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!

Introducing Kevin La, a young optometrist who has followed his passion of introducing delicious foods from around the world and now runs a succcessful Instagram page. Read on to find out more about him. 

Tell us a little bit about yourself

Hi, I'm Kev! I'm an optometrist in my second year out, working in the Greater South West of Sydney. In my time off, I search for places to eat really good and authentic foods from cuisines around the world and write about them.

Where can we follow you?

Find me at @sydneyfoodboy on instagram!

How did you get into what you’re doing in your time outside optometry?

Well, I love to travel. It gives me so much joy to hop off a plane somewhere to immerse yourself in a rich culture with a completely different way of life. And one of the things I definitely look forward to most is trying all of the amazing food that each new place has to offer!

I think we can all agree that working everyday is a little less exciting than that. On my last trip out, I wondered - how can I make everyday feel like a holiday?

We’re lucky enough to live in Sydney, one of the cultural capitals of the world. So many people from all walks of life have come together to call one place home, meaning there is a world of different flavours waiting to be tried around Sydney. So that’s when I started on my quest and started writing about it!

Tell us about one of your most memorable food experiences

I was walking down the quiet-end of Liverpool and noticed a small, bustling eatery. People were coming and going with huge bags of takeaway containers to feed their families. With Lebanese cuisine being one of my favourites, I was so intrigued. I had to sit down for a meal.

The hummus and falafel I tried there turned out to be amazing - some of the best I’ve eaten. Turns out that the restaurant was family-run and has been well-known in Liverpool’s Lebanese community for years. I read somewhere that the falafel recipe has been passed down a few generations too. We’re definitely lucky to be able to have that and many other food experience at our doorsteps!

Do you find it easy to juggle your optometry career and your other passions?

I find that searching for and writing about good food doesn’t take much effort from me! Before I started the IG page, you'd find me chatting away about food to my friends in my spare time anyway… or even to patients in the consult room ha! Food is a love shared by many and you can really talk to anyone for ages about the great food they’ve eaten. Because of this, it was a hobby that I easily translated into a passion project outside of work.

Does time away from optometry help you appreciate it more? 

I would say so. I love being an optometrist. We help people to see again, and we improve people’s lives because of it! Even if you don’t see it, you’re making a very positive impact on the world as an optom.

I’ve seen a few of my peers become burned out from their jobs though. It’s understandable. It can get stressful, especially if you work in a practice with a high volume of patients. Being a guy that finds it really hard to stand still, I definitely didn’t want to go through that. Starting @sydneyfoodboy allowed me to pursue another love of mine and I would say I’ve enjoyed life more, both within and outside of work, since. 

Do you have any advice for young optometrists out there who would like to pursue their passion but haven’t quite gotten started?

You’ve just gotta do it! If you have something that you’ve wanted to pursue in the back of your mind, you should get out there and turn that thought into action! You won’t know if you’ll be successful or not until you try. You only have one life, so you have to make sure that you do everything in your power to enjoy every single day of it.

Student's Corner is a new space which is designed to introduce some of the amazing Optometry Students - delving deep into their likes, dislikes, struggles and current mood. And although we've called it Student's Corner, our first guest not-so-student anymore. Keep scrolling to read more about 2019 UNSW Optometry Society President: Ivy Kol.

What is your favourite Disease?

Microbial keratitis - it's the first red eye I ever saw!

What about Optometry really grinds your gears? 

When a patient is non-compliant with your treatment and then returns for the review complaining about the same issue.

What drives your passion for Optometry?

I really enjoy solving a person’s problem and seeing the positive impact on their life. It gives me a lot of personal satisfaction and is what keeps me motivated! 

Something you discovered about the uni not everyone may know? 

The structure at the top of the main walkway (where Scientia is) is designed to look like an open book   

Would you rather do 100 body-weight squats or walk to and back from Village Green to Sir John Clancy?

Walk to and back from Village Green to Sir John Clancy - so I can get a Stockmarket salad too 

Something others may not know about you?

I studied Exercise Physiology for a year before transferring into Optometry

What song do you play that instantly lifts your mood?

