Defocus Media Eyecare and Optometry Podcast Network

Artificial intelligence is rapidly changing healthcare, but for optometrists and practice owners, the biggest opportunity may not be replacing people. It may be helping good people perform their jobs better. That distinction matters especially as virtual assistants grow in optometry and eye care.

That idea shaped a recent Defocus Media conversation between Dr. Darryl Glover and Corey Pinegar, CEO of Teem, about human virtual assistants, artificial intelligence, phone coaching, denied claims, staffing, and the operational pressures facing eye care practices. Rather than positioning AI as a substitute for practice staff, Pinegar described a model in which technology enhances real people’s capabilities.

Teem provides human virtual assistants who support practices with administrative responsibilities, using AI-enhanced tools to improve how they perform certain tasks. Two examples stood out during the conversation: an AI phone coaching tool designed to help team members improve patient conversations and a claims copilot that can help employees analyze denied claims.

For eye care professionals, that distinction matters. Virtual assistants in eye care are people—not AI bots replacing the practice team. When those people have the right AI tools, they may work more efficiently, improve consistency, and reduce the administrative burden on doctors and in-office employees.

The bigger question for practice owners is no longer simply, “Should the practice use AI?” It is: How can people use AI to solve real problems without sacrificing the human experience?

Virtual assistants in optometry are remote human team members who support administrative and operational responsibilities within an eye care practice. Depending on the role and the practice’s needs, they may assist with patient communication, scheduling, insurance-related tasks, recare, claims support, and other nonclinical responsibilities.

That definition is important as AI becomes more prominent. An optometry virtual assistant does not necessarily mean an AI chatbot or automated system. In Teem’s model, the virtual assistant is a person. Artificial intelligence is a tool that can help that person perform certain responsibilities more effectively.

For Pinegar, the opportunity begins with a problem familiar to many practice owners: staffing has become difficult. Hiring, retaining, and training employees requires significant time, while the administrative responsibilities of running a practice continue to grow.

Teem’s model gives practices access to remote human talent that can take on some of this work. But the conversation with Glover went beyond traditional virtual staffing. Pinegar explained how Teem is layering AI tools onto its virtual assistant model to help good team members become even more effective.

The opportunity is therefore not simply moving a task from someone inside the practice to someone working remotely. It is identifying repetitive, time-consuming work and giving the person responsible better tools.

For optometrists already balancing patient care with payroll, staffing, insurance, scheduling, training, and other business responsibilities, this can have implications far beyond convenience.

Virtual assistants in eye care can help practices manage administrative responsibilities without keeping every task in-house. When paired with appropriate AI tools, human virtual assistants may also be able to complete certain processes more efficiently and consistently.

Pinegar described the economic challenge facing practices as a widening gap between the cost of operating a business and what practices are able to collect for services. Historically, one response has been to increase patient volume. But continually adding patients without improving the systems that support those visits can put more pressure on doctors and staff. Burnout then becomes more than a doctor problem.

Front-desk employees answer calls throughout the day. Team members verify insurance, manage schedules, work denied claims, handle recare, collect information, and respond to patient questions. When someone leaves, the practice has to recruit and train a replacement while remaining employees absorb additional responsibilities. That instability eventually reaches the doctor.

Human virtual assistants in optometry provide another way to distribute that workload. Teem’s approach adds a second layer: equipping those people with AI-supported tools that can help them improve specific areas of performance.

The goal is not simply doing more work. It is creating a better operating model around the work that already needs to be done.

AI should not replace the human connection in eye care. Its strongest applications may involve improving the processes surrounding patient care so doctors, virtual assistants, and in-office team members have greater capacity for meaningful human interactions.

Pinegar used commercial aviation to illustrate the concept. Modern airplanes contain extensive automation, yet pilots remain essential. Technology handles portions of the process, while people provide judgment, oversight, communication, and intervention when something unexpected happens. Healthcare carries a similar lesson.

Patients still want someone who listens when they call. They want a team member who understands their concerns. They want an optometrist who can interpret information, communicate recommendations, and build trust. As Pinegar explained:

That philosophy helps define how Teem approaches virtual assistants in eye care and AI. Rather than pushing artificial intelligence into every patient interaction, Teem uses technology behind the scenes to coach people, analyze information, improve processes, and reduce repetitive administrative work.

The patient can still interact with a human. AI simply gives that person another tool.

Teem’s phone coaching tool uses AI to analyze completed calls and provide feedback that can help human virtual assistants and other team members improve future patient conversations. This was one of the most practical examples discussed during the podcast.

