Our 'Unconventional Optometrist' column is where we chat to optometrists who are a bit out of the ordinary! Do you know anyone who we should feature? Let us know!
This Young Unconventional Optometrist is both a practice owner AND a locum - talk about juggling roles!
Tell us a little bit about your journey into your field.
After I graduated uni I worked for corporate optometry to build up basic skills. A number of years later I ended up doing locum work and the odd BHVI clinic a few times a year to experience a different variety of practice. I was also limited in what I could do in corporate eyecare, and honestly I got bored do refraction day in and day out. I considered doing medicine at this stage but figured it was not worth the investment. I now own a small practice in partnership and continue to do locum and part time work in conjunction. I basically bought myself a job and didn’t do the numbers properly before I bought in (its nothing I regret though) I work for a behavioural optom once a week, which I never thought I would, and now has definitely changed the way I practice and see optometry as a whole, rather than just VA/refraction.
Tell us about your typical day at work (if 'typical' exists)
Typical optometry hours 9-5. General eye tests, mainly. (this is your bread and butter) Specialty contact lens fits (KC/ scarred cornea/ post graft) Lots of dry eye Myopia control for my kids on the weekend.
What are some benefits to working as both a locum and a practice owner?
Has allowed me to learn different niches of optometry and find what I like best.
What are some differences between what you do and a 'traditional' optometry job?
My job is pretty traditional. I just get more exposure to interesting cases due to the practice location. We have to deal with a lot of politics though including issues with referrals from the public to private sector.
What is the best thing about your job?
Freedom to do what I want for both myself and my patient. Everything you put into your practice eventually goes back to yourself (and your partners). Generally more rewarding, though the same can be said for a good independent or corporate practice. There’s also things that you hate doing, but you’re good at due to the numbers you see. So it’s good in a way for the practice still? Sometimes you’re just put into that positon and end up following that path.
What advice would you give to other optometrists who also wish to locum or own their own practice?
NETWORK, attend conferences , and always be eager to learn. Finding a good mentor who inspires you will help. Nothing beats actual experience, doing something yourself and getting your numbers up to improve your skill. A textbook or talk/seminar can only teach you so much. Its always different once you apply your knowledge in real practice.
What has been one of your most memorable patient encounters?
When your patient goes from 3/60 to 6/9 with an RGP and you change their life.
Is there anything you would like to change or improve about the way you practice?
Lots of things. But everything needs money/ enough budget to achieve. This isn’t always possible so you make do and remember there’s always plenty of time to learn it/or build it later.
We're excited to announce that Jane Kwon is joining us as a subcommittee member. She is a recent UNSW Optometry graduate and we're glad to have her on the team. Find out a bit more about her.
Tell us a little about yourself?
I was born in Paddington but grew up near the "Koreatowns" of Sydney (Yes, Strathfield for those of you who know ). I currently live in Port Macquarie which is a lovely city on the mid-north coast. I’ve fallen in love with the beautiful weather and beaches up here. My hobbies include vlogging and watching cute animal videos (I miss my cat).
How did you end up in optometry as a career?
I always wanted to be a healthcare professional because I love helping people and thought optometry would be a rewarding career. I now love that it also gives me the freedom to take up other hobbies.
What are you most passionate about outside of optometry?
Spending quality time with friends and family which has been quite difficult since moving up to Port Macquarie. I always keep in touch over skype and plan on visiting every month. I also love eating!
How do you spend your free time?
I love eating but hate cooking so now that I’m living away from home, I’m trying to figure it out one step at a time. Apart from that, I spend most of my free time filming and editing videos or watching dramas.
Most embarrassing moment?
Hmm.. I’m usually good at erasing any embarrassing/stressful moments from my memory so I really can’t remember any.
What inspired you to join YO as a subcommittee member?
YO has been with me during my optometry studies, I enjoyed going to their events and getting to know the team who were all very lovely and supportive. I wanted to be part of this amazing team who provide a great network and strong voice for young optometrists and soon-to-be optometry students.
