As members of the community of health care providers, optometrists are educated and trained to protect their patients’ health, guide them in making decisions related to their care, and ensure that they end up with the best possible outcomes. Over years of practice, it’s common for optometrists to find ways to streamline their efforts, foster better patient relationships, improve practice culture, and gather other tips and pearls from their experiences and from their colleagues.

Modern Optometry asked members of its editorial advisory board and contributors to the publication to share the best tips they’ve learned over the past year. The pearls they contributed relate to life in general, clinical matters, patient care, and practice management. We hope you find these to be of value in your own life and practice.

GENERAL

There’s an episode of the podcast The Tim Ferriss Show (bit.ly/Ferriss322) in which he interviews educator, author, and US Chess Federation life master Adam Robinson about outsmarting the competition that really speaks to me. In fact, I share one specific section of the episode transcript with our graduating residents. In it, Robinson advises students entering the real world to “adopt an experimental attitude towards everything, continually testing what works for you and what doesn’t.” He also suggests that, rather than asking yourself what you want to do, ask who you want to be, and advises that, whatever you do for work, “throw yourself into it wholeheartedly, even if you realize it’s a transitional gig while you search for something better.”

Other words of wisdom Robinson shares in this episode include his advice to have patience, to be unrelentingly enthusiastic in all matters, and to figure out what you love to do and what you do best and then cultivate those talents.

Josh Johnston, OD, FAAO
Atlanta, Georgia


Staying engaged with my profession while working full time, lecturing, attending conferences, and raising a 1-year-old daughter is hard, but not impossible. Through my experiences, I hope my daughter will one day learn that a work-life balance is achievable, especially with the right plan in place.

Maria Pribis, OD
Stamford, Connecticut


I’ve worked in eye care for a little more than 20 years. This past year, my oldest daughter graduated from the Southern College of Optometry, my alma mater, before getting married and moving away to continue her professional education. My youngest is a senior in high school. I am now realizing what lifetime learning really means. It is one thing to keep up with emerging trends in treatments and new technologies, but it is another to change from being a parent to being a colleague—an entirely different situation, as my wife and I prepare to live in an empty nest. There is a lot of talk about work-life balance, with criticism of those who want to be focused on their home or family and equal criticism of those dedicated to their professional lives. One pearl of wisdom I’ve gained in this past year is to make sure you can look back with no regrets by working just as hard at balancing your life as you did learning in school or caring for your children. No one will do it perfectly the whole time, so be sure to enjoy the ride, both personally and professionally.

Kristopher A. May, OD, FAAO
Coldwater, Mississippi


CLINICAL

I recently saw a patient with several risk factors for glaucoma but no measurable glaucomatous damage, and I told him that he was a glaucoma suspect. The ambiguity of the word “suspect,” when paired with a potentially vision-destroying disease, did not sit well with him. I now discuss the evaluation of potential glaucoma as “looking to see if you are on a trajectory toward optic nerve damage.” This wording allows me to create enough urgency with the patient to ensure adherence to additional follow-up testing without getting tangled up in ambiguous terminology.”

Leanne Liddicoat, OD, FCOVD
Roseville, California


When dealing with complex disease processes, it’s easy to get overwhelmed by the clinical picture. Take in small details: the size and shape of an epithelial defect, the eyelid laxity causing exposure, the spontaneous venous pulse in a patient with crowded nerves, for example. In forming your differential diagnoses, remember that pertinent negatives are just as important as what you do see. For example, when dealing with a corneal process, noting a lack of infiltrate or absent perineuritis can aid in diagnosis as much as describing the presence of anterior chamber cell or infiltrate.

Alison Bozung, OD, FAAO
Miami, Florida


Nerve growth factor treatment can play an important role in reestablishing a healthy interaction between the corneal nerves and the corneal epithelium. Work with nerve growth factor for the treatment of neurotrophic keratopathy is exciting and just might have significant implications in the treatment of moderate to severe ocular surface disease.

Ahmad M. Fahmy, OD, FAAO, Dipl ABO
Minneapolis, Minnesota


A tip I learned from Rachael Canania, OD, via Instagram, is always to remember to use lissamine green or rose bengal when examining conjunctival lesions. Doing so can help you to differentiate between a benign lesion and a malignant lesion.

