In September 2017, a report was published in OSLI Retina of a 77 year old woman blinded after receiving stem cell injections in both her eyes to treat macular degeneration. Despite years of treatment for wet macular degeneration, this patient's vision was limited to 20/400 in the right eye and 20/200 in the left eye due to the severity of her disease. She reached out to a clinic in Georgia that reported doing new stem cell treatments for macular degeneration, where she thought she was enrolling in a clinical study. She paid $8,900 for the treatment, money she raised on a crowd funding website. On the day of treatment she was injected with stem cells in both eyes. A little over a month later she presented back to her usual doctors at the Florida Retina Institute with retinal detachment in the left eye, and then another 2 months later the right eye also detached. Despite multiple surgeries to try to repair the tissue, she suffered devastating vision loss. Her sight is now reduced to hand motion in the right eye and no light perception (unable to see anything at all - just total darkness) in the left eye, and she is no longer able to walk on her own.

What's even worse?  This has happened before.  In March, major news networks picked up the report of 3 women blinded after similar stem cell injections in Florida published in the New England Journal of Medicine.  Like the Georgia case, these women had macular degeneration, had paid $5000 to be treated, were injected in both eyes on the same day, and thought they were participating in a clinical trial. In this instance, the study center in question was actually listed on ClinicalTrials.gov, but the National Health Institute released a statement after this report that the Clinical Trials website is open to anyone in the medical community to post a study, and the listing of a study center is not an endorsement that the FDA is supervising or involved in the study.  Since that time the rules for posting a study have been updated.

With over 570 clinics advertising stem cell treatments directly to patients online, the lack of oversight by the FDA and the confusion that exists as to the safety of these treatments poses a major risk.  How can you spot a potentially dangerous treatment?

• Are you being asked to pay out of pocket?  Federally funded clinical trials will not require you to pay to participate!  Paying thousands of dollars out of pocket is a red flag that you are not in fact participating in a clinical trial.
• Are you receiving treatment at an accredited ocular treatment center? The safest place to have any experimental treatment is at a center known for participating in clinical trials. Especially for ocular treatments where the risk is so great, make sure that you are being seen by an eye doctor specifically.  If something were to go wrong, like retinal detachment, you'll need to be in a facility that is equipped to take you immediately into ocular surgery. Ask if there is an ocular surgeon on site to treat complications like retinal detachment if you are at a private facility and aren't sure.  If the answer is no, it is a big red flag. 
• Are you being treated in both eyes at the same time? Never, never, never should an experimental procedure be conducted on both eyes at once.  Only the worst seeing eye should be treated in a clinical study of a high risk treatment, and that eye should be observed for improvements or complications for a period of months before treating the other eye would be considered.
• Is the treatment specifically approved by the FDA or under a clinical investigation that has been approved by the FDA?  Stem cell therapy is regulated by the FDA, so require that you see paperwork confirming you are in a FDA regulated and approved clinical trial.  You can learn more about how to spot a scam on the FDA's website.

In March 2017, a study out of Japan reported a man received the first of its kind stem cell transplant treatment for macular degeneration. One year after treatment his vision is stable with no improvement or worsening from baseline. via

Yellow tinted lenses have an overt color skew to everything you see, which was less effective in improving visual performance for patients with vision loss in this study. via

Newer to the market is lash perming, a procedure that focuses on enhancing the look of your own lashes.  Dubbed Lash Lift, these procedures promise to be a more natural approach to bolder looking lashes for people who want to lay off daily eyelash curling and heavy mascara or false lashes. The process uses no long term glue holding in fake lashes, and can enhance lash appearance without the need for irritating lengthening serums or mascara.  The person's own eyelashes instead are permed so that they curl dramatically upwards; one treatment can last 6-8 weeks. The beauty world has been abuzz with dramatic before and after images, with features on daytime TV, magazines, and a huge push from beauty bloggers sharing their results. 

