EyeDigest Magazine September 2022

CONTENTS

Practice Management & Industry

2023 BCDO Annual Conference

OPTOFAIR

The Potential of Artificial Intelligence in

Fear Digital Disruptors

A Case for Synchronous Ocular

Acuvue: Life demands more of our eyes

Education for Doctors and Patients

The Scotia Professional Plan for

Planning

Morel: Life begins with

Best Practices

Law Solutions

4 HR Best Practices for Handling Poor Staff Performance at Your Clinic

Alcon: Total 1

Alcon: Precision1

Fitscan

Spotlight on a Member

Member Spotlight - Dr. Alexander Jobe

Programs & Events

BCDO PR Collateral Form

BCDO Annual Conference

BCDO Annual Conference

BCDO Upcoming Events

BCDO 2022 Public Education

OPTOFAIR

Gallery

You Interested in Locum Work?

Us Know!

The Potential of Artificial Intelligence in Optometry

By Maria Sampalis Founder of Corporate Optometry

Artificial intelligence is a branch of computer science that uses various techniques that aim to mirror human intelligence. One AI technique is machine learning, which relies on vast data sets to learn and predict results without human inter vention.

Artificial intelligence has slowly made its way to optometry as well. It is unlikely that AI will ever replace an optometrist but it does have the poten tial to ease many aspects of their jobs.

This doesn’t mean that robots will be running around in our healthcare facilities; rather, AI focuses on a large amount of patient data to give

insight into diagnosis and treatment methods.

Let’s look at how it has the potential to change an optometrist’s practice.

Streamline Management

Software is coming to the market that provides autonomous management of tasks related to patients. Repetitive tasks like scheduling, bill ing, and follow-ups can be done on the fly and updated in patient records as new information is received.

This improves organizational productivity for many optometry practices, making them more

efficient leaving more time to focus on patient care.

Early Detection

One of AI’s advantages is that it can process vast amounts of data more quickly as a computer is doing most of the legwork.

This especially comes in handy when processing optical coherence tomography (OCT) images, retinal images and dry eye. It can look for patterns within these images that optometrists might miss because of the subjective nature by which these images are analyzed.

Diabetic Retinopathy

Machine learning can monitor these images over time and see if any changes are occurring that lead to eye diseases that manifest progressively.

FDA-approved AI systems are already appearing on the market that analyze fundus photography to detect elements of diabetic retinopathy such as hemorrhages, aneurysms, and other lesions.

It can detect these changes early on, leading optometrists to formulate a health plan with the patient. Additionally, this system requires minimal training and can outperform humans.

Glaucoma

Technology to detect other ocular diseases such as glaucoma by fundus photographs, optical coherence tomography (OCT), and visual fields is currently in its early stages.

AI is beneficial for open-angle glaucoma cases where symptoms don’t typically exhibit them selves. Since glaucoma can’t be cured, early detec tion may help manage the disease to prevent it from getting worse to the point of severe vision loss or blindness.

Dry Eye

There is also new AI technology emerging in the

dry eye arena.

When it comes to talking to patients about their dry eye disease, a picture is worth a thou sand words. Conversations become easier when you can show a patient an image of their ocular surface. Suddenly it all clicks (pun intended).

AOS is one company that takes it a step further with innovative technology. The platform auto matically grades an image for Bulbar Redness, Injection and Lid Redness. In Staining mode the software counts punctate of a fluorescein image. It can also convert a fluorescein image into 2D and 3D which brings a real wow factor.

The images show patients proof of their condition and the analysis provides context. It’s much like the difference between stating a fact and telling a story.

We can now give meaning to symptoms felt and seen in the eye. And it’s especially useful for assessing progress during follow up appoint ments. Lower redness numbers or lower punctate counts tell me and the patient we are on the right track.

AOS analysis improves patient education which helps boost compliance. Better compliance leads to better outcomes and that leads to happy, loyal patients.

Reduce False Positives

False positives occur when a test result shows that a disease is present when it is not in reality. Here AI can help as well.

By looking at vast amounts of medical data regarding symptoms that a patient presents, AI can predict the likelihood of a disease or condition being present.

As a result, patients can save time by avoiding unnecessary consultations with their optometrist

or an ophthalmologist and save money on unnec essary medications.

In Optometry and Beyond Artificial intelligence is showing its potential in many medical fields other than optometry, includ ing oncology, dermatology, pharmacology, and genetics.

Though still in its infancy, improvements in this technology will help doctors verify their diagno ses and interpret data faster independently.

This does not mean that a doctor’s work will become redundant, as AI algorithms are not yet 100% accurate. There will cases when a doctor’s

AI a tool to benefit the health care provider and the patient.

References

By Jack Persico, Review of Optometry Editor-in-Chief

It wasn’t too long ago that providing eye care was the near-exclusive province of optometry and ophthalmology. Aside from a few simple vision screening techniques used by pediatricians and other family practitioners, if you wanted your eyes checked out, you got in a car and drove to see an OD or an OMD. That model isn’t going away any time soon, and it remains the gold standard, but we’d all be remiss if we ignored the growth of alternative modes of eyecare delivery.