If you had one superpower, what would it be?
I think all regional optoms/optoms working away from home will agree with me on this one - teleportation. While I love everything about working and living in Port Macquarie, it would be nice if I can go back to Sydney more often and skip the 4.5 hour drive/1 hour flight.
What is your current favourite phrase?
The journey of a thousand miles begins with one step.
Here's this month's Unconventional Optometrist. Megan Tu is an optometrist who works in primary and high schools in South-West Sydney. Read ahead to find out more - what an interesting optometrist she is!
Tell us a little bit about yourself and how you got into being a School Optometrist.
I graduated from UNSW School of Optometry and Vision Science at the end of 2011. Upon graduating I worked at a full-scope independent practice in regional NSW, which allowed me to freely explore different avenues of Optometry, such as behavioural optometry, contact lenses, sports vision and advanced optical dispensing. This was a fantastic experience to help me develop clinically and professionally, and helped shape my passion for Optometry.
Tell us about your typical day at work. Is it a full-time or part-time position?
On Monday to Fridays, I work in primary and high schools in South West Sydney, providing comprehensive eye examinations to students. In the evenings and on the weekends, my partner and I have recently opened an after-hours optometry clinic. I also work a couple hours a week at the UNSW Optometry clinic as a clinical supervisor for the paediatric clinic. Finally, I was a founding member and current Secretary for Young Optometrists NSW/ACT.
What are some benefits to working in your unique situation?
My work puts me into very different environments and allows me the opportunity to develop a good mix of clinical, teaching, networking and business administration and management skills. It keeps me on my toes and it means that I am never bored! Being a part of YO keeps me aware of our professional environment outside of the consultation room, and allows me the opportunity to actively contribute to shaping the future of Optometry.
I am generally not in your typical consulting room, as the bulk of my consultations are in a mobile working environment. My own practice operates after-hours, which again is different from the usual 9-5 job, and can involve home visits as well. With a particular interest in behavioural optometry, the bulk of my patients are children and I am fortunate to be able to offer and develop my skills in areas such as vision therapy.
How did you get into this unique area of optometry?
I was passionate about paediatrics and behavioural optometry since my undergraduate degree, where (unlike most of my peers) paediatrics clinic was my favourite clinic! I did the Behavioural Optometry units of the UNSW Masters course and I have practiced in full-scope behavioural practices since graduating. I am a member of ACBO and continue to develop my interest by attending CPD conferences.
What advice would you give to other optometrists who also wish to pursue this type of optometry?
Keep an open mind, critically think about information that you’re given and keep on learning and improving yourself. Don’t just accept the status quo. Find your passion and pursue it.
Change isn't easy, but forming new habits could be the start! We all have a morning routine when we get up (bathroom, brush teeth, eat breakfast, run for the train....) but these habits are triggered automatically in response to contextual cues (e.g. the action of washing our hands comes from the contextual cue of finishing our business)?
If you've got a spare hour, check out this fantastic article, but if not here's the gist:
Habit forming is never easy, and realistically of everyone who reads this only 5% will enforce any of the above. Most of the time we'll revert back to our old ways, because they're familiar. But don't give up, give it a go - whether it be checking less social media, walking the dog daily or even writing in a gratitude journal daily. Best of luck!
Deciding which professional organisations to join can be quite daunting as an optometrist, especially as a newer graduate. There are many questions that may be lingering on your mind. How will I meet the right people in optometry? How can I find my niche? What organisations are “worth it”? How much will it cost? Do you really want to be spending your first paycheck on member fees?
Joining professional organisations can connect you with valuable professional networking opportunities and access to a wealth of relevant information. Most organsisations have 'members only' access to exclusive forums, CPD events, netowrking activities and educational resources. Networking can create lasting ties through common ground and support you in times of need. In optometry, continuing education is a key part of our career. The more varied and rich CPD events we undertake, the more likely we are to implement positive changes to our optometric practice.
