Picture: Vincent enjoying his 'birthday cake' at work - who said work can't be fun?
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!
Here's our first Unconventional Optometrist. Vincent Ling is an optometrist who works full-time in a rural Queensland ophthalmology practice.
Q: Tell us a little bit about yourself and how you got into what you are doing
Hi, So basically I was a new graduate who started my career with OPSM in Wagga Wagga. I spent about 5 months with OPSM before I decided I wanted a change. I did enjoy my time at OPSM and gained a lot of my skills there. I did a placement at Omni Eye services and I really enjoyed how optometry was practiced in the US. There was a strong relationship between optometrists and ophthalmologists which isn’t quite as apparent here. When an opportunity came up and to work on a coastal area, it was too hard to pass up.
Q. What is a typical day at work like? Is it a full-time or part-time position?
Full time. So I work 4 days a week and it is very hard to describe a typical day of work. This is what makes my job so fun. A wide variety comes in through my door since often my boss will have a full book and she will not have time to take any more patients. I do many of her follow-ups such as cataracts, glaucoma, uveitis, red eyes. She gives me full control to change medications or management plans as I see fit. Other stuff that comes in through my door include emergency referrals from the hospitals, often I will see the patient first and if I don’t feel comfortable managing whatever is through my door, my boss takes over. Sometimes if a patient cannot afford to see an ophthalmologist, they will see me and she will ‘duck’ in too have a look. All my consultations are bulk billed besides any scans that I may need to do. I really enjoy my job and I look forward to waking up everyday and going to work.
Q: What are some benefits to working in your unique situation?
My boss said to me during the interview was that I would be “under her protection.” It certainly does feel good being able to call the shots and when in doubt, she is always next door. There will be days where I do not need her help, but there will be days where I would be calling her every 10 minutes. I have a walking Kanski next to me so I feel comforted by that, however, there will be days where she is in theatre, charity work, conferences and I am left alone and I am responsible for the patients. It is certainly tough having to be the one that breaks the bad news. It never is easy to tell a patient they will lose their vision permanently or they will be requiring injections for life. I realise how complicated the art of surgery is, whether it be lids or cataracts. I am also responsible for calculating the lens implants that goes into people’s eyes, ordering them and making sure they are ready for my boss on time. This is probably the most stressful part of my job, as unlike glasses, changing a lens is much more difficult. My boss does double check my work. I am surprised how the IOL industry is evolving, we rarely implant monofocal lenses , most of the time we deal with multifocals or extended depth focus lenses which gives patients functional vision for both distance and near. However these patients are selected very carefully. Given the many happy patients outcomes I have seen, getting an IOL done when I undergo presbyopia is certainly something I would consider. Hopefully the IOLs will have come close to a normal human lens. I realise there is so much I am ignorant about when it comes to the eye and this unique situation allows me to realise this.
Q: How did you get into this unique area of optometry?
I found this job online, I think ophthalmologists are starting to see the worth in having an optometrist within their clinic. I cover about half my wage on consults but I believe I bring much more than monetary value to this clinic and I think my boss shares this belief. Especially where I am in rural Australia, ophthalmologists are often very busy and so having an optometrist with therapeutics can really lessen the load.
Q: What advice would you give to other optometrists who also wish to pursue this type of optometry?
If you take a keen interest in pathology, it is absolutely worth it. Although I cannot speak for what your responsibilities are at other ophthalmology clinics, I certainly couldn’t really think of anything, that I would change about my current job.
Q: What was your most memorable patient encounter?
I have plenty of memorable patient encounters that I can’t really single out one. I do build very strong connections with patients because I get to follow them up regularly and make the choices that impact their ocular health. I suppose the ones that are most memorable primarily revolve around delivering bad news to the patients.
Our 'Clinical Pearl of the Month' column is where we present a clinical pearl to provoke thought and discussion.
Optical dispenser: "Hey Optometrist, Mrs. Smith is having issues with his new glasses"
Optometrist: *knots begin to form in their stomach and they feel a sense of impending doom*
We all know the feeling.
Remakes are costly to a business and inconveniences the patient. Taking care of our patients is our top priority and we want to get it right each and every time. It isn't possible to eliminate remakes, but there are steps we can take to help reduce them.
1. What does the patient want to use the glasses for?
Show how much you care about your patients by listening to them and trying to understand what they want to use the spectacles for. A prescription is not just a jumble of numbers - it is also your recommendations. A prescription means nothing without recommendations. Does the patient need reading glasses, multifocals, split-seg bifocals with prism, extended focus lenses or a special set for their fine jewellery work? Clearly state your lens recommendations. Set aside some time to discuss realistic expectations in the consultation room.