Sunflower by Post Malone

In Orthokeratology, Axial, Tangential, Refractive and Elevation plots have different roles

• Axial: better to assessing treatment zone size and refraction change achieved
• Tangential: better for assessing centration and to assess seal of lenses overnight. It also assesses the position of the lens on the closed eye environment, for example the patient had a corneal scar, this plot may be ideal as it draws data at a 90 degree tangent to the surface. The tangenital map also helps us assess the effect of corneal reshaping.
• Refractive Power: better for assessing treatment zone size and quality of vision. Note: the more consistent or uniform the power, the better the quality of vision. This is not used independently, as it does not give us information  on curvature or size and shape of the corneal surface.
• Elevation: height of the corneal surface compared to "best fit sphere" (in microns). Corneal elevation above the reference sphere is denoted in positive microns and is red, whereas blue shading denotes the corneal surface is below the reference sphere and is measured in negative microns. This may be helpful in predicting areas of excessive bearing (red or positive microns) or pooling (blue or negative microns).

We need accurate topography maps to predict corneal sag for an accurate lens fitting.  Maps should be taken before and after lens wear so we can compared the changes, and use the subtractive function/compare function on the topographer to view this.

Displays

• Single View: This shows a single exam for the selected patient, a good tool for baseline screenings
• Difference/Subtractive/Compare Display: This shows the difference between two exams, for the same eye. It subtracts each measured point from one map to another. Flatter areas are displayed in cooler colours e.g. blues, and areas of steepening are displayed in warmer colours e.g. reds.

For example:

• Tangential Subtractive Plot:
• • A big red ring appears here unlike in axial. This will tell you if the lens is sealing off at 360˚. Make sure that the ring lines over the pupil properly.

• Axial Subtractive Plot
• • Look at the blue zone to assess size of treatment zone, whether it covers all the pupil and what the refraction change is

Potential Fitting Outcomes

•       Bulls Eye result:  

When the sag of the cornea is predicted correctly by the topographer and the sag of the lens matches appropriately

•       Smiley Face

When the sag of the cornea is UNDERESTIMATED by the topographer and the sag of the lens is too shallow for the cornea, so that it touches centrally and then rides high on the eye overnight.

•       Central Island

When the sag of the cornea is OVERESTIMATED by the topographer and the sag of the lens is too deep for the cornea, so that instead of flattening the cornea centrally, it actually steepens it.

•       Frowny face

When the alignment curves on the edge of the lens are too TIGHT and the lens drops LOW in the closed eye environment (the sag does not matter in this case). 

Introducing Martin Diep (MOptom BOptom BSc FACBO) from  See Optometry, Victor Harbor SA. He has a special interest in Behavioural Optometry and is doing some amazing things in the world of Vision Therapy and Binocular Vision. Read ahead to find out more! 

Tell us a little bit about yourself and how you got into Behavioural Optometry

Born and raised in Sydney, I studied Optometry at UNSW and graduated in 2014.  My first gig was in regional South Australia in Port Augusta, a small town of 14,000 people 300km north of Adelaide, where I worked for 4 years before moving to my current practice in Victor Harbor, 80km south of Adelaide.  It only took me a few months after graduating when I realised that my undergraduate degree only taught me the bare basics needed to survive the world of optometry, and I needed to upskill myself to actually know what I was doing, especially with patients with visual symptoms but no clinically significant visual findings. Hence I started my journey into the world of behavioural optometry; getting my Masters degree through UNSW in 2017 and my Fellowship with the Australiasian College of Behavioural Optometry (ACBO) in 2019.

-Tell us about your typical day or week at work

Optometry in my practice probably looks a bit different from a regular city optometry practice. On top of all the regular optometric clients, I also do a fair few paediatric consultations that have been referred by other optometrists and educators for learning related vision problems.  These include a full binocular vision check as well as a developmental information visual processing check where I investigate problems with reading eye movements, visual spatial dysfunction, issues with visual analysis and visual memory, as well as visual-motor and visual-auditory integration skills.  Throughout my week, I also do in-office vision therapy with my clients for a wide range of visual dysfunctions, from convergence insufficiency, to learning related visual dysfunctions and post traumatic vision syndrome following concussions and strokes.

How did you get into this unique area of optometry?

