If you wear glasses or contact lenses to view distance objects then you might be familiar with the term myopia. Myopia, also referred to as being nearsighted, is described when an individual requires concave lenses placed in front of their eyes to see clearly. It has become a topic of interest for vision scientists as more people are needing glasses. In the United States as much as 33% of adults have myopia,1 and it has been recorded as high as 80% of young adults in Taiwan.2 There is evidence that genetics plays a role in myopia development, however that cannot possibly explain the emergence of myopia when 100 years ago few people required glasses. Since completing 100 hours of the Optometric Extension Program Foundation’s clinic curriculum for vision therapists, I wish to write on my view of myopia progression, including it’s cause and how behavioral optometrists can be part of the solution.
I call it the myopia sickness. That is my term for when an individual presents for an eye exam and I measure their myopia has worsened. Academically, I was taught that this only happened to children, and it was normal – both of these are false. Although uncommon, myopia progression occurs in adults. It causes frustration, insecurity, and despair. Optometrists commonly answer the questions: “when will my eyes stop getting worse?” or “Am I going to go blind?” Myopia is a disability, requiring the individual to keep glasses on their face at all times in order for function. Worsening myopia is not normal, it is product of a near-point visual dysfunction.
How did we get here?
What is different about our environment, our careers, and our hobbies from what people enjoyed 100 years ago – lots!. One hundred years ago there were no smart phones or tablets – there were no computers at all. People spent more time working outdoors farming, hunting, fishing, or as carpenters. Children spent less time doing near vision tasks.
Understandably our vision has adapted to the stresses of our new environment of electronics, news feeds, and novels. To the behavioral optometrist reading is a biologically repulsive task. Our eyes were not meant to focus at near for extended periods of time without significant stress on our visual system. If our visual system cannot cope with the increased stress it can respond in a number of ways: 1) develop a reading problem 2) develop strabismus or 3) develop myopia to relieve the stress. Myopia is our vision’s response to unnatural near-point stress that it cannot cope with. Studies have even shown reduced myopia in children that spend more time outdoors.3
Often the number one complaint for someone with worsening myopia is distance blur. So naturally when they present to their optometrist they ask for stronger glasses. Most optometrists have been trained to comply and achieve optimal distance acuity – you are familiar with the term 20/20 vision; however prescribing stronger lenses for distance vision comes at a cost. For most myopes the full distance prescription increases the stress on the visual system when doing near tasks. I have read blogs that blame optometrists for their worsening vision – I will respond by saying myopic progression in adults is still uncommon and most times offering the full spectacle prescription does not do harm to the patient. Most patients desire seeing the letters on the 20/20 row; however, I will agree that optometrists should offer more dialogue about near vision correction to protect from myopia progression.
Let’s make it better
So how can we work to stop myopia. For the individual there are a number of lifestyle and postural changes that can be made. This includes reducing our time spend looking at a screen. It is also believed that taking more frequent breaks and practicing distance viewing exercises can be helpful – an example of this is the 20/20 rule: taking a break after 20 minutes of a near-vision task to look view in the distance something greater than 20 feet away. Another lifestyle change might be adopting a greater acceptance of distance blur. A full distance prescription improves clarity when distance viewing, however for most people less than 10% of their day is spent viewing in the distance. Most of our time is spent indoors, therefore it might be more appropriate to have a task specific prescription to improve visual comfort and efficiency – this can also produce a reversal of the myopic progression. Other postural changes should be considered, including holding near material at Harmon distance (the distance from our elbow to our knuckle) or using a more upright posture to reduce stress on our neck and shoulders. A slant board is an excellent device to improve posture and reduce stress on the visual system.