The pandemic accelerated some trends that were already in motion, notably the desire or need to provide some semblance of care virtually. Many observers see in the Millennial and Gen Z cohorts a generational shift toward viewing eye care as just one more product to purchase online. That’s an easy overgeneralization to make, but when you grow up conducting much of your day-to-day life online, you see it as the default experience, not an outlier.

Online refraction services get a lot of flak from optometrists—rightly so, they’re terrible—but they do at least show that a market is there for it. It stands to reason that these will evolve and eventually achieve a level of respectability such that ODs themselves might even employ them for limited uses, like doing a contact lens Rx refill on a pre-existing patient who does also periodically come in for an exam.

Telehealth services, after being the only game in town during the 2020 lockdown, looks to main tain an ongoing presence too in optometry. In this month’s 45th annual Technology Report, Marta O’Grady, OD, weighs in on lessons learned and where the experience is heading.

Most ODs think of telehealth as a half-a-loaf-isbetter-than-none method of maintaining contact with their patients, and there’s something to be

said for that view, but it can also expand optom etry’s reach. “As optometry historically moves towards more systemic treatment and collabora tive work with other medical subspecialties, virtual visits may accelerate this pursuit by allowing us to virtually consult in emergency departments with out leaving our offices as well as collaborate with primary care practitioners, internists, nutritionists and neurologists,” writes Dr. O’Grady in her article

Artificial intelligence—covered this month by Lauren White, OD—is another way technology is disrupting the delivery of eye care. AI-powered cameras that screen for diabetic retinopathy in GP offices and drug stores may not yet be common place, but there’s every reason to expect that’s coming. These tools can also come in handy for optometrists, serving as sort of an instant consult with a digital retina specialist. As Dr. White writes, “Al can democratize fundus photo interpretation by leveling the playing field for providers with

varying clinical expertise.”

These technology and market-driven changes were part of a wide-ranging discussion held last month at New England College of Optometry. For me, the take-home message was this: even if these trends and tools aren’t ready for prime time, it behooves us to reckon with them now so they can support optometry’s general ethos and commitment to patient care. Otherwise, we stand vulnerable to outside forces that see only profit and conquest in the disruptive power of new tech.

A Case for Synchronous Ocular Telemedicine

By Drs. Alexander Jobe, Cindy Shan, and Lauren White

Optometry is a profession that has evolved and widened its scope of practice each generation to better serve its patients. Interest in telehealth is the latest advancement that has accelerated since the COVID-19 pandemic. Telehealth is already used in optometry. Applications have included problem-focused at-home exams, remote health monitoring, asynchronous screenings, and

synchronous ocular telemedicine. This article will focus on synchronous ocular telemedicine. In this modality, a patient presents at an office fully equipped for an examination, while the doctor is located remotely. Ocular disease diagnosis and management can be performed with appropriate patient selection and quality data.

In synchronous ocular telemedicine, eye exam inations are performed while the doctor and the patient are separated by space. When a patient presents for an exam, they are asked to complete an electronic intake to ensure they are an appro priate candidate for the platform. Afterwards, like in most offices, a trained technician performs a standardised set of pre-testing including pupils, ocular motility, colour vision, stereopsis, fundus photography, OCT, automated visual field, and video-recorded biomicroscopy. Data is uploaded to PIPEDA compliant servers where an optome trist or ophthalmologist can interpret them. Next, the eye care professional remote controls a digi

tal phoropter coordinated via live video confer encing. The results of all tests are consolidated and a treatment/management plan is designed. A patient is asked to return for follow-ups or referred for further tests to in-person optome trists or specialists, as needed.

When implemented responsibly, synchronous ocular telemedicine increases direct access to eye care and has been used to diagnose and manage a myriad of diseases. The following case report is one example of having access to a facility offering comprehensive eye exams through synchronous ocular telemedicine.

Case Report

Initial Visit

A 32-year-old Caucasian female attempted to schedule an appointment with her optometrist, but was unsuccessful due to lack of availability. As an alternative, she presented to a clinic providing synchronous ocular telemedicine. She reported concerns of increased blur, mild photophobia, and a headache that had evolved from worsening at the end of the day to becoming constant. She denied trauma, weakness, numbness, sudden loss of vision, or diplopia. She denied significant ocular or systemic history. She reported no use of ocular or systemic medications. She reported a family history that is non-contributory to this case.

Her entering uncorrected visual acuity was 20/20 OD and OS. EOMs and pupils were within normal limits. Colour vision was normal OD and OS. Her IOP was slightly elevated at 23mmHg (540um CCT) OD and 25mmHg (539um CCT) OS. The 24-2 visual field was free of defects OD and OS. Her subjective refraction indicated +2.00sph OU.

Biomicroscopy was significant for mild lid erythema, 1-2+ papillary reaction on the inferior palpebral conjunctiva, increased tear meniscus and trace SPK inferiorly OU. These findings indi cated mild dry eye disease. The anterior chamber was deep and quiet. The lens was clear.

