Dry eye care has changed dramatically over the past decade—but with more diagnostics, pharmaceuticals, in-office treatments, and technology than ever before, it can also feel increasingly complicated. In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Etty Bitton, Professor at the Université de Montréal, Head of its Dry Eye Clinic, and a Canadian ambassador for the Tear Film & Ocular Surface Society (TFOS), to discuss how optometrists can simplify their approach while staying aligned with the latest evidence in dry eye disease.

Dr. Bitton explains why clinicians should start with diagnosis before investing in treatment technology, including the importance of standardized symptom assessment with the OSDI-6 and a systematic approach to evaluating tear-film stability, osmolarity, ocular-surface staining, eyelid disease, inflammation, and other anatomical contributors. She also discusses how the evolving TFOS DEWS III framework moves beyond simply categorizing dry eye as evaporative versus aqueous deficient and instead encourages clinicians to identify the specific structures and mechanisms involved.

The conversation also explores several issues increasingly relevant to everyday optometric practice: screen time, incomplete blinking and meibomian gland dysfunction in younger patients; Demodex and its connection with dermatological conditions; cosmetics, retinoids and products used around the ocular surface; and the value of building referral relationships with other optometrists, dermatologists, rheumatologists and specialists. Dr. Bitton's message is ultimately a practical one: before building an advanced dry eye clinic around expensive equipment, make sure you understand the disease, use evidence-based diagnostic tools, and speak the same diagnostic language as your colleagues.

3 Key Takeaways

1. Get the diagnosis right before worrying about the technology.

Dry eye management can become overwhelming when clinicians start with IPL, RF, meibography, pharmaceuticals or other treatments. Dr. Bitton argues that the first priority should be a consistent, evidence-based diagnostic process—including standardized symptom assessment such as the OSDI-6.

2. Screen time may be affecting the ocular surface much earlier than we think.

Screen use is associated with more frequent partial blinking, which can interfere with normal meibomian gland function. Dr. Bitton discusses seeing significant gland changes even among optometry students in their early twenties and emphasizes the opportunity for earlier patient and parent education.

3. Dry eye history-taking needs to extend beyond the eyes.

Cosmetics, skin-care products, retinoids, dermatological conditions and systemic disease can all provide important clues. Asking patients about what they put around their eyes—and developing collaborative relationships with other healthcare professionals—can become an important part of comprehensive dry eye care.

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What if one of the most overlooked opportunities for growing an optometry practice is already sitting in the contact lens room? In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Harmin Chima, VP of Professional Services at West Point Optical Group, to explore the business case for private label contact lenses and why optometrists may be underestimating the value of contact lens patients. The conversation examines how private label contact lenses can create stronger margins, improve patient retention, increase in-office purchasing and help differentiate an optometry practice from online contact lens retailers.

Harbir and Dr. Chima also challenge a common mindset in optometry: that contact lens sales simply aren't an important source of practice revenue. They discuss the long-term value of contact lens patients, the importance of proactively introducing contact lenses as a vision correction option, and why doctors shouldn't wait for patients to ask. Harbir shares his own approach of discussing contact lenses with patients across virtually every age group — including offering simple in-office trials to patients who may never have considered themselves contact lens candidates.

Beyond the numbers, this episode is ultimately about delivering better patient care while building a healthier optometry business. From selecting lenses based on lifestyle and clinical needs to allowing the product to “do the talking,” the discussion offers practical ideas ODs can immediately bring into the exam room. If you're an optometrist, practice owner, corporate or sublease OD, or anyone looking to improve contact lens profitability, patient loyalty and practice growth, this conversation may change the way you think about private label contact lenses and the role contact lenses can play in your business.

3 Key Takeaways

1. Private label contact lenses can strengthen both margins and retention. By creating a product patients associate directly with the practice, private label can help keep more contact lens purchases in-house while improving the economics of each sale.
2. Optometrists may be underestimating the lifetime value of contact lens patients. Contact lens wearers tend to return more frequently and can create additional professional-service and optical opportunities over time.
3. Don't wait for patients to ask about contact lenses. Proactively presenting contact lenses as a vision correction option — and reducing friction with simple in-office trials — can uncover demand that patients may never express on their own.