How your eye doctor can be part of the solution
Lenses can also be a powerful tool to reduce myopia progression or even reverse myopia. Correcting a person for near activities can be helpful at reducing visual stress. This might come in the form of a bifocal or simple reading glasses. It has been documented that this is an effective treatment for reducing myopia progression. Dr. Darrel Harmon discovered that myopic and hyperopic children adapt different postures when reading, and that the use of lenses can alter a person’s posture by either increasing or decreasing muscle tonicity.4
In my personal journey I am pleased that I have cut my distance prescription back 0.75 diopters in less than 2 months. I wear a bifocal to reduce near vision strain. In the future I plan to reduce my astigmatic correction. I have not found a patient that actually wants their myopia to worsen, so I thought it would be valuable to write this post. I hope that it was easily understood and that colleagues reading this question what they’ve been taught about prescribing.
There are of course other alternatives to slow myopia progression including vision therapy, orthokeratology, MiSight contact lenses and atropine penalization; however none of these treatments have been tested in adults to understand whether they will slow myopia. Visit our website to learn more about these other treatments offered at North Peace Optometry Clinic.
Relationships require communication. At different periods and aspects of life I would say that I have been a poor communicator. The most memorable ah-ha moment was a time when my wife asked that her and I go grocery shopping together.
“But why? That sounds so inefficient.” Was my response. “Why don’t I go do this errand, and you do the grocery shopping. That way we’ll be done our work faster.”
At the time I thought my reasoning was logical and fair. It is likely a common response that many people would give – not just myself. My brain is programmed like an agenda with a to-do list. The more items that I can check off my list, the more accomplished I feel about my day. It is my measure of success. I have a Type-A personality and if you’ve seen me on my phone you will notice the lists that I conjure in the day.
What I did not realize was that my partner was really saying “Lets spend time together. We are both busy, why don’t we spend time together getting groceries.”
Wow. I had no idea. Men really have no idea what women are thinking. It is like our brains are on two entirely different channels. I think what both of us learned from this is to communicate in a way that conveys our emotions. If we feel the need for connection then we are better to recognize that and tell our partner rather than send mixed messages. If she had just said “Lets spend time together,” I would have understood that and complied.
Why am I writing this
This post is about communicating with patients, specifically during the COVID-19 pandemic while our business is closed. For those of you that are reading my blog for the first time. I am the owner of North Peace Optometry Clinic. This time has been very difficult on a lot of small businesses and their employees. Individuals are instructed to stay home as much as they can, and that drives a wedge between many small brick & mortar businesses and their customers. Yesterday I received an email from Canada Post notifying me to expect delays due to large volumes of parcels being delivered, similar to the large volumes of parcels delivered during the busiest weeks of Christmas season. As you read further I explain some of the steps that our business has taken to communicate to our customers.
Email is King
It was a worrisome time when the very first cases of COVID-19 came to British Columbia. We were fortunate to have good guidance from the Canadian Association of Optometrists as well as the BC Centre for Disease Control as to how to screen patients that could be infected with COVID-19 and to caution anyone that had been travelling, had flu-like symptoms, or had been in contact with COVID-19, to stay at home for 2 weeks after they were symptom free.
Act fast, email blast
Our immediate response was to communicate this on a channel that would reach all of our customers very quickly and efficiently. On March 13, 2020 we sent an email blast to 6096 patients at our clinic asking them to stay home if they met any criteria of our COVID-19 screening protocol. As the number of cases rose in British Columbia, and a lockdown of non-essential businesses was ordered, our business sent out another email blast on March 24, 2020, this time to 6,122 patients, announcing our closure. In the message we communicated how they could reach us, how we could support them, and how our business was adapting to the current conditions.
Email blasts have been immensely successful at our business over the past few years. It remains my favorite marketing tool for its low cost and high penetration. I attended a communication webinar given by a member of Twilio, who demonstrated research that showed customers preferred emails for “reference” type communications that were non-urgent. We’ll talk more later about what customers preferred for urgent communications.
