trips to Jamaica, Malawi, and the Philippines. Jim is looking forward to future adventures with the group as well.

Episode 63 - Over The Boards: Triumphs In Ice Hockey And Medicine With Dr. Hayley Wickenheiser

Many people look up to Olympians for their grit and determination. One of the athletes many look up to is female ice hockey player Dr. Hayley Wickenheiser. She led the Canadian Women's national team to 7 World Championships and 4 Olympic Gold medals. Dr. Wickenheiser was also hailed as the MVP of two of those Olympic campaigns. When she left her hockey career, she decided to pursue medicine. As of today, Dr. Wickenheiser is completing her residency training. In this episode, Dr. Wickenheiser shares her insights with Harbir Sian about what it takes to succeed in sport, business, and medicine.

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Watch the episode here

Listen to the podcast here

Over The Boards: Triumphs In Ice Hockey And Medicine With Dr. Hayley Wickenheiser

Welcome back to another episode. Thank you so much for taking the time to join me here to learn and grow. As always, I truly appreciate all the support and everything that everyone has done to share the show and help it grow. I asked this one favor right off the top, which is if you do find any value from this episode or any other episode, share it with someone else who you think could get value from it. Take a screenshot, throw it up on your Instagram story, hit like and subscribe, leave a comment and a review or any of those things. Whichever one is easiest for you, please go ahead and do that.

Talking about bringing value, I'm always trying to bring on guests who are going to help us be better in some capacity, form and way we can learn from their experience to grow in our own life and experience. Our guest takes the cake in all of those categories. I love all my guests and I have some pretty special people on the show. I've been very blessed. Our guest for this episode is the greatest at what she does. When somebody is good at their job, profession or whatever they do, it's hard to say that you are the single greatest person in the entire world at what you do. That is something special.

That person is Dr. Hayley Wickenheiser. If you haven't heard of her before, it's understandable, but I know that there are a lot of Canadians out there who have heard of her. She is a 7-time World Champion and a 4-time Olympic Gold Medalist with the Canadian Women's National Team. She was the captain on most of those teams. She was the MVP twice at the Olympics, at a whole different level when it comes to her sport. To go beyond that, after her hockey career, she completed her Medical degree and is in the process of completing her residency as a medical doctor. After many years of playing hockey, she's moved on to this new phase of her life and is no doubt succeeding and crushing it in this capacity as well.

All of this over the background of the pandemic, she's continued to grow and succeed. To that end, she wrote a book called Over The Boards: Lessons From The Ice. That was the impetus for me to reach out to her. I'm already very familiar with Dr. Wickenheiser from her years as a hockey player. When I saw this book, I had to read it. I'm glad I did because the lessons that come out of this book apply to any one and every one, no matter what industry and profession you’re in. She goes from talking about motherhood and challenges early on in her career as a child, 6, 7, 8 years old, playing on the rink in the backyard, being told that she can't play with boys, having a change in sleep in boiler rooms and closets when she goes on trips for tournaments, to becoming the greatest in the world.

You have to cut out things that aren't important or not serving your purpose.

It’s unbelievable to have her on the show and have her share these insights about the ups, downs and struggles. The gender bias, grit, and resilience it takes to get to where she is. I hope that everyone reading can take at least small pieces of insight from this and apply them to their lives right away. I have and will from reading the book and after speaking to her, I will for sure. Let me know what you think. I'm excited to know everyone's feedback on this one. Shoot me a DM on Instagram, send me an email or whatever you like. Finally, here's the episode with Dr. Hayley Wickenheiser. Talk to you soon.

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Dr. Hayley Wickenheiser, thank you so very much for joining me on the show. I am truly grateful.

Thanks for having me. It's great to be here.

It’s my pleasure. I can only imagine how busy you are with everything you've got going on. I'm grateful for that. I had a guest a while back and I said to her, “You must be so busy,” She said, “I don't like using the word busy because it's got a bit of a negative connotation to it. My life is full.” I said, “That sounds better.” If you wouldn't mind, what types of things is your life full of?

Over the Boards: Lessons from the Ice

I like that too. I am very busy, but it's always a choice. A little bit less when you're doing a residency in medicine. Your life is not fully your own. I'm in a family med residency program here in Toronto and the work that I do with the Toronto Maple Leafs. That is two full-time jobs on top of each other. I've been able to manage both. The pandemic has thrown lots of twists and turns into all of our lives. In some ways, it's been a blessing with a lot of virtual learning and less commuting. In other ways, it's been a nightmare for everyone in terms of not being able to travel. I have spent my whole life on the road traveling. This has been a bit of a weird couple of years here because of not traveling, but it's been good in some ways. Between those two jobs, it's been a full-time gig.

What I've heard about residency is it’s more than one full-time job. In there, somewhere, you managed to also write a book, Over The Boards: Lessons From The Ice, which was my impetus to reach out to you because this was such a great book. Can you tell me where you found the time to do that?

I was asked to do this book and I did one in 2010. It was called Gold Medal Diary. It was about what goes on inside the Olympic village at the games, so I was asked to do a second one. In this one, I thought I would divide up into these almost three periods of offensive, defensive and neutral zone in the game of hockey. I started it before the pandemic hit. About three months into the pandemic, I had it finished because we had a bit of downtime there. NHL was canceled and there were residents pulled out of the rotations. Life was a bit of a wall. I was able to do it.

The way I wrote it was by driving. I talk into my phone. We would put and type it out. I had Nancy McDonald in Vancouver put it into a bit of a structure. We worked through it and she did a fantastic job that way. I was able to get all my language down on paper and my thoughts. It turned up a little better than I expected, but it's a process. There's a lot of work.

Anybody I've spoken to who's written a book says it's one of the most challenging, time-consuming things they have ever done. Kudos to you. Going back to your work. I was telling my wife as I was going through your book, “Can you believe she did this as well?” One of the things is I have friends and family who are medical doctors.

I've heard how grueling that whole process can be. Whether it's the first few years while you're in school, clinical stuff or residency stuff and here you are with a full-time job working with the Toronto Maple Leafs, a professional national hockey team at the same time. It is mind-blowing to me. You mentioned in your book, “Efficiency is one of the keys to getting a lot of stuff done.” Can you share a little bit of some secrets around efficiency? What might you be doing to be efficient?

Efficiency comes when you're well-rested.

I've done this my whole life as an athlete where I had to be a good time manager. I had a young child at the age of 21. I’m managing to be a young mom, traveling the world and being an athlete. I'm very internally driven. A little bit of that A-type personality to want to prepare and be the best in everything that I'm doing. What I realized at a young age is the first thing is you’ve got to cut out things that aren't important or not serving your purpose. I don't spend a lot of extraneous wasting time. I'm not a time-waster. I believe that every minute matters. I like to prepare, not looking down the road but the day before, that’s I will usually prepare my day. What I was training and competing in was very militaristic in terms of every minute plotted out.

It is a bit the same with residency and the Leaf schedule because so much has to get done and we need to stay on top of it. I like to prep that way. Efficiency also comes when you're rested. I believe in getting sleep. I try to get eight hours a night if I can, minimum. That's not always possible in residency, but I have become a good napper through the years being an athlete, so I can power nap if I have to for twenty minutes and usually come alive.

The last thing is physical fitness. I train every day and try not to let that fall by the wayside because if you can't take care of yourself, you can't do anything else very well if you're not feeling good. Those things attribute to efficiency and then prioritizing things and not checking in where you're maybe wasting time, having days too where you can Netflix and do nothing, which I also do. I also try to carve out leisure time. People think that I worked 24/7. I do work extremely hard, but then I also rest hard too, chill out, shut off the phone, take breaks and do things like that at times as well. Probably not as often as I should, but that's important also.

Ice Hockey And Medicine: Athletes become very good because their whole life, they get told everything they’re doing wrong. And so, on a daily basis, they get used to absorbing criticism, dealing with it, and letting it propel them forward versus crushing them.

That's good to know. I mean this in the most positive way possible. You do come across as a machine. You are driven, do things efficiently and are incredibly successful, but it's nice to know there's that aspect to your life as well, where you are human. You need to rest, recover and have that alone time. There's a chapter in your book Rest Is A Weapon. That's key because we also live in a hustle culture. You’ve got to work hard, grind 24/7 and sleep is for the dead. I'm a little more like you, where I feel like I need that 7 or 8 hours every night to function well. If I meet someone who's like, “I only sleep four hours,” I'll say, “Hayley Wickenheiser sleeps eight, so I'm good.”

This culture of more and better is not necessarily efficient, wise, or productive. I don't think people do their best work. It hit me between the eyes in residency when I'm on hour 24 of 26 and I have had 20 minutes of sleep, went to the bathroom once and ate an apple at 10:00 in the morning. I'm like, “This is crazy. Nobody can be at their best doing this.” It forced me to have strategies to survive those shifts and this period in residency where I know I have to grind it out for another 18 to 28 months to get through it all. In the end, the payoff for the rest of my life is going to be the freedom and wings that I have gotten through this profession. It's a trade-off sometimes where it is a grind, but you have to always have that wall or pause to get to the downside of it or you'll hate it and burn out.

Burnout with the pandemic has been a big topic as well. Take care of yourself. Everybody out there who may be working really hard, make sure you do get that rest so you can continue to succeed. You are the highest level athlete I have spoken to, which is probably not a surprise, but in other sports, whether it's hockey or basketball, I find that if they're successful or high achievers in their sport or athletics in general, they're able to transfer something from sport or athletics to whether it's business, education, medicine or whatever it is.