2. Trial frame
Trial frame the prescription. Trial framing can tell you a lot about how the patient likes the prescription. After what I think are stellar refractions, I've been met with a humbling "oh my gosh that is way too strong!" or I feel nauseous" from my patients. Trial framing can save you a world of pain.
2. Make sure you correctly neutralise their current/favourite glasses (including heights, PD and check for prism)
Watch out for prism (of any orientation, up, down, in, out, yoked) or accidentally induced prism by the way the frame is sitting on their face. Lopsided glasses never did anyone any good... Check their cyl axis and don't make huge changes to their prescription without explaining adaptation.
3. Check their tear film
An unstable tear film is one of the biggest contributors to inconsistent refractions. If you suspect your patient has dry eyes affecting their refraction, instill a lubricating eyedrop before commencing. Long-term management of the dry eye issue is the goal.
4. Communicate with your optical dispensing team
The optical dispensing team is your greatest asset. Trust in your team and communicate regularly to ensure you are all on the same page. Ensure you clearly communicate what you would like dispensed for the patient. Has there been a prescription change?. E.g. Mrs. Wood has a +7.00DS prescription for reading. "Hi Dispenser, Mrs. Wood has quite a high script so it'd be great for her to have a smaller frame and custom (grind) high-index lenses to keep them nice and light for her."
Remember to communicate to the dispenser as to what vision the patient should be expecting with their new glasses. If the patient only reads N10, the dispenser will know not to ask them to read the N4 line when they pickup their new reading glasses (hopefully).
5. Remember, YOU are the expert
There will be times where the patient will need time to adapt to their new spectacles. It may be due to a new frame, material or change in prescription. Reassure them and give them time. However, some remakes may be due to unrealistic patient expectations. Pass on your expert advice without forcing your opinion on their decision.
Alison A.: My year as a new graduate has been quite a unique experience. I decided to head across the pond to learn from some of New York’s best ophthalmologists. It has been a steep learning curve, but the experience I have gained in just a year will surely shape my optometric practice for the better once I return home.
Patricia L.: I’ve found my first year out to be a steep learning curve but very worthwhile. It has allowed me to strengthen my clinical skills and helped me work out my areas of interest.
Anonymous: One of best/worst moments was when my patients chief complaint was that his eyes hurt too much when playing on the pokies. On a more serious note, it's also amazing how good the optos is at picking up retinal tears/detachments even with undilated pupils. One of my patients with previous retinal tears had a full blown asymptomatic RD and came in to get her RMS form. She was lucky she had an optos taken that day.
Anonymous: It’s been quite diverse (at least more than I expected in a metro area) in terms of patients, ocular disease and aspect of optometry like ortho-k/myopia control, cl, paediatrics.
Marriette K.: I would describe first year as incredible because of the many ways I have seen the applications of optometry improve people's vision and lives. All the challenges of time management and troubleshooting has helped me become more confident and competent practitioner and I am enjoying growing and becoming better and better everyday.
Piranaa A.: Moving out of home to a new town to start a new job was challenging at first but the community feel of working in a regional town where everyone is so welcoming and appreciative makes it so much easier! I have enjoyed my first year out of university and would definitely recommend my colleagues to work in regional towns where all your skills will be utilised everyday and your service will be always valued.
Michelle C.: Working in a regional location has been very rewarding. Patients are very grateful for everything we do whether it’s changing the add or detecting a retinal tear. The five minute drive to work is also great.
Howard L. : This year has been a large learning curve, with the most eye opening experience as you come across so many types of people in different walks of life.
Charles W.: I've had a great year so far, really enjoying what I do because I get along well with the staff. I stuck to the same practice that I was working as a dispenser during uni, so the friendships and bonds that was formed during that time carried over when I became an optom. It's really been rewarding for me.
Anonymous: One of best/worst moments was when my patients chief complaint was that his eyes hurt too much when playing on the pokies. On a more serious note, it's also amazing how good the optos is at picking up retinal tears/detachments even with undilated pupils. One of my patients with previous retinal tears had a full-blown asymptomatic RD and came in to get her RMS form. She was lucky she had an Optos taken that day.
Jessica C: “I think this year has been a big confidence booster. Working in a busy practice is tough but worth it because you learn lots so quickly.”
Vincent L: Sudden loss of vision . Fuck. RAPD. Fuck.
Lyn P.: My first year out since graduating has been filled with interesting and challenging patients and I've learnt a lot along the way. But being out in the real world has also allowed me to realise that there is so much more to learn and work on, both clinically and personally. I've also come to realise that becoming strong and confident as a person is something that needs time and focus too.