Most importantly, organisations depend on the power of people and numbers. Optometry is a small profession and we have our strength when we join together in numbers. The 'collective voice' is a powerful tool. Large organisations are able to advocate for optometry in the wider sense, whether it be in politics, the healthcare system or otherwise. Their influence is governed by your membership - with fewer numbers, their influence dimishes.
If you find a passion in certain aspects of optometry, we highly encourage you to join the organisations that align with your personal and career goals. By joining an organisation, you are providing yourself with a competitive advantage as an active, informed member of the industry.
We've selected some key organisations we reccommend you join. Keep reading because we’ve tried to narrow it down for you! Remember all membership fees are tax deductible.
Young Optometrists (YO) NSW/ACT
YO is run by young optometrists, for young optometrists. Young Optometrists (YO)’s mission is to support optometrists and students by providing a dynamic and progressive environment to advance the profession. We provide a collective voice to support optometry students and optometrists in their first 10 years of practice (within NSW/ACT). We know and listen to what you want and strive to represent young optometrists in this ever-changing world of optometry.
As part of our YO Community, you get a huge range of benefits. Our focus is not only continuing education through tailored CPD events and workshops, but also networking, social outings and your overall well-being.
As a member you also get access to CCLSA member discounts for your first 12 months. This is a great way to trial out CCLSA events before joining up as a full member.
For the price of a big night out, you have access to our myriad of benefits as a Full YO Member (incl. access to >30CPD points). If you don't want to miss out, sign up ASAP to become a part of a dynamic YO NSW/ACT community.
Let us welcome you into the YO NSW/ACT community today - https://www.yoptoms.com/Membership/
Free Membership for New Graduates
Optometry Australia (OA)
OA is a not-for-profit body which represents about 90 percent of Australian optometrists. They are an influential voice who aim to provide clinical and professional advice, professional development opportunities, networking and career-advancing opportunities for optometrists by optometrists. Optometry is a small profession and historically membership rates have always been high, with the majority of optometrists choosing the join OA. The only way OA will remain influential is if you choose to be a member. Membership is free for the first 6 months for new graduates.
Australasian College of Behavioural Optometry (ACBO)
ACBO is an association for optometrists with an interest in functional vision care, neurodevelopmental optometry and vision therapy. ACBO kindly extend a free 12 month membership to all final year students.
Australian College of Optometry (ACO)
ACO is an independent, non-for-profit institution in science, education and optometric practice dedicated to preserving sight and preventing blindness. First year graduates can enjoy free membership for 12 months.
Discounted First Year Membership
Cornea and Contact Lens Society of Australia (CCLSA)
CCLSA’s mission is to support research and innovation and promote professional development and education amongst members in the field of cornea and contact lenses. First year graduates receive a 50% discount off their annual membership.
Recent graduate fees for optometrists, who have worked for 6 months, are discounted to $1746 (incl. GST)
Other Memberships to consider
Orthokeratology Society of Oceania
OSO is dedicated to improving the lives of people now and in the future through Ortho-K and Myopia control. OSO members will be recognized as a member of the International Academy of Orthokeratology (IAO) as well. Joining fee is $275 (incl. GST).
These are not just memberships but communities where you can network and learn from each other. So what are you waiting for? Get signed up!
Note: This post does not represent all the optometry organizations and societies in Australia.
*Prices are for optometrists practicing in Australia or New Zealand (as of Feb 2019).
Ptosis is an abnormally low position of the upper eyelid. It can be congenital or acquired, but is more common in elderly patients due to a gradual loss of muscle function. It typically impacts vision as it reduces the amount of light entering the eye.
However we can’t blame everything on “age” or “you were just born this way” … there are other sinister causes of ptosis and it is important to rule them out or identify them in order to manage your patient appropriately.
PEARL 1: IDENTIFY THE PTYPE OF PTOSIS
Ptosis can be classified broadly based on their cause.