After a new-patient, existing-patient, outbound, or recare call, the tool can analyze the recording or transcript. The phone coaching tool can evaluate whether the employee performed appropriate discovery, developed warmth and rapport, collected and clarified necessary information, and moved the conversation toward the appropriate outcome.

That creates an entirely different approach to staff development.

Rather than using AI to replace the person answering the telephone, Teem uses AI behind the human interaction. The patient still speaks with a person, but technology can help that person communicate more effectively.

This distinction matters most for practices evaluating virtual assistants in optometry. Hiring a virtual assistant can provide additional capacity, but coaching and developing that employee remains important. AI creates an opportunity to make that coaching more consistent and measurable.

The telephone remains one of the most important conversion points in an eye care practice.

A practice can invest in its website, Google presence, social media, referrals, and advertising, but those efforts lose value if a prospective patient calls and has a poor experience. Glover captured that opportunity during the conversation:

A prospective patient may have questions about insurance, appointment availability, contact lenses, symptoms, or what type of appointment to schedule. Answering the call is only the beginning.

Did the team member listen? Did they understand why the person called? Did they establish rapport? Did they collect the information required for insurance verification? Did they confidently guide the patient toward the appropriate next step? Practice owners cannot personally listen to and coach every conversation.

A phone coaching tool enables a more consistent feedback loop. A human virtual assistant can complete a call, receive structured feedback, identify opportunities for improvement, and apply those lessons to future conversations.

Pinegar gave the example of moving new-patient conversion from 64% to 68%. Four percentage points may seem modest in isolation, but across hundreds of prospective-patient calls, incremental improvements can become meaningful.

This is where Teem’s combination of human virtual assistants and AI phone coaching becomes especially relevant. The technology is not replacing the employee who speaks with the patient. It is helping that employee improve.

Teem is also developing AI-supported claims tools designed to help human team members understand denied claims and identify information that may require correction or clarification.

Denied claims represent a very different challenge from patient phone calls, but they illustrate the same AI strategy: use technology to help a person solve an administrative problem more effectively.

When a claim is denied, someone must determine why. That can involve reviewing the denial, comparing it with the original claim, identifying missing or incorrect information, correcting documentation, and resubmitting the claim.

Pinegar described a claims copilot that can analyze information from a denied claim and compare it with what was originally submitted. The tool can help identify potential problems, such as a narrative requiring clarification or documentation that may need to be reattached.

Importantly, the Teem tool described in the conversation is not automatically resubmitting the claim. Humans remain part of the process.

For practices using virtual assistants in eye care, this represents an important example of what AI enhancement can look like. Instead of expecting someone to manually work through every element without assistance, technology can organize and analyze the information so the team member can determine the appropriate next step.

Denied claims are ultimately a cash-flow and operational-efficiency issue. When a legitimate claim remains unresolved, the practice waits longer to collect revenue for services it has already delivered. Repeated denials compound the problem.

A team member may correct a claim, resubmit it, wait for another response, and discover that additional information is still required. Each cycle consumes employee time and delays payment.

For an optometry business owner, improving that process can affect more than the billing department. Revenue cycle performance ultimately affects cash flow, staffing, profitability, and the practice’s overall financial health.

There is also a patient-experience component. Administrative problems can eventually become patient problems when someone receives an unexpected or confusing bill.

A Teem virtual assistant supported by AI tools for denied claims represents one model for approaching this workflow. AI can help the employee analyze the information while the human remains responsible for evaluating and acting on it.

The philosophy is consistent with the phone coaching application: AI amplifies the person rather than replacing the person.

Optometrists should begin with a business problem, not an AI product. Pinegar acknowledged that earlier in his entrepreneurial career he sometimes chased new ideas because they were exciting. That experience shaped a more practical approach to technology: determine whether it actually solves a problem or improves performance.

Practice owners can apply the same thinking when evaluating virtual assistants in optometry, virtual assistants in eye care, and AI tools.

If prospective patients are calling but not scheduling, examine the phone process. If managers do not have enough time to coach staff consistently, an AI phone coaching tool may be worth evaluating. If employees spend too much time understanding denied claims, claims-support technology may add value. If the front desk is overwhelmed by repetitive administrative responsibilities, a human virtual assistant may provide additional capacity. The technology should follow the problem.

This is also why Teem’s approach matters in the broader AI conversation. Instead of treating artificial intelligence as one giant solution, AI is being applied to specific workflows real people perform.