If you can't take care of yourself, you really can't do anything else.

That's the case for you, having been so successful in your hockey career and then being able to almost seamlessly transition to becoming a medical doctor, a business owner, working with Leaps, all these things. Are there specific things that you can put your finger on that you transferred from athletics to a non-athletic world that could have helped you succeed?

There's a lot. I tell people every day that every single thing that I did in sport, I use every day in medicine like discipline, teamwork and preparation. One of the reasons that athletes become very good at other lives is that you get told everything you're doing wrong with your whole life. Daily, you get used to absorbing criticism, dealing with it and letting it propel you forward versus crush you. I have seen in residency for sure, maybe younger medical students who don't have the life experience I have. When you do get criticism, which you always do, and feedback on things you're doing wrong because you're constantly failing forward, people get demoralized.

One of the things athletes do well is they don't let it demoralize them and they keep going. They have this, “I will make it,” mentality because that's what you have to do in sports. It's such a dog-eat-dog world. There is an incredible level of commitment, preparation and discipline that goes into being the best in the world or at the top of your sport that many people have never experienced in life. They are pushing your body to the limits that it can go to playing and living day to day through fatigue, injuries and actual physical, mental and emotional pain. That hardens and makes people resilient. Athletes tend to be very good at those types of qualities and then bring them into the business world.

Ice Hockey And Medicine: There is an incredible level of commitment, preparation, and discipline that goes into being the best in the world or at the top of your sport.

One of the things that male sports, especially pro sports, can learn from female sports is a lot of these guys make a lot of money. When they retire, they don't have a life plan for life after, whereas most female athlete is thinking about life after because they're not set off financially. They are set off to hit the beach and call it a day. That's a healthy thing because a lot of these guys ended up struggling with no purpose and direction. All of a sudden, the day is done and there are no twenty other players or whatever to go and hang out with. These things are real. I was the last player on the national team to get my university degree. I was in my late 30s. Most of my other teammates already had one. They have MBAs and all sorts of things. They are very educated and have good discipline along the way.

There are so many points that you touched on throughout the book, such amazing themes and topics. One of them was you're pretty direct about certain things, which I like a lot. You're upfront about some of these struggles that players do face. You talk about in male sports some of the guys who struggle with mental illness or whether it's substance abuse that is not talked about very much. It's important to bring that to the forefront so people understand, “We look and put these athletes,” like yourself as well but athletes on a pedestal and assume that they're all good and everything's fine because you're a successful athlete, but there are so much more happening there.

Thank you for sharing those types of things in there as well. For yourself also, you were quite vulnerable throughout the book. I imagine it’s not something that you were necessarily good at based on the other things you talk about yourself as being the type of athlete you were, which is key. For somebody else, even like myself looking at an athlete, you assume that people got this shield around them. They're protected. They don't let things get to them or bother them, but that's not true.

One of the quotes that you have in there, pivot a little bit from that was from the 2010 Olympics, “The pressure is a privilege.” You were referencing that quote from Billie Jean King. I love that. It's easy for anybody to get caught up under pressure, even in day-to-day life, but we have to look at that pressure as a privilege. If you wouldn't mind elaborating on that quote and where you came across it?

To go back to the vulnerability piece too, which ties in as an athlete, captain and leader, early on, it was like, “You must have it all together. You can't let your guard down. You can never show anybody that you're struggling.” I learned through the years, maturity and being around long enough that sometimes the best effective form of leadership is to show that vulnerability and humanize yourself with the people that you work with because you're more relatable that way. That was something that, for me, didn't come naturally. It made me a better leader. When it comes to, “Pressure is a privilege,” in the Vancouver Olympics in 2010, the entire media of Canada kept saying to us, “Are you guys going to choke? It’s the Olympics in your home country. Can you get the job done?” These types of back and forth.

This whole culture of more is better is not necessarily efficient or productive.

We decided that it's not the weight of a nation pushing us down and wanting us to fail. It's the weight of the nation pushing us from behind 37 million people like the Seventh Man in the stance. We're going to flip the narrative on its head and the pressure would be a privilege. I use that mantra a lot in every aspect of my life. When I'm quietly whining to myself or complaining about how much I don't like residency a lot, I check myself. I would say, “People would die to have this position that you're in and have this opportunity. Get over yourself to the first-world problem here.”

I remind myself like, “We all do it. It's normal. We all have our struggles and perspective. It doesn't matter if you're rich, poor or what your status is. We all struggle.” Sometimes it's the way to reframe it. It's also a way when I do feel like the weight of the world or there is a lot of pressure to do something, “I'm not alone. I've got a team here.” Other people are capable and deflecting. In a team sport, you learn to deflect pressure a lot because you can. I don't know how those single tennis players who were there on the court went by themselves. They don't have too many places to deflect the pressure, but I certainly used it as a tactic to survive those moments.

Sports like golf or tennis could get tough. You're out there all by yourself. No one to lean on her or delegate to that could get challenging. You can see why certain tennis players explode on the court sometimes. We've touched on this briefly a bit, but you start the book with this and something that stays in my mind a lot, in general, is grit and resilience. You make a distinction between those two terms. I imagine that's a key skill or quality for an athlete to succeed but also in the business world, in medicine, all these things to get through school, your day-to-day business and downtimes. If you wouldn't mind, can you first distinguish the difference of what you see between grit and resilience? Can those things be built or is it innate and you're born with?

Ice Hockey And Medicine: Sometimes, the best effective form of leadership is to show that vulnerability, to humanize yourself with the people that you work with, because you're more relatable that way.

Grit is the ability to get up every day, do hard things and get through hard times to work and persevere through whatever's difficult, assignments you don't like in school, a project that works that you don't like, dealing with people that you don't get along with, finding ways to get the job done. Resiliency is built over time where you cumulate this grit by working through difficult things and then you gather this internal confidence like, “There's no task. It's too tough for me to get through. I can do this.” That resiliency is built over time. For athletes who are in the sports world, the best athletes that I've ever been around are the most resilient.

They are the ones that can get knocked down, whether it's injury, swamps, poor play, coaches' decisions, get back up, keep going and find a way. They are the most solution-based people that I know. They know the glass is generally half full. That develops a lot of resiliency and fortitude. When you get into a bind in a tough pressure situation, you can always go back to the well knowing, “I did this work. I'm prepared. There's no one more ready than I am.” I hung my hat for my career on work ethic and preparation. I always felt like someone could be more talented than me. There's not much I could control, but no one's going to outwork me. That's what I'm going to hold onto. That's where I'll have my control and where the resilience came in.

It's something that you can build. You can train yourself to be more gritty and build that resiliency. I feel like that's an important message. Sometimes it's easy for some to look around and say, “That person's got whatever quality it might be that's making them more successful than I.” You can work on it. As long as you're working hard, you should be able to build that as well. That’s the important thing.

The last big topic I wanted to touch on was gender bias. There's no doubt that you face your challenges as a young person and a young girl coming up in a sport that was male dominant, whether not getting playing time, having to change in closets, boiler rooms and sleep in those spaces because there's no space for girls in these facilities. How about when you were older? As you're becoming a more well-known or successful hockey player, please do if you're comfortable sharing certain scenarios. Is this something that you face throughout your career? Even in medicine, do you feel that you face these types of things as well?

It is something that I faced my whole career. It was probably harder until I was midway through my national team career because a few things changed. I felt when I was younger, I needed to constantly prove myself that every time I stepped on the ice, I wanted people to say, “That's a good hockey player,” not a female hockey player and leave impressed. As I got older, I dropped that because an exhausting way to live is trying to prove something to someone every single day.

At the end of my career, moving into medicine and my role with the Leafs, I have settled into this place where I feel very comfortable that I can hold my own with anyone at any given time and situation. I don't feel like I experienced that. I know it exists and it's out there. I feel that you're constantly having as a female, prove yourself, work harder or give it right back when it's dished out. There's this dynamic that does exist, especially in a male-dominated world like hockey, maybe not so much in medicine because it's a little bit more male and female dominant. Certainly, the hockey world was still stuck sometimes back in 1972 and it's a challenge. Internally, I feel different about it than I did when I was younger.

Would you be able to then share your thoughts with a young person or a young lady who may be coming up, whether in sports, medicine or business, lessons that you've learned there that maybe help them come through these potential challenges as well?

You’ve got to have thick skin. We can never control what other people are going to say, do or how they're going to react. When I was a little girl, my parents supported me. There's no easy way. If you want to do things that are unorthodox and maybe not female or male-dominated, you have to be willing to walk through some uncomfortable positions.

I always tell young women, “When it's dished out, don't be afraid to give it right back. Persevere and have that belief in yourself. If you don't believe in yourself and you're not going to be your own best friend at times, nobody else is going to do it. It's not comfortable. It's not easy. It's getting easier, but it's like anything, work ethic, your passion and preparation.” People are more open-minded to give young girls and women unorthodox male. Typically male positions give them opportunities to have a chance, but you’ve got to be prepared to walk through that door when it happens because you may only get one shot.

Unfortunately, there are limitations for females to have the pressure of having to take that shot when it gets there, having to stand up, push back or whatever in all those things. It's nice to have a role model like yourself to show that it can be done. Thanks to people like yourself, there are more opportunities for young girls who are coming up. Thank you for everything that you've done. From the father of two little girls, I appreciate that for creating these opportunities for them in the future.