Rachel K.: As I look back on the past year, it's quite amusing to think how scared and nervous I was in the first few months I started out as a graduate optometrist, constantly worrying over whether I have made the right diagnosis, didnt miss anything, given proper management etc.. now after almost a year out, it has become less of that and more about providing best patient care and really utilising the support network around me. I have learnt so much through my peers and mentor, and undoubtedly my mistakes. Also, moving to a regional location definitely had it's advantages in terms of patient volume and variety, and I would recommend it to all the grads just starting out. All in all, if there is one thing that I have learnt from this past year as I transitioned from a nervous fresh grad to a somewhat more competent optometrist, is to not become complacent in testing and think that everyday/ every test is repetitive, because it's not.
Anonymous: Trust yourself by don't let it get to your head
Sylvia C.: The first year out has been both challenging and rewarding. My experiences have varied from simple script updates, to an emergency BRVO with macula oedema, to a young lady diagnosed with a brain aneurysm. Despite the occasional angry patient or screaming child, I'm looking forward to the surprises next year has to offer.
Emily P.: My first year out was daunting at first but it turned out to be the most rewarding so far. I was fortunate to be in a nurturing workplace with supportive front of house staff and optometrists. I also had opportunities to attend conferences where I realised my special interests in myopia control, orthok fitting and specialty cl fitting. Refraction is your bread and butter, explore and you'll find theres more to optometry."
Lisa F: The most rewarding and unexpected experience this year is definitely the connections I made with my patients. A red eye patient whom I was reviewing was getting weekly update of my training progress for city2surf and a patient's dad went out of his way to call and thank me for doing a thorough eye exam. Maybe I'm just really lucky to have had so many kind patients this year.
Anonymous: Still don't know what I'm doing half the time :)
Tyson X: A fantastic year of personal and professional growth. Highlights include seeing my first retinal detachment, initiating therapeutics for contact lens related microbial keratitis, removing metallic foreign bodies, dealing with a CRAO, comanaging an acute angle closure attack and teaching a 9-year old who had been bullied about his glasses how to insert/remove contact lenses. What makes these moments extra special is that on a personal note, they’re signs that I’ve overcome some of my greatest fears as a graduate optometrist; Missing disease, handling emergencies and dealing with kids
Jennifer B.: In my first year as a graduate optometrist, I feel that I have learnt so much more about optometry - not just in developing clinical skills but understanding how to deal with different characters and personalities of our patients. Some of the most rewarding moments of my year include convincing a patient with a macula-on retinal detachment to go straight to the closest hospital eye clinic rather than to his work meeting, finding papilloedema in an asymptomatic mentally impaired young girl, prescribing contact lenses for countless patients who just want to be specs-free on their wedding day, and prescribing specs for a 50 year old mentally impaired woman who just wants to read again.
Anonymous: Looking back, I have grown a lot as an Optometrist in the past year. Every mistake I've made along the way had been a great learning experience, and I was extremely lucky to have the help of really supportive mentors!'
Congratulations to Carina for receiving the inaugural YO Placement Scholarship. She has and is always involved with all things Optometry. Read more about this influential lady:
Name: Carina Trinh
Practice: Dresden (MLC Centre, Martin Place, Sydney)
What do you plan to do with the scholarship?
Originally, I wanted to visit a contact lens practice in Victoria that fits numerous babies, along with a whole variety of interesting patients with all sorts of lenses. However, I'm also curious to visit some orthokeratology gurus in New Zealand, so I will do some further research and approach the practices to find out what suits best - then will keep you posted!
How do you think the scholarship will help you?
I'm hoping that it will provide me a really good understanding of how their style of contact lens practice works, and also harness my interest into advancing my skills, so that I can better service patients in my area. I look forward to witnessing on-the-spot calculations and measurements from the experts, and also learning the nuances in communication, education, and counselling patients while balancing their contact lens needs with their other ocular health needs.
If you could choose one superpower what would it be?
Time travel - I've always had a curiosity to meet my ancestors to learn about the upbringing of my parents, my grandparents, and far beyond. It seems like a really humbling experience to better appreciate all the people who've made it possible for me to be here in existence today on this planet, typing away right now on my laptop. I suppose I'm really interested in what contributes to the making of a person be who they are and behave the way that they do, and this would allow me to use my parents as case studies! Although, time travel would also allow me to explore other galaxies, and also maybe experience life as a bacterium - sounds sort of zen.
Please join us in congratulating the Tier 3 Scholarship winner for 2018, Vivian Ho! Read more about her upcoming plans to make the most of her prize.
