Eye Digest Magazine September 2024

SE PTE MB E R 2 024

BC DO’S Q UA RTERLY OPTOMET RIC MAG AZIN E

Eyes Forward: Paediatric Eyecare

A Robot Friend for Vision Treatment

What Optometrists and Canadians with Children in BC Need to Know.

p. 8

p. 28

Overcoming Behavioral Barriers to Help Children See More and Be More p. 48

BC Doctors of Optometry 121–10551 Shellbridge Way, Richmond, BC. V6X 2W8 info@optometrists.bc.ca | 604.737.9907

CONTENTS

Enhancing Emotional Intelligence: Nurturing a Child-Friendly Environment in Optometry Clinics. .............. . . . . . . . . . . . . . . . . . . 4 A Robot Friend for Vision Treatment............................... . . . . . . . . . . . . . . . . . . 8 Axial Length: An Essential for Myopia Management............ . . . . . . . . . . . . . . . . . 12 Eye Care Community Unites for Clear Vision and Cleaner Oceans. . . . . . . . . . . 18 Pollen and Our Patients................................................ . . . . . . . . . . . . . . . . . 22 What Optometrists and Canadians with Children in BC Need to Know.. . . . 28 Vision Related Quality of Life Matters in Myopia Management.. . . . . . . . . . . . . . 30 Sitka Polk and Nora Francis: Nora’s First Rainbow and the Power of Gene Therapy. ........ . . . . . . . . . . . . . . . . . 36 Bracing for Your Next Paediatric Eye Exam....................... . . . . . . . . . . . . . . . . 40 Accessing Pediatric Vision Care through First Nations Health Benefits.............................. . . . . . . . . . . . . . . . . . 42 The Impact of Summer Activities on Dry Eye Symptoms. ...... . . . . . . . . . . . . . . . . 44 Overcoming Behavioral Barriers to Help Children See More and Be More. ................................................ . . . . . . . . . . . . . . . . . 48 Paediatric Eyecare: 7 Tips for Long-Lasting Growth. ........... . . . . . . . . . . . . . . . . . 54 The Impact of Optomap in Pediatric Optometry. ............... . . . . . . . . . . . . . . . . . 56 HR’s Role in Creating a Child-Friendly Workplace. .............. . . . . . . . . . . . . . . . . 60

Enhancing Emotional Intelligence:

Nurturing a Child-Friendly Environment in Optometry Clinics

By Jade Bodzasy

In the bustling environment of an optometry clinic, dealing with children can present unique challenges.

From apprehension about eye exams to fear of the unknown, children often experience heightened emotions during their clinic visits. Therefore, fostering emotional intelligence among optometry clinic staff is paramount in creating a supportive and comforting atmosphere for young patients.

By increasing emotional intelligence skills, staff members can not only alleviate children’s anxieties but also enhance the overall quality of care.

Here are some strategies to cultivate emotional intelligence among optometry clinic staff when dealing with kids.

Empathy as a Foundation: Empathy forms the cornerstone of emotional intelligence. Understanding and acknowledging a child’s feelings, whether it’s fear, confusion, or discomfort, can significantly impact their clinic experience. Staff should actively listen to children’s concerns and validate their emotions. By showing genuine empathy, staff members can build trust and rapport, paving the way for a smoother examination process.

A great example of this is allowing children the opportunity to speak. Don’t gloss them over the moment they start to say something. Of course, it is part of your job to keep the doctors on time, however this doesn’t mean you would completely disregard what a patient is trying to tell you. When we take a moment to listen to children, a few things will happen. They will listen to you in return, and you will greatly increase your rapport with their guardian as well.

This will result in a positive experience for everyone and improve your chances of referrals and sales.

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Effective Communication: Clear and age-appropriate communication is essential when interacting with children in the clinic. Optometry staff should use simple language and avoid jargon to ensure that young patients comprehend instructions and explanations.

Moreover, maintaining a calm and reassuring tone can help alleviate any apprehensions the child may have. Encouraging open dialogue and addressing any questions or concerns can foster a sense of security and empowerment in children.

Think about how you can simplify the terms you would use for taking a PD measurement with a child or when you mark an OC. By directing your responses to the child and making sure they fully understand what you are saying, they will be more involved in the process and in turn more attentive and patient with you while you are taking those measurements.

Tailored Approach to Care: Recognizing that each child is unique, clinic staff should adapt their approach to meet individual needs. Some children may require extra reassurance and encouragement, while others may prefer a more independent experience. By being attuned to each child’s temperament and preferences, you can tailor their interactions and interventions, accordingly, fostering a sense of personalized care.

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Watch the guardian and child for body language cues and “read the air” when the guardian is speaking. When focusing on these two aspects, you can quickly determine what might cause tension in this experience and how to remedy it.

For example, little Tim likes to touch EVERYTHING, and his parents are trying their best to make sure he’s not grabbing every frame off the shelves.

Instead of letting him search the board with you, sit him down at the table and let him know he is the king today and it is your job to bring the king only the best frames for him to look at. Ask him lots of questions and bring the frame options that will work best for him to the table. Get the parents to take lots of pictures and if he needs a break to stand up and move his body, direct him to your child-friendly space so that he can do so. You will find his parents are incredibly grateful for helping them keep their own stress levels down through the experience which will make it more enjoyable for everyone.

Nurturing emotional intelligence among staff is essential for creating a child-friendly environment where young patients feel safe, supported, and valued. By cultivating empathy, effective communication, and a tailored approach to care, staff members can enhance the overall clinic experience for children and their families. If you’re not sure how to start nurturing emotional intelligence in your staff, I invite you to visit www.emotionalintelligenceconsultinginc.com where you will find Continuing Education centered around increasing emotional intelligence in yourself and your team.

A Robot Friend for Vision Treatment A social robot could help children and families stick to a treatment for ‘lazy eye’.

By Karen Kawawada, University of Waterloo School of Optometry & Vision Science

It’s a potentially life-altering medical condition typically diagnosed in childhood. The good news is treatment works well if followed properly.

The bad news is the treatment is hard to stick to.

An interdisciplinary team of University of Waterloo researchers is trying to improve treatment adherence through use of a social robot that can educate and motivate children and their caregivers.

The condition is amblyopia, where one eye doesn’t see as well as the other. Though sometimes called ‘lazy eye,’ the problem is with the brain, not the eye.

If the problem doesn’t get corrected early enough, permanent vision loss can result, and poor vision

in one eye can limit learning, well-being and future career options.

Amblyopia treatment involves patching the stronger eye for two to six hours a day, which can be challenging. When children and parents don’t sufficiently understand the condition or its treatment, it’s easy to give up, because many amblyopic children don’t struggle in obvious ways.

Typically, clinicians briefly explain amblyopia to parents. However, it’s hard for parents to absorb all the information at once and these conversations often don’t engage the child.

Waterloo researchers, who have backgrounds in optometry, engineering and psychology, are developing a social robot they hope will overcome these hurdles.

The idea is that while they’re at an optometry clinic, children and caregivers will spend time with the robot. The robot will interact with family members Eye Digest Magazine | 9

age-appropriately. For example, a young child could put a patch on the robot’s eye and feel kinship with it, while the robot could show parents through a screen what each of their child’s eyes sees and provide information about amblyopia and its treatment.

At home, children and parents will be able to interact with the robot virtually through an online platform providing further information, support and motivation.

“We’ve seen social robots being used effectively in settings such as restaurants but not in eye care,” said Dr. Ben Thompson, a professor at the School of Optometry & Vision Science and the project lead. “This project is proof of concept to see if we can use them effectively for patient education.”

“Compared with using a tablet or computer, there is a lot of research that shows children find working with social robots more enjoyable; they want to interact with them,” added Dr. Kerstin Dautenhahn, a professor in the Department of Electrical and Computer Engineering. “A robot can motivate and encourage children, so I’m very optimistic that this work will lead to behavioral change.”

The team previously received Graham Seed Fund support to carry out interviews with parents of amblyopic children and create a prototype robot based partly on their input.

Now the team has received funding through the New Frontiers in Research Fund of the three federal research funding agencies (CIHR, NSERC and SSHRC) to bring the robot into the clinic and carry out a study with volunteer patients and families. The two-year study will examine patching adherence and changes in children’s vision. Researchers will also observe children and families interacting with the robot and assess their psychological well-being over time.

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“Research shows that children with amblyopia experience challenges such as reading difficulties, lowered self-esteem and reduced emotional well-being,” said Dr. Maureen Drysdale, a professor of psychology at St. Jerome’s University. “Robots are exciting for kids, so I hypothesize that engaging with one will be a positive experience – and positive experiences have positive mental health and well-being implications. The robot may also improve parents’ well-being by reducing the pressure on them to make their children adhere to the treatment.”

“ If the social robot helps improve treatment adherence, it will help improve vision, and that will make a difference in a child’s life over the long term.”

Dr. Marlee Spafford, Professor Emerita of Optometry

The researchers foresee future applications beyond vision.

“ If it works for amblyopia, it could be applied to other conditions to help improve health outcomes.”

Dr. Lisa Christian, Associate Clinical Professor of Optometry

Axial Length: An Essential for Myopia Management

By Nicole Poon, OD, FAAO

Myopia is more than a refractive error requiring optical correction. It is an ocular disease of eye length elongation. With global prevalence projected to reach 50% by 2050 and 10% expected to have high myopia, there is no safe level of myopia1,2.

