The Memphis Meeting

This upcoming weekend. July 10-12, 2015, Southern College of Optometry will be hosting the Conference on Clinical Vision Care (CCVC) (also known as the Memphis Meeting) for the 21st year in a row. I was fortune enough to attend last year and wrote about my experience on the OEP blog. The following is my experience and my recommendations on why it is important to attend this meeting:

As the resident liaison for the Optometric Extension Program (OEP), I was fortunate enough to attend the 20th anniversary of the Conference on Clinical Vision Care (CCVC) in Memphis this past July. The conference welcomes optometrists, students, and residents who practice or have an interest in behavioral optometry. The mission and goal of the meeting is to attain a call for action to further the profession of optometry.

If you are expecting a lecture setting where a doctor stands in front with a power point and the rest sit and take notes, this is not what you will get at CCVC. If you want to have a voice, share ideas, and learn from other optometrists, students, residents from all walks of life, this meeting is one you won’t want to miss. When I first came to this meeting, I didn’t know what to expect. As a new graduate just starting residency in vision therapy, I was a little shy and apprehensive to be surrounded by some well-known doctors in the behavioral optometry world. However, what I got out of this meeting was more than what I imagined.

The entire group was relatively small, providing a more intimate setting for learning. It consisted of about forty doctors, students, and residents from all over the world.  On the first day, we were given the theme of the meeting, “Errors, Expected, and Competencies…According to Whom?”. I learned that every year for the past twenty years, a different theme is presented to the group that has three subsequent open-ended questions proposed for discussion for each day of the meeting. Dr. Paul Harris, President of OEP, opened the meeting with an introduction. He explained the way the meeting works where we are broken up into four groups that incorporate “simple sharing”, “reverent listening”, and “corporate sharing” into our discussion.

Simple sharing means that when the question is presented, each person of the group gives their own input and opinions on the question presented. “Reverent Listening” means that when each person shares, there is an understanding that everyone listens to his or her viewpoints and does not interject or interrupt when they are sharing. “Corporate sharing” happens after simple sharing and reverent listening when we acknowledge the common understanding and viewpoints of the group as a whole. After this, we resume the meeting altogether and each group presents their commonalities which opens the floor for questions and more thoughts among the entire group.

Communication is a key element in this conference. The input of ideas, knowledge, and experience is what drives this meeting and what it depends on. The members in my group ranged from an incoming first year optometry student to a past president of OEP.  Everyone is expected to contribute and it was interesting to see how such different experiences can come together to a common understanding.

As the meeting went on, I realized that this meeting is nothing I’ve ever experienced before and nothing like any other meeting I’ve attended in the past. I did not feel like I was in a classroom expected to take notes on whatever subject the lecturer was speaking about. I did not feel like I didn’t know as much as the other doctors. At this meeting you are treated as an equal, a colleague, and an individual that everyone can learn from. I had conversations that included optometry and some that went beyond that to music, art, and literature. To me, the meeting was more of a mindful social gathering with deep thought-provoking discussions.

After Saturday’s meeting we all went out to dinner at a popular barbecue restaurant on the infamous Beale Street in Memphis that had a live blues band. The barbecue ribs were unbelievably delicious, nothing I’ve ever had before. It was the fall-off-the-bone and melt-in-your-mouth kind of delicious! Afterwards, we walked around Beale Street, a long two-mile street full of people, entertainers, bars and restaurants. Being my first trip to Memphis, I was amazed at all the culture and diversity on one street.

Although we all were optometrists, residents, or students, everyone d their own experiences and everyone had a voice. It was a meeting distinct from all the other optometry meetings. One always hopes to gain something from meetings attended, knowing that some meetings provide more of an opportunity to gain and assimilate knowledge than others. Not knowing what to expect prior to “The Memphis Meeting” as CCVC is informally known, adds to its intrigue. I came away with the sense that Behavioral Optometry encompasses a great deal about our profession, but at the same time represents a small percentage of the way in which our profession is practiced.  The style of this meeting each year enables a spotlight to be placed on specific aspects of behavioral optometry and challenges attendees to think about how these concepts can be incorporated into their mode of practice. I would highly recommend this meeting to anyone in their optometric career whether student or private practitioner to experience this type of meeting and how it can impact the profession.

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COVD Annual Meeting

I was lucky enough this year to do my residency during the transition period when COVD decided to move their annual meeting from October to April. That meant there were 2 meetings during my residency! The October meeting was in my home state of California in San Diego. I wrote a blog post on the COVD Blog about my favorite lecture of the meeting, by Dr. Torgerson and Dr. Lenart and their OD/OMD collaboration.

