Welcome to the Eyelid and Ocular Hygiene eNewsletter! My name is Dr. Mike Cooper, but my friends (of whom you all are now) call me "Coop". Over the course of the next year, we will take a journey of discovery together, from the depths of lid anatomy, to the untapped technological ingenuity set before us on the horizon—with a touch of whimsy. What I have not lost sight of is the incredible opportunity given to me by Optometric Management to share my ocular surface clinical experiences and my adroit business skills with you all.
Furthermore, I would not be here without acknowledging the numerous mentors and inspirations, seasoned and emerging, that I have been fortunate enough to meet and gain knowledge from over the course of my career. Paying homage to the great Sir Arthur Conan Doyle’s The Adventure of the Red Circle, Sherlock Holmes states "Education never ends, Watson. It is a series of lessons, with the greatest for the last."1 In essence, the pearl to be gleaned from this powerful statement is to stay both humble and understand there is always more to learn.
With this all said, let us begin our voyage in a fictional galaxy far, far away visiting with the tiny sentient Midichlorians. These organisms are intracellular symbionts determining in many ways the path of which an individual may take within "The Force" and likely merged out of necessity for their own survival.2 Although in a sense (pun intended), the sum is greater than the whole of its parts, as many life forms on Earth contain mitochondria and chloroplasts within their cellular membrane; nevertheless, this might not have always been true. In 1967, one brave biologist, Dr. Lynn Margulis-Sagan, advanced and substantiated microbiological evidence that these nascent organelles might very well have been free-living bacteria before a series of events led to what we now refer to as endosymbiotic theory.3
While it might be hard to swallow that we might be mitochondrial DNA descendants of Rickettsia, it is equally important to understand that this process did not occur overnight by combative means.4 In actuality, these single cell organisms made the leap into the eukaryotic world by networking, due to the changing conditions on the planet. When large amounts of free molecular oxygen began to accumulate and shower down from the atmosphere, these organisms began to band together to survive and truly thrive.5
You might be asking yourself right about now how this might be relatable to my clinical practice. It’s a valid point and allow me to explain. In our training, we were all given the muscle memory skills to examine patients, along with critical thinking problem-based learning sessions to diagnose and manage cases. After graduation and practicing daily to hone our craft, we integrate these experiences, our moral compass, and personality into decision-making that affect patient outcomes. Can you feel "The Force" flow through you yet?
In effect, the true symbiosis in eye care occurs in the moments where the patient is empowered to share in the solution process of their care. For instance, the doctor is providing education on how to understand the long-term implications of meibomian gland dysfunction. The patient may ask about treatment opportunities where we draw from our wealth of knowledge to guide on how to best manage the condition over the course of their life. Treatment could be as straightforward as warm compresses, but what about hypochlorous acid products such as HyClear (Contamac) or Avenova (Novabay), tea tree oil derivatives including Cliradex (BioTissue) or gentle to advanced formulas from Eye Eco, to in-office procedures like TearCare (Sight Sciences) or LipiFlow (Johnson & Johnson Vision) or iLux (Alcon)?
Directly from the chair, each of these items could be described in the same manner as blue light glass protection and single use contact lenses. Additionally, the waiting room and optical can be used as a display strategy to plant the proverbial seed of sorts. Soon enough, one might think to gather an inventory and formulate a convenient menu the patient may use to select packages from your conversation.
These ideas serve as great reminders of the power we all have in the medical recommendation. Patients want to know what the next best thing is and what steps will be taken in their care. It might sound cliché, but do not fret, I will be your tour guide!
In closing, every day we are called upon to decide a course of action, whether it be what shoes to put on, how to treat that meibomian gland dysfunction case, networking at a conference, or consulting a colleague on a mind-bending uveitis case. These challenges are real. Ask yourself though—are we really that different from ancient single celled organisms when they made the fateful decision to merge with others?
Look out for next month’s edition when we take a deeper dive into the world of lid anatomy to build our story.
Doyle, Arthur Conan. His Last Bow: A Reminiscence of Sherlock Holmes. The Case Book of Sherlock Holmes. Doubleday, Doran & Co., 1930.
Sagan L. On the Origin of Mitosing Cells. J Theor Biol. 1967; 14(3): 255-74.
Emelyanov VV, Saraste M (ed). Evolutionary Relationship of Rickettsiae and Mitochondria. FEBS Letters. 2001; 501(1): 11-18.
Kasting JF, Siefert JL. Life and the evolution of Earth’s atmosphere. Science. 2002; 296(5570):1066-8.
Michael S. Cooper, OD currently practices and is the Director of Research and Technological Innovation at Solinsky EyeCare in the Greater Hartford area. He specializes in anterior segment disease, treating a variety of conditions including dry eye and external lid diseases, allergy, and uveitis. He has produced research, participated on expert ocular surface disease round tables, and lectured domestically on topics such as corneal disease states, uveitis management, Lyme disease, emerging pathogens, complex glaucoma management, sports-related eye injuries in children, and AMD pedigree relationships. Currently, he is actively involved in global clinical studies for novel anti-infective therapeutics, ocular surface diagnostic validation, and AMD genetic research.