It's getting easier. For a young girl or a little 5-year-old girl growing up, it is a lot different than when I was a little 5-year-old girl. There'll be professional women talking someday for her. She'll be able to have a full-paying job in hockey in any role that she probably chooses. It still has a long way to go, but there is progress. I choose to focus on the things that have been good and progress than what we don't have. I believe in solutions to problems.

You've briefly met one of my daughters via social media. It’s because there's a book that she has. It’s called 5-Minute Stories for Fearless Girls. You're in the book. There are a bunch of stories here of successful women throughout history who've done things to change history and you're in it. It's cool that I could tell her about you in that book and learn about you myself in your book, which is called Over The Boards: Lessons From The Ice. Before we wrap up, I usually have two final questions to ask every guest. Where can people find you, your book and learn more about you?

I have a website. It’s HayleyWickenheiser.com. You can find me on Twitter at @Wick_22 and Instagram @HChickWick. I have a website under my name as well. It's a public website. WickFest.com is my hockey festival for young girls between the ages of 6 and 18 that we host every year in Surrey, Calgary and possibly, Toronto if we can ever get through this pandemic. If people want to pick up the book, there are chapters on Amazon or wherever you buy your books. I appreciate the time. It’s great to chat with you. Thanks for having me on.

I'm not going to let you go yet because I have two final questions that I like to ask every guest. The first one is if we could hop in a time machine and go back to a point in time where you were struggling with something that was happening that was quite difficult, please feel free to share that moment if you're comfortable. More importantly, what is the advice that you would give to yourself at that moment?

I had a bad foot injury at the end of the Olympics that I played in Sochi. I had to get surgery and was non-weight bearing for four months. I didn't know if I'd play again, but I ended up playing a couple more years. The first thing I say is don't panic. You have a good plan and support around you. Start from the end and work backward, create from where you want to be, start working from there and take it every day, one day at a time.

I feel like I've heard something somewhat similar from Jeff Bezos. It seems like you're in good company with that. The last question, which honestly, I feel silly asking you this because it's fairly clear from learning about you. Everything you've achieved, world championships, Olympic gold medals, Hockey Hall of Fame, then a doctor, how much of this would you say is due to luck? How much is due to hard work?

90% hard work and 10% right place, right time. Being at the start when I was a little girl, I had the social support, the right environment to grow up, and fortunate social-economic, middle-class Canada. I had lots of opportunities that way. I took it and ran with it.

Thank you so much for the time, for everything you've done for hockey, for people in Canada and my little girls.

Thanks for having me. It's great to talk to you.

Thank you to everybody who's reading. Don't forget to hit like, subscribe and check out Dr. Hayley. Wickenheiser’s book. It's so good, Over The Boards: Lessons From The Ice. I'll be back with you in the next episode. Take care.

Important Links

• Dr. Hayley Wickenheiser

• Over The Boards: Lessons From The Ice

• Instagram – Dr. Harbir Sian

• Gold Medal Diary

• 5-Minute Stories for Fearless Girls

• HayleyWickenheiser.com

• @Wick_22 – Twitter

• @HChickWick – Instagram

About Dr. Helley Wickenheiser

Hayley Wickenheiser, OC is a Canadian former ice hockey player, resident physician[2] and executive for the Toronto Maple Leafs.

She represented Canada at the Winter Olympics five times, capturing four gold and one silver medal and twice being named tournament MVP, and one time at the Summer Olympics in softball, and is a seven-time winner of the world championships. Hayley is widely considered to be the greatest female ice hockey player of all time.

Episode 62 - Eye2Eye: The Window And The Mirror

Why do some companies make the leap to greatness while others don’t? This is what Jim Collins sought to address in his super-successful business book, Good to Great. Among the many powerful lessons in that book, he wonderfully illustrates the concept of the window and the mirror, which teaches a valuable lesson on taking responsibility. In this episode of Eye2Eye, Harbir Sian shares some thoughts on how this metaphor applies from a leadership perspective. Join in and learn how great leaders see things differently and how that allows them to leap into a place of greatness that others can’t access.

Eye2Eye segments are short solo episodes where Harbir shares some thoughts and insights from his personal experiences. May you find value in these musings and put them to use in your career as well.

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Watch the episode here

Listen to the podcast here

Eye2Eye: The Window And The Mirror

Thank you for taking the time to join me here to learn and grow. I like to bring on guests from different industries, businesses and walks of life to share their insights to help us all grow. I'm growing as much as anybody else who is reading this blog for sure. I'm trying to absorb as much of the information our amazing guests share with us. If you are a long-time reader of the show, you also know that a little while back, I started a new segment that I call Eye2Eye. It's me sitting here sharing some of my thoughts and experiences with you and lessons that I have learned from some of my guests or books that I have read or so on.

It has been a little while I wanted to bring you an Eye2Eye episode. It's a specific lesson that I have shared on social media and other ways in the past. Originally, it comes from the book Good to Great by Jim Collins. If you haven't read that book, I highly recommend it to anybody who is trying to grow. If you don't own a business from a personal or professional development perspective, it's a fantastic book. It's one of the most well-known books in the business world.

What Jim Collins did in that book is he did this retroactive research on previous leaders, CEOs and business people who are able to take companies from good to great. Who are those people who are able to take a company to be even better than where it was when they got there versus others who kept it the same? Even the companies didn't do as well when they were in their leadership roles. This has been in my mind for a while, but a couple of things happened that reminded me of this book.

The ability to take responsibility is a key aspect of good leadership.

Number one, I subscribed to Seth Godin's email list. I get his emails daily with his thoughts on his blog. A lot of his posts have been about leadership and responsibility. There was one talking about that a leader has got to be willing to say, "I got this or it's on me. It's one way or the other in taking that responsibility, which is a key aspect of a good leader." The other thing is that I happened to record a new episode with a wonderful colleague. His name is Dr. Jim Asuchak from Alberta.

You will learn in that episode that he has this super successful busy practice but also has been the President of the Alberta Association of Optometrists. He is the chair of another national organization. He is doing great things. Jim Asuchak happened to quote Jim Collins and this book specifically, Good to Great, in his conversation about how he has been able to grow his practice. It has come back to me a couple of times and I know I have shared it previously on social media, but I wanted to share it here.

The specific story that Jim Collins tells in his book or the parable, moral or whatever you want to call it, is what he calls the window and the mirror, and the differences between a good leader and a not-so-good leader. What he is saying is, "When we are confronted with challenges and successes, we either look out the window and attribute those challenges or successes to somebody outside other people, or we look in the mirror and we look at ourselves."

Good to Great: Why Some Companies Make the Leap and Others Don't

A good leader should be one who, when things are going well, when there's a success, or when things have gone as planned or better, is that person looks out the window and attributes that success to the people around them or other people who are involved. On the flip side, when things are not going so well, that person looks in the mirror and looks at themselves and says, "What can I do better? What am I not doing well enough?"

The other side of that story is the person who is not as good of a leader, who is not willing to take on the responsibility. When things are going well, that person looks in the mirror and says, "You did a good job." The other side of it is, when things are not going well, that person looks out the window and blames everybody else other than themselves. That has been an ongoing lesson that I have been trying to learn. It's giving yourself credit where it's due but making sure you give other people credit when they deserve it and when things are going well. It's making sure you look at yourself in the mirror when things are not going well.

There's another business-minded person that I follow and listen to a fair amount. His name is Andy Frisella. He has got a big successful podcast. I don't listen to him as much for other reasons. I won't go into that. Business-wise and conversation-wise, he is a great person to listen to. He talks about this type of stuff as well. If things are not going well in an organization, you can always look to the person who is at the top. It always comes from the top-down.

In good times, give credit to the people who deserve it. In bad times, look in the mirror and ask yourself what you can do better.

You might say, "It's just one bad apple. It might be this one person who is a bad actor. It's one employee who doesn't like their job and that person is making it rough for everyone else." That is the owner, CEO or whoever leadership role person to take care of that. If that bad apple is ruining it for everybody else, it's the leader's responsibility to have fixed that. I personally face that at work in our offices. We try hard to bring on team members who are going to work well together.

It's important to me to have an environment that is cohesive and almost family-like in a lot of ways where people can get along. You want to come to work. You like coming to work. It's important to me to have that versus somebody coming on board with a high skillset. I have to weigh out those options sometimes. We have been in that position where somebody perhaps was not pulling their weight. It makes other people feel like, "If that person is not pulling their weight, then why should I?" They feel bad about the fact that they are working harder than that other person.

That person who is not pulling their weight is my responsibility as the leader or business owner to take care of that so that everybody feels like they are putting an equal effort. You can say, "That person is uninterested, but it's my responsibility to either get them interested or figure something else out so that everybody is on the same page and putting in the same amount of effort." We had people in the past who didn't like what they were doing. They had negative energy.

Taking Responsibility: If a bad apple is making it rough for everyone else, it’s the leader’s responsibility to have that fixed.

You think, "They will hash it out and figure it out." It's the leader's job to make sure we can make that situation better for everybody. Sometimes that means maybe letting someone go. That's always a difficult decision. It's easy to look out the window and be like, "Those people are not good at their job and they don't seem to care." You've got to look in the mirror and say, "What is it that I'm doing or could do to make this better?"

