The 20/20 Podcast

Is artificial intelligence the key to building a more successful optometry practice? Or could relying too heavily on technology cause us to lose what matters most?

In this episode of The 20/20 Podcast, Dr. Harbir Sian welcomes back Dr. Steve Vargo, optometrist, IDOC practice management consultant, and author of Human-Centered AI, to explore how artificial intelligence is changing optometry practice management.

From using ChatGPT as a strategic business advisor to improving staff communication, analyzing practice KPIs, and enhancing the patient experience, Dr. Vargo shares practical ways optometrists can use AI to work smarter and make better business decisions.

But this conversation goes beyond technology. As AI becomes more integrated into eye care, how can independent optometrists maintain the personal connection that sets their practices apart?

Key Takeaways:

• Use AI as a strategic thought partner: Learn how tools like ChatGPT can help evaluate business decisions, analyze performance metrics, and uncover opportunities for practice growth.
• Become a better leader: Discover how AI can support staff training, prepare you for difficult conversations, and help build a stronger practice culture.
• Keep eye care human: Understand why patient communication, trust, and personalized care may become your greatest competitive advantages in an increasingly automated industry.

Whether you're an optometry practice owner, associate optometrist, or eye care professional interested in the future of AI in health care, this episode offers actionable insights to help you embrace technology without losing the human connection.

About Our Guest

Dr. Steve Vargo is an optometrist, practice management consultant with IDOC, and author of five books, including But I Don't Sell, Prescribing Change, and his latest, Human-Centered AI. Having worked with hundreds of optometry practices across the United States, he brings a unique perspective on leadership, practice growth, and the evolving business of eye care. He also hosts the Eye Own a Business podcast.

Enjoyed this conversation? Subscribe to The 20/20 Podcast for more discussions on optometry, practice management, leadership, innovation, and the future of eye care. Share this episode with a colleague who wants to work smarter and build a better practice.

Special thanks to our episode partner, FIGS, for supporting The 20/20 Podcast.

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Does Canada need more optometry schools, or could expanding optometric education put the future of the profession at risk?

With plans underway for two new optometry schools in Alberta and New Brunswick, one of the biggest debates in Canadian optometry is heating up.

In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Allison Scott, President of the Canadian Association of Optometrists (CAO), and Joelle Walker, CEO of the CAO, to discuss what these new schools could mean for the profession.

From addressing optometrist shortages and reducing student debt to concerns about market oversaturation, declining compensation, and potential corporate influence, this candid conversation tackles the questions Canadian optometrists are asking.

Are these new schools the solution Canada needs, or could they create bigger challenges down the road?

3 Key Takeaways

1. Canada needs more opportunities for optometric education. Approximately half of Canadian optometrists train in the United States. New schools could reduce student debt, improve accessibility, and help address shortages in underserved communities.

2. Oversaturation remains a major concern. Could increasing the number of graduates lead to more competition and declining compensation? The CAO discusses the importance of workforce planning and protecting the profession's future.

3. Who is driving the expansion? The CAO addresses concerns about corporate influence and explains how universities, provincial associations, and government are working together to develop these new programs.

About the Guests

Dr. Allison Scott is President of the Canadian Association of Optometrists, advocating for the advancement of optometry and improved access to eye care across Canada.

Joelle Walker is CEO of the Canadian Association of Optometrists, bringing experience in healthcare advocacy, government relations, and workforce planning.

Learn more and get involved: https://opto.ca/new-schools

What if one of the most powerful tools for growing your optometry practice isn't a new piece of diagnostic equipment, but the software you're already using every day?

An electronic medical record (EMR) system should do much more than document patient exams. The right EMR can streamline your workflow, reduce administrative headaches, improve the patient experience, and provide valuable insights to help your practice grow.

In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Marie-Hélène Morin, Director of Implementation, Sales and Training at Optosys, to explore what optometrists should really expect from their practice management software.

With 25 years of experience in the optical industry, Marie-Hélène shares how Optosys, the EMR solution offered through OSI Group, is helping independent optometrists work smarter, not harder.

From integrated online appointment booking and automated patient recalls to customizable exam templates, streamlined referral letters, inventory management, and powerful practice analytics, this conversation highlights how a modern optometry EMR can transform day-to-day operations.

Dr. Sian also shares his firsthand experience transitioning to Optosys, including how the platform has simplified government billing, reduced administrative work, and made it easier to monitor key performance indicators (KPIs). The discussion also explores targeted patient marketing, data-driven decision-making, and why switching EMR systems might not be as intimidating as you think.

Whether you're considering a new EMR or simply wondering if you're getting the most out of your current system, this episode will challenge you to think differently about the technology running your practice.