Fundus photography and OCT scans of the optic nerve and macula were unremarkable. The vitre ous was clear. The optic discs were pink, flat, and round. The cup-to-disc ratio was measured to be 0.4 OD and 0.5 OS. The maculae were flat & intact. The posterior poles and vasculature were normal.

The patient was flagged as a moderate risk glau coma suspect due to her slightly elevated IOP OU and slight disc asymmetry. She was diagnosed with latent hyperopia resulting in asthenopia and was provided a glasses prescription for concen

trated near tasks. She had a secondary diagnosis of dry eye disease and was educated on the bene fits of artificial tears. The symptoms from asthe nopia and dry eye matched her chief complaint of blur, light sensitivity, and worsening headaches. She was asked to return in 5-7 days to recheck symptoms and monitor improvement.

1st Follow-Up

(9 days after initial visit)

The patient presented 9 days later with increased “fog” in the right eye and a new “sparkly” phenom enon. She reported increased headaches that originated at the base of the neck and radiated towards the right eye. Since her last visit, she had visited a GP and was prescribed Cambia, Trama cet, and Sumatriptan, which provided some head ache relief.

Her entering uncorrected visual acuity was 20/40 OD and 20/20 OS. EOMs and pupils were within normal limits. Colour vision was 8/14 OD and 14/14 OS. Her IOP was still slightly higher than normal, 22mmHg OU. The 24-2 visual field was stable OS, but OD showed a significant diffuse defect, with out a discernable pattern.

Slit lamp evaluation was stable to previous find ings. Angles measured by OCT were open. Eval uation of the posterior pole was significant for a change in the right optic disc, which now had indistinct margins and a smaller CD ratio (0.35). On OCT, the RNFL of the right eye indicated thick ening beyond the normative database.

Based on the right-sided reduced acuity, reduced colour, non-specific visual field defect, and abnor mal OCT, the patient was diagnosed with optic neuritis. She was immediately referred to the ER. She was provided appropriate documentation, which indicated recommended testing of CT, FLAIR MRI, LP, and blood tests to rule-out differ entials for unilateral optic disc edema. Based on the patient demographics and clinical findings,

differentials include auto-immune diseases result ing in optic neuritis (i.e. MS), mass occupying lesions, NAION, and infectious etiologies.

Phone Follow up

(11 days after initial visit)

Four days after the follow-up exam, the patient was called and she reported that she had been assessed by a neuro ophthalmologist. Her CT scans, lumbar puncture, and blood work were within normal limits. Her MRI showed some suspi cious white matter lesions, which indicated a 50% chance of MS. With these results, optic neuritis was confirmed. She had finished IV steroids and

transitioned to oral steroids.

Second Follow up

(4 weeks after initial visit)

The patient presented one month later with improved symptoms. The patient’s examination showed normal colour vision and optic nerves. The optic nerve swelling had resolved, but resid ual paramacular GCL thinning was noted by OCT. She was advised to return for monitoring in six months.

The Role of Remote Optometry

This case highlights the contributory role that synchronous ocular telemedicine brings to the health care system. The case report began with a gap in care caused by the patient's inability to see her optometrist due to scheduling conflicts. This gap was filled by an optometrist using synchro nous telemedicine to provide same-day care. Expansion of telehealth can increase availability appointments for patients.

Second, this case was professionally handled and the patient was referred when the findings indi cated the need for testing and treatment that exceeded the scope of the platform and profes sion. If the quality of care provided to a patient differs between a synchronous ocular telemedi

cine exam and an in-person eye exam, then the platform is inappropriate. While specific elements of a comprehensive eye exam will never be completely replaced by ocular telehealth, the port folio of cases that can be appropriately managed via synchronous ocular telemedicine will continue to expand.

References

FORAC-FAROC Policy on Teleoptometry. Published online September 12, 2020.

Digital Education for Doctors and Patients

By Dr. Diana Nguyen

In the digital world, almost every question can be answered at your fingertips and health topics are often one of the top searches. We’ve all experienced patients searching their diagnosis on the internet. They listen to Dr. Google and then ask a series of questions in our chairs. Some questions pertain to their condition, but most of the time, the websites they encounter with answers are not credible and instill more anxiety than reassurance.

MyDryEye.ca’s goal is to reduce the dry eye ambiguity on the internet and become an authoritative source for these patients. Each month, MyDryEye.ca releases two blog posts that address common questions asked by patients. There are many blogs outlining intense pulsed light, thermal pulsation therapy and radiofrequency since in-office procedures are now setting the bar as the dry eye treatment standard of care. Dry eye doctors can also direct their patients to these blogs if they have further questions and make counseling more efficient.

Another popular series of blog topics are around debunking dry eye myths. MyDryEye.ca demystifies using baby shampoo for blepharitis, tea bags for dry eye and the toxicity of tea-tree oil for meibomian glands. The blogs also go over conditions in detail such as ocular rosacea, meibomian gland dysfunction and blepharitis. MyDryEye.ca also made a dry eye glossary page that outlines all things dry eye in an easily digestible format.