PEARL 2: RULE OUT OR REFER
Ensure you have a mental check list of ruling out all sinister causes of a ptosis and refer appropriately if necessary.
PEARL 3: PTYPES OF PTESTS
PEARL 4: PROPER RECORDING IS KEY
Ensure you record in detail the responses to the questions you have asked (both yes and no), results of tests you have conducted (positive and negative), and state that you have explained to the patient the situation, reason for referral (if necessary), and the importance of further testing/imaging.
Our 'Clinical Pearl of the Month' column is where we present a clinical pearl to provoke thought and discussion.
The Demodex mite is an eight-legged ectoparasite that resides in our hair follicles and sebaceious glands, including our eyelashes. Every adult will have some demodex mites, but presence of blepharitis indicates they simply have too many. Demodex infestations increase with age, affecting 84% of the population at age 60, and 100% of those older than 70 years old.
It is contracted and spread by either direct contact or dust containing eggs. Two species are found on humans:
- the shorter Demodex brevis (0.2mm long) which tends to live inside the lashes' sebaceous glands and meibomian glands, and is suggested to be associated with posterior blepharitis
- and the slender, tapered Demodex folliculorum (0.4mm long), which bury themselves face down in the lash root, associated with anterior blepharitis
There are multiple types of blepharitis, each with their own path to effective treatment.
How do I diagnose Demodex Blepharitis?
Patients suffering from a demodex infestation may complain of crusted or matted eyelashes, tearing, burning, madarosis, and foreign body sensation on the base of their eyelashes. It is important to rule out other sources of anterior surface inflammation as there are many crossover symptoms to a myriad of conditions. N.B. Demodex mites are found in both symptomatic and asymptomatic individuals, and there is poor correlation between Demodex infestation and symptoms, as paralleled in other anterior segment conditions such as blepharitis.
A definitive diagnosis can be made through lash sampling. Select an eyelash with cylindrical dandruff as it is more likely to yield results. Mount the lash onto a coverslip with a droplet of oil.
However, this is not always practical in a clinical setting. Some signs which may be noted on routine clinical examination include cylindrical dandruff, eyelash disorders such as madarosis, and lid margin thickening and erythema. Inflammation of the lid margin can spillover and result in blepharoconjunctivitis and corneal inflammation.
What is that classic cylindrical dandruff?
This fine waxy, dry debris is considered pathognomonic of Demodex. The clear cylindrical dandruff classic of Demodex blepharitis is through to be a product of the mites' claws scraping around the eyelash follicle. Demodex infestation can cause increased keratinisation near the base of the eyelashes. As the keratinisation is mixed with lipids, it produces the classic clear cylindrical dandruff.
What is the lifecycle of Demodex?
Understanding the lifecycle is important to how we tackle demodex. A demodex mite lives around 2-3 weeks. A female will lay 15-20 eggs inside the hair follicle. These eggs turn into larvae and subsequently develop into an adult mite. They are fast little creatures, walking around 10 millimeters/hour.
Ok, I've heard enough, how do I treat my patients of these mites?
Long-term lid hygiene is required as Demodex is a chronic condition requiring chronic therapy. Prior to initiating therapy, there are several effective in-office demonstrations that have proven to increase compliance among patients with Demodex, as many lid therapies targeted specifically for Demodex cause ocular discomfort contributing to therapy dropout.
The most effective and commonly used agent for demodex is tea tree oil. Tea Tree Oil (TTO) is currently the most effective in-office and at home treatment option. The TTO stimulates the mite to exit the hair follicle and migrate to the skin before mating. Studies have shown that concentrations of TTO as low as 5% (applied 2x/day) and as high as 50% (applied in office once a week) to the base of the eyelashes and lids, is effective in reducing Demodex infestation.
There is no one single treatment method that fully eradicates the Demodex after 4 weeks of therapy. It is a chronic condition that requires long-term treatment. Here are some common treatments you can implement in practice.