The potential visually debilitating consequences of myopia are due to the increased risk of pathological complications, such as myopic macular degeneration, retinal detachment, cataracts, and glaucoma.

The IMI white papers define pathological myopia as posterior structural changes that lead to reduced best corrected visual acuity, often associated with an axial length greater than 26mm5. Hence, the goal of myopia control is to keep the axial length under 26mm. Studies have demonstrated that an axial length greater than 26mm is associated with a 25% chance of visual impairment after seventyfive years old, and this risk increases to 90% if the axial length exceeds 30mm6.

Studies show that the benefits of myopia management outweigh the risks and reveal that the Number Needed to Treat (NNT) to prevent five years of visual impairment is approximately five3.

This means that for every five myopic patients that are treated, one five-year visual impairment is averted. Eye care providers should initiate myopia management as early as possible to reduce the risk of complications. This will improve a patient’s quality of life and reduce the burden on our public health system.

Measuring Axial Length

The Shift from Dioptres to Millimeters Traditionally, risk assessment in myopia management relied on monitoring refractive error. However, there is a paradigm shift towards incorporating axial length measurements because axial length monitoring is becoming the new standard of care.

Axial length measurements are ten times more sensitive than refraction4. For instance, consider two seemingly similar patients, matched in age, race, genetic, and environmental risks. Both have a refractive error of -2.00D, but one has an axial length of 23mm, while the other has an axial length of 25mm. The management of these two patients is very different. In myopia management, axial length should be considered essential as visual fields and OCT are in glaucoma management. Just as eye care practitioners would not monitor glaucoma based solely on IOP, they should not track myopia progression based exclusively on refractive error.

Axial length is an objective measurement easily obtained in clinical practice. It is not influenced by pupil size or accommodation and can be measured via ultrasound or optical biometry.

Ultrasound Biometry: This contact method requires a topical anesthetic, making it less suitable for the pediatric population. Due to user variability, the measurements can be less consistent and accurate.

A 0.1mm difference is significant when monitoring changes in tenths to hundredths of a millimeter.

The devices, however, have a lower price point and a smaller office footprint.

Optical Biometry: This method utilizes light, which has a shorter wavelength than ultrasound, allowing for precise measurements. It is non-contact and provides repeatable results across different users.

Several devices are on the market, some of which offer additional functions such as topography and autorefraction. Some also incorporate software that enables practitioners to track progression and analyze a patient’s risk.

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Assessing Risk with Axial Length and the AL/C Ratio Axial length can provide a broader perspective on risk assessment and when to initiate treatment.

Changes in axial length occur before the onset of measurable myopia, with the fastest changes happening the year before a child becomes myopic7.

On average, children under ten can experience an axial length increase of 0.1mm to 0.2mm per year, which reduces to 0.1mm per year if they are ten or older7. However, this rate varies based on age, sex, race, and baseline refractive error.

Younger children show more rapid shifts in axial length compared to their older peers7. Males typically have longer eyes than females, reaching approximately 25.5mm versus 25mm, likely due to height differences6,8,9,10. Axial length accelerates faster in Asians than Caucasians and in myopes than emmetropes or hyperopes11 12. Myopic children experience significant axial elongation up to three years before onset and through to five years after onset7. For myopes under ten years old who are not on myopia management, axial length growth

can exceed 0.3mm per year, decreasing to 0.2mm per year during their preteens and teens10. If a child has an axial length progression greater than 0.2mm per year or their axial length approaches 23.7mm in females and 24.1 mm in males, they have a higher predisposition to myopia13.

Several studies also evaluate axial length with corneal curvature when assessing the risk for myopia. This is because axial length is synchronized with the refractive component of the eye, specifically corneal curvature. The ratio of axial length to corneal curvature (AL/C), both in millimeters, has proven more predictive than axial length alone8,11,14,15.

Patients with an AL/C ratio of greater than three are likely premyopic and should be considered for treatment15. The power of the cornea can be calculated by averaging the flat and steep radii and can be obtained with topography or optical biometry.

Figure 1. Diez’s axial length growth charts for Chinese children, showing females (top left) and males (bottom left). The right part of the figures illustrates the prevalence of myopia associated with axial length percentiles in females (top) and males (bottom)8.

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Utilizing Axial Length Growth Charts Instead of using average axial length changes for the entire population, specific growth charts that match a patient’s gender and ethnicity should be used. Parents are very familiar with growth charts, which are great tools for communication and education. See Figure 1 for growth charts for Asians and Figure 2 for Caucasians8,11.

To utilize these charts, plot the patient’s axial length as a function of age to determine their percentile. A percentile greater than the 50th indicates a higher risk of developing myopia, while a percentile greater than the 75th suggests a higher risk of high myopia11.

A group in the Netherlands customizes their treatment based on axial length percentiles. Patients in the 75th percentile or higher require aggressive treatment, such as combination therapy or higher concentrations of atropine. Those below the 75th percentile can be managed with a less aggressive approach16. As further research is conducted, eye care providers will have access to growth charts for various patients.

Figure 2. Tideman’s axial length growth charts for European patients, males (left) and females (right)11.

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Monitoring Axial Length Overtime and Determining Treatment Success

Control Goal: The aim of myopia control is to maintain the axial length below 26mm.

Axial length should be monitored at least every six months, and management should be adjusted according to axial length and percentile changes17.

Treatment is successful if a patient’s axial length acceleration matches that of their emmetropic peers. This would mean an axial length change of 0.1mm to 0.2mm per year in those under ten and 0.2mm in those older than ten. Treatment can also be deemed effective if there is a reduction in percentile on the growth charts. If there is no reduction in percentile, then therapy needs to be adjusted.

Reliable Measurement: Optical biometry provides more consistent and repeatable results across users.

Summary and Key Points The importance of axial length in assessing the risk of myopia and monitoring myopia is indisputable.

Eye care practitioners should incorporate axial length into their clinical practice to manage myopia more effectively.

Increased Sensitivity: Axial length measurements are ten times more sensitive than refraction.

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Early Changes: Axial length changes typically precede measurable myopia, with the most rapid changes occurring the year before onset. Children with an axial length acceleration greater than 0.2mm per year are at a higher risk of developing myopia.

Growth Charts: Use age- and gender-specific axial growth charts to assess a patient’s risk for myopia.

Those above the 50th percentile are at increased risk of becoming myopic, and those above the 75th percentile should receive more aggressive management.

Predictive Ratio: Axial length (mm) to corneal curvature (mm), AL/C, can be more predictive than axial length alone.

Regular Monitoring: To determine treatment efficacy, axial length measurements should be conducted at least every six months.

References

1. Holden BA, Fricke TR, Wilson DA, Wong TY, Naduvilath TJ, Resnikoff S. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.'

2. Bullimore MA, Brennan NA. Juvenile-onset myopia—who to treat and how to evaluate success. Nature. 2023;38(3):450-454.

3. Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology. 2021;128(11):1561-1579. doi:10.1016/j. ophtha.2021.04.032 4. Wolffsohn JS, Kollbaum PS, Berntsen DA, et al. IMI – Clinical myopia control trials and instrumentation report. Investig Ophthalmol Vis Sci. 2019;60(3):M132-M160.

5. Flitcroft DI, He M, Jonas JB, et al. IMI – Defining and classifying myopia: A proposed set of standards for clinical and epidemiologic studies. Investig Ophthalmol Vis Sci. 2019;60(3):M20-M30. doi:10.1167/iovs.18-25957 6. Tideman JWL, Snabel MCC, Tedja MS, et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol.

2016;134(12):1355-1363.

7. Mutti DO, Hayes JR, Mitchell GL, et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Investig Ophthalmol Vis Sci. 2007;48(6):2510-2519.

8. Diez PS, Yang LH, Lu MX, Wahl S, Ohlendorf A. Growth curves of myopia-related parameters to clinically monitor the refractive development in Chinese schoolchildren.

Graefe’s Arch Clin Exp Ophthalmol. 2019;257(5):1045-1053. doi:10.1007/s00417-01904290-6

9. Twelker JD, Mitchell GL, Messer DH, et al. Children’s ocular components and age, gender, and ethnicity. Optom Vis Sci. 2009;86(8):918-935.

10. Hou W, Norton TT, Hyman L, Gwiazda J, Group C. Axial elongation in myopic children and its association with myopia progression in the Correction of Myopia Evaluation Trial (COMET). Eye Contact Lens. 2018;44(4):248-259.

11. Tideman JWL, Polling JR, Vingerling JR, et al. Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol. 2018;96(3):301-309.

12. Jones LA, Mitchell GL, Mutti DO, Hayes JR, Moeschberger ML, Zadnik K. Comparison of ocular component growth curves among refractive error groups in children. Investig Ophthalmol Vis Sci. 2005;46(7):2317-2327. doi:10.1167/iovs.04-0945 13. Jos R, Sebastian D, Iribarren R, Lanca C, Saw SM. Axial growth and lens power loss at myopia onset in Singaporean children. Investig Ophthalmol Vis Sci. 2019;60(8):30913099. doi:10.1167/iovs.18-26247 14. He X, Sankaridurg P, Naduvilath TJ, et al. Normative data and percentile curves for axial length and axial length/corneal curvature in Chinese children and adolescents aged 4–18 years. Br J Ophthalmol. 2023;107(2):167-175.