In addition to the blogs, MyDryEye.ca connects with their patients through Instagram (@ MyDryEyeSpace) and the patient-facing Facebook group (@MyDryEyeSpace).

Educational infographics that correlate to the monthly blogs give a fresh perspective for the visual learner on Instagram. The patient-facing Facebook group allows for patient engagement to ask questions and share their experience as a community of dry eye sufferers. The group is

moderated by the MyDryEye team to answer questions accurately and to guide the patient to a nearby dry eye clinic using the doctor locator.

Speaking of the doctor locator, MyDryEye.ca has a unique feature that allows patients to search by location and specific dry eye procedures. The locator includes all the necessary information for the patient to contact the clinic and outlines what they have to offer for with regards to treatments. The presence of dry eye clinics continues to grow everyday and the locator includes doctors from all across Canada, the United States and Mexico.

With dry eye management and patient awareness evolving rapidly, many doctors want to add dry eye services to their practice.. Fortunately, Learn. MyDryEye.ca was created specifically to aid doctors in gaining the necessary knowledge and skills to treat this new group of patients. Optometrists can learn at their own pace with COPE approved lectures from the Canadian Dry Eye Summit (CDES). If doctors want to implement dry eye in their office, there are videos on everything from practice management, equipment and tech reviews and how to perform various diagnostic and treatment procedures. There is also a valuable section for staff as well. The staff learning center goes over the basics of dry eye and how to perform in-office procedures that many doctors are now delegating to their staff. This learning platform is a fantastic digital resource for the dry eye doctor - beginner or advanced. A bonus of joining this platform is an automatic placement on the dry eye locator.

The digital world is taking off faster than ever, but MyDryEye.ca has learned to grow with it by catering to patients and also to doctors. Knowledge and education is the most powerful tool the internet holds and creating a safe, reliable space is exactly what MyDryEye.ca is all about.

Visit: Learning Platform & Canadian Dry Eye Summit

Reading

By James Thompson FAAO FCOVD Developmental Optometrist

Reading is one of the most complex things a modern brain must do. It requires reprogramming and rewiring of many areas of the brain.

Let's begin with an example. A young patient comes into your office for an eye exam. Her parent says “She is 2 years behind in reading - can you help?”.

We don’t know what to fix unless we know what we are fixing, so let's start with a working defi nition of reading. There are many defi-nitions of reading but we are going to use this one.

Reading is the Sport of Looking at a Series of Words and Converting them into Pictures.

With this definition you can figure where your skills fit into the puz-zle.

The obvious part that we work with is “Looking at a Series of Words”. There is a developmental timeline of when the eyes are op-timized for this sport. Just because you can play soccer at age 6 does not mean you are skilled at soccer. Devel opmentally, EOMs are not at the adult level until 10 years of age. The use of large print in younger years is to allow the eyes to start reading earlier.

Looking requires the use of all of our ocular muscles. Accommoda-tion must be sustained for 20 minutes with minimal fluctuation. The accom modation cannot fluctuate more than 0.5 D before going blur-ry. There should be 2,500 accurate saccadic eye movements during that same 20 minutes. Unfortunately we cannot practically test

ac-commodative sustainability or saccades for that amount of time, so this is where case history questions now become very important. “How long can you read before the words blur or move on the page? How long can you read before your eyes tire?”. Ask the caregiver the question “Does your child need extra help with school? What subject(s)? Since when?”. Do not ask caregivers general questions such as “How well does your child do in school?” Often their answer will be that the child is doing fine, and only later you discover that they have been in a pri-vate school for learning disabilities for 2 years, or that they can only read for a few minutes before the words go blurry.

It is helpful to know how to interpret the responses to these ques-tions. If the words are blurry on one side, then it is a binocular prob-lem. If blur is more generalized, then it is most likely an accom mo-dative problem. If the report is double vision, think recent-onset. Long term diplopia is typi cally reported as blur. If there is a report of reading words backwards, think saccadic problems.

Now it comes time to check out the usual suspects of accommoda-tive in-facility, range of motion, and binocular vision dysfunctions. Perform these tests at the child’s Harmon distance. This can be measured by having them hold a picture book with a couple of words, asking them to read a couple of letters, and measuring the working distance.

The more classic method of Harmon distance is obtained through measuring the distance from their elbow to middle knuckle. These tests will give you a moment in time however, not 20 minutes worth. If you test in primary gaze with phoropter you can get different re-sults than in inferior gaze - typically worse. When doing stereo test-ing have the patient hold the book down and take at least 60 sec-onds to do the test. Ask if the targets are moving.

Things often get better as they get older. The Harmon distance at Kindergarten is typically 30 cm while Grade 4 is much closer to 40 cm - a difference of more than 1 D of accommodation. Additionally, at the shorter distances saccadic distances are greater. Try reading 1 D closer than your natural reading distance for 20 minutes, espe-cially with material that you are unfamiliar with - and remember that for emerging readers, all reading material is unfamiliar. If you want to cut testing to the minimum for the patient with positive case history, have the patient

read out loud below grade-appropriate material. Place +0.50 OU (typically +1.00 does not help) over their distance prescription and ask them to continue reading. If they improve (quality, quan tity, and/or comfort), you may want to continue with more near point testing. If it doesn’t help you may want to consider referring them to a devel opmental, behavioural, or rehabilitative optome trist for a vision therapy assessment.