- Commercial eyelid cleansers (foam or wipes) used 2x/day: Patients are instructed to clean the lids and lashes, as well as smear the lid cleanser onto the eyelash roots of the lid margins. They can also be instructed to use the wipes on their eyebrows, forehead and cheeks as well as demodex live in those regions. The foam/scrubs are meant to be left on the skin to dry. Examples of lid cleansers include: Blephadex, Cliradex, Oust Demodex, Ocusoft Lid Scrub Plus
- In-office high concentration TTO: A weekly office lid scrub with 50% TTO solution is to stimulate the migration of mites out of the lash follicle. Anaesthetic is instilled in both eyes and then the eyelashes are thoroughly debrided with a cotton bud soaked in 20-50% tea tree oil. 100% tea tree oil solution causes intense patient discomfort and toxicity to the ocular surface. A 50% TTO mixture can be prepared by diluting the tea tree oil in macadamia oil. Caution must be taken in those patients with nut allergies and allergy to tea tree oil. This is then followed by daily home therapy with eyelid cleansers 1-2x/day.
- Microblepharoexfolation: This involves a high-speed rotary sponge (BlephEx) soaked in a lid cleanser. It removes the biofilim on the surface of the lids and lashes, removes the cylindrical dandruff and helps to remove the mite eggs at the base of the eyelash follicle. This is a powerful tool to kickstart treatment and may need to be repeated at 3-6month intervals for those with severe blepharitis.
- Other hygiene measures: All makeup should be discarded, hot water should be used to wash clothers and linens dried on the high-dryer setting.
- Aiding compliance: Compliance tends to be simple once the patients can see photos of their mites. This can be taken through the slit-lamp or in free space if the infestation is severe enough. A digital microscope can also be used to take photographs and video of an extracted eyelash.
The standard of clinical record keeping is extremely variable. It is easy to get stuck into poor habits of record keeping. Accurate record keeping is important for the provision of quality eyecare, especially in a multi-practitioner setting, to protect the optometrist in the event of an accusation of negligence and for use in My Health Record to be accessed by other practitioners. Not surprisingly, there is a strong link between poor record keeping and successful claims against practitioners for clinical negligence.
Optometrists tend to under-report, that is, perform and examine more than is recorded on their record cards.
The Optometry Board of Australia Guidelines dictate that optometrists must: "Keep accurate, up-to-date and legible records that report relevant details of clinical history, clinical findings, investigations, information given to patients, medication and other management in a form that can be interpreted by another optometrist."
Here are some reminders and tips to refresh your clinical record keeping skills:
- Detail your case history: This should have a clear indication of the patient's concerns and complaints that led them to seek a consultation. Questions asked during history taking (negative or positive answers aside) must be recorded. Their ocular and health history, medications and allergies and adverse reactions must also be recorded.
- Examination findings: The results of every test and procedure performed should be recorded, whether it is normal or negative. It should be recorded in a way that it is easy to interpret. Recording such as WNL (within normal limits) or NAD (no abnormality detected) should be preceded by the tissue or structure examined. e.g. Cornea WNL.
- Therapeutic prescriptions: When a therapeutic medication is prescribed, supplied or administered by the optometrist (including diagnostic eyedrops), the date and details of the medication should be recorded alongside the instructions given to the patient.
- Be smart with your smartphone: Increasingly, clinical images may be captured on private hand-held smartphones. A good example is taking an anterior eye photo with a phone camera through a slit-lamp. Clinical images and videos on your mobile device are considered part of the patient's clinical record, and should be treated as such. Patient consent is essential when capturing images or videos using your smartphone or tablet. Patients when giving consent should understand the purposes of the clinical image, how the image will be used, who will have access to the image, whether it will be de-identified, and how the image will be stored. Once consent is obtained, document this on the patient’s clinical file and delete the file from your device after the image has been transferred to your computer