15. Liu L, Li R, Huang D, et al. Prediction of premyopia and myopia in Chinese preschool children: a longitudinal cohort. BMC Ophthalmol. 2021;21:1-10.

16. Klaver CC, Polling JR, Group EMR. Myopia management in the Netherlands.

Ophthalmic Physiol Opt. 2020;40(2):230-240.

17. Gifford KL, Richdale K, Kang P, et al. IMI – Clinical management guidelines report.

Investig Ophthalmol Vis Sci. 2019;60(3):M184-M203. doi:10.1167/iovs.18-25977

Eye Digest Magazine | 17

Eye Care Community Unites for Clear Vision and Cleaner Oceans

In a landmark initiative, Alcon Canada partnered with Plastic Bank, the British Columbia Doctors of Optometry (BCDO) and the BC Society of Eye Physicians and Surgeons (BCSEPS) to clean the English Bay shoreline in Vancouver, Canada.

The event is one of many that went beyond collecting ocean-bound plastics: it was an opportunity for participants to come together and impress the importance of enacting sustainability practices within our homes, communities, and eye care practices. Roughly 75 optometrists, opticians, nurses, and ophthalmologists, and their families joined Alcon associates and Plastic Bank staff, scouring English Bay Beach in Vancouver for plastic bottles, discarded fishing gear, and other debris. The clean-up is a continuation of Alcon’s ongoing commitment to championing sustainability stewardship and making an impact in our global communities.

“It’s these types of collaborations that bring change to life,” stated David Katz, Plastic Bank Founder and CEO. “The relationship between Alcon and Plastic Bank creates a space for the rest of the world to act. Our ultimate vision is to create a world without waste, not a world without plastic. Plastic is critical in healthcare. It’s about looking internally and saying ‘How might I participate? How might I be a part of the solution?’”.

“The local action of Eye Care Professionals has, not only an environmental impact but, a profound global influence on peoples’ lives. By supporting Alcon’s partnership with Plastic Bank, this has the potential to put another child in school and provide consistent nutrition and medical insurance. The event demonstrated how powerful individuals are in the world,” Katz added.

Alcon’s partnership with Plastic Bank began in 2022 and has resulted in more than 125 million bottles being prevented from reaching oceans, representing more than 2.5 million kilograms of plastics collected.

Plastic Bank views plastic as “currency,” using it as a resource to end poverty in areas that lack secure income and access to social benefits. For each ton of plastic used in select Alcon Vision Care and Surgical products, Plastic Bank collects the same amount of ocean-bound plastic in areas with high levels of plastic pollution that lack formal recycling

structure, including the Philippines, Indonesia, and Brazil. Plastic Bank has created a micro-economy whereby collection members exchange plastic for social benefits, such as health, work and life insurance, digital connectivity, grocery vouchers, school supplies, and fintech services.

“ Tremendous momentum has been built around sustainability programs, driven in part by the various North American and European optometric and ophthalmic societies,” according to Alcon Canada General Manager Jeroen Bastemeijer.

“Working together with these societies, our customers, and our partners, is central to achieving sustainability in eye care. Alcon’s collection programs in Canada are designed to gather the equivalent amount of plastics used in surgical products such as preloaded intraocular lens delivery systems (Ultrasert® and AutonoMe®), as well as vision care contact lenses (DAILIES TOTAL1®, TOTAL30® and PRECISION1®). We’re also examining our manufacturing and distribution processes in this regard.”

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A total of 475 communities have been impacted and 4,718 plastic collectors support the activities.

“The results of our partnership with Plastic Bank have been significant, not just for the environment but also in transforming lives in these communities.

We want to share this success with our customers and patients to inspire more sustainable practices in eye care”, noted Bastemeijer.

Dr. Heather O’Donnell, at Providence Health Care, commented, “As an ophthalmologist I see what a detrimental effect climate change has had on health, both in my clinic in Vancouver and around the world. Every year, I see a significant number of patients with severe ocular surface disease linked to the effects of climate change. As healthcare providers, we must demonstrate our commitment and lead by example. Unequivocally, the most effective way to reduce our carbon footprint in healthcare is to keep our population healthy to avoid carbon-costly interventions. Patient education and communication to promote disease prevention are paramount.”

do necessary surgeries without them. It’s about developing a circular approach to treating those plastics.”

Alcon is committed to protecting our planet, and we continually focus on minimizing our environmental footprint through efficiency, optimization, and collaborations that focus on furthering our social impact and sustainability goals. Partnerships with organizations like Plastic Bank and projects like this shoreline cleanup demonstrate how Alcon is taking action to keep our planet brilliant.

Want to learn more? Check out our most recent Social Impact and Sustainability Report

According to Dr. Pavan Avinashi, an optometrist at Hollyburn Eye Clinic in Vancouver, “We all need to be aware of and involved in sustainability and the long-term safety of our planet, in our homes and workplaces. Even simple initiatives, like the contact lens recycling program I introduced for my practice, can be a great way for optometrists to make the world a better place. Alcon knows how important it is to take care of our planet and keep our ecosystems and oceans clean. From a manufacturing perspective, they’re taking action to ensure a carbon-neutral effect by 2030. Alcon wants to make a difference, and their actions demonstrate that this is a priority for the organization” stated Dr. Avinashi.

“We have a responsibilty to see what we can do differently to reduce the use of plastics and to ensure that items don’t reach the ocean and other vulnerable ecosystems,” says Bastemeijer.

“We’re not fighting a war against plastics. We can’t 20 | Eye Digest Magazine

Watch the highlights video from the Shoreline Clean-Up event.

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References: 1. Alcon data on file, 2022. 2. In a clinical study wherein patients used CLEAR CARE® solution for nightly cleaning, disinfecting, and storing; Alcon data on file, 2021. 3. Merchea M, Evans D, Kannarr S, Miller J, Kaplan M, Nixon L. Assessing a modified fitting approach for improved multifocal contact lens fitting success. Paper presented at Optometry’s Meeting, the 121st Congress of the American Optometric Association; June 20-24, 2018; Denver, CO. 4. Bauman E, Lemp J, Kern J. Material effect on multifocal contact lens fitting of lenses of the same optical design with the same fitting guide. Poster presented at: British Contact Lens Association Clinical Conference & Exhibition; June 9-11, 2017; Liverpool, UK. 5. In vitro evaluation of bacterial adherence in commercial lenses: Alcon data on file, 2020. 6. In vitro evaluation of bacterial biofilm in commercial lenses: Alcon data on file, 2020. 7. In vitro evaluation of lipid deposition for lehfilcon A and commercial lenses using 3D confocal imaging; Alcon data on file, 2021. 8. Ishihara K, Fukazawa K, Sharma V, Liang S, et al. Antifouling silicone hydrogel contact lenses with a bioinspired 2-methacryloyloxyethyl phosphorylcholine polymer surface. ACS Omega. 2021;6:7058-7067. 9. Laboratory assessment of ultraviolet and visible light transmission properties of lehfilcon A sphere contact lenses using spectrophotometer; Alcon data on file, 2020.

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Pollen and Our Patients

By Dr. Tanya Flood, OD, MSc.

Pollen, Dust, Preservatives, Grass, you name it, and I am probably allergic to it! These sensitivities cause my eyes to itch, feel irritated and the skin around my eyes to be red, itchy, and puffy, often evolving into dermatitis.

As someone who lives in BC, where the allergen and particulate count is high from March through to October, I have direct experience with how frustrating sensitive eyes and eyelid tissue can be.

It can be even more frustrating for the kids in our practice.

Many of my patients also experience dry, irritated, or itchy eyes and find they must use anti-allergy drops to control these symptoms. Often these eye drops have preservatives which could potentially further irritate their eye. With some recent introductions to the Canadian market, combined with long-established treatments, I have found a multi-pronged approach that can work for both me and my patients. As allergy season ramps up, dips, or roars back with a vengeance, this can be tailored for each patient to address their specific needs, whether they suffer from seasonal or perennial allergies.

Recent Canadian market entrants for our allergy patients:

Liposomal Spray Up until recently, I had to use oral medications, preservative-free steroid eye drops and/or ointments to settle my eye and eyelid symptoms.

There is now a novel spray with a combination of hyaluronic acid and the PER-LIP® complex, which includes liposomes, to relieve itchy, dry, and irritated eyes. This is sprayed on closed eyelids and when utilized at the first sign of symptoms, it helps reduce these symptoms and reliance on oral anti-allergy medications, particularly if they are just experiencing ocular symptoms.

Eyelid Cream A new treatment modality for optometrists – which focuses on the delicate 0.32mm thick eyelid skin that can become itchy, irritated, puffy and discoloured. A new product will be widely available across Canada in mid-June. I had the opportunity to try it early and found it is an easy to apply eyelid and eye contour cream that soothes, protects, and repairs this delicate eyelid skin, which in turn supports overall ocular health, which I have found helpful specifically to OSD, MGD and Dermatitis.