Staffing HR is probably the most difficult challenge for any business owner. I'm sure everybody who has to deal with staffing would agree. To go back to the story, you are either looking out the window or looking in the mirror. You have to think about when you are doing those things. In the good times, it's making sure we are giving credit to the people who deserve it. In the bad times, it's making sure you are looking in the mirror and asking yourself what you can do better.

That's the lesson for this Eye2Eye episode. I hope you found it valuable. If you find this episode or any of the other episodes valuable, please share them. Take a screenshot, throw it up on your Instagram, tag me and let me know what you think. Send it off to people that you know who you think might find value. Hit like and subscribe. Leave a comment and review. Thanks again, guys. We will be coming to you with a bunch more content in the near future. I'm excited to share it all with you. We will see you soon.

Important Links

• Good to Great

• Dr. Jim Asuchak

• Andy Frisella

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

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

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Watch the episode here

Listen to the podcast here

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Important Links

• Dornn Eye Care

• Eye-Revive

• InMode

• Lumecca

• Eyeeco

• E9

• Neutrogena

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

• Tea Tree Lid Cleanser

• DornnEyeCare@Shaw.ca

• Apple - The 20/20 Podcast

• Spotify - The 20/20 Podcast

About Dr. Bruce Dornn

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

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

Episode 57 - Omega-3 Almighty with Dr. Kimberly Friedman, VP of Physician Recommended Nutraceuticals

Dry eye afflicts a third of older people, and one in ten of younger patients. To combat this condition, physicians have used a multitude of treatments, including nutraceuticals such as Omega-3. In this episode, Harbir Sian interviews Dr. Kimberly Friedman as she shares some eye-opening findings about the power of Omega-3 for our ocular systemic health. Dr. Friedman is one of the founders of Moorestown Eye Associates and the VP of Physician Recommended Nutraceuticals (PRN). She shares step by step discussion points for patient interactions and how to know which omega is right for you and your patients. Tune in for more expert insights from Dr. Friedman today.

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Watch the episode here

Listen to the podcast here

Omega-3 Almighty With Dr. Kimberly Friedman, VP of Physician Recommended Nutraceuticals

I'm grateful to be here with an incredible guest, Dr. Kimberly Friedman. You've heard me talk about dry eye. I'm trying to build my dry eye practice and trying to integrate different things. Dr. Friedman truly is an expert in the field. She is one of the founders of Moorestown Eye Associates and the Director of the dry eye clinic at Moorestown. Her resume is incredibly long with many achievements. I'm going to list a few, and then I'm going to let her talk a little bit herself about who she is and what she does.

She's a Diplomate of the American Board of Optometry. She's a fellow of the American Academy of Optometry. She has been on many TV shows to talk about dry eyes and eye health, including the Rachael Ray Show. I'm sure lots of us know what that is. She spends a lot of her time educating, speaking, lecturing around North America. In fact, I was fortunate to attend a lecture here in Vancouver but also in Las Vegas, hearing her speak and having the chance to speak with her personally. I'm excited to introduce Dr. Friedman. Thank you, Dr. Friedman, for being here on the show to share all of your amazing insights.

Thank you so much. That's quite an introduction. I'm very excited to be here with you. I’ve got to say I did not know as much about optometry in Canada as I learned when I was up there in Vancouver with you. I am amazed by all the great things that you've got going on there and your show, business, how you're growing and thriving in this dry ice space as well. It's exciting. Kudos to you as well, thank you.

One thing I want to start with is I'd like you to tell us a little bit more about yourself but specifically, one thing I know you've said in the few times I'd met you is that you're a self-proclaimed nerd. I'd love to know from your perspective what makes you a nerd and how has that benefited you up until now?

I was one of those academic students. I graduated from, at the time, PCO now, part of Salus University in Pennsylvania. A long time ago, I was there in the ‘80s and early ‘90s. That academic background led me through the years to where I am now and where ever I will be tomorrow or the next day. That tendency to always strive to learn led me to what has been the hallmark of my career, which is a constant reinventing of oneself. If you're doing the same thing over and over again, year after year, it does get a little stale. It was exciting for me to do, which is better 1 or 2, maybe for the first 5 years of my practice but after that, I needed to do a little bit more.

The fact that I am a bit of a nerd and I do read a lot, I do look at the studies and I'm always trying to evolve and improve led me to different emphasis during my career. When I first got out, I was doing a lot more pediatrics at that time. As I got older and my patients got older, I developed Sjogren's personally. I started to have dry eye issues and I want to learn more about that. That led to my diving into a specialty clinic on dry eye.

My use of dry eye products and learning more about them in different treatment modalities led to where I am now as a Vice-President of Physician Recommended Nutriceuticals because I was using nutriceuticals as part of my practice. The nerd in me has served me well. It is allowed me to reinvent and reinvigorate myself in this wonderful career because we don't have to take a one size fits all approach in optometry and being a nerd has helped.

I am also a self-proclaimed nerd and I've leaned into that more as I've gotten older. I realized the benefit of being a nerd and, of course, there's this negative connotation around it but being that person who is so driven by learning, absorbing information, and then you have to apply it, which you've done. Let's talk a bit about dry eye practice. I'd love for you to share maybe more from a beginner's perspective. What if somebody was in the early stages and they want to build a dry practice, A) Is there value in it? I know that's a rhetorical question. B) What are the early steps? Not going too deep into too many devices and equipment, but what would you recommend a place to start?

I say to doctors when I'm talking to them about dry eye all the time, “The only thing you need is a slit lamp and your ears, that's it.” I have a lot fancier equipment than that at this point but I didn't start with that. The patients will tell you if you listen, and if you ask the right questions, you can discern what's going on with our patients. What's that rule of thumb like 80% to 90% of the time you already know what the diagnosis is by the time you've done the history, and that's not that different with dry eye disease. Paying attention, asking the right questions, and taking a look at the slit lamp, anterior segment, Meibum, see what's going on. That is 99% of the battle.

You can get a lot of fancy equipment that can help with patient compliance, the bottom line of the practice, treatment modalities, and such but the reality is to get started, you need a slit lamp and your brain, and that's about it. In terms of how I started and how many people started, we do go back to that nerd thing. You do have to go back and learn. You're going to want to read as much as you can read. You're going to want to attend a few beginners dry eye lectures. It's ironic because I grew up in the ‘60s and ‘70s. Before I became President, my job or my role with the NJSOP was that I was in charge of developing their continuing education classes.

Ironically enough, this would have been roughly in the ‘90s or so, the big thing then was, “Not another dry eye class.” At that time, we didn't have the scope of practice that we have now. There wasn't as much with therapeutics, narcotics, advanced lasers, and things that we can go and attend these intense, robust continuing education classes. Back then, it was like, “The only thing they're going to talk about is dry eye and red eyes.”

90% of the time, you already know what the diagnosis is by the time you've done the history. It's not that different with dry eye disease.

It was considered superficial fluff that they would give to the optometrist because they couldn't give us anything with any meat to it. Now come full circle all these years later, we realized that dry eyes are a heck of a lot more than here's your boatload of artificial tears. Try them all and figure out which one works for you.

Now, there are dry eye classes that are terrific, intense, scientific, and will feed the nerd in you as well as allow you to develop means that would be very successful for your practice. I'll give a shout-out to one in particular but there are plenty. Arthur Epstein does a series that is good, where it's like a four-part series that he does through the year quarterly. It's a webinar. You get continuing education classes, credit for it as well.

It's a nice one because he starts with the basics like, “This is what you might need to do. This is how I set up the protocol in my office.” He goes a little deeper, into equipment, and then those strange outlier cases that are particularly tough but it's a nice building philosophy and I know that there are other ones like that as well. There's a Dry Eye University and a bunch of them like that. I will say I didn't do that. The way I did was a lot of self-learning and reading but there are some great classes out there that can get you started if you don't have the motivation or the wherewithal to do it on your own, those classes are good.

We're fortunate now to have many resources online but quality resource like Dr. Epstein is one of the more well-known names, but the Dry Eye University is great stuff too. I know they spend some time talking about the business of it too, not just the clinical, which is important. When we’re doing this, we want to help our patients.

We want to improve the results clinically but we need to be able to support that side of the business by making some money from it too. You've already touched on it. I apologize. I forgot to mention it in my intro, which is that you're the Vice President of a Physician Recommended Nutriceuticals PRN, which I'm sure many of our colleagues have heard of.

In particular, the talks that I had attended of yours were more related to Omega-3 and its benefits. Before your talks, I knew Omega-3 was important. I was telling my patients, “You’ve got to look for the EPA, the DHA.” After your talk, I've completely changed. My office manager even came up to me. He's like, “We're selling a lot more Omega-3.”

It's a little bit different from the way I talk to my patients. Thank you for that, Dr. Friedman. We're going to see our patients are noticing a lot of benefits in the near future but let's dig into that. If you can, maybe on a broad level, what's the benefit of Omega-3 systemically and then for eye health, and then we'll go a little deeper.

What happened was going off what we were previously talking about when I started the dry eye clinic, one of the things that I started to realize was when I looked at the data. The data relative to Omega-3 fatty acids is even a little more robust than the data that is present on certain drugs that we have available to us. As with anything, we learn as we go, we make our mistakes and adjust. When I started working in the dry eye space, truthfully, what I would do is I would often use Restasis at the time. It was before the Xiidra and Cequa.

