Article Date: 1/1/2012

Out With the Old: 12 in 2012
dry eye

Out With the Old: 12 in 2012

Consider these 12 options to recharge your “work” battery in 2012.

Kelly Nichols, O.D., M.P.H., Ph.D.

It is that time of year: new beginnings, resolutions that are still fresh and unbroken and an opportunity to try something you have not done in years past relative to the practice of optometry. Read on for a list of “I just might do that” options that can recharge your “work” battery in 2012.

1. Commit to ocular surface disease. Okay, this is my favorite topic. But even if it wasn't, the uptake of dry eye by optometry has been remarkable in the last five years. It's time to join the crowd. Here's why:

► Optometrists continue to write a growing number of prescriptions for ocular surface-related diseases.
► Optometrists are people-people who are willing to spend the chair time required to grow their practices.
► Practice management experts time-and-time again can show you the way to make dry eye a practice profit center.

If you do commit to ocular surface disease, consider joining the Ocular Surface Society of Optometry (OSSO, www.ossopt.com) and/or the Tear Film and Ocular Surface Society (TFOS, the sponsor of the Report of the International Dry Eye Workshop and the International Meibomian Gland Dysfunction(MGD) workshop, www.tearfilm.org).

2. Attend a new continuing education (CE) meeting. Think about picking a specialty meeting, such as the Global Specialty Lens Symposium, or going to lectures at a large regional meeting that are different than your usual selections. Some practitioners choose to attend all lectures related to a single disease state — essentially education by“immersion.”

If ocular surface disease is your interest, consider several aspects of the condition, such as diagnosis or practice management, and don't forget to look through the program. An interesting lecture about the impact of glaucoma medications on the patient who has ocular surface disease, or dry eye in contact lens wearers might not be offered in the same “track” as a course on managing dry eye. Different lecturers will also have a different spin on the same topic as well, which can provide you with a well-rounded perspective of the topic.

3. When attending a CE lecture decide, ahead of time, to become fully engaged in the material. Find a link between the material presented and your practice. Ask a question to reinforce what you learned, which will help you remember. If you have a patient who has the condition being discussed, think about how what you learned applies to your patient, or the next patient you haven't even seen yet.

4. Go to a meeting that highlights science, or the scientific process. For example, the American Academy of Optometry meeting is comprised of both scientific paper and poster sessions that highlight the latest trends in management and provide up-to-the minute science. There will be changes to the scientific program at this year's meeting to allow for “science” to count for CE seamlessly with traditional lectures. And if last year's meeting is any indication, ocular surface disease, MGD, contact lenses and compliance/compatibility will be topics that continue to grow in popularity, as shown by the number of accepted lectures on the topic and the number of scientific abstracts and case reports in the area.

Some of the dry eye cutting-edge research presented in 2011 included the assessment of the meibomian glands using infrared meibography, evaluation of tear osmolarity, grading of abnormalities of the meibomian gland — including meibomian expression — and an interesting re-evaluation of the Schirmer test — an oldie, yet still an important test to rule out (or confirm) a Sjogren's syndrome diagnosis.

5. Talk to a colleague about a case (real or hypothetical). Market surveys have shown that a clinician's preferred method of obtaining knowledge is through podium presentations or discussion with colleagues. So, take the time to pick a friend's brain.

6. See one, do one, teach one. Have you mentored anyone lately? Mentorship comes in all shapes and sizes. Mentor a staff member, a junior colleague, an optometry student, a high school or a college student. Mentor someone, and your own skill set will grow — whether it be personal or professional. Mentoring can result in strong team building, and your team can be critical to recruiting and maintaining patients or in starting a dry eye clinic.

7. Be proactive rather than reactive. I have the pleasure and honor of having colleagues committed to optometry in controversial states, such as Kentucky. Rather than sit by and wait, these optometrists are on the cutting edge of optometry. So if you want change, go get it. The same applies to ocular surface disease. Decide to start a dry eyeclinic, market yourself, actively seek patients through community service, and be proud of it.

8. Express the meibomian glands. In fall 2011, I was surprised and proud of the response I received when I asked the question during ocular surface disease lectures, “How many of you have expressed meibomian glands this month?” The incredible answer? Roughly 40%. Now, these are clinicians that chose to hear a lecture on dry eye or MGD. Therefore, there was likely more interest in the topic. But even given that fact, I would not have received the same response even two years ago. Rarely is there an opportunity to appreciate a paradigm change relative to diagnosis, yet here we are. Dry eye disease has been a diagnosis in many ways of exclusion, yet for years we neglected (to some degree) to evaluate the eyelids and meibomian glands. Evaluation of meibomian gland expression resets our start-point for ocular surface disease. Management of lid conditions early in the disease may prevent progression or complications long term.

9. Read the Executive Summary of the Report of the International Meibomian Gland Dysfunction Workshop. Or, better yet, download the app (CITYnet TFOS MGD Report @ the Apple Store). Yes, there is an app, and it is free.

10. Think about taking the board certification test. If the American Optometric Association President Dori Carlson, O.D., can do it with her hectic schedule, so can you. At minimum, decide where you stand politically on the issue. And by the way, one of the specialty sections for certification is ocular surface disease.

11. Be uncommonly and over-the-top kind to a patient (or all patients). When all is said and done, how you treat people day-to-day is a mark you can leave on you practice and in the lives of your patients. Patients just want to be heard — and as a profession we are really good at listening.

12. Find your passion. I have been so fortunate to really love what I do in research and teaching, lecturing and consulting, yet there are so many other things I like and hope to find more time in 2012 to further appreciate, many of which involve my family. Years ago, a friend showed me his work/life/balance circle — a drawing he kept posted in his office. It is good to take some time to reflect on the things that matter to you. Early in 2012, create your own work/life/balance circle, and post it somewhere so that a friend or family member can ask you about it. Most of all, enjoy what you do in 2012. OM


DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY AND THE OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. DR. NICHOLS CAN BE CONTACTED AT KNICHOLS@OPTOMETRY.UH.EDU. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAIL.COM.

Optometric Management, Volume: 47 , Issue: January 2012, page(s): 52 - 53