A young pediatric patient with significant preseptal cellulitis.  Often this appearance is brought on by a hordeolum (stye). via

Loving Tim Gunn's new eyewear this season - gone are the aging rimless frames, replaced with a much more youthful black zyl.  But he's still the thoughtful, constructively critical Tim we all know and love. via

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Morning talk shows and nightly news segments are abuzz with the promise all Americans over 40 are desperate to hear: "Say So Long To Reading Glasses" and "The End of Reading Glasses" blaze headlines. But before you open your wallet and throw your progressives and drug store reading glasses out the window, let's talk the real science behind what the newly FDA approved presbyopic refractive surgeries can truly accomplish and what they can't.  Many are finding success with these treatments, but only after they have clear expectations for what is possible, what isn't, and what the risks include.

What is Presbyopia?  Around age 40, our eyes begin having difficulty focusing up close.  Looking at books, cell phones, and computers gets more and more difficult with every passing year. This is a completely normal change associated with the aging eye, and no humans are immune.  There is a popular misconception that presbyopia is a weakening of the muscles of the eye, but in fact the muscles are just as strong as they've ever been.  This is why eye exercises or the idea of avoiding glasses wear to "use your eyes" unfortunately won't work.

The lens inside the eye changes shape as the eye muscles contract and release when we change focus, but with time all those layers it accumulates as it grows from year to year add up, and the muscles struggle to get it to adjust its shape. via

The reason we lose our ability to focus at close ranges is because of the lens, a structure of the eye that sits right behind the iris.  The lens changes shape to focus vision near and far, and the muscles of the eye control this movement.  From the day we are born, the lens lays down layers like a tree trunk -- it's one of the only body parts that never stops growing.  Year after year the lens is layering and thickening, and around age 40 it has gotten so thick that it is very difficult for your eye muscles to move and adjust its' shape.  And it just keeps getting thicker every year after, eventually to the point that the muscles can barely move it at all and you would need reading glasses to focus clearly on nearly all close objects.  With today's science we can't thin down the lens to restore flexibility, and if we remove the lens we don't have any artificial lens implants yet that can truly mimic the flexibility of the original.  The presbyopic refractive procedures on the market at this time do not affect the lens at all, but instead try to improve near vision through changing the corneal surface of the eye.  This is important to understand because both the KAMRA and Raindrop procedures available can't give you 20 year old vision again.  The vision will be different from that provided by young, naturally flexible lenses, but if you are prepared for what they can achieve, you may still find success!

The KAMRA Inlay
FDA Approved: April 2015
What It Is: The KAMRA Inlay is a solid dark ring implanted in the cornea in the center of the visual axis (the middle of the pupil) to create a pinhole effect.  The device itself is just 3.8 mm in diameter with a 1.6 mm pinhole in the center for vision.  Due to the optics of a pinhole, objects will appear clear at a range of distances when viewed through such a small "window" because the pinhole blocks light rays that would be entering the eye off angle (which would make things appear blurry). It's the same way a pinhole camera works if you are wanting to learn more. The inlay itself has 84,000 small holes to allow oxygen and nutrient exchange through the inlay to the corneal tissue underneath.

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Who is a Candidate: Age 45 to 60 years old requiring reading glasses between +1.00 and +2.50 in strength.
Who is Not a Candidate: People with cataracts, corneal degenerative conditions (like keratoconus), uncontrolled diabetes, glaucoma, immune system disorders, a history of corneal infections or scarring or dry eye are not candidates.

The Procedure: Only one eye (the nondominant eye) will have the KAMRA inlay placed into the cornea with an outpatient laser procedure, leaving the dominant eye to have clear distance vision. The eye with the inlay will have a range of both distance and near vision, and the untreated eye will only see distance.
The inlay can be removed if there are complications or if vision isn't acceptable, but it is possible that scarring will have occurred where the inlay was placed and vision may be permanently damaged even after removal of the inlay.
The procedure is often coupled with LASIK or PRK to achieve prescription-free distance correction. The inlay eye is ideally left undercorrected at distance by -0.50 to -0.75 D at the time of surgery to improve near function.