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Established Allergy Products:

Antihistamine Eyedrops While we try to reduce the use of preservatives, sometimes a patient requires a prescription antiallergy drop during the peaks of the season. There are many well-established drops that provide fastacting, long-lasting allergy relief by targeting the allergic reaction at the ocular source. Certain products are safe for use in children aged three and older. This can be used in combination with liposomal sprays to ensure we are completely addressing patient symptoms.

As an example of a daily routine for someone with allergies, I will share what I do. When the morning arrives, my eyes are often itchy, dry and my eyelids are puffy. My morning routine involves washing my face, applying preservative-free eyedrops and spraying my closed eyes with liposomal spray. I take my clean finger and rub it into the lash line and allow it to air dry, after which I then apply a cream specifically designed for the eye contour, upper and lower. In the evening, I warm my lids and use a lid wipe. After this air dries, I apply the eye contour cream around the eye region from bone to bone. I will also use the liposomal spray anytime through the day when I feel itching increasing.

As part of the comprehensive care, we provide we may also recommend some lifestyle changes: • Limit exposure to allergens to which patients are sensitive • Wear sunglasses • Wash clothes and bedding frequently • Avoid drying clothes outside

Antimicrobial Lid Wipes

• Consult local pollen calendar

At the start and the end of the day it is important to ensure the lid margin is clean and reduce the allergen load that may accumulate during the day – there is one daily lid hygiene wipe with clinically proven antimicrobial properties (Peral et. al) which is approved by Health Canada as a medical device which I have found the most helpful. It is safe for use in children three months and up.

It is exciting for our profession to have so many new treatments approaches for our allergy patients.

Along with long-established treatment modalities, I encourage you to prescribe these new preservative free options for your patients.

24 | Eye Digest Magazine

Dr. Flood is a BC Doctor of Optometry with a special interest in ocular surface disease treatments.

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What Optometrists and Canadians with Children in BC Need to Know.

By Vishal Gill, Portfolio Planning

Eye care is a vital aspect of health, particularly for children, but it can be costly.

However, in British Columbia there are several tax credits and benefits available that can help alleviate the financial burden. In this article, we will explore the Medical Expense Tax Credit (METC) and Health Spending Accounts (HSAs) and how educating optometrists and their patients about these options can lead to significant savings and improved affordability.

The Medical Expense Tax Credit (METC) The Medical Expense Tax Credit is a tax credit that can be claimed by individuals or their spouses or common-law partners for qualifying medical expenses. In British Columbia, the threshold for claiming the METC is based on a percentage of the individual’s net income. For 2024, the threshold is 3% of the lesser of the individual’s net income or $2,616. It makes sense to utilize the lower income earning spouse for the credit as it allows them to claim the tax credit sooner, thus providing tax relief earlier Health Spending Accounts (HSAs) for Incorporated Business Owners Health Spending Accounts (HSAs) are tax-efficient accounts that can be utilized by incorporated business owners, including optometrists, to cover eligible medical expenses. Contributions made to an HSA are tax-deductible for the corporation, and the funds can be used to pay for various medical expenses, such as eye exams, prescription glasses, and corrective surgeries.

Educational Resources For optometrists seeking informational handouts or digital videos to send post-appointment to share with their clients, we provide resources to help educate and inform patients about the Medical Expense Tax Credit, Health Spending Accounts, and other tax-saving opportunities. Email us at info@ portfolioplanning.ca to request these resources for your clinic.

By sharing knowledge about these tax-saving options, optometrists can improve their clients’ understanding of financial incentives for eye care and ensure that essential services are affordable and accessible.

Real-Life Story Meet Sarah, a single mother living in British Columbia. Sarah’s daughter, Lily, was experiencing vision problems, but Sarah was concerned about the potential expenses associated with eye exams, glasses, and any necessary surgeries. Thankfully, Sarah’s optometrist informed her about the Medical Expense Tax Credit and how it could help reduce the financial burden.

With this knowledge, Sarah was able to prioritize Lily’s eye care without worrying about the cost.

By utilizing the tax credit and exploring affordable options, Sarah ensured that Lily received the necessary treatments. Today, Lily’s vision has significantly improved, and Sarah feels grateful for the assistance provided by her optometrist and the information they shared.

At the end of the day by understanding how tax credits and Health Spending Accounts work, both optometrists and their patients can benefit from increased affordability and accessibility to essential eye care services. By sharing this information we can improve your bottom line while ensuring that affordable eye care is within reach for all.

Eye Digest Magazine | 29

Vision Related Quality of Life Matters in Myopia Management Review of Myopia Management Trade Article sponsored by Johson & Johnson Vision

By Monica Jong

Today myopia may be considered a chronic, progressive disease1 because once a child develops myopia, it tends to progress.2 Every dioptre is associated with an increased risk of disease3 and it is excessive axial elongation that is strongly linked with future disease and vision impairment such as cataracts, glaucoma, retinal detachment and myopic macular degeneration.4 Therefore, managing myopia is imperative given that the prevalence of myopia is increasing in many parts of the world.5 In the US the prevalence of myopia increased from 25% in the early 1970s to nearly 42% in the early 2000s6 and myopia is forecast to affect 50% of the world’s population by 2050.5 Recent innovation and advancements in myopia research have led to an explosion of myopia treatments that include specially designed spectacle lenses, soft contact lenses, ortho-k and pharmacological† treatments available across various parts of the world.7,8 Today practitioners have the opportunity to change the lives of pediatric patients with myopia and manage it better than ever. Practitioners have the opportunity to provide personalized care for myopia management by selecting the most appropriate treatment for patients based on their clinical profiles, preferences and lifestyles.9 Eye Digest Magazine | 31

Stock

Vision related quality of life may not initially come to mind when you have your patient in your chair, but it should be strongly considered. Talking to the child about what they like to do, understanding their hobbies and activities in daily life, their motivations and having their parent or caregiver alongside leads to better patient outcomes.¹⁰

Studies comparing vision related quality of life in children wearing spectacles versus contact lens have found that children wearing contact lenses reported better self- perception, confidence and participation in activities such as sports.11,12,13,14 A study in China also reported that children wearing ortho-k spent more time outdoors15 and more time outdoors can delay myopia and slow axial elongation as well.16 Time outdoors itself has other health and psychological benefits17 and may help to take children away from screen time.

Additionally, the American Academy of Pediatrics has issued screen time guidelines, and this is something we should be weaving into our conversations with patients and encouraging the 20/20/2 rule – every 20 minutes look into the distance 20 feet and go outside 2 hours per day18.

As practitioners, we know firsthand that a child that is happy with their correction is more likely to wear them. Myopia management studie s also demonstrate that greater wear time is associated 32 | Eye Digest Magazine

with better treatment efficacy.19,9 Additionally, contact lenses move with the eyes and are not as easily removed compared with spectacles which may further improve treatment compliance.

Vision related quality of life should be considered in myopia management. The pediatric patient in your chair can tell you a lot about who they are and what they like to do and help guide us to the most appropriate treatment option. Ask them if they like to play sports and what sports, do they like to play video games, when and how often are they wearing their correction? Is the need for no daytime correction appealing to the patient and parent? Do parents want to be in control or part of the process? If so, co ntact lenses or ortho-k may be the most appropriate treatment.

Today we have many treatment options to select from and having a proactive conversation with the child and their parents will help guide better decision making for long term myopia management success.

Key Takeaways Vision related quality of life matters

Consider a more holistic and patient-centred approach when managing myopia that takes into patient clinical factors, lifestyle and preference

Every child matters, and every dioptre counts³

Footnote †Low dose atropine may be used off-label by ECPs in countries where regulatory approval does not exist. ECPs may be subject to local regulatory, legal and professional requirements that the ECP must understand and comply with to cover all aspects of off-label prescribing in their country.

References 1. 1. Bullimore, M. A. & Brennan, N. A. The underestimated role of myopia in uncorrectable visual impairment in the United States. Sci. Rep. 13, 15283 (2023).

2. Mutti, D. O. et al. The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia. Optom. Vis. Sci. Off. Publ. Am. Acad. Optom. 99, 424–433 (2022).

3. Bullimore, M. A. & Brennan, N. A. Myopia Control: Why Each Diopter Matters. Optom.

Vis. Sci. Off. Publ. Am. Acad. Optom. 96, 463–465 (2019).

4. Tideman, J. W. L. et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 134, 1355– 1363 (2016).

5. Holden, B. A. et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 123, 1036–1042 (2016).

6. Vitale, S., Sperduto, R. D. & Ferris, F. L. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch. Ophthalmol. Chic. Ill 1960 127, 1632–1639 (2009).

7. Wildsoet, C. F. et al. IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest. Ophthalmol. Vis. Sci. 60, M106–M131 (2019) 8. Walline, J. J. Myopia Control: A Review. Eye Contact Lens 42, 3–8 (2016).

9. Gifford, K. L. et al. IMI - Clinical Management Guidelines Report. Invest. Ophthalmol.

Vis. Sci. 60, M184–M203 (2019).

10. Boland, L. et al. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement. Sci. IS 14, 7 (2019).

11. Walline, J. J. et al. Randomized trial of the effect of contact lens wear on self- perception in children. Optom. Vis. Sci. Off. Publ. Am. Acad. Optom. 86, 222–232 (2009).