For first-time prescriptions, ask the child “What happens when I put these lenses in front of your eyes?”. If they respond positively, ask “If I give you these glasses, will you wear them for reading?”. It is helpful to get both child and parent onboard with the idea of glass-es, and important that they know what results the glasses are meant to achieve.

If you want more information contact BCDO, and I will add another couple of articles regarding the other parts of the definition.

Portfolio Planning INC

By Vishal Gill Founding Partner & Financial Planner Portfolio Planning INC.

If you’re a subscriber to Eye Digest Magazine, it’s safe to assume that you’re either an already establishedoptometrist,juststartingyourjourney down an exciting career, or a veteran optometrist gearing up for retirement. No matter your position, perhaps the question of incorporating your optometry business has come up in your practice. Like anything in the financial w orld, this can be a complicated topi, with an equally complicated answer Let’s dive in and try to tease some of these complicated knots apart.

Before asking if incorporation is right for you, it’s important to break down key indicators so you can self-identify whether it’s a good fit or not. As always, we recommend consulting your financial planner and accountant to ensure that this fits into your holistic strategy before moving forward.

Portfolio Planning’s ‘Self-identification Questionnaire for Incorporation’

1. Personal debt - Some of you may enter the workforce with a large amount of student debt and potentially some line of credits. When thinking of incorporating, you want to think of where you need this money to end up. If you need most if not all of your money on the personal side to pay off these loans, then it doesn’t make sense for you to incorporate and pay the extra fees, since you’ll likely end up pulling all the money out anyway You’re better off waiting a couple of years with the side benefits of having increased

RRSP contribution room and more buying power for real estate.

2.Primary Residence – If home ownership is a goal of yours then waiting until you have acquired your primary residence could be a great decision. To reiterate, you may need to pay yourself almost all of your income to qualify for a mortgage. If this is the case, it doesn’t make sense to incur the extra costs of incorporation to eventually take all of your money out.

3.Personal asset classes – RRSP, TFSA, and Primary Residence are all great tax-efficient tools available to you. Many professionals prefer to use their first couple of years to have the income personally, get mortgage approvals, max out their registered accounts, and then incorporate and reduce taxable income to themselves. Following this approach would allow you to keep more money in your corporation and pay less tax while having multiple assets invest and grow for you.

4.Income - Cost of living is different for every person. If you notice through a cash flow exercise that you don’t need all of your income to live off of, incorporation can be very aligned for you. If you incorporate, you can likely only pay yourself what you need to live off. leaving the rest in your corporation, which is subject to far less tax than your personal rates. With this extra money in your corporation, you can now use it for your net-worth goals through corporate investments.

(Be careful with tax rules and the type of income you receive on these.)

5. Large amounts of tax at year-end –Behavioural finance is a constant struggle and it's no secret. The world we live in is meant to keep us spending and deferring our own needs. This can hurt come tax time if you have all this income as a sole proprietor and need to pay a large tax bill. If you incorporate, you can work with your accountant to put you on a payroll strategy and have your corporation remit taxes on your behalf. This will give you income similar to if you had a traditional employment job before. You will receive your money after tax which could help you budget much easier. Extra tip! Be sure to utilize automation to save first then spend what's left over. Your financial planner can help you identify the correct amounts to pay yourself and how to implement this strategy.

6. Scaling your business – If you have become an efficient practitioner and are now looking to increase your income by growing your practice, incorporating can help you reduce your risk exposure. If you don’t incorporate you could have all of your personal assets accessible to creditors. Incorporating, on the other hand, will give you a level of separation from what you hold personally and corporately. This can also allow you to move business liabilities from your personal name to the corporation, increasing your personal buying power with little effort.

7. Private practice – If you have a private practice, chances are that you have already incorporated –and that’s a good thing! Being incorporated will give you more tax planning opportunities during your working career by allowing your team to control how you pay yourself and how you invest. When it comes time to sell your practice, you may qualify for the Lifetime Capital Gains exemption which is currently $913,630

All in all, there are a lot of factors to take into consideration when it comes to incorporation and how it fits into your financial plan. The good news is you don’t have to make this decision on your own.

Portfolio Planning is a team of net worth advisors who work closely with medical professionals and incorporated business owners. Our firm is boutique size and independent, which allows us to serve our clients better and quicker. The team at Portfolio Planning is made up of seasoned financial planners and consultants who are experienced enough to help you with a variety of financial services. Our team has helped many of your colleagues navigate questions around incorporation and so much more.If you’re feeling called to incorporate, book a complimentary discovery call with one of our financial planners. We’ll help you see eye to eye.