The next meeting in April was in Las Vegas, NV. It was nostalgic for me because this was the same location of my first COVD meeting during my 2nd year in optometry school. (Definitely a step up from the Tropicana to the Bellagio!) It was also the first time I presented a poster at the meeting. I did a case report on a 4-y.o. boy I saw in the office with accommodative esotropia and the importance of incorporation of bilateral integration techniques in VT when treating strabismus. A PDF version of my poster can be found here.

Going to these meetings as a resident gave me a different perspective than as a student. It was nice to sit with my resident supervisor and one of our therapists in the lectures and discuss the topics as it related to specific patients we see in our office. The COVD meeting is always a good time to re-connect with friends, past professors, and colleagues, and meet other amazing doctors who are dedicated to visual development and vision therapy. Can’t wait for the next one in St. Louis, Missouri!

Secrets to Building a Multi-Million Dollar Practice

On February 27, 2015, Dr. Barry Tannen, practice owner of Eyecare Professionals PC in Hamilton, New Jersey gave a lecture to SUNY residents and myself on how to build a successful private practice.

He gave the following tips to build a successful practice:

#1: Success is in the System

This idea stems from the book “E-Myth Revisited” by Michael Gerber, where the idea of having documented systems in place is essential when organizing and running a successful business. Examples: patient recall system

#2: Invest in New Technology and “Critcial Non-Essentials” (CNE’s)  These are the “little” things that make a big difference, ie. coffeemaker, snacks, computerized eye charts, and a clean office that will “wow” your patients and will make them remember you when talking about your practice with their friends and family.

#3 Analyze and Act on Major Trends Before you are Forced To

Good example is electronic medical records. Keep up with the times, no matter how hard it may be because in the end it will be worth it.

#4 Understand What are Your Most Profitable Services Are and Devise Effective Marketing Systems to Maximize That

Keep in mind Warren Buffet’s term “high barrier to entry”, something not easy to do, but will make you profitable. Ie. vision therapy or Ortho-K

#5 Build your Practice so that it Will Bring You Happiness

You basically live and breathe your practice for most of the waking hours of the days, weeks, months, years. Why not make it a place that brings you happiness?

Dr. Nicholas Despoditis, co-owner with Dr. Tannen, expanded on the last tip about building a practice that will bring you happiness. Dr. Despoditis lectures all over the country with his “Supercharge Your Practice” lectures which help other practice owners supercharge their own practices. He gave us a small taste of his lecture when he had each of us write down four governing values that we have in life. Values can be anything from happiness, family, honesty, control, love, adventure, etc. We chose 4 and put them in order of importance. He reminded us of the importance of building a practice revolved around your own core values.

I thoroughly enjoyed Dr. Tannen and Dr. D’s lecture and it made me really think about my own future. My long term career goals include building my own private practice, which is a reason why I decided to do a residency in a private practice setting. I’ve learned a great deal from my own residency, however, the learning does not stop there. I’ve visited and plan to visit other vision therapy offices to learn more about how to succeed in private practice.

Amblyopia as a Window to Neuroplasticity in the Visual System

On February 13, 2015, Dr. Leonard Press gave a lecture to SUNY residents about current research and management of amblyopia. As the resident at his private practice in New Jersey, I attended the lecture and met many great colleagues from different areas of residency including ocular disease, contact lens, primary care, and of course, peds and binocular vision.

The lecture was aimed to expand our knowledge on amblyopia as it relates to neuroplasticity in the visual system. His goal was to broaden the view of amblyopia, not just as a visual acuity problem, but as a “developmental disorder of spatial vision”. There is a vast amount of research concerning this area of optometry, including the PEDIG studies and many others.

The power point presentation can be found here on the Visionhelp Blog, a site orchestrated by many of the top developmental OD’s in the nation. While you are on the blog, don’t forget to subscribe so that you can keep up with the latest on developmental optometry.

Before residency, amblyopia was something that I learned in school and had minimal clinical experience with. After seeing tons of different types of amblyopia from refractive to strabismic to form deprivation during my residency, I’ve been given the tools to manage and treat these patients. Seeing a patient with 20/200 vision in one eye and being able to help him improve not only in their visual acuity, but also with reading and sports through vision therapy, has been a truly rewarding experience.

Vision Screening with Special Needs Patients

Yesterday I went on a vision screening at the Horizon Lower School, an elementary and middle school dedicated to special needs patients, part of Cerebral Palsy North Jersey (CPNJ) with Michael Montenare, the associate in our office.