It took me about three months after graduating when I realised that there were a lot of patients where I could not explain the symptoms they were getting from the tests that I got taught at university and so I started trying to find some answers.  I knew there was a gap in my knowledge (which were not a result of falling asleep in many lectures at uni!)  I discovered that ACBO offered many postgraduate courses that covered the topics that I was least confident about and decided to go to the Art & Science course offered by the Optometric Extension Program.  That was when my I realised that there was SO much that optometrists could offer clients that was not even mentioned during undergraduate study!  As I learnt, I discovered how optometry is really the only profession that has the functional vision science knowledge to provide services for vision development, enhancement and rehabilitation and this opened up my world to the optometric management of developmental delays, autism, brain injury, sports vision and other visual issues that conventional optometry has no way of treating.

How do you keep up with the optometry world?

Postgraduate courses are the crux of my professional development.  I go to more postgraduate courses than that needed to meet my minimum CPD requirements; at one stage I racked up 350-odd CPD points in one registration period!  Keeping up with colleagues in the industry is also a great way of keeping in touch with what is happening in optics and it gives me great ideas on how to implement changes to my practice to enhance the patient experience.

Do you have any goals for your optometry career?

In Australia, the delivery of vision services to brain injury clients is abysmal.  Even a basic visual acuity check, refraction and gross assessment of binocular vision is severely under-valued in hospitals and rehabilitation centres around the country.  It is one of my goals to increase general awareness of the huge impact brain injury can have on the visual system and that optometrists can fix a lot of these problems with a simple pair of glasses. 

I would also love the general optometric community to begin to understand that the unique tools that we have access to - lenses, prisms, tints, filters - can be used in more than one way. I want to encourage other optometrists to think outside the box; think about the person as a whole and how can you use what you have in front of you to change their lives for the better?  For example, using based down yoked prisms in a CNIV paresis to eliminate diplopia on downgaze when reading. Sometimes the solution is easier than you think!

What keeps you sane outside of your work life? Do you have any hobbies or passions you pursue?

My hobbies are what keep me sane enough to to work in a high pressure environment with clients with complex needs.  I work out regularly, 5 days a week at the gym and run a few times a week.  I would like to think this is to keep fit, but in reality it’s to offset my love of baking for friends and family (and myself)!

What advice would you give to other optometrists who also wish to pursue this area of practice?

To be successful in behavioural optometry, you must approach it with an open mind, and be ready to learn and learn and learn. Once you start, you only then begin to realise how much you don’t know about the very job you’ve been trained to do and have been doing for the last however many years. ACBO is the best resource for optometrists looking to further their knowledge on binocular vision, learning related vision problems, and higher level topics like brain injury and sports vision.  They have material of all levels that can meet your needs regardless of how in-depth your knowledge is in the area.  Colleagues that have been practicing behavioural optometry for decades still benefit hugely from the ongoing CPD they provide.

It's easy to get stuck in the bubble of Optometry. What's something that you wish people knew about behavioural optometry?

Optometry is not just about subjective distance refraction and eye health. Don’t get me wrong; they are hugely important and they are the basic things all optometrists must test, but there is a whole other level of fundamental visual functions that a lot of optometrists do not even consider.  For example, when was the last time you thought about fixation, let alone test for it? How do you even test for it?  When you really think about it, what are the basic visual skills a person must have to even read your logMAR visual acuity chart? A few come to mind with examples:

●       Accurate fixation and saccadic movements - to even know where to look let alone read across the line without skipping letters or confusing lines

●        Accommodation - think of the psuedomyope with poor control of accommodation in the distance

●        Vergence control - divergence excess strabismus have poor vergence control in the distance

●        Visual spatial skills - how do you distinguish between an S and Z when they are fundamentally the same squiggle, just mirrored?

●        Visual discrimination - how do you differentiate between a Y and V when one just looks like a longer version of the other?

●        Visual figure-ground & central-peripheral control - How do non-amblyopes isolate the letter they are fixating on without getting distracted by all the other letters around them?

●        A proper understanding between spatial concepts like text with temporal concepts like speech - How do they know that the visual representation of “A” is the same concept as the sound it makes?

How do you think a child with these vision problems would do at school with reading comprehension and spelling? They may see 6/6 and refract plano but there is so much more at play here and you as the optometrist can be the one who changes their lives.