FDA Approved: June 2016

This year's Small Business Saturday had me thinking: optometry is full of independent practitioners but for many years we've been providing eyewear designed by large corporations.  Don't get me wrong, I am a fashion world junkie as much as the rest.  But while we can be wowed by designer names on the side of our glasses, we often aren't getting much in the way of true design.  Many large fashion house designers outsource their optical divisions to larger corporations, and that's where you see entities like Luxottica retailing everything from Oakley to Tory Burch and Michael Kors.  Where can you find truly crafted eyewear?  Until recently there was very little going on in America, and the top independent eyewear craftsmen were designing in France, Italy, and Japan.  But in the past few years we've seen a Renaissance in American eyewear design, and in honor of Small Business Saturday, we're featuring 6 reasons that you should shop small for your eyewear this year too!

Were your glasses made by hand? I challenge you to try on a custom crafted pair of eyewear and feel the difference true design and quality can make.  Wonder why your glasses always push dents on your nose or pinch behind your ears?  You don't have to hate your glasses; you just need to invest in quality, thoughtful eyewear design. Photo above via State Optical

Article One Eyewear: Based in Flint, Michigan, Article One originated as an idea to give back. Designer Wes Stoody was inspired to create an eyewear line that combined luxury craftsmanship with a cause. Every frame purchased donates money to Helen Keller International, a non-profit fighting blindness from vitamin A deficiency in impoverished nations.  To date over 15,000 lives have been touched by their mission.  Right now Article One frames are handcrafted in Northern Italy, but Stoody dreams of bringing production to craftsmen in his hometown of Flint in the future.  You can hear more of his story here.

A bonus for you  Sign up for the Article One newsletter and you'll have a chance to earn a free pair of Article One eyewear and 50% off future orders. This promotion is only open to eyecare providers.

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Bevel This Kansas City based eyewear company is the brainchild of opticians Richard Mewha and Rick Nelson, and their mission statement is a bit unusual.  "Neither wants the brand to be the coolest or hottest or most recognizable" states their website, but the focus is on the simple perfection of minimalist ideals: great fit, clean lines, quality materials. Their titanium and acetate frames are designed in America and hand crafted in Japan with a focus on bold colors like the chartreuse used in their graphic brand logo and marketing campaigns. 

• Start your own practice! The best way to have flexibility over your own schedule is to be the boss. As an employed optometrist your schedule is dictated by the doctor or corporation you work for, but when you are working for yourself, you can arrange your hours in the office to best suit your needs.
• Treat your practice like your first child.  Right out of school, Dr. Shen Lee put all of her time, energy, and disposable income back into her practice. The first few years are the hardest and the leanest, but that dedication to the practice in the start lays the foundation for future success.
• Focus on creating patient loyalty by giving patients a reason to come back every year. One of the biggest mistakes Dr. Shen Lee sees practitioners making around the country is letting a patient that isn't complaining or demanding solutions go without getting education for what she can offer.  Even when a patient is successful in a contact lens, she encourages them to try out the newest technology on the market.  Her practice had grown to around 70% daily disposable lens wear because of her dedication to encouraging her patients try out the best lenses on the market, and she's found this technique is a great practice builder.  Her patients come in asking "what's new?" every year because she has focused on building loyalty and value in her exams. 
• How does she balance home and work life? “Instead of telling you what I do, let me tell you what I don’t do.  I don’t do dishes; I don’t do laundry.” She spends her precious time at home being present and active in the lives of her family and loved ones, helping with homework, trekking to fencing lessons and tournaments with her daughters,and  just being a mom and mentor to her children.   Getting help for the day to day chores that can steal away precious time is essential for her to have the time to explore her passions in optometry and as a mom and wife.

Can I rewind myself in time and start over as a member of Gamma Omicron at my alma mater, the Southern College of Optometry? I'm not saying I want to go back to school, or that I haven't enjoyed the last 5 years seeing patients and you know, getting paid to do so. But today's generation of future female ODs isn't messing around.  They've seen the statistics on the 16% gender starting salary gap for new graduates in our profession and while most of their classmates are women (67% of all enrolled optometry students were female in the 2015-2016 calendar school year), they noticed some overt discrepancies.  When asked, Sandy Trybus (SCO '17) says she cofounded Gamma Omicron on campus when she began realizing none of the successful doctors brought back to speak on campus were women.  Where were her female optometric role models and mentors? Women that could help her and her classmates navigate the issues that they would disproportionately face as they graduated and began searching for job opportunities and navigating establishing leadership and authority in their relationships with employers, staff, and patients? Where were the people like her that were success stories and leaders in our profession? She and cofounder Michelle Moscow set out to bring more female voices on campus by giving them a place all their own.