Practice owners can then evaluate meaningful outcomes: Did phone conversion improve? Did team members collect better information? Are denied claims easier to analyze? Is administrative work becoming more efficient without sacrificing quality? Are doctors and in-office employees spending less time correcting preventable operational problems?

Those questions are far more useful than simply asking whether a practice “uses AI.”

Virtual assistants in eye care may reduce burnout by providing additional human support for repetitive administrative tasks, while AI tools can help those assistants work more efficiently.

Burnout in optometry is often framed around the doctor, but Glover and Pinegar emphasized the need to consider the entire team.

A front-desk employee managing nonstop phone calls can become overwhelmed. A billing employee repeatedly working denied claims can become frustrated. A practice manager dealing with constant turnover can spend more time filling staffing gaps than developing the team. Eventually, those problems affect the optometrist.

Pinegar described a sustainable business as requiring balance between employees, customers, and healthy economics. If employees are not supported, turnover can increase. If the patient experience deteriorates, patients may not return. If the business cannot generate adequate profit, maintaining the first two becomes increasingly difficult.

Teem’s human virtual assistant model, enhanced with AI tools, is designed to address part of that equation. The virtual assistant provides the human talent; AI adds capabilities that help that person perform certain responsibilities more effectively.

It doesn’t promise that technology will eliminate burnout. It is a strategy for reducing some of the operational friction that contributes to it.

Virtual assistants in optometry and virtual assistants in eye care represent a growing opportunity for practices that want to improve efficiency without losing the human connection.

No one knows exactly how artificial intelligence will reshape optometry over the next decade. What is becoming clearer is that practices do not necessarily have to choose between people and technology.

What happens when a beloved children’s television mascot becomes a ruthless killer? In this episode of the OD’ing on Movies Podcast, Dr. Jacobi Cleaver and Dr. Jacob Wilson review Buddy, a horror comedy that transforms the cheerful world of 1990s children’s programming into a bloody nightmare. From its outrageous violence and dark humor to an unexpected discussion of ocular injuries, the two optometrists explore what makes this unconventional film both entertaining and unsettling.

At first glance, Buddy resembles a familiar children’s television show, complete with colorful characters, catchy songs, and an enthusiastic orange unicorn. But beneath the cheerful exterior lies a disturbing reality: Buddy demands unconditional love and eliminates anyone who threatens his happiness.

Wilson appreciated how quickly the film establishes its twisted premise. What begins as an innocent disagreement over dancing shoes soon reveals Buddy’s violent nature. Cleaver, meanwhile, recognized the film’s deliberate resemblance to Barney, particularly its nostalgic setting and revolving cast of children.

For Wilson, the combination of absurdity, gore, and unpredictable humor made Buddy one of his favorite moviegoing experiences of the year.

As the story unfolds, Buddy’s increasingly violent behavior transforms his colorful television world into a dangerous prison. Children disappear, familiar characters are replaced, and attempts to escape are met with gruesome consequences.

Both optometrists found humor in the film’s outrageous premise, although certain creative decisions divided their opinions.

Wilson felt the encounter with a cowboy and puppet in the woods introduced an unnecessarily uncomfortable element. Cleaver similarly questioned its relevance to the story and expressed disappointment with Buddy’s eventual transformation into a dragon-like creature.

Despite these reservations, the film’s willingness to embrace the ridiculous kept both engaged.

One particularly memorable scene provided an unexpected opportunity to connect horror with eye care.

After Buddy suffers severe facial burns, Cleaver draws attention to the damage surrounding the unicorn’s eye. Wilson explains that patients with significant facial burns can experience impaired eyelid function, leaving the ocular surface vulnerable.

Without adequate eyelid closure, the cornea may develop exposure keratopathy, potentially progressing to more serious complications, including corneal ulceration and perforation.

The conversation takes a humorous turn when the doctors question whether Buddy even has functional eyelids.

Their clinical observations highlight the podcast’s distinctive approach: finding meaningful optometric connections in even the most unconventional films.

The film’s final confrontation leaves Freddy battling Buddy after her mother sacrifices herself to help the children escape. Although Freddy ultimately defeats the murderous unicorn, her journey ends without the reunion Wilson had hoped for.

Rather than restoring everything to normal, the conclusion leaves unanswered questions about Buddy’s world and the possibility of other sinister television characters.

For Cleaver and Wilson, Buddy succeeds through its unusual blend of nostalgia, horror, and dark comedy, even when its storytelling becomes excessive.

Ultimately, this episode demonstrates how two optometrists can turn an outrageous horror movie into an entertaining conversation about filmmaking, childhood nostalgia, and the surprising importance of healthy eyelids.