Prior to COVID-19 it was often difficult to collect emails from customers. Nobody likes spam or receiving emails that are irrelevant. For that reason many customers were reluctant to give us their emails. Now, we find that it is a useful tool. Not only can we send customers important updates about COVID-19 protocol and business hours; but we can send customers copies of invoices or instant notifications when their glasses are ready. The relevance of emails has grown significantly. For customers, this will be a recognized and trusted method to stay in contact with our clinic.
Tips to get it right
As I mentioned earlier, nobody likes receiving emails that are irrelevant. Our time is limited and often we don’t have time to read all of our emails. Here are some tips for writing great email blasts:
Keep your material relevant for customers. If you are sending a message that is only specific to a certain group, try to filter your recipients so it only targets customers that would appreciate you message.
Keep it short and impactful.
Break up large lines of text with images.
Use a catchy subject line
Create a call to action in your email
Include a link to unsubscribe.
Social Media Frenzy
This is a great opportunity to make a splash into social media. Building a fan base takes a significant investment of time but can also be rewarding. Social media is not a useful tool for communicating urgent information, like when someone’s appointment is cancelled, but can be a great reference tool to create a positive impression of our business in the minds of your customers. Customers want to feel a connection to the business’ that they deal with; many individuals use social media to research similar businesses before making a purchasing decision. Social media is an opportunity to give your business a personality and demonstrate your purpose.
During this time our business doubled down on our social media posts to communicate to patients outside our email reach that we are temporarily closed to the public during the COVID-19 pandemic; however we emphasized that we are available to help customers who need glasses and contact lenses or have an eye emergency. Very rarely is offering emergency services relevant at the time that the customer is reading your post, but it creates and impression and the customers remember your message for when they do have a need. Shortly after our post, I received a call from a customer of mine that was having eye pain and had been told about our emergency services from her daughter, who coincidentally had seen our post.
There will never be another pajama day
It is important to be genuine. Share with customers what you are doing
during this time. During the closure the staff had joked that every day was blue-jean day. This turned into fun theme events on two occasions. April 17 was pajama day at work. It was a once-in-a-lifetime (hopefully) opportunity for the staff to wear their pajamas to work. We captured the fun and posted it to our social media page. We also post more relevant information, like how we’ve been offering free shipping and curb side pickup.
Prior to COVID-19 we had not been very active on our Instagram account.
We took our business closure as an opportunity to post some of our ophthalmic frames as a gallery on Instagram. This will create some buzz on our platform and can become a useful tool if a customer is wanting to browse frames that we have available.
How is my hair?
It is important to have live content. It sounds scary, but is an important part of an active business page. This is an intriguing new form of branding your business, as you become recognized as the face of your organization. It is important to keep your live videos relevant and brief. We have made 2 videos recently to announce some of our exciting initiatives. On April 8, 2020 we proudly announced that our business was donating free prescription eye wear to hospital staff that work in the ER department of our local hospital. Safety eyewear is an important part of their personal protective equipment, as it is required to prevent virus particles carried in water droplets from reaching the vulnerable mucus membranes of the eye.
“Okay Google, Communicate for Me”
What can’t Google do for us? Google Business is similar to social media, except that customers interact with your Google Business page whenever
your business appears in the results of a Google search query. Your Google Business account can display important information such as your phone number and business hours. It can display images of your business and encourages you to add new contact. Your Google Business page also displays Google Reviews that customers leave for you. Maintaining an active account is valuable in being the top ranked website in search results.
Start a Blog
A blog is just one more way to communicate with customers. It is especially useful for customers that want to learn more about a specific topic. If you can provide an expert opinion on a subject, you are now a trusted source. Your blog should contain links to reference other websites or to your business page. This becomes useful because a website with links to other websites becomes more “reputable” in the eyes of search engine bots, and ultimately it makes the blog easier to find in search engines. If nothing else, it is a great way to let off steam while writing about topics that have been swirling in your head. I chose to write this current blog post in order to prepare myself for a webinar that I am hosting Monday April, 27, 2020.