Bring them back in three months and if they were not feeling better, I would add the Omegas. What I learned in time was that I was probably doing it backward and I probably should have used Omegas as the foundation, as an inside-out treatment first, in order to address the inflammation that's happening systemically and thereby being reflected in the eye as well, and then I would add on the topical. I flipped my protocol.

When I did that, I started noticing not only whereas I have seen better results behind the slit lamp but I was also getting happier patients back. Overall, what Omega-3 fatty acids do in the body in the right form is reduce inflammation, which we now know is the hallmark of dry eye disease. Omega-3 fatty acids, in a broad sense, come in different forms but the form that works for the eye is the EPA and DHA form, which is the Marine, fish, shellfish or algae-based Omega-3 fatty acids.

Omega-3: If you're doing the same thing over and over again, year after year after year, it does get a little stale.

Unfortunately, the plant-based Omega-3 doesn't have an effect on the ocular surface and systemically in the anti-inflammatory way that we once thought they did. That would be the ALA like the flaxseed oil stuff. We want to avoid those but in the space of EPA and DHA, and we can get deeper into it if you want to but that will have an anti-inflammatory effect in the body, which is beyond the eye.

When I'm talking to patients about this, I'll say, “We're going to start treating this with a systemic inside out approach to dry eye, which is not going only to benefit the eye but it's also going to have benefits for your overall health, whether it be joint inflammation, the cardiovascular risk for issues there and skin health.” The benefits of Omega-3 throughout the body are incredible and we're not getting enough in our diet but I will say, “For our purposes, I'm doing this for your ocular health. You're going to start taking this product. I'll see you in three months. We'll reevaluate where you are, and then decide if we need to go on.”

When I present it that way, the patients are usually thankful that I'm going with something that has a 90% reduced risk of sudden cardiac death. That's a nice thing. The fact that I'm making them feel better in their eyes are great but the fact that I'm reducing their cardiac risk as well, and other things, is a good thing. Overall, the patients are happier because they know that they're getting a more natural systemic benefit as well as an ocular benefit. Honestly, in terms of tear osmolarity, MMP-9, and all those lovely little numbers that I measure in my office, they get better as well.

The different indicators that we are looking for, Omega-3 improves more of them than some other prescription medications that we often will prescribe to our patients.

The Omega-3 fatty acids in the right form and dose at all are not drugs. The nutriceutical industry, not just PRN where I work but the nutriceutical industry in general, is an industry and a business. When you know that you have Omega-3 fatty acids that can have a reproducible dose indicated a benefit to our patients and a company wants to come out with those, they have two choices, “Am I going to go the drug route or am I going to go the nutraceutical route?” If I go the drug route, the average cost from inception to out in the market for a drug based on a Tufts University study is $2.7 billion.

It is incredibly expensive to get through the trials, the FDA process, the regulatory process, let alone then go and get it on the formularies and get it so the prescription drug plans will pay for it without a high copay or deductible and then do the coupon game. We all know it. We deal with it every day. The prior authorization game, all that. That game's expensive, $2.7 billion for one little drug to get out there in the market.

We know Omega-3 fatty acids play a role in anti-inflammatory in the entire body. If I decide to go a pharmaceutical route, the way the Vascepa, Lovaza those drugs did, I'm looking at a $2 billion price tag to get there. The other way to do it is with a nutriceutical company, certainly a price tag to get there but it's not in the billions.

If you do it with a nutriceutical approach, the countries are different. In Canada, you can make different claims than you can in The United States. In Canada, you have to prove efficacy in order to get it there. In the United States, you have to put a disclaimer that says, “This product has not been indicated for the treatment cure or prevention of the disease.”

It's interesting how the different states and different countries deal with nutriceuticals but a nutriceutical is not necessarily less effective than a drug. It was a different business decision on how to get it to market. You do have to have a nutriceutical company that is using good practices, that is willing to submit their product for lab analysis and show a certificate of analysis and things like that. All nutriceutical companies are not created equal but with a good quality nutriceutical company, PRN is not the only one. They are producing products that could make an impact on our patients, just as a drug does but as a different approach.

Finally, I would like to add, going back to nerd again, look at the studies Restasis, hit the endpoint of Schirmer's. Xiidra hit the endpoint of corneal staining and a dry eye questionnaire that they had developed. Cequa hits the endpoints of Schirmer's, staining, dry eye questionnaire, and their stainings were conjunctival as well as corneal. If we look at an Omega-3 fatty acid in an EPA and DHA form in the right form dose ratio, that hits the endpoints of MMP-9, tear osmolarity, corneal staining was improved by over 50% as well. The OSDI was improved by over seventeen points. The blood index level.

Omega-3 fatty acids in the body in the right form reduce inflammation, which we now know is the hallmark of dry eye disease.

All of the objective and subjective markers that we utilize for dry eye have been shown to be met with roughly 2 grams, 3 to 1 EPA to DHA, re-esterified triglyceride form Omega-3 in a blind randomized multi-center placebo-controlled study. Comparing study to study, there is a heck of a lot more endpoints there in the Omega-3 box than there are in some of these topical boxes that we use.

When I first heard you say that, I was blown away because I knew Omega-3 was valuable and how to place it in my dry eye treatment protocol but I didn't realize that it was hitting all of those endpoints. Maybe more so I didn't realize those other drugs were only getting 1, 2, maybe 3 because they don't tell you. We didn't hit these other endpoints. They zone in on a dial-in on the one that they did. It's important to know that this nutriceutical that can have these other systemic benefits to our health, as well as improving dry eye symptoms and signs, can help this much compared to the medications.

The next thing I wanted to ask you was something you already touched on, the form, the dosage and the ratio. A lot of my patients that I'm talking to, I'll say, “You got to be on good quality and taking Omega-3 daily, which we don't get enough.” Most patients say, “Don't worry. I have already taken one.” I'm going to let you talk, and then I'm going to give you my side of the story but if you can tell me about the difference and not all Omegas are made equal, what are we looking for in a good quality product?

I am the Vice-President of PRN, I'm biased but when I'm doing an interview and things like this, I want to play real with you. I want to not be an infomercial here. I want you to have the information that you can have to make an impact in your practice and in your patient’s bottom line in terms of their health. What it comes down to is regardless of what product you use, form, dose and ratio.

Form, we need it to be in re-esterified triglyceride form. In Canada, I'm pleased to say that most of what is sold in Canada is in the re-esterified triglyceride form. Canada has a big headstart than in the United States on this. In the United States, not so much. Most of what's out there are in ethyl ester form. To cut to the chase of the two forms, if you were to get an Omega-3 fatty acid from fish, it would be in a triglyceride form. That is the form that our body can absorb, identify and get all the benefits of Omega-3s.

When we make a non-Omega-3 supplement, we have to clean the oil that is harvested from fish because, unfortunately, we put PCVs, heavy metals and all the lovely stuff in our oceans. In the process of cleaning the Omega-3 from the fish, it biochemically converts them into an ethyl ester. Most of the companies in the United States and the two pharmaceuticals that I talked about earlier as well take that ethyl ester form, put it in a capsule and put it out there in the market.

The problem is that it's not that absorbable in the GI system. Only about 1/4 to 1/3 of it gets absorbed. The rest of it sits in your stomach, gives you fish burps and indigestion. If you've ever had a patient tell you they were tasting it all day, it was disgusting and they won't take that again, it's because they were on an ethyl ester.

The only way you can get a form like that to work is to megadose it. You got to give them 4,000 to get 1,000 in, 8,000 to get 2,000 in, roughly depending. Any of these Omega things that I talk about if you take it on a full stomach, it does absorb a little better than an empty stomach and that's true if it's ethyl ester or triglyceride.

The ethyl ester is not going to be bioavailable enough to make an impact on the ocular surface. The first thing we remember is the form has to be re-esterified triglyceride. That's the same form that is found in nature, only cleaned, and then reconverted back into a triglyceride form. It's as close as you can get to nature in a clean form. Canada's good with that. In the United States, not so much.

We look at a dose, you have to look back again at the studies. There are studies that have shown that Omega-3 doesn't work. There are studies that show that Omega-3s work like the best thing since sliced bread. That's why Omega-3s can be a little confusing in our profession because there are inconsistent results in some of the studies. If you read the studies, you'll see that there are no inconsistent results at all. The studies that show it doesn't work are generally doing 1,000 milligrams of ethyl ester, and then 1,000 milligrams of ethyl ester won't work every day of the week.

Omega-3: Overall, the patients are happier because they know that they're getting a more natural systemic benefit as well as an ocular benefit.

The studies that show that it does work are generally doing 2,000 milligrams or more of re-esterified triglyceride. The data that I was pointing to was a study that was published in Cornea in 2016, which to this day is still considered one of the best blind randomized placebo-controlled studies in the dry eye on Omegas and it did hit all those endpoints.

That study was roughly 2,200 milligrams of a re-esterified triglyceride. We know roughly 2,000 is what will work. The last part is the ratio. What that study showed is that the EPA to DHA amount was critical to getting these results. What does that mean? Omega-3 supplements come in ALA, EPA and DHA, largely. ALA does not work. There are studies that indicate that it becomes pro-inflammatory in the body and has a 49% increased risk of macular degeneration.

If you have a patient who's taking a flaxseed oil-based substance or if you're taking it, please stop. We now know that ALA is not a good source of Omega-3 and, in fact, increases the inflammatory burden in the body. EPA and DHA are what we're looking for. If it's anti-inflammatory intent, which is what we're using for dry eye, we want more EPA. It is more anti-inflammatory.