12. Walline, J. J. et al. Benefits of contact lens wear for children and teens. Eye Contact Lens 33, 317–321 (2007).

13. Santodomingo-Rubido, J., Villa-Collar, C., Gilmartin, B. & Gutiérrez-Ortega, R. Myopia control with orthokeratology contact lenses in Spain: a comparison of vision-related quality-of-life measures between orthokeratology contact lenses and single-vision spectacles. Eye Contact Lens 39, 153–157 (2013).

14. Yang, B., Ma, X., Liu, L. & Cho, P. Vision-related quality of life of Chinese children undergoing orthokeratology treatment compared to single vision spectacles. Contact Lens Anterior Eye J. Br. Contact Lens Assoc. 44, 101350 (2021).

15. Zhao, F., Zhao, G. & Zhao, Z. Investigation of the Effect of Orthokeratology Lenses on Quality of Life and Behaviors of Children. Eye Contact Lens 44, 335– 338 (2018).

16. Wu, P.-C. et al. Increased Time Outdoors Is Followed by Reversal of the Long- Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology 127, 1462–1469 (2020).

17. Maller, C., Townsend, M., Pryor, A., Brown, P. & St Leger, L. Healthy nature healthy people: ‘contact with nature’ as an upstream health promotion intervention for populations.

Health Promot. Int. 21, 45–54 (2006).

18. Klaver, C., Polling, J. R., & Erasmus Myopia Research Group. Myopia management in the Netherlands. Ophthalmic Physiol. Opt. J. Br. Coll. Ophthalmic Opt. Optom. 40, 230–240 (2020).

19. Cheng, X., Xu, J. & Brennan, N. A. Randomized trial of soft contact lenses with novel ring focus for controlling myopia progression. Ophthalmol. Sci. doi:10.1016/j. xops.2022.100232.

Eye Digest Magazine | 33

2024

fall symposium A LOOK INTO PAEDIATRICS Sunday Sept 22, 2024

08:30am 05:30pm

REGISTER NOW

Virtual event

Sitka Polk and Nora Francis:

Nora’s First Rainbow and the Power of Gene Therapy

Imagine being told your newborn might never see the world. This was the harsh reality for Sitka Polk and her husband David. Just five weeks after the joyous arrival of their daughter Nora, her eyes began to flicker uncontrollably. The emergency doctors at IWK Health Centre in Halifax were baffled. “We’ve never seen this before,” they confessed.

After several tests and consultations, Nora ended up in the hospital’s neurology clinic, where the neurologist explained that Nora had an eye issue.

“ Prepare yourself for lifelong blindness,” he said.

Fortunately, lifelong blindness was not what awaited young Nora. What followed instead was a journey of fear, hope, and eventual triumph, as a community rallied to restore Nora’s sight.

“Nora was diagnosed with Leber congenital amaurosis (LCA) at age two, and then genetic testing confirmed RPE65 gene mutation,” says Sitka. Nora’s family and school adapted brilliantly to her needs. "we always had bright lights on at home."says Sitka.

“We had a big lamp on our kitchen table so Nora could eat her food and draw. She had a desk lamp at school and they installed bright lighting in the bathrooms and hallways.” Nora also had a magnifier and was being trained in using a white cane.

The accommodations could only do so much, however. As the sun set each day, Nora’s world dimmed significantly, forcing her indoors while her peers played outside. Exploring new places was a challenge. While she loved drawing, Nora always chose a dark sharpie because of its strong contrast with the white paper. And the looming fear of inevitable blindness cast a shadow over her vibrant young life.

But there was hope.

“ I knew that there was a treatment in the U.S. for LCA with this gene mutation,” says Sitka. “We started advocating for it to come to Canada.”

Doug Earle, the former CEO of Fighting Blindness Canada (FBC), reached out to Sitka and got her involved in FBC’s advocacy work to get the new treatment, Luxturna, approved in Canada. “Having a child with a rare disease can be lonely,” says Sitka.

“Working with FBC made us feel supported, part of a community fighting for a common cause.”

Thanks to groundbreaking research and advocacy work by FBC and others, Luxturna —a one-time gene therapy for individuals with retinitis pigmentosa or LCA caused by mutations in the RPE65 gene that can slow the progression of vision loss and may also restore some vision—was approved by Health Canada in 2020. In the spring of 2023, provinces (including Nova Scotia) agreed to publicly fund the treatment. Nora received her treatment over two sessions that spring. The results were beyond what anyone had dared hope.

“ It’s mind-blowing how good her vision is now,” says Sitka.

Nora, now eight, no longer needs the intense indoor lighting that once scaffolded her life. She plays outside with her friends in the twilight, reads fine print, and sees the world in vivid contrast.

Eye Digest Magazine | 37

Fighting Blindness Canada (FBC) is the largest charitable funder of vision research in Canada. In its 50 years FBC has funded more than $45 million in critical visionsaving research and educational programs.

Help your patients connect with other members of the sight-loss community and access the latest information about vision health and research with FBC’s educational resources.

VIEW POINT View Point is an education series providing the latest information about vision health and research by way of virtual, hybrid and in-person events. 2024 topics include innovative treatments, inherited retinal dystrophies (IRDs), age-related macular degeneration (AMD), glaucoma and living well with an eye disease.

YOUNG LEADERS The Young Leaders Program is a career-oriented initiative aimed at creating a brighter, more inclusive future for youth living with vision loss. The program provides young people in Canada, aged 15-35 who are blind or partially sighted, with the opportunity to gain access to resources, guidance and the support they need on the path to pursuing rewarding careers and finding fulfilling employment.

HEALTH INFO LINE Our Health Information Line is here to help!

Our knowledgeable staff can help direct your patients to trusted resources about disease information, genetic testing, clinical trials, treatment options, community supports and more.

Email healthinfo@fightingblindness.ca or call 1.888.626.2995.

Visit: fightingblindness.ca

Oliver, 9 Goal: Read 20 books this school year In a parallel arm study, Neurolenses increased incremental reading speed by over 60% after a period of 35 days meaning your patients can be more productive for longer.

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Relief is in Sight

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Bracing for Your Next Paediatric Eye Exam

By Dr. Trevor Miranda, OD, Cowichan Eyecare

Whenever I hear a screaming or crying child in the office, I say a small wish, hoping it's one of my associate's patients and not my next one!

It can be a real challenge to examine a child who refuses to open their eyes while tears run down them and also simultaneously dodge baby left jabs. I have learned to duck and weave while doing retinoscopy and contort myself into yet undiscovered yoga poses as I try to catch a glimpse of the fundus.

Examining a child can be very easy and enjoyable but can also require patience, determination and hostage negotiation level communications!

We are all aware of how important vision is developmentally. 80% of learning comes through the eyes in normal sighted children. Ensuring good vision and binocularity can have massive impacts on a child's ability to learn, lead to a higher level of selfesteem and be a good proxy for future successes.

Are we looking to examine every child? Are we as optometrists educating communities about the importance of a child's first eye exam and about regular and routine annual care?

Every child deserves the opportunity to see as well as possible. Advances in vision therapy and contoured prism can improve reading comprehension and reading speeds. As a follow up to its reading speed improvement study, Neurolens recently demonstrated contoured prism in lenses not only improves reading speed immediately, but also maintains the improvement over time. The initial study found a 70% improvement in reading speeds when wearing Neurolenses, compared to the control, realizing an increase in reading speed as soon as 30 minutes of wear and more significantly at 7 days. The follow up study revealed that the increased reading speed was maintained beyond the first 7 days:

As illustrated above, both the control lens wearers and Neurolens wearers saw an improvement in their reading speed, however the Neurolens wearer results were continually almost double throughout all study visits at 30 minutes, 7 days, and 35 days.

Neurolens demonstrates that their lenses will assist with reading right away and into the future. More than just visual acuity, modern day optometry can provide tools to improve a student's performance.

Optimizing visual function is also important in that the way students learn is mainly through digital devices. As a side note all three of my university attending children use Neurolens glasses to improve their reading speed, support their neck and brain function and thus improve productivity.

Myopia management can assist in controlling the progression of myopia. Identifying myopia early and measuring axial length can help reduce longer term issues associated with high myopia.

Tints and treatments combined with optimized prescriptions can reduce strain and improve reading speeds and brain processing. These can be added to the contoured prism solutions from Neurolens as well.

Knowing these facts, are we committed to examining every child?

There are so many patients we may be missing.

Are we speaking about the risks such as amblyopia that can occur when children aren't examined early and often? Would parents be interested in not just seeing better, but feeling better and enhancing reading speeds? Many parents may come into our clinic but not understand that examining their children is very important. A great way to keep your “book” full is to recommend the whole family be examined when a patient calls in. Our five cold start clinics have used this tactic to improve bookings and keep doctor schedules full.

Children grow up and become parents. Making the Eyecare experience wonderful for children and informative for parents is a practice builder.

Promoting UV protection for kids and parents alike results in higher sunwear sales. Neurolens, Vision Therapy, Myopia Management, fashion kids frames and protective eyewear are ways to increase profitability and service levels when managing children's vision care.

So sure, sometimes you might have to put in that extra effort to calm a child. You might have to crawl around and play with a child to win their trust only to lose it forever with the sting of instilling cycloplegic drops. You will be coughed on, cried on, and potentially spat on. Know this that by examining every child you will certainly change lives for the better. You're a superhero!