Is Your Website Dusty?
It is important to add new content to your website. Search engine bots recognize websites that are regularly adding new content. This contributes to your website being the top ranked result when a customer is looking for a business similar to yours. Take this opportunity to write about something that you are already doing. This also becomes a useful tool when you want to offer your website as a resource for customers. As an example, I recently created a new page on our website for myopia control thinking it would be attractive for new customers to see the great services that we offer outside of comprehensive vision and eye health examinations. What has been even better is that now I can print off this page for patients when I discuss myopia control with them, and reference my website as a resource.
Pop-ups that don’t aggravate people
It is important to notify visitors to your website that your business is closed during COVID-19. It sounds bleak, but customers appreciate having current information; turn this into a positive by taking the opportunity to collect their information so that you can notify them when you are open. A simple way to do this without changing the message on your homepage is by creating a pop-up that sends the message. Include an icon to close the box and a web form to collect patient information if they so choose.
Woo commerce are all examples of interfaces that customers can shop local while browsing the web. My advice is choosing the service that you see fitting your needs for the long term. I was very fortunate to view a webinar demonstrating OSI’s new Vision Store. We will launch our own Vision Store in the near future. This will allow our customers to renew their contact lens order, and purchase dry eye products and other accessories online from our branded web store. A web store poses new challenges, including fulfillment of orders and monthly subscription fees, so if it isn’t suitable for your business I think it is very important to have web forms for customers to contact you with questions or to re-order their contact lens supply.
For those with trouble sleeping
Lastly, another communication tool for your website is a chat bot. If customers are not able to find their answer on your website, a chatbot allows them to have commonly answered questions answered, or speak to a live person to get support. If you have a knowledgeable staff member who is tech savvy, this is a great job for them. Unfortunately because of my type-A personality, I’m the one who takes ownership of this. Members of the Generation Z era love this feature because they don’t have to speak to a person; however it can be agony when you receive messages at 11pm because someone broke their glasses. Our website plug-in integrates seamlessly with Facebook Messenger and sends instant messages to our Facebook business page.
SMS Has Arrived
The newest Optosys communication module on our electronic health record system allows for SMS communications with our customers. This is a remarkable tool for sending appointment reminders, as well as to notify customers when a product is ready for pickup. Twilio, coincidentally the tech service company that provides this SMS service, reports that SMS is a customer’s preferred form of communication for urgent messages. Their explanation for this is because a person is likely to check messages on their phone several times in a day. Rarely does a person go a full day without reading a message that was sent to them. Whereas alternatively, a person may go a full day without listening to their voicemail or reading an email.
Here are some useful tips that I’ve discovered using the communications module in our Optosys software:
Save time by pre-programming messages to send to customers.
Remember that each message costs money – something like 5 cents.
At this time, customers cannot respond to our messages.
To business owners, I hope that some of these tools will be helpful in re-igniting the spark in your relationship with customers.
To customers, please don’t migrate to another social media platform. I don’t have the energy to manage any more accounts 🙂
To my wife, I will go grocery shopping with you anytime babe.
One thing is certain – We don’t know much about COVID-19
It is unfortunate that nearly every headline I read in the news revolves around the novel COVID-19 pandemic sweeping the world. It is on everyone’s mind and people are looking for answers. Whether right or wrong you’ll find answers to questions like: how the virus started; how much fluids one should drink to prevent infection; whether to take acetaminophen or ibuprofen; and what treatments are effective. In just a short matter of time, some of these answers have already been proven wrong. Now I’ll admit that for the longest time, while news reported the COVID-19 virus spreading thru china and into Italy, the only thing I was following closely was the stock market. It wasn’t until at a staff meeting that a co-worker cited news that wearing contact lenses could increase a person’s risk for COVID-19. I didn’t believe that to be true, nor did I want to, but I didn’t have any evidence to support my belief either. Can I claim to have a professional opinion – writing 3 blog posts has to count for something, eh?