We both started the morning off with a large cup of hot coffee for the 11 degree weather and the long day ahead of us. We brought equipment from the office that included our diagnostic kits (Ret, DO, Transilluminator), Teller Acuity Cards, Fix and Follow targets, the OKN drum, Loose lenses, a 20D lens, and Snellen Charts.

When conducting vision screenings on special needs patients, the best tools to use are those that give OBJECTIVE measurements. Since a majority of the patients are either non-verbal or do not know their shapes or letters, it’s difficult to get any kind of subjective measurement. In this population, I want to get GROSS objective measurements. For example, gross observation of their facial and eye alignment is the first thing that should be done. This tells me if they have a significant head or eye turn or if they may prefer one eye over the other. Visual acuity can be grossly measured with Teller Acuity Cards and if that is tough to do, the OKN drum gives you knowledge that the optokinetic reflex is present. Alignment can be measured with a small toy for fixation and your thumb to cover and uncover. Attention can be fleeting with this, therefore the Hirschberg test can be done to assess the corneal reflex for ocular misalignment.

Retinoscopy is the best way to measure for any refractive error. For me, retinoscopy is an area I need to work on. It’s one of those skills that if you don’t use it you lose it. Apparently, it’s been awhile since I’ve picked up my ret. As I saw more patients, I felt more comfortable but there’s always room for improvement. Retinoscopy is a great skill to keep on hand, not only for special needs patients but also for infants and any patient who is non-verbal.

Screenings for special needs patients takes a lengthier amount of time than a normal vision screening. There are many more people involved like occupational, speech, and physical therapists who work with these kids on a regular basis. Information from these people are important to help in diagnosis, ie. Do they ever seen an eye turn in or out while they’ve worked with the patient? They will also comment on things like, “she likes to look down and rarely looks up” which can indicate a “V” pattern exotropia, or he has difficulty navigating on different stepping surfaces like stairs, which can indicate a decrease in depth perception. Listening to their comments will help with diagnosis, and recommendations are important to explain to these therapists because they will be the ones working with the patients on a regular basis.

Throughout the day, we saw intermittent exotropia, accommodative esotropia, “V” pattern exotropia, high myopia, anisometropia, corectopia, endpoint nystagmus, and optic nerve hypoplasia in children with autism, chromosomal disorders, and cerebral palsy.

Back in optometry school, we learned common ocular findings in patients with Down Syndrome, Autism, Cerebral Palsy, and other special needs diagnoses. A great book that highlights these is Visual Diagnosis and Care of the Patient with Special Needs. I was able to see some of these yesterday and from this experience, if I do see it again in my exam chair, I will know exactly what to do.

A Gift of Gratitude

I’ve had the pleasure of sitting in on vision therapy parent conferences with Dr. Press and the office manager, Miriam. There was one particular conference I sat in with that I will never forget. A few months into my residency, an 8-year-old boy came into the office with his parents due to trouble focusing, reading issues, and reversals. The examination revealed convergence insufficiency and perceptual deficits. While sitting in on the conference, the mother was very receptive to therapy and the father was not so sure (a common occurrence during conferences as I’ve learned). Both parents were pleasant and kind. After the conference, while walking out, the father looked like he wanted to say something, perhaps ask more questions. I said to him that if he had any questions he could call us anytime. Although still seeming like he was unsure of vision therapy, he remained quiet and both parents left.

The very next day he called the office and asked for me specifically. I was with another patient at the time and I called him back as soon as I was free. He thanked me for calling him back and said that he had some questions about vision therapy. Since I sat in on the examination as well as the conference, he probably wanted my perspective on what I thought. He wanted to know what kinds of things we would do in therapy and how it would help his son. After discussing with him the benefits of VT and what our goals are for his son, he seemed pleased and receptive to therapy.

Days and weeks passed and I took a mental note to check up on if the parents had scheduled vision therapy. I bothered Tina, our patient care coordinator in charge of scheduling, day after day to see if they had scheduled. It was important to me because, since it was the first time a parent took the time to call the office and asked to speak to me specifically, I felt a small responsibility to prove to these parents that vision therapy was the way to go and to help their child succeed.

They finally scheduled about three weeks after their conference. I was ecstatic! I know it wasn’t just because of our conversation, but I was happy to take part in the process of starting a new patient in vision therapy (which is a detailed process that undoubtably takes a village). Now, after over a month into therapy, the parents have already noticed improvements in school performance and were very grateful for the wonderful care they’ve received and gifted the office with a beautifully wrapped box of homemade chocolate and a card expressing their gratitude and appreciation. It isn’t about the gifts or the parents’ appreciation, it’s being able to help a struggling child improve and succeed in school that makes it all worth it.