Childhood myopia, or nearsightedness, does not have to mean stronger glasses every year. Myopia management offers treatment options designed to slow the progression of nearsightedness in children, including MiSight contact lenses, orthokeratology (Ortho-K), atropine, and myopia-control glasses. As these options become more widely available, optometrists can move beyond simply correcting vision and help families take a more proactive approach to their children’s eye health.

In Partnership with CooperVision

On the Defocus Media Podcast, Dr. Jennifer Lyerly and Dr. Alicia Barnes explore how to select the right myopia control treatment, educate parents, and make myopia management part of everyday eye care.

Barnes’ experience with orthokeratology began roughly 25 years ago, before she thought of it specifically as myopia management. At the time, ortho-k offered patients another way to correct their vision without relying on daytime glasses or soft contact lenses.

When she opened TrueVision Eye Care in 2013, patient demand helped shape the practice. Many families in the community already knew about orthokeratology and expected it to be available. As new research and myopia management options emerged, Barnes continued building on that foundation.

Her experience also illustrates an important lesson for doctors interested in myopia management: you do not have to have everything figured out before getting started.

With more myopia control options available, selecting a treatment requires looking beyond the prescription.

Barnes considers the child’s lifestyle, comfort, and preferences alongside the family’s concerns. A young athlete may appreciate the freedom of orthokeratology, but a child uncomfortable with overnight lenses may be better suited for another option, such as MiSight contact lenses. For children who do not want contact lenses, atropine or myopia-control glasses may also be considered.

Lyerly emphasizes that anatomy, corneal topography, prescription, and daily activities also influence the decision. An avid swimmer, for example, may have different needs from a child with significant astigmatism.

Just as important is including the child in the conversation. Barnes has learned not to spend an entire visit discussing a treatment with the parent only to discover that the child has no interest in it.

Introducing myopia management does not require turning every comprehensive eye exam into a lengthy consultation.

Barnes recalls times when enthusiasm led to 15-minute explanations that overwhelmed parents who had never heard of myopia management. The practice has since refined its approach: introduce the concept, provide educational materials, and invite families back for a dedicated consultation when appropriate.

Lyerly takes a similar approach. Her goal isn’t for every family to choose MiSight, orthokeratology, or another treatment right away. Instead, she wants every parent to know that myopia management exists.

That philosophy extends to cost. Providing financial information early lets families realistically evaluate their myopia control options before committing to a particular approach.

Successful myopia management extends beyond the exam room. Barnes emphasizes training technicians, front-desk employees, and opticians so the entire team understands the purpose, processes, and pricing behind the service.

Education matters for doctors, too. Lyerly points to CooperVision representatives as a resource for education about MiSight contact lenses and staff training, while Barnes highlights conferences such as Vision by Design for broader clinical and practice-management education.

After a dedicated staff meeting on myopia management, Lyerly noticed parents were already holding educational brochures when she entered the exam room—evidence that the conversation was beginning before the doctor arrived.

That may be the episode’s most practical takeaway. Myopia management does not have to begin with a perfect program. It can start by educating the team, introducing the conversation, and ensuring families know that options such as MiSight, orthokeratology, atropine, and myopia-control glasses exist. For Lyerly and Barnes, success begins with making sure parents know they can discuss more with their eye doctor than simply moving to a stronger prescription.

Dry eye care has become far more than recommending artificial tears and sending patients home. For practices willing to build the right systems around diagnosis, treatment and follow-up, it can become a sophisticated clinical service that improves patient care while creating a meaningful new revenue stream. On the 20/20 Podcast, Dr. Harbir Sian and Dr. Trevor Miranda explored what it takes to build that kind of practice and why success depends as much on people and processes as it does on technology.

Dr. Miranda’s approach begins with what he calls the LION method: lids, inflammation, obstruction and nutrition. Rather than relying on a single treatment or device, the framework encourages clinicians to identify the different factors contributing to a patient’s ocular surface disease and address them accordingly.

That philosophy naturally leads to a multimodal approach. Depending on the patient, Miranda’s clinics may incorporate lid hygiene, medications, nutritional support, gland expression, IPL, radiofrequency or other technologies. The goal is not to fit every patient into the same treatment plan, but to build a system capable of adapting to what each patient needs.

Clinical results, Dr. Miranda emphasized, remain the foundation. When patients improve, they return, refer others and become advocates for the practice.

Perhaps the biggest operational lesson from Miranda’s experience is that dry eye care should not depend entirely on the optometrist.