Contact lens wear is safe
Then it came, like an answer to my prayers. I received a newsletter from the Canadian Association of Optometrists, the countries largest membership of optometrists. In the newsletter was an article titled COVID-19 and contact lens wear: what do eye care practitioners and patients need to know?, published by a Karen Walsh, a clinical scientist at the University of Waterloo (Canada). In the article were statements from the world’s leading contact lens experts. One of the experts was Dr. Lyndon Jones, a clinic professor and director of the Centre for Ocular Research & Education at the University of Waterloo. So what did the world’s best contact lens researchers conclude:
Contact lens wear is safe.
Washing your handsis essential whether wearing contact lenses or spectacles. Contact lens wearers should wash and dry their hands before insertion or removal of their lenses.
Disinfect contact lenses. Contact lenses should either be disposed of at the end of the day (absolute best option), or regularly disinfected.
Disinfect your spectacles. The virus can live on certain materials for days, so keep your glasses clean too. Rember that you are often touching them with grimy hands.
Discontinue contact lens wear if you are sick.
Spectacles are not proven safer.
What Has Past Research Taught Us?
Interestingly, and older study published also found that individuals who purchased contact lenses from the internet were at a greater risk to develop serious infection.
I feel a lot of uncertainty in this difficult time, but I’m thankful that Canada has incredible forward-thinking scientists that are fast to dispel myths about eyecare. If my blog has taught you anything, I hope that it was to wash your hands regularly and purchase your contact lenses from your eye doctor 🙂
Last weekend I had the opportunity to attend the BC Doctors of Optometry annual conference hosted at the Hyatt Regency hotel in downtown Vancouver. Each year, optometrists in British Columbia are required to acquire 20 hours of continuing education. I didn’t get all 20 hours but I was able to attain 18 hours at this meeting. One thing I learned, and I’m about to share with readers, is the changes coming to MSP billing for optometrists. Although this topic might sound dull to some readers, I would like to highlight the benefits of MSP to residents of BC and how the agreement between MSP and optometrists in BC is different than all other provinces and territories in Canada.
Medical Services Plan (from now on referred to as MSP) is public health insurance for Canadian citizens and permanent residents that live in BC. It covers the cost of medically-necessary insured doctor services (www2.gov.bc.ca). The BC government has negotiated a fee schedule for insured services provided by optometrists; this includes eye exams for children, seniors, or individuals with a sight threatening eye condition. Anyone in the age group 19-64 with healthy eyes might feel left out, because in 2001 the BC government de-insured coverage for those individuals.
Understanding Balance Billing.
In British Columbia, optometrists’ reimbursement for government insured services is less than most other provinces in Canada. As part of negotiations many years ago, the BC government granted the ability for optometrists in BC to perform balance billing. Balance billing is the ability of the optometrist to charge the balance owing when a service is under-insured. This is the reason why in British Columbia, a child’s eye exam may include a fee. This might come as a surprise to some parents that were expecting a “free” eye exam. Hopefully I can clarify some assumptions about optometry fees, including and not limited to children’s eye exams. First, nothing is “free” – the government pays the optometrist according to the MSP fee schedule for the service provided, and new to BC as of January 1, 2020 businesses pay a tax to cover health benefits for all British Columbians. Secondly, the purpose of the exam fee is to collect on the remaining balance owed for the exam – the existing insurance coverage provided by MSP is not sufficient to provide the services that we do. Our clinic specifically is proud to offer the highest level of care that goes beyond the minimum standard. Each year we re-invest in new equipment, computer hardware and security, and training for our doctors and staff.
Does balance billing create barriers to access?
While we hope that every individual has access to affordable eye care, perhaps not everyone does. Fortunately our clinic offers free eye exams and eyewear to individuals in need. On May 9, 2020 we have offered to perform eye exams for children of single parents at an event held at the Fort St. John Alliance church. Last December we approached School District 60 to nominate children and families that were in need of help, and with parental consent we helped 9 children. The year before, we helped 10 people nominated by their friends or family on social media.