It's almost the best time of the year... Christmas! It's not unusual for patients to bring in gifts, such as chocolates, or a bottle of wine. But, can we accept these gifts? Where do we draw the line? 

Consider the following scenarios:*

• Margaret is a long-term patient of yours that you see monthly for epilations. Just prior to Christmas she gives you a large box of chocolates and a card thanking you and the staff for your care. 
• Ben is a new patient of yours and he comes in on a Thursday night with a very expensive bottle of wine and two Gold Class Event tickets, to thank you for the detailed eye assessment. 
• John was a long term patient of yours and you were co-managing his glaucoma. Sadly he passed away, and his wife comes in and gives you $2000 in cash as a token of her gratitude. 

Most gifts are innocent gestures of goodwill, and patients don't give these expecting preferential treatment or something in return. However, beware the patients who may have other motives - some may think their gift entitles them to additional services, you squeezing them in during your lunch break or bending the rules just for them. If you accept their gift, you might find it difficult to refuse their demands and requests. If you reject a gift, remain tactful as otherwise the patient may interpret this wrongly and be hurt by the gesture. You could explain the rejection in terms of a general policy and/or ethical obligation, for example "I really appreciate the gesture, however our office policy doesn't allow me to accept such a gift.“

Realistically accepting small gifts is reasonable, however monetary, large gifts or personal items might be considered unethical. Of note, the Medical Board in Good Medical Practice: A Code of Conduct for Doctors in Australia writes:

Doctors must be honest and transparent in financial arrangements with patients. Good medical practice involves… not encouraging patients to give, lend or bequeath money or gifts that will benefit you directly or indirectly.

So what happened in the scenarios?

• You thanked Margaret for the chocolates and shared them with the office.  
• You thanked Ben for the gesture, however politely declined this. You felt uncomfortable with the gesture and after discussing this with another optometrist at the practice, they offered to take over the care for Ben.
• You told John's wife you were sorry for her loss, but could not accept the monetary gift. She decided to donate the $2000 to Glaucoma Australia instead. 

Here's a great article from MDA National if you want to read more.

What to say to your boss when you’re planning on quitting

Firstly consider, do you actually WANT to quit? We all have those bad days at work that make us want to quit, but are you simply acting on anger? Can you discuss the situation with your boss? Have you tried discussing this many times before, and it’s obviously a dead road? Is there anyone else you can talk to in the company who may offer you insight? If you think it’s all a matter of miscommunication and can be salvaged, maybe reconsider quitting.

However, if you’re ready for new adventures and are sure about quitting, what do you do?

How do you deliver the news?

Focus on the positives and what the job has taught you. Let your boss know how appreciative you are for the opportunity, but you are ready to move on. It may not be worthwhile bringing up petty disagreements you may have had.

Giving notice

Read over your contract, most organisations require 2-4 weeks’ notice of leave. Give notice in the form of a resignation letter, emphasizing on the positives and how you have benefitted from your time there and offer to help during the transition. Make sure you detail your end date with them.

Restraint of Trade

Read over your contract, do you have a km radius restraint, and if so for how long?

Do you have a job lined up?

Whilst Optometry is thankfully very flexible, consider having a job lined up. Will you take a break and or holiday in between the jobs? If you are unsure about your next workplace, consider sitting in for a few days first to see if you are the right fit for the practice.

Ask your boss for a reference

It’s wise not to burn bridges before you leave! Ask your boss for a written reference, especially as time moves on it, it may be difficult to get a hold of these references, especially if you need these quickly.

Return Company Property

Return any company property, such as company keys, uniform, intellectual property, company equipment, or car (if you were lucky enough to have one!). Do not take any patient information, although this should not leave the practice in the first place.

Telling patients you’re leaving

Over the years you may have built a very strong bond with your patients. It would be respectful to tell them you are moving on and another optometrist will take over your care. If you are certain patients, such as vision therapy cases, which require your care – consider finishing off their therapy or referring them on so they are able to receive best care.

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 this month's Unconventional Optometrist. Sarah Pham is an optometrist who works in metro Sydney and has pursued a side career in Events Planning. Read on for her thoughts on how to keep interested in Optometry and how to follow your passions. 