Maria Pribis, OD


PATIENT CARE

Put your phone away during examination time. Don’t text and drive, and don’t text and practice.

Joshua Davidson, OD, FAAO
Baton Rouge, Louisiana


It is important to consult patients when determining which refractive option best fits their specific daily living and hobbies by asking detailed questions. Before assuming a one-size-fits-all final prescription, I find it necessary to spend that extra bit of time discussing working distances and educating patients why certain upgrades, such as an anti-reflective coating or even a multifocal lens implant, could be beneficial for their individual goals.

C. Jade Coats, OD
Fayetteville, Arkansas


This spring my mother decided to have cataract surgery. She does not live nearby, so we arranged for her to stay with me to have her preoperative evaluation, both surgeries, and postoperative visits. As I went through my routine of giving informed consent, discussing the risks and benefits of surgery, and doing a dilated exam, I found myself acutely aware of every word I was saying and exactly how I was saying it. I was suddenly looking at my actions as a clinician through the eyes of my mother, the patient.

I always knew that I would have her travel to my office for her surgeries because I wanted to ensure that she had access to the same technologies all of my patients enjoy, including the femtosecond laser, a choice of advanced technology IOLs, and cataract surgery without a topical drop regimen. I didn’t anticipate how the experience would make me reflect on every little thing I normally do in the office on a daily basis. Since that experience, I find that I’m thinking more about how patients hear, interpret, and react to my actions and discussions. I’m also very cognizant of trying to raise my game to be a more conscientious and understanding clinician. Every patient deserves to be treated by a doctor to whom we would send our own mothers.

Robert S. Stutman, OD, MBA
Towson, Maryland


A pearl I learned a while back but continue to follow is to write a little piece of information about each patient or about the conversation you had with him or her in the chart so that the next time you see the patient you can continue the conversation and connect deeper rather than engage in small talk.

Keylee Brown, OD
Blairsville, Georgia


Walk into each exam room with a smile and try your hardest to get the patient to smile back.

Joshua Davidson, OD, FAAO


Recently, there has been a shift toward a better appreciation of the role that ODs play in their patients’ surgical care. Whether it is decision-making for IOLs, surgical management of glaucoma, or performance of laser procedures, there is renewed emphasis on the important role that primary eye care has in the success of surgical eye care. No matter the practice setting or geography, patients turn to their optometrist as their trusted adviser to guide them through surgical processes, beginning with early education and continuing through ongoing care for years after a procedure. The onus is upon us to make sure we are prepared to provide care and support by staying abreast of technology shifts, educating ourselves on current and emerging trends, and being able to help each patient navigate the decision process for optimal outcomes.

Kristopher A. May, OD, FAAO


PRACTICE MANAGEMENT

I’ve devoted more time to helping my team (ie, anyone involved in caring for our patients) become more clinically knowledgeable on the basics of the most common conditions we treat. When team members have a better understanding of the procedures and medications we use, patients are more likely to have better treatment outcomes. Spreading this information among as many team members as possible also alleviates multiple potential pain points. It takes significant time and effort on the front end, but it’s totally worth it.

Ahmad M. Fahmy, OD, FAAO, Dipl Abo


While lecturing at a New Hampshire Optometric Association meeting, I learned the importance of incorporating a plan when implementing new technology. In discussion during a dry eye lecture, it came up that most doctors purchase new equipment but don’t train their staff on how to work it into patient flow. I took this to heart when purchasing my own thermal pulsation device and created a game plan with my staff. When the system is fully up and running at the beginning of 2020, my staff will be prepared and ready to go.

Maria Pribis, OD


Invest in useful technology. In 2019, our office got a wide-angle fundus camera, and I quickly added it to my “I don’t want to practice without it” list. I love it for documenting and tracking pathology. It’s so nice to see a good portion of the retina all at one glance versus in pieces during the silt-lamp examination or binocular indirect ophthalmoscopy.

Keylee Brown, OD


Have a Great Tip of Your Own That Could Benefit Your Colleagues? Send it to us via email at modernod@bmctoday.com and we’ll share it on social media!