A special thank you to CooperVision for supporting this episode.

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Optometrists see the opportunity in building a dry eye clinic but often get stuck on how to get started. In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down once again with Dr. Trevor Miranda to explore the business of building a successful dry eye clinic, from creating treatment protocols and developing your team to improving patient conversion and generating a meaningful new revenue stream.

Dr. Miranda shares how dry eye has grown to the point where his practices now generate more revenue from dry eye products and services than from contact lenses. He breaks down his LION approach — Lids, Inflammation, Obstruction and Nutrition — and explains why having a structured clinical philosophy makes it easier to develop treatment plans, train staff and create consistency across a practice. Just as importantly, Trevor explains why doctors should not be doing everything themselves. By developing highly trained ocular hygienists, his clinics are able to run dry eye treatments alongside primary eye care, creating greater efficiency while giving patients more education and support.

The conversation also dives into the systems behind a thriving dry eye business: creating a dedicated dry eye assessment pathway, clearly recommending the optimal treatment rather than simply the cheapest option, training team members to confidently discuss treatment, establishing a dry eye champion, setting revenue targets and tracking KPIs. Trevor explains why implementation — not simply acquiring knowledge — is what separates practices that dabble in dry eye from those that truly build a successful specialty service.

Finally, Harbir and Trevor discuss the Dry Eye Summit, which brings together doctors, staff, industry partners and dry eye leaders for focused education, hands-on exposure to new technology and practical business strategies. The Summit also offers dedicated training for ocular hygienists and an advanced procedures lab, making it an opportunity to elevate not only the doctor’s knowledge but the capabilities of the entire dry eye team. And because the Dry Eye Summit is now held only once every two years, this year's meeting represents a valuable opportunity for practices looking to take their dry eye services to the next level.

• Build systems, not just a collection of technology. Successful dry eye clinics need structured treatment protocols, patient pathways and clearly defined roles for the doctor and team.
• Empower an ocular hygienist or dry eye champion. Properly trained team members can educate patients, coordinate treatment, perform delegated services and help the dry eye clinic operate alongside primary eye care.
• Treat dry eye like a real business unit. Set revenue goals, track referrals and KPIs, hold regular team meetings and continue investing in education and training.
• 
  

Dr. Trevor Miranda is the owner of Cowichan Eyecare in British Columbia, operating five clinics with a team of 12 doctors. He has built two dedicated dry eye centres and a team of ocular hygienists, and is one of the founders of the Dry Eye Summit alongside Dr. Richard Maharaj and Dr. Jeff Goodhew.

The Dry Eye Summit takes place November 21–22, 2026, with an Advanced Procedures Lab on November 20. The ocular hygienist course takes place November 21.

Learn more at mydryeye.ca.

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Following our eye-opening episode on Australian optometrists unionizing in response to growing corporate pressure, The 20/20 Podcast turns to the United Kingdom—and the warning signs are just as important. Dr. Harbir Sian sits down with Dr. Keyur Patel, an experienced UK optometrist who has worked across corporate, hospital and independent practice settings and also trained in the United States. Together, they examine how decades of undervaluing clinical services, increasing corporatization and a growing dependence on retail revenue have reshaped optometry in the UK. Keyur also shares his own experience of being dismissed from a refractive surgery company despite no concerns about his clinical ability—because he was not converting enough patients to laser surgery.

The conversation then moves to one of the most consequential issues facing the profession: workforce oversupply. With more optometry schools opening and more graduates entering already saturated markets, compensation can be driven lower while individual optometrists lose negotiating power. Keyur and Harbir discuss reports of locum positions paying as little as £25 per hour and the uncomfortable economics behind it: when there are more optometrists competing for fewer desirable jobs, employers gain leverage, salaries decline, and clinicians may feel increasingly pressured to accept working conditions or business models they otherwise would not. Combined with low reimbursement for eye examinations and diagnostic services, that environment can push practices further toward KPIs, spectacle sales and other commercial metrics simply to remain profitable.