His clinics employ five “ocular hygienists”—team members trained to understand treatments, educate patients, perform delegated procedures and communicate progress back to the doctor. That allows dry eye services to run alongside primary eye care rather than competing with the doctor’s exam schedule.

Sian has seen a similar benefit in his own practice after training a technician to deliver treatments and document them in the electronic medical record. The shift, he said, took work off his plate while allowing treatment to continue as he performed exams elsewhere in the clinic.

Dr. Miranda believes practices often underestimate what staff members can do when they receive meaningful education and responsibility. His ocular hygienists began by observing doctors as scribes, learning not only the clinical information but also how treatment recommendations were communicated to patients.

Identifying dry eye is only the beginning. What happens after the diagnosis can determine whether patients actually receive care.

Instead of asking front-desk or optical staff to explain specialized treatments, Miranda’s practice routes those conversations to ocular hygienists. If one is unavailable at the time of the exam, the patient can be contacted afterward for education and scheduling.

The distinction between roles is deliberate: the doctor diagnoses the condition and recommends the appropriate treatment opportunity; trained team members then explain logistics and costs and help patients move forward.

That system also allows the practice to offer structured pathways for different needs, including rosacea, chalazia and hordeola, and ocular surface optimization before cataract surgery.

For Dr. Miranda, building the service also requires measurement. His recommendations include establishing a dry eye revenue goal, identifying a “dry eye champion,” holding quarterly team meetings and tracking internal referrals and other key performance indicators.

Training must continue as well. Team members attend conferences, learn from industry representatives and stay involved in patient education. The objective is to create staff members who understand not only how to perform a treatment, but why it is being recommended.

That emphasis on execution may be the episode’s clearest takeaway. As Miranda put it, ideas are widely available; implementation is the harder part.

Burnout has become a familiar word in optometry, but Dr. Adam Ramsey believes it may not tell the whole story. In a solo episode of Play Chess Not Checkers, Ramsey challenges doctors to consider a different question: Are they truly burned out—or have stress, repetition and shrinking margins simply made the profession less enjoyable?

Ramsey acknowledges that practicing optometry has changed. Greater financial pressures and tighter margins can leave practice owners working harder while feeling less fulfilled. Rather than immediately considering an exit, he encourages doctors to examine their businesses closely—reviewing expenses, pricing, vendors and profitability to identify where pressure can be relieved.

Dedicated administrative time, he argues, can create the space needed to work on the practice rather than constantly working in it.

For Ramsey, reducing burnout does not necessarily require leaving optometry. It may require changing how you practice it.

He points to doctors who have built schedules around family responsibilities, reduced patient-care days or developed specialty services such as myopia management, vision therapy and specialty contact lenses. The goal is to shape the profession around the life you want rather than assuming there is only one acceptable model of practice.

Variety can also break the monotony. Ramsey describes speaking and lecturing as activities that give him something different to anticipate while creating additional professional opportunities. He also highlights nontraditional roles, including medical science liaison positions, as examples of how optometrists can use their training beyond routine patient care.

Perhaps most importantly, Ramsey encourages doctors not to navigate difficult seasons alone. Conversations with colleagues, conferences and professional friendships can provide new ideas, perspective and renewed energy.

His message is ultimately one of intentionality: before assuming burnout means it is time to leave the profession, identify what is actually creating the frustration. Sometimes the answer may be rest. Other times, it may be restructuring the business, pursuing a new specialty, changing the schedule or simply finding something that makes the work exciting again.

A flock of sheep solving the murder of their shepherd may not sound like an obvious starting point for a conversation about optometry. But on OD’ing on Movies, Dr. Jacobi Cleaver and Dr. Jacob Wilson welcomed Dr. Janette Pepper for a discussion that moved effortlessly from The Sheep Detectives to grief, belonging, ocular anatomy, optometry education, and the relationships that shape a career. Pepper, an associate professor at Southern College of Optometry who teaches pediatric eye exams and vision therapy, brought both an educator’s perspective and a personal connection to the film’s rural setting, having grown up on a farm in Southern Illinois.

The Sheep Detectives follows a gentle shepherd who reads murder mysteries to his flock each night. When he unexpectedly dies, the sheep use what they have learned from those stories to investigate his death themselves.

What initially sounds like a lighthearted premise became, for Pepper, a surprisingly thoughtful story. She was particularly drawn to the film’s treatment of the “winter lamb,” an outsider repeatedly seeking acceptance from the flock. Beneath the humor, she saw a message about embracing those who are different and recognizing the value they bring to a group.