3 Key Takeaways

1. Your EMR should do more than manage patient records.

A fully integrated optometry practice management system can connect scheduling, online booking, patient communications, clinical documentation, inventory, orders, and billing. By keeping these functions in one place, practices can eliminate repetitive tasks, improve efficiency, and free up valuable staff time.

2. Better data leads to better business decisions.

Your EMR contains a wealth of information about your practice, but that data is only valuable if you can access and use it. Optosys offers customizable reporting, KPI dashboards, and Optometrics analytics to help independent optometrists track performance, identify opportunities for growth, and make more informed business decisions.

3. The right technology can improve both patient care and practice growth.

From customizable clinical templates and automated referral letters to targeted patient communications and integrated appointment booking, a modern EMR can support better patient experiences while creating new opportunities to grow services such as myopia management, specialty contact lenses, and dry eye care.

Special Thanks

A big thank you to OSI Group for supporting independent optometry and helping make this conversation possible.

We'd also like to thank Nikon Optical for supporting this episode of The 20/20 Podcast and for its continued commitment to precision, innovation, and personalized vision care.

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What if we could slow childhood myopia progression without compromising visual clarity?

Myopia management continues to evolve, and SightGlass Vision's innovative Diffusion Optics Technology (DOT) is offering optometrists a different approach to controlling childhood myopia.

In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with renowned myopia management expert Dr. Vishakha Thakrar to explore the science behind DOT lenses, how they differ from traditional peripheral defocus technology, and why the child's visual experience should be a key consideration when selecting a myopia control treatment.

Drawing on five years of clinical experience with DOT lenses, Dr. Thakrar shares compelling patient cases, discusses the importance of visual acuity and comfort, and explains how MiSight Spectacles featuring DOT technology can fit into a comprehensive myopia management program.

The conversation also explores practical strategies for introducing new myopia control technology into an optometry practice, overcoming concerns about lens appearance, and creating a sustainable, patient-centred myopia management service.

Whether you're just getting started with myopia management or looking to expand your treatment options, this episode offers valuable clinical insights and practical advice you can bring back to your practice.

3 Key Takeaways

1. A different approach to myopia control

Unlike traditional myopia control spectacles that use peripheral defocus, SightGlass Vision's DOT lenses use contrast modulation and light-scattering technology to help slow myopia progression. Dr. Thakrar explains the science behind this approach and how it expands the treatment options available to optometrists.

2. Visual performance matters as much as treatment efficacy

Effective myopia management isn't just about controlling axial elongation or refractive progression. Children need to see comfortably throughout their daily activities. Dr. Thakrar discusses research on visual acuity, reading performance, peripheral vision, and gaze independence, highlighting why practitioners should evaluate the child's experience when prescribing myopia control spectacles.

3. Clinical success starts with patient education and practice-wide commitment

From demonstrating lenses to parents and children to training optical staff and structuring professional fees, successful myopia management requires more than selecting the right product. Dr. Thakrar shares practical strategies for improving patient acceptance, supporting long-term treatment adherence, and differentiating independent optometry practices.

About Dr. Vishakha Thakrar

Dr. Vishakha Thakrar is a residency-trained optometrist specializing in cornea and contact lenses, with more than 15 years of experience in myopia management. She operates a specialty optometry practice in Vaughan, Ontario, focusing on myopia control, specialty contact lenses, and dry eye management.

A respected speaker, author, and educator, Dr. Thakrar has extensive clinical experience with orthokeratology, soft contact lenses, atropine, and myopia control spectacle technologies. She is passionate about advancing myopia management and helping fellow optometrists integrate evidence-based treatments into their practices.

Connect with Dr. Thakrar: [email protected]

A special thank you to SightGlass Vision for supporting this episode of The 20/20 Podcast and helping advance the conversation around innovative myopia management solutions.

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Increasing optical sales doesn’t have to mean becoming more “salesy.” In fact, Andrew Bruce argues that the best optical practices grow by doing the opposite: slowing down, asking better questions, understanding the patient’s lifestyle, and confidently recommending eyewear solutions that genuinely improve how they see and function throughout their day.

In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with licensed dispensing optician, educator, consultant, and longtime industry veteran Andrew Bruce to explore practical ways optometrists, opticians, and optical teams can increase eyewear sales while delivering a better patient experience. Andrew shares why one pair of glasses rarely meets every visual need, how a strong doctor-to-optician “transfer of authority” can dramatically strengthen the optical conversation, and why clinicians shouldn’t be afraid to recommend multiple eyewear solutions when they are truly in the patient’s best interest.