Eye Digest Magazine | 41

Accessing pediatric vision care through First Nations Health Benefits Did you know that approximately 80% of visual impairment is either preventable or curable with treatment?

Regular eye exams are essential for maintaining good eye health, as they ensure up-to-date prescriptions for glasses and contact lenses, and help to detect any eye and brain diseases.

This is particularly important for children, as early detection of any eye and vision problems helps support their overall development and academic success. Early detection is key for vision health and wellness.

First Nations Health Benefits Coverage for Vision Care First Nations Health Benefits (FNHB) is a program of the First Nations Health Authority (FNHA) and seeks to provide coverage for medically necessary items and services that are not covered under the Medical Services Plan (MSP). FNHB strives to ensure coverage is accessible, offers Clients choice and aligns with industry best practices.

Coverage under the FNHB Vision Benefit includes:

EYE EXAM

PRESCRIPTION EYEWEAR

$100 for a routine eye exam every two years (annually for those 18 years and under).

$275 every two years for prescription eyewear ($415 for high index prescriptions).

This coverage is in addition to the MSP eye exam coverage for those over 65 years and under 18 years of age. MSP coverage should be accessed prior to the FNHA’s coverage.

This coverage is in addition to MSP coverage. Providers must bill MSP first and FNHB’s coverage can be used towards the remaining balance.

Accessing the FNHB Vision Benefit

of colonialism and anti-Indigenous specific racism, which can create significant barriers to accessing care. It is important that vision care providers build cultural safety into the delivery of services as part of their work towards offering high quality care.

To access the benefits, eligible First Nations People in BC must first enroll as a Client with FNHB. Clients can submit claims to FNHB online, by mail, or choose a provider that can bill directly to Pacific Blue Cross, which administers vision benefits on behalf of FNHA. Clients can choose any qualified optometrist that they are comfortable with, including those who are experienced in working with children and youth if needed.

Cultural Safety When Accessing Vision Care Many First Nations People have experienced culturally unsafe care due to the ongoing impacts

To support ongoing learning across the health care system, the FNHA partnered with Health Standards Organization on the BC Cultural Safety and Humility Standard. A video about the standard is also available here.

For more information about FNHA’s Vision Benefit or eligibility, please visit the website or call FNHB at 1-855-550-5454.

Eye Digest Magazine | 43

The Impact of Summer Activities on Dry Eye Symptoms Hot summer days may result in an influx of patients presenting with dry eye symptoms.

While dry eye is commonly associated with older age groups, it's not uncommon to see a diverse range of individuals, including younger people, experiencing dry eye symptoms.

Many factors can contribute to the increasing prevalence of dry eye across all ages (Dana et al., 2019; Stapleton et al., 2017). During summer, this trend can be attributed to air conditioning and increased screen time as well as outdoor activities.

When patients visit with complaints of dry eye, eye health professionals need to be equipped with effective and efficient treatment tools to address the widespread dry eye disease.

How Outdoor Activities May Worsen Dry Eye Symptoms Sunny summer days offer countless opportunities for spending time outdoors. While you embrace the warmth of summer, here are some areas which may cause an increase in dry eye symptoms you should be aware of.

44 | Eye Digest Magazine

Swimming in a pool or at the beach is a summer staple, but it may also lead to some dry eye symptoms. Chemicals such as chlorine, often used in pool water for hygiene purposes, can be harsh on your eyes. Chlorinated water may give what is commonly known as “swimmer’s eyes” by disrupting the lipid layer of the tear film. This disruption can lead to increased tear evaporation and dry eye symptoms such as itching and burning (Ishioka, 2008).

What about swimming in a saltwater pool or in the ocean? Should you be worried? While seawater does not contain excess chlorine, its high salt content can still irritate the eyes. Salt is a great absorber of water and can draw moisture from the eyes, inducing osmotic stress. The resulting hyperosmolarity contributes to dryness with symptoms such as irritation, gritty sensations, and itching and burning (Fernández-Luna et al., 2016).

When you are away from the water, the sun might be the culprit behind your dry eye symptoms.

Prolonged UV exposure can trigger oxidative stress, reducing tear film stability and leading to dryness.

Other pursuits such as hiking and biking in windy conditions could accelerate tear evaporation, further exacerbating dry eye symptoms (Alves et al., 2023).

Indoor Environment and Potential Dry Eye Symptoms When the summer days are hot and humid, seeking relief indoors can be a smart move. But even while indoors, you may still encounter dry eye symptoms.

Increased screen time – whether from computers, tablets, or smartphones – can lead to digital eye strain that presents dry eye symptoms. The primary reason is reduced blinking. Every blink is vital for maintaining and replenishing the tear film. When concentrated on a phone or computer, the blink rate can decrease from the average norm of 12-15 blinks per minute to as low as 4 times per minute (Bentivoglio et al., 2004)! This decreased blink rate can cause dryness and discomfort.

Additionally, relying on air conditioning for refuge from the heat can inadvertently worsen dry eye symptoms. Air conditioning cools the air by lowering the humidity level. While this can keep your cool, it also accelerates the evaporation of moisture from the eyes.

As a result, air-conditioned environments can exacerbate dry eye symptoms such as irritation, excessive tearing, and discomfort (Wolkoff & Kjaergaard, 2007).

Lubricating and Supporting the Tear Film for Dry Eye Relief Dry eye symptoms can bring a great level of discomfort and may pose risks of potential vision problems. Fortunately, lubricating eye drops and eye sprays can help prevent dry eye from putting a damper on summer activities.

Here is why eye health professionals recommend HYLO® mini/HYLO® to their patients: HYLO® is available in two different pack sizes: HYLO® mini, a starter pack size with 150 drops and HYLO®, a value pack size with 300 drops for long-term use.

• High molecular weight sodium hyaluronate provides long-lasting lubrication on the ocular surface (Müller-Lierheim, 2020).

• HYLO® bottle features an airless delivery system with 6 months of in-use sterility, dispensing one drop at a time!

• Preservative-free and phosphate-free formulation ensures a comfortable and gentle application on the eyes!

• Can be used while wearing contact lenses, anywhere and anytime!

Eye Digest Magazine | 45

After lubricating the eyes, CALMO® Eye Spray can lock-in the moisture with renourishment of the lipid layer! Simply spray once on each eye and blink a couple times!

• CALMO® Eye Spray is a liposomal suspension that is very similar to the lipids of the tear film.

• CALMO® Eye Spray provides immediate comfort and humidification of dry eyes and stabilizes the lipid layer (Dausch et al., 2006).

• Preservative free and can be used for 6 months after first use.

Prescribe today and help your patients Feel the Difference with HYLO® mini/ HYLO® and CALMO® Eye Spray. Available at selected optometry and ophthalmology clinics and at pharmacies behind the counter alongside HYLO® family of dry eye treatments and CALMO® / NACLINOTM lid hygiene.

CandorVision™ – Your eyes are everything!

References 1. Alves, M., Asbell, P., Dogru, M., Giannaccare, G., Grau, A., Gregory, D., Kim, D. H., Marini, M. C., Ngo, W., Nowinska, A., Saldanha, I. J., Villani, E., Wakamatsu, T. H., Yu, M., & Stapleton, F. (2023). TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface. The ocular surface, 29, 1–52. https://doi.org/10.1016/j.jtos.2023.04.007 2. Bentivoglio, A. R., Bressman, S. B., Cassetta, E., Carretta, D., Tonali, P., & Albanese, A. (1997). Analysis of blink rate patterns in normal subjects. Movement disorders : official journal of the Movement Disorder Society, 12(6), 1028–1034. https://doi.org/10.1002/ mds.870120629 3. Dana, R., Bradley, J. L., Guerin, A., Pivneva, I., Stillman, I. Ö., Evans, A. M., & Schaumberg, D. A. (2019). Estimated Prevalence and Incidence of Dry Eye Disease Based on Coding Analysis of a Large, All-age United States Health Care System. American journal of ophthalmology, 202, 47–54. https://doi.org/10.1016/j.ajo.2019.01.026 4. Dausch, D., Lee, S., Dausch, S., Kim, J. C., Schwert, G., & Michelson, W. (2006). Vergleichende Studie zur Therapie des Trockenen Auges bedingt durch Lipidphasenstörungen mit lipidhaltigen Tränenpräparaten [Comparative study of treatment of the dry eye syndrome due to disturbances of the tear film lipid layer with lipid-containing tear substitutes]. Klinische Monatsblatter fur Augenheilkunde, 223(12), 974–983. https://doi. org/10.1055/s-2006-927266

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5. Fernández-Luna, Á., Burillo, P., Felipe, J. L., del Corral, J., García-Unanue, J., & Gallardo, L. (2016). Perceived health problems in swimmers according to the chemical treatment of water in swimming pools. European journal of sport science, 16(2), 256–265. https:// doi.org/10.1080/17461391.2014.1001877 6. Ishioka, M., Kato, N., Kobayashi, A., Dogru, M., & Tsubota, K. (2008). Deleterious effects of swimming pool chlorine on the corneal epithelium. Cornea, 27(1), 40–43. https://doi. org/10.1097/ICO.0b013e318156d200 7. Müller-Lierheim W. G. K. (2020). Why Chain Length of Hyaluronan in Eye Drops Matters. Diagnostics (Basel, Switzerland), 10(8), 511. https://doi.org/10.3390/diagnostics10080511.