If it is brain health or retinal health intent, we would like a little more DHA. It resides in the cell membranes in the brain and the central nervous system like the retina and EPA in more of the peripheral nervous system and the peripheral body. Upshot all is form, dose and ratio matter. The form needs to be re-esterified triglyceride.

The dose needs to be above 2,000 milligrams, and the ratio needs to be EPA to DHA, and what we use at PRN is a 3 to 1 product. It's the one that's been clinically proven three times as much EPA as DHA for dry eye. Form, dose, ratio, that's pretty much what you can remember. In America, we say FDR because FDR was a President everybody knows.

It's interesting you say that in Canada, we're doing a little better on that as far as the form because if it doesn't say triglyceride on the bottle, are we going to safely assume it's not triglyceride form, it's ethyl ester?

Most likely. When it is a triglyceride form, the manufacturers usually want to tell that. They usually want to sync it from the rafters or whatever because it costs more to produce a triglyceride. It has to go through the normal process that everybody else does but then there's an additional process on top to reconvert it back into a triglyceride.

When you look at two Omega-3 sitting on the store shelf in America, one of them might be $17.99 and the other one might be $39.99, it's like, “What are you going to buy if you're the consumer?” There's a significant price difference between them. Usually, the manufacturers will want to put triglyceride on the label to highlight to the informed consumer that this is not the same thing. That's in the jug official at Costco for $1.99. It'll usually be on the label.

One of the other ways you can tell if it's not on the label is in an ethyl ester form. The poor quality form is usually going to have an enteric coating around it to try to prevent the fish burps or it's going to have a D-Alpha Tocopherol preservative in it to prevent it from going rancid. There are a few other cues that you can take from it but usually, if it's going to be a triglyceride, they're going to tell you.

That Tocopherol, is that vitamin E?

Yes, it gets a little confusing sometimes. Almost all Omega-3s are going to have vitamin E in them in some form. All Omega-3s aren’t equal, and all vitamin Es aren’t equal, either. The full natural form of vitamin E is a sub-components of two tocopherols and tocotrienol combined together. That combination of mixed Tocopherols and mixed Tocotrienol is the nutritionally sound beneficial of vitamin E. Most of your Omega-3 products are going to have some form of vitamin E in it because vitamin E does act a little bit as a preservative. It can help maintain stability.

The reality is that the proof is in the clinical studies and the patients.

What some companies do, going to a cheaper route, is they don't use the full form of vitamin E. They use a synthetic form. One part is called D-Alpha Tocopherol. I've seen it written as Alpha-Tocopherol or DL-Alpha-Tocopherol, it can be written in different ways but it's usually the Alpha-Tocopherol one. That is 1 of 8 sub-parts of a full vitamin E. If you are seeing only that 1 of 8 sub-parts that D-Alpha-Tocopherol, that is a good clue that its ethyl ester.

That is also a good clue that the product may have with it a bleeding risk because you always hear about how they say, “Go off your Omegas before you have surgery. If you're on Plavix, Warfarin, Coumadin or if you're on a blood thinner, you can't be on an Omega-3.” That's not true. Nobody says, don't eat salmon because you're on Plavix. You can eat Omega-3s when you are on a blood thinner or when you have surgery.

What you can't do is take an Omega-3 supplement that is D-Alpha-Tocopherol because it is a blood thinner. It's the preservative. That’s the problem, not the actual Omega-3. It gets a little convoluted but if you turn the bottle over and take a look at what it says on the back, it'll tell you what vitamin E is in there. If it's a full form, vitamin E, you're fine. I pulled a bottle here and it said, “Natural mixed Tocopherols.” That means that it has that full mixture of food-based vitamin E. That's fine, no problem but when you see that D-Alpha-Tocopherol, that’s the synthetic one part thing that has the bleeding risk and you have to be more careful with that.

I know that there are at least a few other people out there who like that stuff because I get people telling me, “I didn't know that tiny little detail.” That's what Dr. Friedman's all about. Since hearing you speak and speaking to you personally, I've been more aware of this. I've been looking at the bottles I have at home.

Every time I pop into a drug store or wherever I'm flipping. There's a store here called London Drugs, which is like Walgreens. I turned over every bottle of Omega-3 and none of them said triglyceride. I was like, “Is there something else I'm missing or all of them are ethyl ester?” They were all at different prices and concentrates. Some were bad as far as the concentration, the ratios and whatnot.

I tell my patients, I'm like, “I get it. You've been taking Omega-3. I've been taking Omega-3 for years but now I realize that the one that I was taking was not the best.” A little while back, I switched anyways but now I'm more conscious of it. I'll tell patients like, “We sell this one here, whether you buy this one or not, next time you buy an Omega, look for this word. If you don't see that word, don't buy it.” It’s because they see me being as transparent as I can about it, they're more likely to buy it from me because they don't want to go through the effort of sifting through all the bottles. They end up buying from us and knowing that we have that better quality product.

I hate to use the cliché that you get what you pay for, I'll say in this particular instance, you do. There is a difference in quality. They're not all the same. If you have an asymptomatic patient, one of the things you can say is, “If you were taking the right Omega-3, you would not be as symptomatic as you are now or if it was working for you, I would not be seeing Meibum, Meibography or the dry eye look like this.”

Sometimes, depending on the study, it takes somewhere between 2 and 3 months to get a clinical effect from an Omega-3 fatty acid approach. Sometimes I'll even like, “Humor me, give me three months, take the good stuff for three months. Let's see what happens if you don't see a difference, I'm not going to argue with you anymore.” They always see a difference.

If I can get them to switch for three months, I know that they will experience the difference and be okay. We are skeptical by nature. There is a bigger price tag associated with the better Omega-3s. If the doctor is selling it in their office, people will naturally get a little bit more skeptical. The reality is that the proof is in the clinical studies and in the patients when they come back to your office. Doctors don't have any trouble talking to the patients about why a daily contact lens is better than a monthly, a yearly contact lens or why an anti-glare coating from company X is better than the cheapy $15 one that they get it online.

We don't have a problem saying that. Why do we have a problem explaining that nutriceutical A from Costco is not going to make a difference but nutriceutical B in a good quality form, dose and ratio will make a difference? We have to stop getting in our way. We don't have a problem prescribing TobraDex. Why do we have a problem prescribing an Omega-3 when it works as well and it's got as much clinical data?

Omega-3: Not all nutraceutical companies are created equal.

We do tend to get in our way when it comes to that. I was guilty of this for so long, too. A patient doesn't want to pay that much and you're afraid of bringing it up with them. Give them the information, knowledge, and then let them make the decision after that. On the note of prescribing, something that we started doing is I have these little prescription pad things that say on them, hot compress, artificial tears and Omega-3. I'll fill in the blanks with what brand or product specifically. I'll tear it off the little pad and hand it to the patient. I feel like that has a little bit of an effect on them psychologically of like, “This is something I need to do as a prescription,” and that’s been helpful to us.

In my office, I have this GI folder and it has a checkoff sheet at the beginning where it's like, “We're going to do this.” I also like it because they can see that there are other things. I may have given them, in your case, the checkoff pad. Maybe you gave them 2 or 3 checkoffs on that pad but there are 3 or 4 other things listed there that you did not check off for them.

Psychologically what that does is that they know that, “If I'm not feeling better in 3 months or 6 months, I don't need to go doctor shop and find another doctor. I sold this thing that he gave me and he wasn't giving me the full paraphernalia yet. There are more things we could do if I'm still having a problem. I'm going to go back and talk to him a little bit more.” It shows them that there's plenty we can do. We're going to start simple and then we'll build up if we have to but I'm not going to throw the kitchen sink at you if you don't need it yet.

I didn't think about that but that makes sense because we have a bunch of other stuff listed on there and I'm rarely ever checking all of this stuff off.

Reinforcing to them that, “This is our starting point. This is going to work on you.” There was a study that was done with a particular doctor out of Wills Eye. In his case, 70% of dry eye patients with the Omega-3 approach were asymptomatic after, in his case, it was an eight-week study. I have hard patients, though a lot of them have rheumatology conditions, co-morbidities and stuff.

I would say half of them are okay on the Omega-3 and an occasional artificial tear approach or the Omega-3 with maybe a breakthrough Lotemax here in there on a bad flare-up in a week or something. A lot of my patients are controlled well with the nutraceutical approach with some little bit of stuff with it but the other half are not.

I certainly am writing my share of Restasis, Xiidra and Cequa. I'm on Restasis personally, so I'm not anti these drugs at all. They work great. When the patient sees like, “This is where we're going to start,” I even say to them, “There are tons of things we can do with this to make you feel better and it took you many years to get to this point. It's going to take me a few months to figure out what the right cocktail is for you.”

“We're going to start simply because if I throw everything at you off the top. It's going to cost you a lot of money, rigmarole and maintenance. Maybe you only needed one thing. We're going to start with this. I'm going to see you back in three months. We'll see how you are.” If you're like the study, 70% of patients, were done but if you're like the 30 percenters, we're going to need to do more. Let's see where you are and then we'll go from there.

That's remarkable, even if it's 50%. That Omega-3 fixes that half of the people that are walking in the door is crazy. My staff was noticing that we were going through the Omega-3 a lot faster than we were. I'm hoping to see those people back and hoping to hear a lot of positive things. You alluded earlier that you spend less time clinically.