Hiring Best Practices

By Harmit Sarai Employment Lawyer, Forte Workplace Law

With the economic rebound generating a demand for workers in recent months, it’s a good time for employers to take a critical look at their hiring process. At all stages, from the job post ing and interview stage to checking references and providing the successful candidate with an employment contract, employers must ensure that they conduct a fair and legal hiring process.

1. Job Posting

A common way for an employer to start the hiring process is by simply posting a job ad. Typically, job ads include the business name, location, position title, job duties, and a list of qualifications and skills expected of the successful candidate.

Before publishing a job ad, it is important for employers to be familiar with BC’s Human Rights Code (the “Code”), which applies to all aspects of employment, including job ads, interviews, and hiring. The Code protects against discrimination, which simply means treating someone badly or denying them a benefit on the basis of a personal characteristic. Employees are protected by the Code from discrimination in hiring or on the job if the discrimination is based on one or more of the following protected characteristics: race, colour, ancestry, place of origin, political beliefs, religion, marital status, family status, physical or

mental disability, sex, sexual orientation, criminal conviction, indigenous identity, gender identity or expression, and age.

Employers should be careful not to publish an ad for a job that expresses a limitation or prefer ence for a protected characteristic. For example, a job ad that reads “The company is looking for a person who is young and dynamic” shows a pref erence for age, particularly young individuals, and would be considered discriminatory. Even though it might not have been the employer’s intention to discriminate against older individuals, the courts have said that having good intentions is not a defence that can be relied on by employers.

2. Interview

After publishing your job ad, you have some great candidates lined up and are now ready to inter view. The general rule for questions during an interview is to ask only what is needed to make a hiring selection based on skills and merit. Employ ers must ensure their decisions are based on crite ria that is related to the job and not any protected personal characteristics.

As an example: Jenny is hiring a receptionist for her busy optometry practice. When she inter views Karen for the job, she strongly suspects

Karen is pregnant. Jenny would like to hire some one who can stay on for the next few years and who can keep working without need for an extended leave of absence, so she tactfully asks Karen if she is pregnant.

If you’re thinking this might be discriminatory,, well, you’re right. This would be discriminatory based on the protected characteristic of sex. Employers should also not make assumptions that a parent will be less committed to their work. If an employer has legitimate concerns about an applicant’s availability for work, such concerns should be addressed through, for example, direct questions about whether the applicant would be available to work night shifts or be able to travel.

Nonetheless, there may be legitimate reasons for an employer to ask questions about a protected characteristic. If a characteristic is required for the job - what’s referred to as a bona fide occupa tional requirement – then an employer may ask about the characteristic.

3. Checking References

What employer out there has ever thought to them self, “Gosh, I really wish I had not checked references!” Nobody.

Generally, it is a good idea to check references. If you could only ask the applicant’s current or former employer one question, this is a good one: Would you rehire this person?

Before you decide to speak to the applicant’s employer, it’s important to be mindful of what the applicant’s contractual relationship is like with that employer – you do not want to be the reason for any conflict. For example, ask the applicant whether their employer knows they are interview ing elsewhere. The applicant might appreciate you telling them that they don’t need to give you their employer’s contact information if it’s going to cause tension for them at work.

As mentioned previously, the Code protects all aspects of hiring. So when you are checking references, be mindful of the questions you ask a former employer and avoid any discriminatory questions about an applicant’s personal charac teristics.

4. Employment Contract

It’s true that verbal agreements can constitute a legally binding contract. However, the thing is, reaching agreements verbally leaves a huge amount of room for misunderstanding. What's more, should the relationship ever go south,

proving that a verbal agreement exists can be extremely difficult. In such circumstances, there is a risk that the employer may be burdened with obligations it never meant to agree to, such as an obligation to pay more severance than the mini mum required by legislation.

Written employment contracts reduce this risk by clarifying entitlements and expectations and limi ting exposure to damages in lieu of termination notice. It’s also just easier to agree on things at the start when there is no friction between the parties. Having a written agreement with an employee means that everything is clearer and more robust, and it gives both the employer and the employee some peace of mind.

Some employers do not know that an employee must get something new and of value, referred to as “consideration,” in exchange for signing a contract that essentially limits their rights. An employment contract without consideration is not legally binding. Often when a new employee signs a contract, they get a job in exchange. Howe ver, if an employee has already started working, they need to get something new in exchange for signing a contract, such as a wage increase or a signing bonus. Without this fresh benefit, the contract will not be enforceable. Best practice is to give the contract to a potential employee as their job offer and have them sign and return the contract before their first day.

The most overlooked section of an employment contract is the termination clause. This section of an agreement can limit the amount of notice or pay in lieu of notice that an employer owes an employee if they are let go from their job without cause (this covers a wide range of reasons, inclu ding lack of fit, restructuring, and poor perfor mance). Employers should make sure the termi nation clause is clear and unambiguous. If you

want to terminate an employee without cause and you do not have a good contract that legally limits what you owe that person, you could owe them up to 24 months of pay, depending on their length of service and other factors (including age, employment position, and availability of similar employment). With a good contract, you can limit your liability to a maximum of 8 weeks – a big difference.