Tell us a little bit about yourself

My name is Sarah Le Pham, 2016 UNSW School of Optometry graduate. I predominantly work a mixture of corporate, mobile and independent practices based in Sydney metro.

Since graduation, I’ve been actively involved with the excellent and devoted Young Optometrists (YO) as an executive for 2 years prior to help bridge the gap between the generations of optometrists which has been very rewarding.

At the same time, I’ve looked into various specialties and discovered that all of them were interesting in their own right. OrthoK and myopia control particularly tickled my fancy! I’ve tried to go further and look at different demographics as the care and management require different finesse.

In terms of who I am, words that are commonly used to describe me are compassionate, curious and enthusiastic. I’m constantly on a journey to try different things and have the most fulfilling experiences in life!

Tell us about your typical week at work 

Every week has been very different hence there’s no such thing as a typical week for me. This is quite refreshing for me personally however I do understand it may not work for everyone!

In my circumstance, my work is deliberately irregular to give myself an opportunity to explore my other interests (more below).

How do you keep up with the optometry world? 

The advantage of optometry being a niche community is that it is not too difficult to keep up. There are CPD events, articles published online and groups (YO, OA etc) that promote discussion.

Being the nerds we all are, even just a regular catch up with the friends you’ve made during university (who have now become your colleagues), talk about developments in optometry come up!

Do you have any goals for your optometry career?

Optometry is constantly changing and consequently, I want to constantly focus on improving my skills and overall care for my patients. My goal is to be a better optometrist than yesterday! 

What keeps you sane outside of your work life? Do you have any hobbies or passions you pursue?

Keeping up with my attitude to trying different experiences, I’ve actually looked into various jobs and hobbies outside optometry. As much as I like optometry, I would not stay sane if every breathing second was about optometry!

I’ve pursued a side career in Event planning. Nothing as extravagant as weddings, but I’ve delved into parties and smaller scale events! (Birthdays, hen’s night etc). This is ongoing as there are always projects for me to get in touch with my artsy and creative side where the precise and logical optometry career path may not allow!

For a busy practice, one might find that they spend the entire day sitting in the consultation room (can’t be helped!) but it does not contribute to us achieving our active needs. Hence, I’ve involved myself in playing a team sport (Volleyball) in my free time which has evolved into a passion allowing me to eventually be appointed Captain of the newest and developing rep team.

What advice would you give to other optometrists who also wish to pursue something a little out of the ordinary?

You’ll never really know if you like something or not unless you put yourself out there and try it!

It's easy to get stuck in the bubble of Optometry. What's something that you wish people knew about the industry you work in now? 

Yes, it is important to grow as a practitioner and deliver your best care but I personally think it’s equally important to mix things up so that you don’t get burnt out!

As rewarding as Optometry is, I find that there are some aspects that the career simply cannot offer. To really pursue a fulfilling and balanced lifestyle, it’s a good idea to look into things outside of Optometry. 

Author: Austin Tang

Mr. Smith who you remember just purchased his $1000 multifocals just a couple of weeks ago comes in and tells you that he just can’t see well out of his right eye… that things just aren’t as crisp and that something’s just not right but he can’t pinpoint it. You vert the glasses and the cyl in each eye has been made correct to the nearest degree: Rx: +1.00/-0.75x66 with a +2.25 Add. Then you go to check the heights and PDs and nothing’s out of line.

Then you remember you actually never saw him; he had brought in his prescription from down the road. You have a closer look at the prescription and its from 6 months ago. Mr Smith says he could see even better out of his previous glasses, so you take those and vert them and see if there’s any difference. The vert reads +1.00/-0.75x 166with an add of +2.25. Axis 166?!

Patients have the right to have their prescriptions dispensed wherever they choose, whether that is where they’ve just had their eyes tested by yourself or whether it’s elsewhere. However, it is often more difficult to resolve any spectacle related problems when prescribing and dispensing are separated. In the case of yourself and Mr Smith, you’ve figured that there well and truly could have been a typo in that outside prescription, but the lenses that you’ve ordered have been made to the prescription that has been presented to you by his optometrist. Or it could have been that his prescription could have changed since his last refraction? You do a quick refraction to get more information and you get +1.00/-0.75x170 and your thoughts on a possible typo heighten.