Now you do a lot of stuff outside of the clinic, whether it's speaking or PRN. For any young ODs or any ODs out there who may be looking for opportunities outside of the clinic and I feel like I hear that conversation is a lot more. There's a bit more of this entrepreneurial spirit floating around. I'd love if you could share any pointers, tips or whatever for somebody looking to do those types of things.

You have to learn to say yes to some of the opportunities that present themselves because you don't know where they will end up.

I don't remember those conversations taking place like in the early ‘90s when I got out of school. You were going to practice as an optometrist with patients and that other aspect I didn't hear as much about. Now certainly, that is a big part of what a lot of us as optometrists do as well. Patient care is critically important and we all love that. That's why we got into this but it doesn't mean that we can't have an entrepreneurial spirit and look into other aspects.

It comes down to a lot of the same old stuff that is true at any stage of life. It's a lot of networking. It's a lot of getting out there and getting to know people, attending the conferences, stopping by the boosts, introducing yourself, making sure that the products that you personally use regularly in your office, you're the best person to speak about those products. That's how I got involved with PRN.

I honestly did not set out to be doing what I'm doing now. I was fairly content to write out my life as the Co-Owner of a four-doctor optometric practice. I run the dry eye clinic. The office does well financially. I was happy and what happened is, in my case, the corporate world came calling to me. They came to me and they said, “You're going through a lot of Omega-3 fatty acids, more so than your colleagues are at a greater rate. What are you doing? What are you saying? Why is it successful in your office?” I honestly started with them being a consultant and teaching doctors is what I was doing.

Teaching doctors like, “This is what I say, and this is what I say if the patient comes back with this. This is why I think it works.” That led to me doing more speaking engagements for them and teaching their salesforce what I was doing and saying so that they could go out and say it to the doctors. That ultimately, led to me being a Director with the company and then a Vice President of the company. It was about a four-year process from somebody who is a lowly Account Manager in my office saying, “You use this. Do you mind if I give your name to my superior? We could go somewhere with this,” and then going up the ladder that way. I am on the speaker bureau for 3 or 4 different corporate entities now.

A lot of times, it starts at the local level. It starts with the local rep coming into your office and saying to them, “I'm impressed with your product. I've been happy with this product. If there's ever an opportunity where you want somebody to give a testimonial or to speak about this product, I'd be all in. I'm comfortable with this. I like it.” I've seen some of the colleagues in my office get speaking engagements and things like that from that.

Honestly, a lot of times, it's networking, being able and willing to put yourself out there and say, “I'm interested in doing this.” I was on the board for the advisory board for Women In Optometry Magazine for a while and it was the same thing. I met somebody at a conference, we got to talking and they were like, “Would you be interested in doing this?”

It builds slowly and organically over time. It's like anything else, don't be afraid of a little self-promotion. Don't be afraid of going out there needing but if you're sitting in your room taking virtual CE classes and I know COVID was different, as things get back into in-person meetings and such, that's where the connections are going to be made.

I do think that we lost a little bit of that colleague connection and that interpersonal relationship and networking when we did have to sit behind a screen and talk all the time. As things slowly open up and as your comfort level improves, getting out there and getting to know the reps and the Regional Directors is how you can move into other areas in optometry. How do you do it? I've seen you do it. You work in a room like nobody else.

That's taken practice. I don't know if I do it better than others but getting comfortable to go around and talk to people is something that takes practice but 100% agree with everything that you said and, in fact, similar to the answer that I give a lot of people, as well as the networking side of things and getting involved with the association.

I give a lot of the credit for opportunities that come my way. I started with me being involved in our provincial association, being part of committees, attending meetings the conferences and it is a little bit of schmoozing for lack of a better term. Something that I talk a lot about or I did up until a while ago was branding as being a personal brand.

Omega-3: You can eat Omega-3 when you are on a blood thinner or when you have surgery. What you can't do is take an Omega-3 supplement.

Everybody has their own brand, whether you think about it that way or not, whether you're a doctor who sits in the office, sees your patients, goes straight home and doesn't do anything else. Whatever your patients think of you, that's your brand. If you want to be the person who's out there speaking, you have to expand your brand to be something that the industry will recognize as something that they want to present to their customers.

When you're out there talking, think about who you are and why that company or whoever might want you to speak on their behalf, one of them is you sell a lot of their product. That's one thing that's going to get their attention but perhaps you have other qualities and you have to let them be known and like you said, “Never be afraid of a little self-promotion.”

You have to let people know that you're interested. Otherwise, they'll say, “That's a nice person who sells a lot of our product but they don't seem interested in speaking. I'm going to go to the next.” I did plant a lot of those little seeds as well. I continue to when I can and say, “If there's an opportunity, let me know.” I do a lot of the same things that you mentioned.

I underestimate the value of those getting involved with the state or the provincial association. The truth is, even long before I started utilizing PRN products in my office, became a big user of them and started working with account managers, that probably is what put me on the path towards alternate careers right out of school.

One of the problems that our profession has now is that, for whatever reason, a lot of optometric organizations have trouble getting new blood in. It can sometimes be perceived as a woman. It can sometimes be perceived as the good old boys’ club and it's hard to breakthrough or if it's not even a male-female thing, just an almost an age thing where as a younger doctor, feel like you're the only one in the room that doesn't quite fit in.

You do have to be confident, strong enough to work through that, get a seat at the table and show up. The truth is your local organization, state organization, provincial organization, national organization are all volunteers. They're no different than you and the only difference is that they agreed to show up at a meeting. They agreed when somebody said to them, “Would you be willing to come and attend this committee meeting?” They said, “Yes.” Granted, you're volunteering. It takes a lot.

I can tell you that the two years that I was President of the state organization, which would be equivalent to the provincial in Canada. I took an income hit. You're traveling all over the place. You are lecturing all the time and volunteering. You're flying, in our case, to the national organization in St. Louis. It is a dedication but, in the end, you end up being able to have incredible connections, incredible network of people that you know, and you can then move into some of these entrepreneurial and they don't even have to be corporate but all kinds of different areas. It's a short-term investment in your career and the future of your career that ultimately leads to a long-term personal investment in yourself, too. To me, it's the best of both worlds.

On a similar note that you alluded to it there again in your answer but when I have a successful woman on the show, I've had lots and amazing from different industries, athletes, Olympians. I liked to have them share their path and if there have been obstacles as a woman to get to where you are. If you're able to share some of your insights, perhaps for younger ODs or other professions who are trying to build their way up.

I'm hoping that it would be different for a younger female OD graduating now than it was back in 1991 when I graduated. Honestly, in ‘91, it wasn't that bad compared to maybe the women that graduated twenty years before me. I do think that we are seeing improvement in this area, which is positive. That being said, there were plenty of times I walked in the room where it was like, “When's the doctor coming in? or, are you the nurse? Could you send the doctor?” I have had patients refuse to see me because I was female but that was a long time ago. Now, there are more patients that will refuse to see my male colleagues because they want the female. I do think at this point, it can go both ways but there were times where it would come up.

We all need to learn to tune in to that inner voice, that gut instinct, because it generally won't lead you wrong.

I was the first female President of the New Jersey Society. At the time, that was like a big deal. Now, there's been 5, 6 or 7 since me. It's not that big of a deal anymore. We've seen change there. That being said, it will still happen at times. We need to understand that when a certain demographic has dominated a profession for a long time, change comes but it takes a little time. You will still bump up against that occasional person who hasn't kept up with the time, so to speak.

I've been fortunate that I've surrounded myself with both strong men and women that have been inclusive, that have invited me to the table. On those few times, you have to think of it as feeling more sorry for that person that thinks that way because they're shutting themselves out of 50% of the great people in the profession.

That takes strength, courage, and confidence to think that way versus the other way of potentially shutting down and thinking that person has taken this opportunity away from me. That's a lot of credit to you and other women who do continue to work through that. Huge kudos to you for being the first woman President of the New Jersey Society. That's incredible. You paved the path for all the women that came after you.

I really enjoyed it. Going back to networking and things like that, the way that happened was when I was in college. I was working for the NJSOP as an intern. I’ve got to know them, and then when I got out of optometry school, I started volunteering for committees. A lot of this stuff starts a long time ago and they start in these little subtle ways that you don't realize are going to balloon into something else down the road. You have to learn to say yes to some of the opportunities that present themselves because you don't know where they're going to end up. Being willing to walk through those doors that open, that's a lot of it.

If anybody is following me on social media and show, I love philosophy, quotes and things like that. One of my absolute favorite quotes is a long one but the core of it is, “Being bold and moving forward is the key to everything because once you do that, you don't realize what all these other opportunities may present themselves and they may be acting on this one thing that's right in front of your face but once you take that step, all of a sudden, there's a bunch of stuff behind that door that you didn't even know existed.” I've had that personal experience many times. I always encourage people to do that.

The flip of it is as a woman and as a man, you also have to know when to say no because now my problem is I'm over-scheduled. You have to take the opportunities as they present themselves. I'm a yoga teacher. In my yoga world, I do believe that our gut instinct, that internal awareness that we all have, that we tend to shut off and go, “That's a crazy thought. That's a coincidence.” We all need to learn to tune in to that inner voice and inner gut instinct because it generally won't lead you wrong.