8. Stapleton, F., Alves, M., Bunya, V. Y., Jalbert, I., Lekhanont, K., Malet, F., Na, K. S., Schaumberg, D., Uchino, M., Vehof, J., Viso, E., Vitale, S., & Jones, L. (2017). TFOS DEWS II Epidemiology Report. The ocular surface, 15(3), 334–365. https://doi.org/10.1016/j. jtos.2017.05.003 9. Wolkoff, P., & Kjaergaard, S. K. (2007). The dichotomy of relative humidity on indoor air quality. Environment international, 33(6), 850–857. https://doi.org/10.1016/j.envint.2007.04.004

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“Effects of long-term computer use on eye dryness.” Northern clinics of Istanbul vol. 5,4 319-322. 8 Aug. 2018, doi: 10.14744/nci.2017.54036; data on file.

Overcoming Behavioral Barriers to Help Children See More and Be More.

By Simon Robert, Senior Director, corporate affairs and strategic partnerships, Canada at EssilorLuxottica

Children's eye health is vital to their overall well-being and development, making it more important than ever.

The Canadian Association of Optometrists’s (CAO) position statement on Myopia Management shares that 30% of Canadians experience myopia and these rates are rising.1 Furthermore, a 2018 study found that 6% of children that were 6-8 years old had myopia, and this rate jumped to almost 30% for children 11-13 years old.² Aside from a societal need, there is a significant market opportunity for eye care professionals (iECPs) to provide children with the best possible solutions. One of these solutions is the innovative Essilor® Stellest® lens. Using HALT technology, the lens has been clinically proven to slow the progression of myopia by up to 67% in children3, compared to single vision lenses when worn 12 hours a day.

However, behavioral barriers often delay parents from bringing their children in for eye exams. A survey conducted in 2023 revealed that over 70% of Canadian parents are unaware of myopia4 and its impact on their children’s educational success, with nearly half not recognizing the need for corrective lenses until their child is already struggling.

According to research 80% of learning occurs through vision5 and 1 in 3 children struggle to see the board clearly6, overcoming these behavioral barriers is crucial to ensuring all children can see more and be more. In this article we will highlight these behavioral barriers and offer guidance on how to overcome them in your practice. The CAO’s recent position statement on Children’s Vision Screening and Comprehensive Eye Examinations further emphasizes the need for parental and community education.

Eye Digest Magazine | 49

Challenge #1

Lack of Regular Eye Exams Among Children.

The percentage of Canadian children undergoing regular eye exams remains low.

A 2023 study revealed that while 81% of parents had taken their child to the dentist within the past year, only 52% had taken them to an eye doctor7.

Given the estimate that by 2050 half of the world’s population will be myopic8, it is critical to improve these statistics and ensure more children receive regular eye exams. Addressing this gap is essential to safeguarding children's vision and supporting their overall development and educational success. This starts with identifying the behavioral barriers that create this challenge, these include procrastination, lack of perceived importance, and parental attitudes towards eye care.

Below are ways to help address these behaviors: Nudges: book the patients next appointment before they leave their appointment create a reminder system such as appointment scheduling apps, SMS reminders or digital postcards.

Social Norms: Emphasize the importance of regular eye exams by showcasing their benefits and creating a sense of urgency through testimonials and community initiatives. A notable example is the "EyeLearn" program, created by the BC Doctor of Optometry (BCDO). This initiative is a children’s vision program that focuses on outreach and education of key stakeholders regarding the importance of vision for learning, the value of a comprehensive eye examination, and modern children’s vision needs including screen time recommendations.

Habit formation: When speaking to patients who are also parents, encourage them to establish eye care routines for their children from a young age and underline the importance and benefits of bringing their child in for an eye exam.

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Challenge #2

Involving the Entire Office Staff in Myopia Management.

For your myopia management practice to be successful, it’s crucial to engage your entire team.

Below are four strategies to engage your office staff:

From the initial booking conversation by reception, to the waiting room and pretests, there are a lot of touchpoints where you can inform patients about myopia management and if your staff is not part of the solution, this becomes a challenge. Potential barriers to engagement include lack of awareness, resistance to change and time constraints.

Social Norms: Foster a culture of collaboration and teamwork by highlighting success stories and recognizing staff contributions during your weekly or team meetings.

Nudges: Implement small visual changes in your office space to make myopia management practices more visible. Seeing is believing! Talk to your rep about getting more assets.

Training and education: Provide comprehensive training sessions on myopia management for all staff members to increase their knowledge and confidence.

Incentives: Offer rewards or incentives to motivate staff members to actively participate in myopia management initiatives.

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While we only scratch the surface of how to overcome these challenges using behavioral science, one thing is certain: children’s eye health is and will always be a top priority.

At EssilorLuxottica, children’s eye health is a priority.

Specifically, we believe it is our responsibility to lead the fight against myopia and help all children see more and be more. Through strategic partnerships with key global players, we are making significant strides. Currently, we collaborate with three leading organizations: the International Myopia Institute, Myopia Profile, and the Global Myopia Awareness Coalition.

These partnerships drive meaningful impact and are just the beginning.Our goal is to continue expanding our global partnerships to better understand the pathways for myopia onset and progression,

advance innovative solutions, and educate and equip healthcare professionals to manage myopia effectively. Together, we can combat this critical visual health condition.

On a local level, we are committed to empowering Canadian eye care professionals (ECPs) with the best possible solutions for their young patients. Essilor's Stellest® lenses, our premier solution against myopia, is now available in six new sun tints. This allows children and teenagers to wear Stellest® lenses for outdoor activities, providing protection from sunlight. We also offer comprehensive educational content for ECPs and their teams through Leonardo, our digital learning platform.

Additionally, we are investing in the children's eyewear category with our latest offer, Kids Complete Pair. This initiative, a first in the Canadian market, provides compelling incentives when EssilorLuxottica kids' lenses and frames are ordered together. Through these tools and initiatives, and by continuously raising awareness about the importance of eye exams for children, we aim to make a significant impact on children's eye health in Canada. We hope you will join us in our mission to help all Canadians see more and be more.

References 1.Yang M, Luensmann D, Fonn D, Woods J, Jones D, Gordon K, et al. Myopia prevalence in Canadian school children: a pilot study. Eye (Lond).

2018;32(6):1042-7 2. Yang M, Luensmann D, Fonn D, Woods J, Jones D, Gordon K, Jones L. Myopia prevalence in Canadian school children: a pilot study. Eye (Lond). 2018 Jun;32(6):10421047. doi: 10.1038/s41433-018-0015-5. Epub 2018 Feb 2. PMID: 29391573; PMCID: PMC5997685.

3. Compared to single vision lenses, when worn by children at least 12 hours per day every day. Bao, J., Huang, Y., Li, X., Yang, A., Zhou, F., Wu, J., Wang, C., Li, Y., Lim, E.W., Spiegel, D.P., Drobe, B., Chen, H., 2022. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial, in China.

JAMA Ophthalmol. 140(5), 472–478.

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4.Proof Strategies. (2023). Canadian Families of School-Aged Children: Myopia Survey.

5. Eyeglasses for Global Development: Bringing the Visual Divide; World Economic Forum, Social Entrepreneurs, EYElliance; June 2016.

6. Essilor See Change - Put Vision First global campaign 2017.

7. Proof Strategies. (2023). Canadian Families of School-Aged Children: Myopia Survey.

8. Brien A. Holden, et al, (2016). “Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050”.. Ophthalmology, 123(5); p 1036-1042.

slow down myopia progression by 67% on average**, compared to single vision lenses, when worn 12 hours a day.

* Essilor, #1 in spectacle lenses worldwide - Euromonitor, Eyewear 2021 edition; Essilor International company; worldwide retail value sales at RSP. **Compared to single vision lenses, when worn by children at least 12 hours per day every day. Bao, J., Huang, Y., Li, X., Yang, A., Zhou, F., Wu, J., Wang, C., Li, Y., Lim, E.W., Spiegel, D.P., Drobe, B., Chen, H., 2022. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial, in China. JAMA Ophthalmol. 140(5), 472–478. https://doi.org/10.1001/jamaophthalmol.2022.0401

Essilor® Stellest® lenses

Paediatric Eyecare:

7 Tips for Long-Lasting Growth

By Paula Weissman, Vice President Communications, Modern Optical Canada

Youth eyewear represents a growth opportunity for your practice.

Besides creating a child-friendly exam room and dispensary, many factors go into building this segment. With thoughtful intention and these seven guidelines, you can service the whole family for many years to come while cultivating a referral base that will make your practice flourish beyond the back-to-school season.

1. Enlighten Patient Families

5. Source Quality Eyewear Vendors

80% of learning depends on good vision, and the prevalence of myopia is increasing across all demographics. In fact, one in four children have undiagnosed eye issues that interfere with learning.

These stats will stop any one in their tracks; yet, most parents rely on schools to detect vision issues.

Sharing vision health information will help your patient families embrace annual comprehensive eye exams just as they do annual dental and physical exams.

Kids’ eyewear should not be a losing proposition.

Purchasing decisions must incorporate vendors whose product offerings represent quality while hitting the sweet spot in pricing. Established vendor partners who understand managed care and can deliver top of the line customer service will optimize this niche. The ability to offer fashionable, on-trend styles with solid warranties is a must for any practice.