For optometrists in Canada and the United States, the UK and Australia may offer a glimpse of what can happen when these changes are allowed to compound over decades. More schools, more graduates, lower professional compensation, weaker negotiating power, increasing corporate influence and the gradual erosion of clinical autonomy do not happen overnight—but they can fundamentally change a profession. At the same time, Keyur offers a powerful counterexample: his independent practice walked away from the low-fee NHS sight-test model and built a practice where patients willingly pay more because they value the quality of care, relationships and experience they receive. The message is clear: if optometrists do not actively protect the value of their clinical services and the independence of the profession, others will define that value for them.

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What happens when highly trained healthcare professionals are measured more by sales targets than by the quality of care they provide? In Australia, growing frustration over workplace conditions, corporate key performance indicators, declining salaries and the rapid expansion of the optometry workforce has led employed optometrists to take an unprecedented step: organizing through the Health Services Union.

In this urgent international edition of The 20/20 Podcast, Dr. Harbir Sian speaks with Australian optometrists Johnny Van Ling and Rory Dowdall, two of the leading voices behind the country’s optometry labour movement. They describe a profession in which some optometrists report struggling to take lunch or bathroom breaks, being pressured to meet targets for spectacle sales and privately billed imaging, and fearing replacement by a growing supply of new graduates. What began as frustrated conversations between colleagues developed into an online community involving thousands of Australian optometrists and eventually became the country’s first optometry union movement.

The discussion goes far beyond salaries and working conditions. Johnny and Rory examine how deregulation, corporatization, new optometry programs and industry influence within education may have shifted the balance of power away from clinicians. They also discuss the tension between commercial metrics and independent clinical judgment, including the potential professional risk to optometrists when business expectations begin influencing decisions about imaging, appointment length, billing or patient care.

For optometrists in Canada and the United States, Australia provides both a warning and a lesson. The guests explain how changes that initially appeared small—or were promoted as improving access to care—gradually affected professional autonomy, employment security and the public perception of optometry. The conversation explores tele-optometry, workforce saturation, the role of professional associations and why individual clinicians may be unable to resist systemic pressure without collective organization.

This episode is not simply a discussion about whether optometrists should unionize. It is a deeper examination of who controls the future of optometry: the clinicians responsible for patient care or the corporations, institutions and commercial interests shaping how that care is delivered. For every optometrist concerned about clinical independence, corporate optometry, professional advocacy, workforce planning or the long-term value of the profession, this is a conversation that cannot be ignored.

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Women experience dry eye at significantly higher rates than men—but the reasons extend far beyond age or screen time. In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Janice Luk to explore the often-overlooked connection between women’s health, hormonal changes, beauty routines, and ocular surface disease. From birth control and pregnancy to perimenopause and menopause, Dr. Luk explains how fluctuations in estrogen, progesterone, and androgens may influence meibomian gland function, tear-film stability, inflammation, and dry-eye symptoms.

The conversation also examines how optometrists can address makeup, lash extensions, lash lifts, and other beauty treatments without simply telling patients to stop doing the things that matter to them. Dr. Luk shares practical questions clinicians can ask, strategies for maintaining eyelid and lash hygiene, and ways to build trust through collaborative patient education. The episode concludes with a discussion of the evolving TFOS DEWS III approach to dry-eye management, the value of introducing multiple treatment modalities earlier, and the role of immunomodulatory therapies in reducing inflammation and improving patients’ comfort and quality of life.

3 Key Takeaways

1. Hormonal health should be part of the dry-eye conversation.

Hormonal fluctuations throughout a woman’s life—including those associated with oral contraceptives, pregnancy, perimenopause, menopause, and hormone-replacement therapy—may affect the ocular surface. Asking thoughtful questions about hormonal changes can help uncover contributing factors that patients may not realize are connected to their eye symptoms.