Name: Vivian Ho
Practice: OPSM North Sydney
What do you plan to do with the scholarship?: I hope to use it towards the Masters of Clinical Optometry program that I'm currently doing. Or the OEP course for Behavioural Optometry which I've completed 2 parts of.
How do you think the scholarship will help you?
It will help me gain more of an in-depth knowledge of what I already know, and extend that to other specialty areas. It will be very relevant and applicable to all areas of Optometry and better equip me when I come across more challenging situations.
If you could choose one superpower what would it be?
I would like to travel through time and space, would be interesting to see things from different perspectives.
YO in conjunction with the Centre For Eye Health (CFEH) held its first ever trivia night on the 18th of August 2018 at the Pyrmont Bridge Hotel. Dr Michael Yapp from CFEH was a phenomenal host, both writing and presenting the questions. It was a raucous night where Dr Yapp kept the crowd entertained with optometry but also non-optometry related questions. We learnt about common but also rare conditions that even the most experienced of us had not heard of before. All through this we dined on seafood or vegetarian platters. Thankyou to Dr Yapp and to those who attended, making it a fun and memorable night.
Congratulations to the prize winners and thankyou to CooperVision and CFEH for supplying the prizes:
1st place: Team OPTOMism (Prize $20 Apple/Android gift card and CooperVision power banks)
2nd place: Team EYE DEER (Prize Guide Dog plush and CooperVision power banks)
Last place: Vitreous is sweet (Free access to CFEH's webinar)
Name: Celine Zhang
Practice: Eyecare Plus Bankstown & Eyecare Plus Kareela
What do you plan to do with the scholarship? I will be attending the 13th Congress of the Orthokeratology Society of Oceania (OSO), held at the sunny Gold Coast this year. Ortho-K is such an exciting field and I can’t wait to equip myself with the latest information to implement into practice.
How do you think the scholarship will help you? Childrens’ vision and myopia control are two of my greatest passions. Myopia control is a strong need in the population of children I am seeing. Currently, I’m drawing upon therapeutic, spectacle lens and soft lens options to slow myopic progression and referring to my capable colleagues to fit ortho-K lenses. I’m very fortunate to work in practices that have topographers and fitting kits right at my fingertips – I would love to have the autonomy to prescribe ortho-K lenses and be involved in every aspect of myopia control for my patients. Being able to learn from the best in the field and attend the Beginner’s Bootcamp at OSO will be invaluable.
If you could choose one superpower, what would it be? The ability to understand and communicate with anyone in the world, regardless of language. It would also be useful to get into the thoughts of babies … what are you seeing through your new glasses?
As part of UNSW SOVS Dry eye "Defy Dry eye 2018" Social Media Campaign they are raising awareness of dry eye symptoms, and encouraging patients to visit their local optometrist. The initiative is part of a final year Masters of Clinical Optometry research project which has been undertaken by their students.
Interested in finding out more?
Like their page:
On Saturday 21st July Optometry Australia held their Optometry 2040 Future’s Workshop in Sydney at the ICC. I was fortunate to attend the morning brainstorming session along with a wide range of other enthusiastic industry representatives, both optometrists and non-optometrists, who have a rich collective knowledge and experience base. The aims of the Optometry 2040 Future’s project are to identify the potential directions for the future of Optometry in Australia, and to identify proactive strategies to direct the profession down the paths that are reflective of what the profession wants. The brainstorming session involved stimulating group discussions on a variety of topics such as specialization within optometry, alternative funding options, the impact of Internet sales and artificial intelligence, to name a few.
As an ONSW/ACT member and as a young optometrist with hopefully many years left in my career, it was rewarding to participate in the project thus far in gaining insights on where Optometry currently is, and where it potentially can be, and it was empowering to actively contribute to shaping the future of my profession. – Megan Tu, Secretary of Young Optometrists NSW/ACT
On Friday 22nd June 2018, our young optom members gathered at the QT hotel, Sydney, on behalf of ProVision to learn the art of business. The private function allowed us to mingle with our peers as well as with ProVision Business Development Manager Graeme and state-based ProVision Business Couches Kelvin and Joanne.
We were seated in a cinema-like room to learn about owning our own business and the support available to independent optometrists. Often a foreign aspect to Optometry, for many of us, it was interesting to learn about establishing a business model and the many layers involved in running your own practice. A standout point made was that independent optometry still has a strong hold in the market, with a market share of approximately 30%! It was rewarding to know that patients still highly regarded independent optometrists and acknowledged their efforts to deliver high quality customer service and personalised experience. The night was a success where connections were made and it became clear how ProVision could be a possible pathway for some members.
ProVision also offers an associate program to all optometrists, which is complimentary to join. To apply for the program, go to www.provision.com.au