2. Turn One Exam into Several

Online, big-box and discount stores compete every day for consumers’ attention. Educate your patients on the unique advantages of coming to your fullservice practice: comprehensive exam, extensive selection of frames and lenses, proper adjustments, and personalized care.

When a young patient is due for an exam, extend your recall process to the whole family. Incentivize full participation by offering family discounts for frame/lens packages. A strong selection of frames representing preschool through college is essential to being a full-service practice.

3. Make 2nd-Pair Sales Standard Lost or broken glasses and computer eyewear go hand-in-hand with outfitting a family’s eyewear needs. Make this a win-win conversation with a buy one, get one offer. Today’s value eyewear has never been better, so carrying a range of frames in this category will score big with parents' limited budgets.

6. Compete with Confidence

7. Nurture Your Referrals Building a network of referrals does wonders for growth.This most obviously starts with your present patient base who deserves to be rewarded for recommending your practice. Next, earn the trust and respect of local primary care providers, hospital pediatric departments and school nurses. Reach out to parent groups and offer to lead a discussion on digital eye strain, for example. The possibilities are endless.

4. Relate to the Teen Scene College-age students are a big part of the youth eyewear segment, so be ready to speak their language. What do they know about computer eyewear? Are your frame styles in line with today’s online marketplace? Do the college students have a second pair? Do they know that sunwear can have prescription lenses?

Eye Digest Magazine | 55

The Impact of Optomap in Pediatric Optometry In the world of pediatric optometry, advancements in imaging technology are transforming how eye care professionals diagnose and manage retinal conditions. One such innovation is the use of true ultra-widefield (UWF™) retinal imaging with Optomap®, which provide detailed images of the retina and uncover issues that might otherwise go unnoticed.

Dr. Sunil Parekh, an optometrist in British Columbia, Canada – who reports that around 40% of his patients are under the age of 40 – shares his experiences with his Optos® Monaco device and the impact it has had on his practice and patient outcomes.

Enhanced detection with UWF imaging to uncover hidden pathologies Dr. Parekh explains how an Optomap is crucial for identifying and diagnosing hard-to-see pathologies, especially in children. He notes that in pediatric patients who are asymptomatic, a quick look might show everything as normal, and many clinicians will conclude that the retina is otherwise good if the patient is seeing well. However, with Optomap, he can pick up pathology that would normally be missed.

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“I once had a teenager come in for contact lenses, and I insisted on a full eye exam since it had been a while since he last had one,” recalls Dr. Parekh.

“Using my Optos machine, I discovered a retinal hole in the far periphery that had fluid filling into it. This was something a simple visual check would have missed, and the patient wouldn’t have known he had a problem until it was too late. I referred him to an ophthalmologist, ultimately saving this from becoming a very major problem down the road."

The Optomap includes a fundus autofluorescence (Optomap af) feature, which highlights retinal structures that are invisible to the naked eye. This capability helps detect significant issues such as optic nerve damage and visual field defects that exams without this technology may miss.

"When examining the optic nerve, it might appear normal, but the autofluorescence can show abnormalities lighting up like a Christmas tree," says Dr. Parekh. “You can't really see what’s going on with the naked eye, but the Optomap shows you so much more, giving you a significantly better understanding of what’s going on.”

“This is only one case being shared but I catch pathology with similar cases like this daily. This truly is the game changer in my practice from a patient care perspective as well as a business perspective”.

Patient reactions, education, Follow-ups, billing advantages, and efficient referrals and positive feedback Patients often react with surprise and appreciation when shown images of their eyes, especially when pathology is detected. The visuals provided by the Optos software, OptosAdvance, makes the abstract concept of eye health tangible for them. This often sparks a newfound interest in understanding the intricacies of their vision and the importance of regular check-ups.

Dr. Parekh notes, "They start to understand the importance of comprehensive eye exams almost immediately. Many are used to quick, routine checks.

They think it’s all eye charts and ‘is lens 1 better or is lens 2 better?’ But when patients get to see detailed images of their eyes, they suddenly realize the depth of the exam. It's a eureka moment for them, and they really appreciate how crucial their eye health is."

Feedback from parents about the use of the Optomap has also been overwhelmingly positive.

When parents see the detailed images of their child’s retina, they are often amazed at the level of detail and the ability to detect potential issues early.

"Parents are very grateful, often mentioning that such thorough exams and advanced imaging were never done previously for their kids. This leads to them recommending our practice to friends and family, and then the next thing I know, I'm seeing their friends and family as well! It’s had an impressive effect on increasing our patient flow."

With an Optomap, eye care professionals can capture detailed images that serve as a reliable baseline for future comparisons. This continuity in imaging allows for the meticulous monitoring of any changes or progression in retinal conditions, ensuring timely intervention and management. This structured approach streamlines billing and follow-ups, alleviating the financial burden that eye care can place on families.

“We can capture detailed UWF images and then compare them over time, billing independently for pathology management. This increases follow-ups and keeps our practice busy. For children, I usually charge a small fee initially and manage follow-ups through billing codes, which parents appreciate as they aren't charged for every visit," explains Dr. Parekh.

Referrals have also become more efficient with Optos. The ability to provide high-quality images alongside detailed notes ensures that specialists receive comprehensive information about the patient's condition. This streamlined process not only saves time but also enhances the accuracy and speed of the referral, facilitating better patient care.

"It's a very simple process to capture images of the pathology,” notes Dr. Parekh. “I just save the image and send to the ophthalmologist with a detailed referral letter (or to my patients when they want it because they are wowed with the image!). This allows them to see precisely what’s going on. It’s really true that a picture says a thousand words!”

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The importance of regular eye exams and maintaining good eye health As Dr. Parekh explains, regular eye exams are vital for maintaining good eye health, especially in children. These exams help detect potential eye conditions early, often before any symptoms arrive. Without regular check-ups, major issues can progress unnoticed, leading to severe complications down the road. Regular exams with Opto map technology ensure that any emerging problems are identified and managed promptly.

"Early detection is crucial. Many eye conditions are asymptomatic, especially among children, and can lead to severe issues like retinal detachment or amblyopia (lazy eye) if not managed early.

Regular exams ensure any problems are caught and treated in time. Additionally, parents should encourage healthy eating habits, ensure children wear sunglasses outdoors, and follow up on any prescribed treatments. We also send out annual reminders for exams and encourage patients, young and old, to come in for a checkup."

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Peace of mind with Optomap UWF technology The Optos UWF device has significantly enhanced Dr. Parekh's diagnostic confidence. Incorporating advanced imaging technology like Optomap in pediatric optometry ensures thorough eye exams, early detection of pathologies, and better patient education and satisfaction. As Dr. Parekh's experience shows, these innovations are vital for maintaining and improving children's eye health.

"It's like having a second set of eyes. I still perform dilation, but the Optos actually enhances dilation, giving me a comprehensive view and ensuring nothing is missed. It just makes me feel like I’m catching anything and everything, and it has significantly improved my practice and patient outcomes."

optomap natural color rgb opto 200° in a Single Shot

www.optos.com

HR’s Role in Creating a Child-Friendly Workplace

By Kiljon Shukullari HR Advice Manager at Peninsula Canada, HR consultancy firm.

Whether you’re an adult or child, visiting the doctor’s office isn’t our favourite thing to do.

Children, especially younger ones, can find routine eye exams scary, which also makes it more challenging for the eyecare professionals who are conducting the exams.

It’s important to ensure your clinic or office is childfriendly, this not only benefits younger patients, but it is also essential for the overall success of a pediatric optometry practice.

Create a Welcoming Environment The first step in creating a child-friendly workplace is designing an environment that is both physically and emotionally comforting for children. This begins with the layout and design of the clinic. You can incorporate more colours or a “kids’ corner.” A few fun additions can make your space more welcoming for younger patients.

Provide Training for Staff who Engage with Pediatric Patients A child-friendly workplace extends beyond the physical environment, it requires staff who are trained and skilled in interacting with young patients.

Consider having specific programs in place such as techniques for communicating with children of all ages, and how to manage their fear by making them feel safe and comfortable.

Child-Friendly Policies Consider revisiting or updating existing policies to ensure they prioritize the needs of pediatric patients and their families. For example, implementing flexible scheduling options can help accommodate the needs of parents who are juggling multiple responsibilities.

You can be proactive and establish protocols for handling challenging situations, such as when a child is feeling anxious. This can include techniques to help make the patient comfortable by playing their favourite cartoon on a TV screen.

Promoting a Culture of Compassion and Patience Working with children requires a high level of empathy and patience, qualities that should be part of the clinic’s culture. These values can be promoted through regular team meetings or recognizing those who have lived the clinic's values by providing excellent service to their patients.

By promoting a supportive work environment, you can ensure that all team members are committed to providing the best possible care to their youngest patients.

Creating a child-friendly workplace in your optometry practice is about creating a clinic that truly meets the needs of pediatric patients. Whether you design a kid friendly space or promote a culture of patience and compassion, it will only help set up your clinic for more success. These strategies can help ensure that young patients have a positive, stress-free experience.

By investing in this specialized training every team member is equipped to create a positive experience for young patients. This not only improves patient satisfaction but also builds a reputation for top tier service in pediatric care.

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