What changes have the BC government approved for 2020?
Beginning April 1, 2020 the BC ministry of Health has approved coverage for extended diagnostic testing for individuals with a disease of their retina. This will allow our doctors to perform additional testing, that isn’t included in a routine eye exam, to diagnose and manage a patients eye disease. Previously, many patients had to pay the full cost of this testing out of pocket. Also, new coverage is provided for patients with diabetes and bleeding in the eye, that allows us to photograph, analyze, and review the information with the patient. These are two services that patients previously had to completely pay for out of pocket or that the optometrist gave the extra time without billing the patient. Overall I am very pleased with these new fee items as they will advance our level of care, where it is much needed in our rural setting.
Amidst the conference and travel I recognize it is important to make time for myself. I took the opportunity to go fishing for Steelhead in the Cheekamus River, close to Squamish. It was a nice break from the 18 hours of sitting that I did in seminars. While I didn’t catch any fish, it was good to be reminded of our great country’s beauty and natural resources. I enjoyed being challenged and improving my craft, similar to how I feel about practicing optometry and being a business owner. I hope that you’ve enjoyed this post and please feel free to leave your comments.
Last November our clinic was excited to add a new piece of equipment, the Californa Optomap. This remarkable machine has changed how our doctors practice optometry. Prior to owning our own I’ve heard great reviews from colleagues, but with the opportunity to blog about it I wanted to share this with followers.
First I would like to give a bit of history about the Optomap. In 1992 the company Optos was founded by engineer Douglas Anderson after his five year old son lost his vision in one eye from a retinal detachment that was detected too late. Although his son was having regular eye exams, routine exams were uncomfortable, especially for a child, which made it impossible for the doctor to conduct a complete exam and view the entire retina. Anderson set out to commercialize a patient-friendly retinal image product that encompassed a digital widefield image of the retina in a single capture.
The optomap is a tool that assists us in the evaluation of your retina. With optomap we can discover any abnormalities or confirm the health of your retina, diagnose any potentially harmful diseases, and if necessary, determine the best course of action. optomap is a simple, non-invasive procedure. In less than a half a second we can generate a high-resolution, digital, 200° image of your retina. This is much wider than a traditional 45° image that most other clinics use. Already, our doctors have been able to image asymptomatic retinal pathology in patients of our clinic.
I’m pleased to say that this new equipment has evolved how our doctors practice optometry and has raised our level of patient care. Optomap is now the standard of care and available to patients of all ages. We are the only clinic in our region to offer this service yet and I think it sets us apart, so be sure to think of this the next time your family member needs an eye exam.
Welcome to eyedoctornearme.ca and its first blog post. My name is Christopher Herriot. I created this website to keep followers updated on new developments at my optometric practice North Peace Optometry Clinic as well as eyecare in general.
I am married with two boys, ages 9 and 2. We live in Fort St. John, a small down in Northeastern British Columbia. My wife and I met here in 2002; at the time we were drawn to the city because it provided great opportunities for young people to work. Today we enjoy it because of the community spirit that we are immersed in. We are connected to the school that my child attends and the families that go there – my wife Kelly volunteers as the hot lunch coordinator; we are connected to the minor hockey community where I’ve coached my oldest son for the last 4 years – and soon I’ll begin a coaching career for my youngest son; we feel connected to members of our extended family that live in the area.
Fort St. John is also a great region for the outdoor enthusiasts. We enjoy camping, fishing, and ATVing. Last summer I enjoyed offering a travelling eye clinic to the Doig River, Prophet River, and Blueberry River First Nations communities. There are many young families in our community and plenty of park space so it is nice for our kids to be able to play outside.
I hope that you enjoy the blog page. Please feel free to post comments and add you input. Please ensure that what you write is tasteful and respectful.