The conversation also dives into the details that can separate an average optical from a great one: frame inventory, merchandising, premium product, pricing strategy, optical measurements, fabrication, dispensing, and knowing your patient demographic. Andrew explains why empty frame boards can unintentionally communicate neglect, why he prefers broader style selection over stocking multiple colours of the same frame, and why starting with premium options can sometimes lead to better outcomes than beginning with the least expensive product.

Whether you’re an optometrist looking to improve optical capture rate, an optician trying to strengthen patient conversations, or a practice owner looking for practical ways to increase optical profitability, this episode is packed with strategies that can be implemented immediately.

Key Takeaways

1. Prescribe eyewear solutions — don’t simply sell glasses.

Ask patients about their work, hobbies, driving, screen use and lifestyle. Every unmet visual demand may represent an opportunity to recommend a more appropriate eyewear solution, whether that means occupational lenses, prescription sunglasses, a second pair or another specialized option.

2. The doctor-to-optician handoff matters.

A strong “transfer of authority” helps reinforce the treatment plan and positions the optician as the expert who will carry out the doctor’s recommendations. Repeating those recommendations during the handoff can increase patient confidence and create a smoother path into the optical conversation.

3. Optical profitability is built on the entire experience.

Great product matters, but so do precise measurements, fitting, fabrication, merchandising, inventory turn, frame selection and presentation. Andrew’s message is simple: quality and attention to detail create value — and patients are more likely to invest when they understand that value.

About Andrew Bruce

Andrew Bruce is a licensed dispensing optician with more than 25 years of experience in private practice and optical management. He holds a master’s degree in ophthalmic optical and contact lens technology and is a Fellow of the Contact Lens Society of America. After retiring from private practice, Andrew became a full-time educator and industry consultant through ASB Opticianry Education Services, where he provides optical training, practice management education, and ABO and NCLE preparation. He is also a prolific writer and speaker within the optical industry.

Learn more about Andrew and ASB Opticianry Education Services at asbopticianry.com.

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Myopia management has quickly become one of the most important areas in modern optometry. But knowing why it matters is very different from knowing how to actually build it into a successful practice.

In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Fallon Patel, multi-practice owner, speaker, and myopia management leader, to break down what it takes to move from simply believing in myopia management to consistently delivering it in everyday clinical practice.

Dr. Patel shares the systems that helped her scale myopia management across multiple clinics and a large team. From starting with just one or two treatment options, to developing a "myopia champion," training the entire staff, mapping the patient journey, and creating repeatable protocols that make it easier for every doctor and team member to participate.

The conversation also dives into the importance of tracking simple KPIs. As Dr. Patel explains, clinicians may genuinely believe they are recommending myopia management consistently, only to discover that the numbers tell a very different story. Tracking creates visibility, accountability, and an opportunity to improve both patient care and practice performance.

Dr. Patel explains why young patients can be excellent contact lens candidates and introduces her "3 Cs" of pediatric contact lenses - convenience, confidence, and compliance. She and Dr. Sian explore why clinicians should be cautious about deciding what a child can handle - or what a family can afford - before the conversation has even taken place. The episode also looks at MySight and MyDay MySight, patient compliance, staff delegation, and why giving families a complete picture of their options may be just as important as the treatment itself.

Ultimately, this is a conversation about turning good intentions into action. Whether you are just starting a myopia management program or trying to scale one across multiple doctors and locations, the message is simple: start the conversation, build the system, measure what you are doing, and stop making decisions on behalf of the patient before they have had the opportunity to make them for themselves.

3 Key Takeaways

·      Keep myopia management simple at the beginning. You do not need every technology or treatment modality before starting. Dr. Patel recommends beginning with a manageable number of options, building confidence, and expanding from there.

·      Your entire team has to understand the patient journey. Front desk staff, technicians, doctors, and team members responsible for insertion and removal training all influence whether a myopia management recommendation actually turns into treatment. A clear system makes the process easier for both patients and providers.

·      Track what you actually do - not what you think you do. Simple metrics such as the number of eligible children seen and the number of treatments initiated can reveal the gap between clinical intention and clinical behaviour. Tracking creates the visibility needed to improve patient care and practice performance.

**Correction: MiSight is supported by a 7- year study. During the conversation, Dr. Sian and Dr. Patel stated it was 8 years.

About Dr. Fallon Patel

Dr. Fallon Patel is a multi-practice owner in the Greater Toronto Area with more than 15 years of clinical experience. She is a recognized speaker and key opinion leader in myopia management and contact lenses, with a particular focus on building practical systems that help optometry teams deliver consistent, scalable myopia care.

A special thank you to CooperVision Canada for supporting this episode of The 20/20 Podcast and for their ongoing commitment to advancing myopia management education, technology, and resources for eye care professionals across Canada.

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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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