The hiring process is crucial to setting your busi ness up for success. At every stage, from the job ad and interview, to checking references and provi ding the candidate with an employment contract, employers must be mindful of their obligations under the Human Rights Code and Employment Standards Act. Getting legal advice on best prac tices before hiring can reduce risk and help your business grow.

This article is not intended to serve as legal advice, and only provides legal information. Every situa tion must be considered on its own facts. If you need legal advice, please contact us by phone at 604-535-7063 or email info@fortelaw.ca.

Employer Advice: 4 HR Best Practices for Handling Poor Staff Performance at Your Clinic

By Andrew Caldwell HR Advisory Manager, Peninsula Canada

Is your practice finding it difficult to have a conversation with staff about their performance?

Every manager and HR professional has proba bly already had or is planning to have that tough conversation with employees about poor perfor mance. Whether it is about an employee not communicating well with patients or about their overall behaviour, it is essential to carefully plan out how you are going to have that conversation. Otherwise, the wrong things may be said or done.

Below are four HR-approved ways to help get an employee back on track and lead them to success.

1. Identify the problem

When you notice an employee is underperfor ming the first step is to sit down with them and have an informal conversation to find out if they have a reason for under performing. They might be aware that they are, or they could identify that they are going through a personal, family, or health issue. Some employees feel hesitant to talk to their manager if they are going through a chal

lenging time because they think it might affect their future in the company.

Encourage open communication with your employees by having an open-door policy. Reas sure staff that anything they share with you is confidential. Provide constructive feedback and solutions to performance issues. If they are strug gling with work, offer additional training. If they are struggling outside of work, offer an employee assistance program if you have one, or suggest they seek support from a healthcare professional.

2. Improvement plan

In some cases, the employee may not know what they need to improve on. Creating a realis tic improvement plan including goals that need to be achieved by a certain date helps paint a clear roadmap for the employee. Once they have a clear understanding on how to improve, then the employer can have regular check-ins to see the employee’s progress. This also reassures staff that you want them to succeed, and you are doing

what you can to help them get there.

3. Provide resources and training

When talking to the employee, try to think about the current resources and training they have. Is it enough or do they need more? Make sure to ask what they need so you can support them in any way that you can. If they need additional resources and training, take that into consideration. It’s important to think of various ways you can help staff succeed.

4. Documenting steps

It is best to always document any conversation, or the steps taken, while reviewing an employee’s performance. These can be formally documented or done via email. Keeping a record allows

managers to track improvement and to determine what additional steps need to be taken.

5. Offering rewards to deter under performance Awards are a great way to recognize great achievement within the workplace. Providing incentives to all employees to meet certain targets or expectations is a great way to encourage great performance.

Additional thought: offering rewards to employees who are over preforming is an effective way to encourage the employee to continue doing the great work they are doing. Recognizing and appreciating good work keeps staff feeling motivated and valued.

About Dr. Alexander Jobe

Hello! I’m Alexander, my friends call me “Ally”. I’m from a small Ontario town, Port Perry, where I lived while I attended the University of Ontario Institute of Technology (now Ontario Tech University). While at UOIT, I cultivated passions for both neuroscience and computer programming. I also enjoyed volunteering for hundreds of hours in various patient care settings including as an emergency responder. Ultimately, the desire to further understand and apply neuroscience inspired my choice to pursue optometry as a career.

I graduated from the Pennsylvania College of Optometry’s Accelerated Scholars program. While at PCO, I completed an advanced studies certificate in neuro-ophthalmic disease under the supervision of Dr. Kelly Malloy. I was inspired to leverage my affinity for computer programming after working with Dr. James Lewis, an ophthalmologist and software developer, who used his technological expertise to improve the efficiency and quality of his patient care. In optometry school, I often designed computer algorithms to help my classmates and I study for classes and optometry boards. Since graduating, I continue to look for ways to apply programming to optimize my optometric education and patient care.

As of 2022, I spend part of my week working at a full scope private practice and the rest of my time working with and improving the use of synchronous ocular telemedicine to perform routine eye exams and disease management. Outside of work, I enjoy reading, spending time with friends and family, and participating in water and snow sports.

Do you have a specialty? If so, what made you choose it?

Prior to the COVID-19 pandemic, I practiced at an OD-MD clinic in New Jersey where I tailored my clinical services towards neuro-ophthalmic cases. I found working with these patients very rewarding. Despite being complex cases to diagnose and manage, I was able to have significant and lasting, positive impacts on the patient’s health and wellbeing.

Given my strong interests in programming and optometry, more recently, my efforts have been focused on developing and refining solutions for synchronous ocular telemedicine in Canada. This started when I was living in Alaska, where I saw optometrists and nurses working together remotely, via webcam, to provide care to isolated villages that would not otherwise have received it. Since that experience, I have focused my profes-

sional efforts in synchronous ocular telemedicine by building a telehealth system and platform, and developing custom eye care solutions. I have seen thousands of patients through remote modalities and although optometrists can’t formally specialize, I think my diverse experience in telemedicine over the past few years allow me to be an expert, and an innovator in remote eye care.