That theme becomes even more meaningful as the sheep learn to work together, turning knowledge gathered over time into action when their circumstances suddenly change.

One of the film’s most resonant ideas centers on memory. When overwhelmed, the sheep can choose to forget. Yet forgetting also means losing part of their connection to those they have loved.

Pepper connected that idea to grief. Painful memories can be difficult to carry, she explained, but they remain part of the relationship with someone who is no longer present. Wilson agreed, noting that both positive and difficult memories help people understand the full meaning of what someone or an experience brought into their lives.

It is an unexpectedly emotional lesson from a movie built around talking sheep: avoiding pain can also mean distancing oneself from what made a relationship meaningful.

The film may be short on traditional eye-care content, but three optometrists were bound to find some.

A conversation about mutton led Wilson to granulomatous uveitis and the familiar description of “mutton-fat” keratic precipitates. The group then turned to sheep-eye anatomy and the tapetum lucidum, the reflective structure found in sheep and many other animals but absent in humans.

For Pepper, who works closely with optometry students, even these playful connections offered an opportunity to make science memorable.

The conversation ultimately shifted from sheep to students preparing to begin optometry school. Pepper’s central message was clear: “Optometry school is not undergrad 2.0.”

Success, she explained, requires students to adapt how they learn. The goal is no longer simply passing the next examination; knowledge must build toward caring for real patients. She encouraged students to ask for help, remain flexible and develop genuine relationships with classmates and colleagues.

Wilson reinforced that distinction between networking and relationship building. Meaningful professional connections, he argued, begin with genuinely wanting to know people—not with calculating what they might provide later.

For Cleaver, that message extends beyond optometry school. He described the larger purpose of ODing on Movies as a reminder not to become so consumed by work and everyday responsibilities that hobbies and sources of joy disappear.

That may be the most fitting takeaway from a conversation that started with a movie about detective sheep and ended with lessons about education, relationships and life beyond the exam room. Sometimes professional growth comes from studying harder. Other times, it begins by making enough room to enjoy something simply because it brings joy.

Dry eye disease rarely presents as a straightforward clinical puzzle. Some patients report burning, grittiness and blurred vision despite showing few visible signs; others have significant corneal damage yet feel little discomfort. In a conversation with Dr. Darryl Glover, dry eye specialist and researcher Dr. Kaleb Abbott explains why this disconnect matters—and how recognizing it can lead to more thoughtful, individualized care.

Dr. Abbott, an assistant professor at the University of Colorado School of Medicine, examined this question in the study What Guides Treatment Decisions in Dry Eye Disease: Signs or Symptoms? His team surveyed 208 optometrists and ophthalmologists, presenting clinical scenarios designed to reveal how practitioners respond when signs and symptoms conflict.

Only 1.1% of ophthalmologists and 5.2% of optometrists said the two frequently correlate. When patients reported moderate to severe symptoms despite having minimal clinical signs, virtually every respondent was at least somewhat likely to begin treatment. Clinicians were also willing to treat asymptomatic patients with significant signs, although symptoms carried greater influence overall.

The same pattern shaped perceptions of success. More practitioners considered treatment successful when symptoms improved without a corresponding change in signs than when clinical findings improved but the patient felt no better.

“Symptoms are king,” Dr. Abbott said, noting that pain and discomfort can substantially affect a patient’s quality of life. Still, he cautioned against allowing symptom relief to overshadow ocular health. Dense staining, corneal desiccation and epithelial defects may increase the risk of infection or ulceration, even when the patient reports feeling well.

Patients with neurotrophic keratitis illustrate this danger. Damaged or impaired corneal nerves may fail to signal pain despite serious surface disease. By contrast, people with neuropathic ocular pain may experience severe symptoms with few visible findings.

The clinician’s task, therefore, is not to choose between signs and symptoms, but to understand what each may be revealing.

The language surrounding the disease can further complicate diagnosis. According to the survey, clinicians ranked burning or stinging, grittiness, fluctuating vision and foreign-body sensation above dryness itself. Watering ranked sixth.

That finding supports Dr. Glover’s practice of training technicians to ask specifically about burning, grittiness and blurred vision instead of simply asking whether a patient has dry eye. Patients may not recognize their experiences under the condition’s familiar name, making precise questions essential.

On examination, both professions prioritized ocular surface staining and tear breakup time. Optometrists, however, placed greater emphasis on eyelid abnormalities, including telangiectasia, Demodex blepharitis, meibomian gland dropout and poor meibum quality.