2. Beauty routines should be discussed, not dismissed.

Rather than simply advising patients to stop wearing makeup or getting lash treatments, optometrists can help them make safer choices. Asking about makeup removal, lash-extension cleaning, product ingredients, and eye discomfort can protect ocular health while respecting the patient’s lifestyle and identity.

3. Dry-eye treatment is becoming more integrated and proactive.

The newer TFOS DEWS III framework moves away from a rigid, step-by-step treatment ladder and encourages clinicians to consider the whole patient and introduce complementary therapies earlier. Addressing inflammation promptly—with prescription medications, at-home care, in-office procedures, or other appropriate options—may lead to faster and more meaningful improvement.

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In Part 2 of this conversation with Conor Heaney, founder of Optical Success Academy and owner of Jones & Co. in Manchester, Harbir and Conor continue their discussion on what it really takes to grow an independent optometry practice. Picking up from Part 1, they explore the difference between being efficient and being effective, and why some of the most meaningful improvements in a practice come from slowing down, becoming more intentional, and focusing on the experience you actually want to create for patients.

Harbir shares more of what he has implemented at Clarity Eyecare after a year inside Optical Success Academy, including better team meetings, improved phone conversations, stronger follow-up, more Google reviews, and a clearer focus on attracting the right clientele. Conor explains why practice owners need a “North Star”: a clear understanding of who they want to serve and what kind of practice they want to build. From there, decisions around pricing, service, marketing, team training, and patient experience become much easier to align.

The conversation also dives into team development, delegation, and the shift from doing the work of the optometrist to doing the work of the business owner. Harbir shares a valuable lesson about putting the right person in the right role, while Conor explains how developing your team can create more freedom, better service, and a stronger business. For practice owners who feel busy, stretched, or stuck in the day-to-day, this episode offers practical insight into how small habits and consistent implementation can create meaningful change.

Key Takeaways

1. Effective beats efficient.
2. The fastest or most efficient option is not always the best one. Sometimes slowing down, adding thoughtful service touches, and creating a better patient experience leads to stronger relationships, better word of mouth, and a more successful practice.
3. Your ideal client should guide your practice decisions.
4. Conor explains that when you are clear on who you want to serve, it becomes easier to make decisions around pricing, service, marketing, appointment flow, and team behaviour.
5. Team development creates freedom.
6. Harbir and Conor discuss how putting the right people in the right roles, trusting your team, and delegating more effectively can help both the practice and the practice owner grow.

Free Report from Conor Heaney

Conor is offering listeners access to his report, The Nine Keys That Unlock the Hidden Profits in Your Practice. To request the report or learn more about Optical Success Academy, email [email protected].

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In this episode of The 20/20 Podcast, Harbir welcomes back Conor Heaney, founder of Optical Success Academy and owner of Jones & Co., a premium independent optometry and optical boutique in Manchester, UK. This conversation was so packed with value that it has been split into two parts. In Part 1, Harbir and Conor explore what it really takes to move an independent practice forward—not just by working harder, but by stepping back, gaining clarity, developing your team, and implementing changes consistently.

Harbir shares his own experience after spending the past year inside Optical Success Academy, including the practical changes that have made the biggest difference at Clarity Eyecare. From weekly team meetings and better phone conversations to creating a more intentional patient experience, this episode is full of real-world lessons for practice owners who want to improve their leadership, team culture, and patient journey.

Conor also breaks down the idea of “critical non-essentials”—the small details that may not seem directly related to optometry, but completely shape how patients feel about your practice. Whether it is the way a patient is greeted, how your space looks and feels, or something as simple as offering a drink, these moments can elevate the entire patient experience.

This episode is especially valuable for independent practice owners who feel busy, stretched, or stuck in the day-to-day. If you have ever felt like you are trying to “brute force” your way to growth, this conversation offers a more thoughtful path forward: better leadership, stronger implementation, more intentional team development, and a renewed focus on creating an experience patients remember.

