Global Perspectives with Behrad Garmsiri

TELL US ABOUT YOUR BACKGROUND.

I was born in the city of Shiraz, Iran. During my early childhood, we lived in a subtropical part of the country. I was often encouraged to explore the local areas that were filled with a large variety of plants, small creatures, and sea life. It is likely where I found my love of biology. When I was 8 years old, my family and I emigrated to Canada, specifically southern Ontario, where I found an entirely new environment and, more importantly, was taught the scientific method for asking questions about that environment. I gravitated towards science, and eventually towards science fiction.

When I was in high school, I read a book with a character who had working prosthetic eyes. The notion of technology fitting in the place of biology was a concept that grabbed my attention and never let go. By the time I was in University, I knew that I would pursue a career in vision science. To that effect, I pursued a master’s degree in visual neuroscience. After working for various organizations and being involved in different types of research, I realized that being in the clinic and interacting with patients is what makes me most happy. In 2019, I enrolled at the State University of New York (SUNY) College of Optometry in New York City (Figure 1).

WHAT ARE YOU DOING CURRENTLY?

I am in my fourth year of a joint OD/MS program at SUNY. I am rotating through a series of externship sites throughout New York and concurrently collecting data for the completion of my MS degree.

WHY DID YOU CHOOSE TO ATTEND OPTOMETRY SCHOOL IN THE STATES?

There are only two schools of optometry in all of Canada. The University of Montreal offers its program in French only and accepts approximately 50 students each year. The University of Waterloo offers its program in English and limits its class size to 90 students each year. Among the Canadian population of 38 million, about 300 individuals apply to The School of Optometry and Vision Science at the University of Waterloo, annually.

As a student who wished to enroll in an accredited optometry school, I maximized my chances by applying to the University of Waterloo and a handful of American schools. Thankfully, Waterloo accepts applications through the Optometry Centralized Application Services (OptomCAS), and I was able to submit all of my applications through the OptomCAS portal, which streamlined the process of applying to American schools as well as Waterloo. SUNY offered me a position with a scholarship. Once I was accepted to SUNY, I had to secure a student visa for the privilege of studying in the United States. Obtaining a student visa can be a tedious process. Although it was not difficult, I did find that this process required a significant amount of time and effort.

WHAT ARE YOUR PLANS FOR AFTER GRADUATION?

I know that my career path will eventually return me home to Canada, but in the meantime, I plan to follow opportunity. My 5-year plan is to complete a residency and work as a clinical professor. Although academic positions are far more abundant in the United States, I will also be applying to positions at the University of Waterloo.

CAN YOU TELL US ABOUT THE STATE OF HEALTH CARE IN CANADA?

Canada boasts provincially run universal health insurance plans (HIPs). There is little that provincial HIPs will not cover. When it comes to eye care, most provincial HIPs will cover an eye exam for anyone 18 years of age and younger, or 65 years of age and older.

The provincial HIP will not cover routine eye exams for patients between 19 and 64 years of age unless an eye exam is medically required. Examples of this include individuals with ocular disease, ocular trauma, systemic diseases with ocular risk (such as diabetes), or those taking medications associated with significant ocular risk. For patients younger than 19 or older than 64 years of age, and those who meet the medically required criteria, all exams, diagnostic tests, and procedures are covered without any cost to them. Universal HIPs are funded by the government and do not require the patient to pay any co-pays or deductibles, which reduces the barriers for individuals to gain access to eye care. The major barrier to access to care is the lack of doctors, especially in more rural areas.

WHAT IS THE SCOPE OF PRACTICE FOR CANADIAN OPTOMETRISTS?

This varies for each province, much like it does between states here in America. Although some provinces have allowed the prescribing of oral medications for some years, Canadian optometrists do not yet have laser procedure privileges. The scope of practice in my home province of Ontario is similar to my current resident state of New York. I expect that the scope of practice will increase, as it has in some states here. I look forward to being able to advocate for those rights soon.

ARE THERE ANY PARTICULAR AREAS OF EYE CARE THAT INTEREST YOU MOST?

While completing my OD degree, I am also working toward a master’s degree in vision science. My current project is related to using electroretinography in the diagnosis of optic nerve head diseases. I’ve been involved in vision science since 2010. I often think about the sci-fi story that led me to vision sciences, and I expect research will always be an aspect of my career in some way.

I am a Student Fellow of the American Academy of Optometry (Figure 2), and I plan on becoming a full Fellow after I graduate. I also plan to complete a residency in ocular disease.

DO YOU HAVE ANY SPECIFIC PROFESSIONAL GOALS LONG-TERM?

I believe Canada would benefit from opening another school of optometry, and I want to be involved in this. Schools of optometry in Canada, however, cannot rely on attracting a patient base the same way that an American school does. The education system in America uses the health care system to provide students with the opportunity to learn, whereas universal health care in Canada largely eliminates this kind of relationship between patient care and academia. To increase the quality of clinical interaction between student doctors and patients, Canadian schools shift the balance towards didactic learning over immersive practical training. To be clear, Canadian schools still train their student doctors in the clinic, but they do so much later in the student’s career. Therefore, there is a puzzle of how to establish a new Canadian school that emphasizes the apprenticeship–style learning, which is often employed early on in American schools. I find this to be an interesting and worthwhile puzzle to solve, and I am always looking for the opportunity to contribute to a solution.

SHARE SOMETHING FROM YOUR BUCKET LIST WITH US.

At the risk of sounding cliché, living in New York City was on my bucket list! I’ve been incredibly lucky to be able to pursue two of my life goals while being enrolled at SUNY College of Optometry in NYC. Building a small greenhouse remains on my list. Having a microcosm of the natural world and taking care of it has always appealed to me.