Head over to the Defocus Podcast for the full interview!!

Gamma Omicron was once a club on campus at SCO back in the 70s, when just a small subset of the student body was female.  At that time, female students at SCO felt they needed a place where they could establish their own leadership and autonomy in a historically male dominated profession.  As female enrollment continued to grow, the club eventually fell out of existence as class sizes became more equally split and equality in the classroom and workplace became less of an exception than a rule in the general public. 40 years later, Trybus and Moscow were looking for a place to focus on women leaders in the profession to help mentor themselves and fellow classmates and came upon Gamma Omicron in old yearbooks.  It was a perfect fit to re-establish the club that had lovingly drawn it's greek letters from "Girls Only."

Gamma Omicron members speak with Dr. Brigitte Keener (SCO '11) at their annual speed-learning event

Over the past month I've had the privilege of speaking with Trybus, and new club leaders Julia Hamm and Maddie Coughlin via the latest Defocus Media podcast, and then to the entire Gamma Omicron club as a speaker at their first 2016-17 school year meeting to talk salary and contract negotiations, and navigating difficulties young women often face in staff, employer, and patient interactions. Our discussions have yielded so many great talking points I wanted to share some pearls with you ladies that might not yet have a Gamma Omicron chapter established at your school:

• When applying for a job, how can you negotiate if you haven't really had any experience?  My recommendation is to think outside the box; you may not be an expert in patient care by the numbers, but I bet you're an expert in something your hiring doctor is not.  Look at their practice: are they offering specialty contact lenses, vision therapy or sports vision, infant and pediatric care, or dry eye specialties?  These are all buzzword specialties in optometry that older doctors may not be personally interested in training on, but would love to bring into their practice through you.  Look at their social media: is their website a mess? Facebook underutilized? Are they even online at all? Taking over social media marketing is a great way to bring instant value, and your hiring doctor will not question your generational expertise in this area. For more negotiating tips head here.
• But hold your horses, because bringing value to a practice is great, but you need to make sure you and the hiring doctor are on the same page about your future.  When we first spoke on the podcast, I was surprised to hear that putting a date on when to begin buying in to a practice at the initial contract signing wasn't a top priority for students.  It's true that you want to try out the practice first before you commit, but many friends and good doctors before and after me have fallen into this trap.  If you don't set a date to begin buy-in negotiations, then the day will somehow never magically come.  Five years later you're still waiting to have that conversation and the doctor you work for still thinks you might not be ready to take on the leadership and commitment of being a full partner because you're about to start a family or you're still growing into the position.  That's 5 years of blood, sweat, and tears you've put into that practice that you will eventually have to buy back from yourself, because every day you've worked there you've grown the business patient encounter by patient encounter.  I highly recommend setting a 1 year from hire date to get the practice evaluated by an outside party and to begin buy-in discussions.  Doctors love their practices and those in the baby boomer generation have universally seemed reluctant to walk away or retire, so they often put off handing over the reigns to their practice even after bringing you on board with the mindset to do just that.  Help keep the ball moving in that direction by getting firm plans set in stone for buy-in discussions right from the start.
• "You look like you just graduated high school" or "when's the doctor coming in?" are questions these ladies will likely be asked as new docs (and 5 years later, yes I'm still getting them).  The best medicine is laughter in these situations - I always laugh a little and say something to the effect of "Oh thank you so much! My wrinkle cream must be working!" with a genuine smile like I truly appreciate the compliment.  Yes, I know patients who criticize our appearance as too youthful aren't complimenting my wrinkle-free skin, but they are telling me with those comments that they feel anxious or concerned that my level of care might not be up to par. Th best way to alleviate fear is to help get the patient smiling or laughing with you on the other side.  If I smile and laugh, they will smile and laugh, and it's hard to feel anxious when you're smiling so much!