Some of the strongest predictors of symptom severity may be non-ocular. Dr. Abbott pointed to chronic pain syndromes, migraines, fibromyalgia, poor sleep, traumatic brain injury, anxiety and depression as factors that may heighten pain perception. Symptoms can arise anywhere along the trigeminal nerve pathway, not solely at the corneal surface.

This broader understanding challenges the conventional stepladder approach in which every patient receives the same sequence of therapies. Instead, Dr. Abbott urged clinicians to remain “naturally curious yet skeptical,” take more complete medical and surgical histories, and investigate suspicious patterns such as unilateral symptoms or pronounced sign-symptom discordance.

The episode’s central lesson is clear: dry eye care begins with listening, but it cannot end there. By combining the patient’s experience with clinical findings, neurologic considerations and broader health history, eye care professionals can move beyond labels and treat the person behind the symptoms.

Long before Phernell Walker became a master optician and the first Black chair of the American Board of Opticianry, a childhood encounter gave him a reason to care about sight. Speaking with Tarrance Lackran at the United Opticians Association Leadership Conference in Chicago, Walker traced a remarkable journey from poverty and limited expectations to national leadership, while outlining the urgent work still needed to strengthen opticianry across the country.

Walker grew up in St. Petersburg, Florida, where his mother raised three children after his father died. She worked during the day, attended college and held a second job at night. Watching her persevere taught Walker to work through adversity and refuse to let others determine his future.

One of the most formative influences in that future was May, an elderly neighbor who cared for him after Head Start. Walker did not initially realize she was blind. When she explained that she could not see the flowers in her garden—or even see him—five-year-old Walker took her hand and promised, “I’m gonna tell you everything that I see, and I’ll be your eyes.”

May’s death left him heartbroken, but the experience gave him an early sense of purpose. He did not yet understand how he would help people see; he simply knew that he wanted to make a difference.

Growing up as a poor Black child in the South, Walker encountered people whose expectations for him were narrower than his own. Although he respected the occupations suggested to him, he wanted the freedom to choose a larger path.

That determination eventually led him to become a master optician, a distinction requiring advanced examination, research and demonstrated expertise in areas such as physical optics, lens design and ophthalmic materials. For Walker, pursuing mastery was about more than earning a title. It was a response to the feeling of being underestimated and a commitment to serving patients at the highest level.

“You are the author of your journey,” he told Lackran, reflecting on what he would say to his younger self.

Walker now carries that philosophy into his leadership of the American Board of Opticianry and the United Opticians Association. His priority is creating a consistent, protected definition of an optician throughout the United States.

Only 22 states license opticians, he explained, producing wide differences in training, professional recognition and mobility. In some unlicensed states, a person may enter the role without meaningful educational or certification requirements. Walker believes the profession’s greatest threat is its own failure to seize the opportunity for unity.

That work includes strengthening certification, protecting professional titles and allowing opticians to practice more fully according to their education. It also means increasing awareness of opticianry in communities where young people may never encounter it as a career option.

Education has remained central to Walker’s impact. While working in Texas, he began teaching evening optical courses and personally supplied students with notebooks. Those lessons later became Pure Optics, a book now used by opticians and educational programs across the country.

For Walker, however, success is measured less by titles than by the people he helps advance. Lackran described him as a leader who does not close the door after entering a room, but instead looks for others who deserve an opportunity.

That may be the clearest expression of Walker’s legacy: turning one childhood promise into a lifelong commitment to help people see—and helping a profession see what it can become.

In part two of their discussion of The Odyssey, Dr. Jacobi Cleaver and Dr. Jacob Wilson are joined once again by honorary co-host Dr. Morgan Jones. Together, they follow Odysseus through the darkest and most dangerous stages of his journey home. Between thoughtful analysis and hilarious side conversations, the three doctors explore the film’s horror elements, standout performances, and whether Odysseus should truly be considered a hero.

The conversation picks up as Odysseus and his remaining men arrive on Circe’s island. Dr. Morgan Jones highlights the unsettling sight of lions, panthers, and other wild animals behaving strangely calmly. Dr. Jacobi Cleaver explains how the starving men aggressively eat Circe’s food before she transforms them into pigs. Dr. Jones adds that the transformation was created using a series of masks, while Dr. Jacob Wilson praises the scene’s frightening atmosphere. Dr. Wilson also notes that the sequence contains genuine horror elements, leading Dr. Jones to jokingly ask whether the movie was already a horror film.