There are many factors at play in this situation. There can be both prescription and dispensing errors. Difficulties can become more apparent in cases of complicated prescriptions such as those involving high prescriptions, high degrees of astigmatism, prismatic correction, anisometropia and paediatric dispensing. Even aspects such as frame and lens selection could play a large part in a patient’s visual experience.

So who’s responsible in this situation? It can be a grey area. One could argue that the given script was incorrect and it should be the prescriber at fault, since the glasses were made exact to that prescription. However, the prescriber could also argue that they do not take liability of the prescription if it is dispensed elsewhere. 

Some strategies to overcome these situations including educating the patient on the potential difficulties of separate prescribing and dispensing, particularly if they have a complicated prescription or lens form. It can also be suitable to include a disclaimer when releasing prescriptions that states that there is no liability taken on the prescription if taken elsewhere. A refraction check could also be carried out prior to dispensing if the prescription is not recent or if the patient feels that there has been a visual change since the last prescription. Simple steps such as trial framing an outside prescription could also help with reducing such situations.  

Author: Linda Lam 

25% of the population manifests anisocoria as a normal, routine examination finding. The hallmark sign in lesions of the pupillary efferent pathways is anisocoria. 

Changing consulting room illumination helps to differentiate between physiological and pathological cases.

Always test both light and near reflexes and test for a relative afferent pupil defect (RAPD). If an RAPD is present it indicates a problem with the optic nerve. 

A quick refresher on some differentials to consider when it comes to pupil reaction:

• Adie’s tonic pupil: post-ganglionic interruption to parasympathetic input to the sphincter pupillae and the ciliary muscle resulting in an internal ophthalmoplegia. Typically in young adult females. Supersensitive to weak pilocarpine (0.1%). No ptosis or motility detected.

• Horner’s Syndrome: due to a compromise of the sympathetic pathway from the brainstem to the eye. It may be described as pre-ganglionic or post-ganglionic depending on whether the causative lesion is situated prior to or beyond the superior cervical ganglion. The affected pupil is smaller with ipsilateral ptosis. If heterochromia is observed it suggests a congential lesion. Reaction to light is normal. Pharmocological evaluation is performed with apraclonidine 0.5% or 1% phenylephrine.

• 3^rd nerve palsy: The patient can present with ptosis, eye diverged, no accommodation, pupil dilated and fixed. If acute suspect an aneurysm if the pupil is dilated, ischemia if the pupil is spared. This is a medical emergency and the patient requires immediate imaging

Pupils are quick and easy to assess and should be done routinely. A thorough case history is also vital in determining acute or chronic cases, especially if the patient has had head trauma in the past.

Join us in welcoming Lucia to the Young Optometrists NSW/ACT Subcommittee! Lucia graduated from UNSW in 2012 and has experience in both regional and metropolitan practices. Keep an eye out for her. 

Read on for our Q&A with Lucia. 

Tell us a little about yourself?

I graduated from UNSW in 2012 and since then I’ve worked in both regional and metropolitan practices, as well as a short stint in London, taking advantage of the Youth Mobility Scheme to work and travel around Europe. I’m currently working part time in Western Sydney due to recently starting a family and deciding to undertake further studies in optometry.

How did you end up in optometry as a career?

Optometry appealed to me because it is a stable and fulfilling job, which allows me to help people by resolving their visual concerns and also work with other healthcare professionals. I’m now also beginning to appreciate the flexibility, good work-life balance and various opportunities in career development.

What are you most passionate about outside of optometry?

I enjoy running as it really helps to clear my mind and relieve stress. I also like it for the way it challenges my mental toughness as ultimately, I choose when to stop. I love watching sports, especially basketball; and spending time outdoors, exploring new places.

What inspired you to join YO as a subcommittee member?

I’ve really enjoyed reading the YO blog posts (Unconventional Optometrist and Real Talk) and have found them to be very informative and relevant. I was then compelled to join YO and assist in furthering the goals of facilitating career development and networking opportunities for young optometrists.

How would you spend your free time?

I’ve started to read a lot more this year, trying to maximize the little “me time” I have outside of looking after a toddler. I also enjoy journaling, travelling and playing board games with my friends.

If you had one superpower, what would it be?

Being able to speak the language of whichever country I find myself in.