But is Lash Lift really safer than other options for lash enhancements on the market? Like most cosmetic products and procedures, there are significant possible dangerous side effects to the delicate surface of the eye.  The process of an eyelash perm itself has several potential hazards, and would need a very careful and well trained aesthetician performing the procedure to prevent the risk of chemical injury to the eye.  

First, protective pads are glued to the top and bottom surface of the eyelid in an effort to shield the eyelid skin from unneccessary exposure to the perming chemicals. If the glue were to come in contact with the waterline or surface of the eye, it could cause major irritation.  Some skin types may also be at risk of having an allergic reaction to the glue, so the skin should be tested before the procedure on the arm to rule this out.

A silicone curler is then glued to the top eyelid, and the eyelashes are then curled up over the curler pad and glued to stay in place.  Then a chemical perming solution is combed through the eyelashes to break down the keratin shaft and encourage the hair to bend to the shape of the curler. Different companies will use different perming solutions, but the main ingredient is ammonium.  Because the beauty industry is not regulated in the same way as the medical industry, companies do not have to share what ingredients and what percentages of these ingredients are used in the procedure. We do know from multiple studies of preservative BAK (benzalkonium chloride) that even low amounts of ammonium is toxic to the cornea and conjunctiva (white of the eye).

To avoid the potential risks, Lash Lift providers have extensive FAQs warning about the dangers of the process to the surface of the eye.  You must remove contact lenses before the procedure, and those that have had ocular surgeries, including blepharoplasty (eyelid lifts) and LASIK must wait at minimum 6-12 months before having the procedure done. Aestheticians warn that Lash Lift should NOT be performed if a person has a history of eye allergies, eye infections, styes, sensitive eyes, watery eyes, or chronic dry eye.  

Are these warnings enough, however when only 8 million of the estimated 25-30 million Americans with chronic dry eye have actually been clinically diagnosed with the disease?  How many women or men pursuing this procedure would have consulted with an eye doctor first to have the opportunity to even be diagnosed with dry eye syndrome?  Because the cosmetic industry is not regulated under the FDA with the same guidelines as the medical industry, this is where the system really breaks down. 

Like all options available on the market for lash enhancement, lash perms come with inherent risks for the ocular surface.  Some people might have severe reactions from lash growth serums but do great with lash perms like beauty blogger Kate of The Small Things Blog.  Others might have recalcitrant dry eye side effects from Lash Lift procedures like Kelly from No Thanks to Cake.  There is no completely safe way to manipulate the ocular surface with chemicals, whether they be from serums, perms, or glues.  Knowing the risks and the dangers before the procedure, and getting routine eyecare to ensure that you aren't at risk before pursuing these cosmetic enhancements is the key!

“Thank you, are you inviting my (husband/boyfriend) too?” and then laugh good-naturedly and reassuringly that it’s not that awkward that just happened, even though it is.

Ok maybe you don’t have a boyfriend or husband, but I think this answer is less awkward than other possible answers, and your patient doesn’t need to know that you are single.  I’ve tried out “It’s company policy we can’t date patients” but that’s really strange to say, and makes the patient think maybe you’d be interested if you could get around company policy. You don’t want to encourage them in any way.

Sometimes you have to use more than just humor though.  I can think of one situation where I had to tell a patient they were being inappropriate and just let things get awkward. I was doing direct ophthalmoscopy (by the way this was the last time I did that on an adult now that I think about it!) and of course you have to get really close to your patient to see anything. The patient started laughing, so when I was done I asked what was funny. My mistake!! He replied, “I was just thinking when you were so close, what would you do if I just turned around and kissed you.”

I think my eyebrows shot into my hairline. I don’t really remember thinking but I just said, “Well I’m glad you didn’t. I would have probably hit you with this piece of equipment and it’s pretty heavy.”

We finished the exam pretty quickly from there. I don’t encourage threatening to hit your patients with ophthalmic devices, but it did straighten him up pretty fast.