If your gut instinct is, “I would love to do this, but…” If you would love to do it, go do it. If your gut instinct is, “Something feels wrong about this,” then don't do it. Don't allow yourself to be put in a position that you're not comfortable with and allow yourself the honor that grants yourself the potential for joy and opportunities by taking them when they come and tell that inner voice to shut up if it's telling you, “You can't do it.” Listen to your gut instinct. You probably can.

The fact that you are also a yoga instructor on top of everything else you do, that's pretty cool. Dr. Friedman, we're getting closer to wrapping up here and I always ask two questions of all my guests at the end of the show. I want to close to you now. The first one is if we could hop in a time machine and head back in time to a point where it was a difficult time for you, feel free to share that moment if you'd like but more importantly, what advice would you give yourself at that time?

The first thing that popped in my head, that's the one I got to go with. I'm not going to censor it. In 2014, I had Legionnaires' disease. I was sick. I was out of work for about six months and I got to this point where I was too sick to work but I was not so sick that I was lying in bed, half unconscious and not knowing what was going on. I was bored out of my freaking mind and I was depressed. It was bad because I was sick, I couldn't do anything and I felt useless.

That's when I created my dry eye clinic because I was sitting in bed, I could not work, my brain was awake but the rest of my body was not awake. I started conceiving of everything. You would do with what you do. I created the logo and look. I figured out the scheduling protocol. What equipment I was going to buy right away. That six months break from life allowed me to decide what my next reinvention was going to be.

Omega-3: Some studies have shown that Omega-3 doesn't work, while some show that Omega-3 works like the best thing since sliced bread. They can be a little confusing because there are inconsistent results.

It allowed me to create the dry eye clinic at Moorestown Eye, which then allowed me to start to utilize products that I had not done before, then introduced me to PRN, to consulting, to my full-time job now and I love it. That was a low point in life. I was sick and scared. It ended up giving me a break from my previous normal day-to-day to create what is now a better life.

The final question that I'd like to ask you then is everything that you've accomplished to this point in your life, how much of it would you say is due to luck and how much is due to hard work?

We create our own luck. We're all given opportunities and we choose whether to take them or not take them. Sometimes, luck and happiness are not things that are necessarily granted to you by the universe. Those are things that we create internally. We can draw luck and happiness to us. Those are decisions that we make and we tend to unempower ourselves to think that these things are either granted to us or not granted to us. There's some grand wisdom out there that, “I'm going to give you luck now and I'm not going to give you luck now. I'm going to grant you happiness now or I'm not.”

Luck and happiness are something that comes from the inside out. It's something that we create for each other and ourselves. How much was luck and how much was work? I think that it was life. I don't know that it necessarily worked. It's attitude and what you believe. It's how you understand how life works. I'm getting very yoga now, forgive me. It has more to do with what you create for yourself. I don't consider that work. The answer is it's not luck. It's work but It's not really work.

I asked the question in that polar way. There's one or the other but I love when guests go off the board and give that feedback. I love the yogic philosophical angle. That resonates with me, too. Thank you for that thoughtful answer. I appreciate it. That's everything for this episode. I do have a bunch of other questions for you but we're going to have to save them for another time. Thank you for taking the time because I know you're busy. There's a couple of more questions. One is where can people find you?

If you have any questions about anything, the easiest thing to do would probably be to shoot me an email. It's KFriedman@PRNOmegaHealth.com or you can even go to PRN Omega Health and click on the Contact. It'll eventually get to me after it goes to them. That's the easiest way probably or you can even do it on my website for my office. Feel free to steal stuff from my website. Not that it's the best thing in the world but feel free to look at the dry eye clinic stuff on my website. That's MoorestownEye.com. You can click on that and that will get to me too, whatever works best.

Any final words of wisdom that you'd like to impart before we wrap up?

Thank you for your time. For those who are reading that work in optometry, you are in one of the best professions in the world. Do not let the naysayers get to you. Don't let them in. People create their happiness. Some people are happy when they're complaining. Don't worry about that. I have had such an incredible life as a result of the profession that I chose for myself.

Omega-3: As things slowly open up and as your comfort level improves, getting out there and getting to know the reps and the regional directors is how you can move into other areas in optometry.

I would choose it again any moment of the day, anytime. There are many opportunities within this profession for how you would like to practice. Enjoy and explore them all. You don't have to define yourself as one way. Get rid of a little box of the definition of who you are and take the opportunity to explore all the possibilities in optometry. It's a great place.

That means a lot coming from the Founder and the Creator of the dry eye clinic, who speaks, lectures, and is also a yoga instructor. That's your living proof, that can be done and we don't need to put ourselves in a little box. Thank you so much, Dr. Friedman. Thank you, everybody, who's reading. I'm sure there was much great value that you could take away from what Dr. Friedman shared now.

If you did find some value, please do share it, take a screenshot, throw it up on Instagram, wherever you like. Hit like, review, comment and all the good stuff. I always forget what you're supposed to do to fit anything that seems a positive thing to help the show grow. I appreciate it. Thank you all so much. I'll be back with another episode.

Important Links

• Moorestown Eye Associates

• Physician Recommended Nutriceuticals

• Safety of Lifitegrast Ophthalmic Solution 5.0% in Patients With Dry Eye Disease

• KFriedman@PRNOmegaHealth.com

• Instagram – About My Eyes

About Dr. Kimberly Friedman

Dr. Kimberly Kester Friedman is one of the founders of Moorestown Eye Associates (est 1992) and the Director of our Dry Eye Clinic. Highlights of her resume include:

• Diplomate of the American Board of Optometry

• Salutatorian of her doctoral class

• Fellow of the American Academy of Optometry

• Multiple television appearances discussing eye care topics. Her television appearances can be seen on our YouTube channel - Moorestown Eye YouTube Channel

  • Rachael Ray Show

  • NBC 10!

  • Fox's Good Day!

  • Cn8's Your Morning

  • Comcast Newsmakers

• Multiple print articles

  • Philadelphia Inquirer, Courier Post, Newark Star Ledger, Asbury Park Press, Burlington County Times

  • Multiple Eye Care Related Journals

• Educates doctors, staff and patients throughout the nation and recently presented lectures at the National American Optometric Association Annual Congress.

• New Jersey Society of Optometric Physicians' President's Award for serving as the first female president

• "Top Docs for Kids" by NJ Family Magazine

• "Top 40 under 40" professionals in the eye care field

• "People's First Award" for the northeastern region of the United States awarded to a doctor who demonstrates excellence in both eye care and community service

• The National Special Olympics Leadership Award

• New Jersey OD of the Year Award, the Young OD of the Year Award, the Special Purpose Award, the Chairperson of the Year Award and the Communication Award

Outside of the office, Dr. Friedman is currently a clinical director for the Special Olympics Lions Club International Opening Eyes Program. Dr. Friedman also works as a part-time instructor for anatomy and physiology and is a certified yoga teacher.

Dr. Friedman currently splits her time between patient care at Moorestown Eye and teaching other eye doctors throughout the country about new products and pharmaceuticals in eye care.  She sees patients in-office Mondays and Fridays, and also offers telehealth appointments on select days.

Episode 56 - Strategies for negotiations and building partnerships with Simon Robert

Listen to the podcast here

Simon Robert is the Senior Director of Group Mission and Public Affairs at Essilor Canada. He leads the charge in Essilor's mission of improving lives by improving sight.

With almost 20 years of experience in the world of corporate social responsibility, Simon has mastered the art of building partnerships, "winning" negotiations, and finding creative ways to achieve big goals.

Connect with Simon:

https://www.linkedin.com/in/simonrobert/

You can also find this episode on Apple Podcasts, Spotify, and YouTube.

Episode 55 - Eye2Eye: Enough Water In The Jug

Listen to the podcast here

Hot off the heels of the BC Doctors of Optometry conference this weekend, I am energized and excited to share what I think was the most important take away of the weekend for me: abundance.

In this episode I discuss how believing that there is enough water in jug to fill all our cups (having an abundance mindset) is important to individual success and the success of the profession as a whole. No matter what profession you’re in.

Also, how to deal with those around us who do not have this outlook.

Follow me on the following channels for more content:

instagram.com/harbirsian.od

youtube.com/harbirsian

linkedin.com/in/harbirsianod

facebook.com/harbirsianod

Episode 54 - Eye2Eye: The Next Right Thing

Listen to the podcast here

At some point or another, we will all face some hard times. Whether its studying for big exams, career-related decisions, or personal challenges.

In this installment of Eye2Eye, I share some thoughts into how we can get through the most overwhelming moments in our lives. The secret happens to lie in a Disney song.

Watch the full episode at YouTube.com/HarbirSianOD

Connect with Harbir - Instagram.com/harbirsian.od

Angus Reid podcast - http://www.aboutmyeyes.com/podcast/2019/11/19/episode-6-angus-reid-discusses-how-learning-to-succeed-as-a-pro-football-player

Amy Cuddy Ted Talk - https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en

Episode 53 - Let’s get Down To Business with Dr. Solomon Gould

Listen to the podcast here

Dr. Solomon Gould is a professional speaker, practice management consultant, and owner of two private practices in the Twin Cities area. He also happens to have an MBA in Healthcare Administration.

In this episode, we chat about foundational business concepts that will be relevant to business owners, associates, and staff.

Learn more about the MBA In A Day seminar happening on September 12: https://www.aoece.com/webinars

Connect with Dr. Gould:

Email - DrGould2020@gmail.com

Social - @drgould2020