Key Takeaways

Working harder is not always the answer.

Many practice owners get stuck trying to solve problems by doing more of the same. Conor explains why growth often requires pausing, reflecting, and making strategic choices instead of simply seeing more patients or putting out more fires.

Weekly team meetings can transform implementation.

Harbir shares how blocking dedicated time for team meetings became one of the most impactful changes in his practice. Those meetings created space to discuss challenges, celebrate wins, train the team, follow up on new systems, and keep important ideas from falling through the cracks.

The patient experience is shaped by more than clinical care.

Conor introduces the concept of “critical non-essentials”—the non-clinical details that strongly influence how patients perceive your practice. These may include the environment, music, hospitality, drinks, and the overall feeling patients have when they walk through the door.

Guest Info

Conor Heaney is an optometrist, practice owner, and founder of Optical Success Academy. He owns Jones & Co. in Manchester, UK, a premium independent optical boutique known for its elevated eyewear experience and strong focus on service, leadership, and practice differentiation.

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In this solo Eye2Eye episode, Dr. Harbir Sian reflects on the idea of detachment through a recent road trip experience that swung from an incredible high to an unexpected setback. After a spontaneous series of events led to seeing Lionel Messi score a hat trick at a World Cup match in Kansas City, the next day brought a very different turn: the truck broke down in Colby, Kansas, forcing everyone to adjust their plans.

The episode explores how detachment does not mean being emotionless or disconnected. Instead, it means enjoying the highs without assuming everything will keep going perfectly, and handling the lows without letting them ruin the bigger journey. Harbir connects this lesson to the Stoic concept of amor fati, or love of fate, encouraging listeners to accept what comes, adjust, and focus on the next right step.

3 Key Takeaways

1. Detachment helps us handle both highs and lows.

When things go amazingly well, it is easy to assume everything will continue that way. When things go wrong, it is easy to feel like the entire plan is ruined. Detachment gives us space from both reactions.

2. Life rarely follows the exact itinerary we create.

Even the most carefully planned trip, project, or life path can change unexpectedly. The goal is not to avoid disruption, but to stay calm enough to figure out the next right step.

3. Amor fati is about accepting the path, not resisting it.

Harbir reminds listeners that loving your fate means being grateful for the experience in front of you, even when it does not match the version you planned.

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In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Donna Mikulecky, Executive Director of Optometry Giving Sight, to discuss how the organization is helping build sustainable optometry services around the world. Donna explains that Optometry Giving Sight focuses on preventing vision impairment and blindness caused by uncorrected refractive error, with a mission that goes beyond short-term vision missions. Instead, the organization helps fund long-term infrastructure, including optometry schools, vision centres, and community-based programs that continue serving patients long after initial support is provided.

The conversation explores the real-world impact of access to eye care: children staying in school, adults being able to work, families becoming more independent, and local communities gaining employment opportunities through sustainable eye care systems. Donna also shares how optometrists, clinics, corporate partners, and patients can support Optometry Giving Sight through programs like the World Sight Day Challenge, Team OGS, patient rebate donations, and practice-based fundraising campaigns. The episode also addresses common questions around charitable giving, including where donations go, how grants are awarded, and how Optometry Giving Sight monitors the programs it funds.

3 Key Takeaways

1. Optometry Giving Sight focuses on sustainable eye care, not just temporary aid.

The organization supports long-term solutions such as optometry schools, vision centres, and local eye care programs that remain in communities and continue serving patients over time.

2. The impact of vision care extends far beyond glasses.

Access to eye care can help children succeed in school, allow adults to work, support family independence, and create career opportunities for local eye care providers.

3. Every optometry practice can participate in giving back.

Whether through the World Sight Day Challenge, Team OGS, donating a portion of frame sales, encouraging patient rebate donations, or sharing OGS content online, practices can make giving part of their culture in a simple and meaningful way.

Learn more and contribute to Optometry Giving Sight at givingsight.org

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