After Circe restores the men, she directs Odysseus toward Hades, where he receives a prophecy about the disasters ahead. Dr. Wilson describes the underworld sequence as “dope” and praises the way the dead rise from the ground. He also identifies Elliot Page’s performance as one of the scene’s strongest elements. Dr. Jones agrees, explaining that Page’s passionate delivery feels poetic and authentically ancient Greek.

Dr. Cleaver points out that the scene reveals how some of the fallen men feel betrayed by Odysseus. Dr. Wilson specifically criticizes Odysseus’s treatment of Sinon, who unknowingly becomes a sacrifice during the plan involving the Trojan horse. Dr. Jones argues that difficult sacrifices are sometimes unavoidable during war, adding another perspective to the debate over Odysseus’s leadership.

Dr. Wilson names the siren sequence as one of his favorite moments in the movie. He especially admires the decision not to let the audience hear the sirens’ song. Instead, the film uses slow, haunting music and Odysseus’s reaction to show its overwhelming power.

The discussion then moves to Odysseus’s choice between sailing into a deadly whirlpool or allowing a six-headed monster to kill six of his men. Dr. Jones initially says she would rather go down with everyone than knowingly sacrifice six people. Dr. Wilson disagrees, arguing that a leader should save as many people as possible, even if it requires sacrificing a few. Dr. Cleaver joins the debate while comparing the impossible decision to the responsibility of a captain going down with a ship.

Dr. Wilson describes Odysseus as a great warrior who is clever but morally questionable. Dr. Jones agrees that he is morally gray, especially because his pride and choices repeatedly endanger his crew. Although Odysseus tries to defy the gods and prevent the prophecy, his men eventually eat the sun god’s sacred cattle and seal their fate.

Near the end, Dr. Wilson offers one of the episode’s strongest interpretations. He explains that Odysseus’s vision of Athena is actually connected to the young priestess killed during the fall of Troy, representing the guilt and shame he has carried throughout his journey. Dr. Jones builds on this interpretation by connecting the vision to the trauma Odysseus experienced at Troy. Despite its long runtime, Dr. Cleaver, Dr. Wilson, and Dr. Jones ultimately agree that The Odyssey is worth seeing in theaters.

For optometry students and new graduates, choosing where and how to practice can be challenging—especially when reliable career information is difficult to find. Dr. Wynn Nguyen is helping close that gap through the Canadian New ODs report, a crowdsourced survey exploring compensation, career priorities, work-life balance, practice location, and professional goals among Canadian optometrists.

Many graduates assume that the best career opportunities are found in major metropolitan areas. In optometry, however, the opposite may be true. Smaller communities often have a greater need for doctors, allowing new optometrists to build full schedules, increase their earning potential, and encounter a broader range of clinical conditions.

Meanwhile, highly desirable cities such as Toronto can be saturated with providers. Success is still possible, but it may require more networking, marketing, and practice-building than a new graduate expects.

Relocating to a smaller community is therefore more than a financial decision. It can be an opportunity to strengthen clinical skills, serve patients who need greater access to care, and establish a career more quickly.

Dr. Nguyen’s insights also challenge the belief that compensation is the primary motivation for new graduates. Today’s optometrists are placing greater emphasis on work-life balance, proximity to family, professional development, flexibility, and autonomy.

That shift should not be mistaken for a lack of ambition. It reflects a deeper understanding that professional longevity depends on building a career that is both financially rewarding and personally sustainable.

Working more days does not necessarily mean earning more. Fatigue can affect a doctor’s energy, patient engagement, and willingness to accommodate additional visits. A well-rested optometrist may be more productive, more attentive, and better prepared to identify opportunities to expand patient care.

Practice ownership remains an important goal, but it is no longer the only accepted destination. Some associates want to become owners, while others prefer the flexibility and reduced administrative responsibility of remaining employed.

Neither path is inherently better. The more important question is whether the position supports the doctor’s long-term goals. Employers must recognize this distinction and create career pathways that include mentorship, leadership, clinical development, and meaningful autonomy—not simply ownership opportunities.

Many students enter optometry school with a specialty already in mind. Yet interests can change once doctors experience the realities of patient care.

Early practice provides an opportunity to build confidence across primary care, manage diverse conditions, and discover which clinical areas create genuine excitement. Specialization should grow from experience, not pressure to define an entire career too soon.

Perhaps Dr. Nguyen’s strongest message is the importance of community. Honest conversations about compensation, workload, ownership, burnout, and career expectations give optometrists the information needed to make better decisions.

The future of optometry will be shaped not only by where doctors practice or how much they earn, but by how openly they share knowledge and support one another.