Direct Ophthalmoscope, ocular assessment tool and an OD's Maglite in case of emergency.

Want to read more awkward new grad scenarios and real world advice? Check out all the topics Jane, Jackie, and I discussed about dealing with the daily challenges of being a young female OD in her blog posts here and here.

Luckily there are a number of optometry entrepreneurs that are excelling at just that.  Look around at the brands that are so ubiquitous in our daily lives: Starbucks, Apple, Amazon - their names conjure up a clear visual and emotional idea.  We understand who, what, and why they are.  Locally I'm sure you can think of stores, restaurants, and bars that are doing a great job branding themselves too - places that have created a clear identity and are go-to venues for their offerings in your community. Optometry, and healthcare for that matter, are no different in how we operate.  We have the luxury of having one of the few medical careers where private, independently own businesses still flourish. But a key to small business ownership in 2017 is creating a brand that is the big idea.  A brand that speaks to your local community and brings them in - that connects with them visually and emotionally to make you the go to source in eyecare and optical. Shopping small is an American movement; 90% of American consumers report shopping at a small business (under 500 employees) at least once a week.  How can you become part of your local shop small movement?

When you think of the biggest independent, privately owned brands in optometry a few names come immediately to mind.  Dr. Tanya Gill's practice, Oakland Vision Center is sure to top your list. Honored as America's Finest Optical Retailer in 2015, her practice has a booming social media following (nearly 10,000 followers on Instagram), and has rewritten the book on what a trunk show should look like. Earlier this year she teamed up with OD social media phenom Dr. Arian Fartash (aka GlamOptometrist) whose 15k and growing Instagram movement has been championing eyecare and optometry as both a career and a go-to profession for fashion as well as healthcare.  Together this dynamic duo has teamed up on a new project to bring social media prowess to optometrists so they too can better connect and inspire their communities to have a passion for independent eyecare and eyewear. 

The Eye Doctors was formed by Drs. Gill and Fartash as a platform and workshop to help ODs better find their brand identity and learn the basics to successful social media management. "We decided it was important to help other ECPs to take control of their social media accounts to help grow their business, because with the right tools and guidance, it really isn’t that hard," says Fartash.

As a lecturer and columnist about social media management in optometry myself, and cofounder of Defocus Media which offers social media services for private practice ODs that are seeking professional help, I see many of the same pitfalls Dr. Fartash cites when helping other ODs get started on Facebook and Instagram. Red eyes, stock photos, and generic bulk posting service offerings have a very difficult time attracting the average patient to want to stop scrolling and click over to your page. Just having content isn't nearly enough - you have to have content that makes people want to stop and look.

Dr. Fartash also suggests skipping the overused equipment shots. "I think the most common mistake is to post pictures of what the office has to offer in terms of equipment.  You see a lot of optometry pages post pictures of phoropters, slit lamps, etc…. Instead, ECPs should post happy patients and awesome glasses!"  Personal photos with recognizable faces: your patients (with permission), your staff and yourself always connect best!

Creating a successful brand story, designing and editing visuals to improve patient engagement - these are all essentials to private practice ownership.  And the returns are impressive: Drs. Gill and Fartash site that the patients brought to their practice from social media tend to be more private pay instead of insurance, and the average sale is $750 per patient encounter, compared to an average of around $300 per exam for an average patient seen by most practices.

Feeling motivated?  Dr. Gill and Dr. Fartash will be hosting the inaugural TheEyeDoctors social media workshop on August 19th and 20th at Oakland Vision Center in Oakland, CA. Head to their website for all the details!

If you are wanting to read up on social media basics and advice for ODs in your free time, you can check out my articles with Dr. Darryl Glover in INVISION Magazine every month (subscription is free!). And I'll be presenting an Introduction to Social Media for Optometrists in Memphis, TN on Saturday, September 16th during the Southern College of Optometry's 2017 Homecoming CE event for COPE approved credit!