Who inspires you?

I think the single most inspirational person in my life is my brother and business partner Ryan (pictured). He has been with me since day one and I am constantly pushed to be more like him. He is extremely dedicated, hardworking and has an admirably calm “every problem has a solution” type of demeanor. We are very different people and what I lack Ryan excels at.

He is a gifted engineer and methodically studied the eye care economics to obtain what I consider an expert level of knowledge about how optometric practices run. Without his help I wouldn’t have even thought it remotely possible to spear-head the RemoteOptometry project.

Why is being a member of BCDO important to you?

BCDO has been an asset to me in two major ways. First, the networking and mentorship they provide has helped me develop professionally. Second, BCDO embodies many of my professional

values. For instance, the organization strives to provide equitable and accessible care for everyone, especially marginalized communities. Consequently, BCDO is now a vanguard organization evaluating and leading new developments of synchronous ocular telemedicine. I believe these initiatives will help ensure an appropriate standard of care is established in British Columbia.

What do you value most about being an optometrist?

I truly value being able to use my knowledge and skills in optometry to help people, especially highneeds populations. During my time in rural Alaska, I traveled to isolated villages via bush plane to provide finite clinical care, often to the entire community. I remember a young boy in Kipnuk coming in for his first eye exam accompanied by his entire extended family. I discovered that he had mild myopia and decided to give him a trial set of glasses to try on. Seeing the delight on his face and the sincere gratitude from his family was a moment I will never forget.

That experience granted me the ability to see the impact of providing optometric care, particularly for the patients and families that need it most. I was also struck by the realization that there are still entire communities that have been deprived for generations of a basic service that most of us take for granted.

What would you like to see BCDO accomplish in the next few years?

BCDO has made impressive technological advancements with the introduction of ocular telemedicine into rural First Nations communities this past year. I had the privilege of being involved with the with the launch of this project and was able to meet other optometrists involved in rural eyecare. I would really like to see the BCDO continue to implement telemedicine into other underserved communities in the coming years. I hope the BCDO also continues to introduce its members to emerging technologies while

advocating for the responsible and appropriate implementation of these technologies into our practices.

What new direction would you like to see happen in Optometry?

I hope the optometry community continues to take active and unified roles in developing and incorporating new and emerging technologies. Optometric care will continue to evolve in the office and at-home. I would like for optometrists, rather than external forces, determine the best use of this technology to maintain patientcentered care. Synchronous ocular telemedicine and other emerging technologies are a new reality in optometry and we have the responsibility as a profession to take a lead in its appropriate implementation.

What are 3 pieces of advice you have for New Grads entering the workforce?

One piece of advice I have is to always seek out and build relationships with qualified mentors. Whether they are formal or informal mentors,

someone who has had success in a similar career path will be able to motivate and guide you to help reach your professional goals.

Another piece of advice is to be honest with yourself and your limitations. Don’t be afraid to do further research or to ask a colleague for a second opinion. In fact, the nature of optometry requires ongoing education to stay up-to-date with the newest guidelines. Remaining open to learning as well as any feedback will allow you to adapt your current practices to incorporate the latest treatments and technologies, ultimately, providing the best care possible for your patients.

Lastly, enjoy this journey. We are often so focused on the next step of our careers that we overlook the small triumphs in our day-to-day job. Whether it’s a patient’s gratitude or mastering a new procedure, take time to celebrate your successes. Congratulations on receiving your O.D. and all the best for this next chapter in your life!

2022 BCDO Annual Conference & Opotfair

By Claire Tusiime BC Doctors of Optometry

Overview

The 2022 Annual Conference & OPTOFAIR was held on May 13 – 15, 2022, and was hosted as an in-person event. The conference took place both at the Hyatt Regency Vancouver, where over 350 Optometrists and Optometric Staff gathered over the weekend for continuing education, the OPTOFAIR tradeshow, and social events.

The weekend’s OD Program offered a total of 31 courses providing 36 CE credit hours, and featured 29 different speakers. For the OA Program, the courses were held virtually and OA’s could attend the social events. A mobile app for the conference was also available, providing conference event information and CE session information for attendees to access on the go. To support the conference events and the continuing education courses, 14 corporate sponsors contributed funding to the 2022 Annual Conference & OPTOFAIR.

Awards Luncheon

The Awards Luncheon, hosted by Drs. Errin Bligh and Mahnia Madan, presented the opportunity to recognize and celebrate members, optometric staff and industry who have made extraordinary contributions to the optometric profession. Once again, congratulations to our award recipients:

• President's Award | Dr. Sally Donaldson

The President’s Awards is BCDO’s top award for our profession and has developed to recognize the exemplary and outstanding professional and community contributions made by a member of the British Columbia Doctors of Optometry.

• Optometrist of the Year | Dr. Cindy Ho

The Optometrist of the Year award honours a member who has contributed to the advancement of optometry in a meaningful way over the past year or cumulatively over many years.

• Young Optometrist of the Year | Dr. Kevin Hua

This Young Optometrist of the Year Award recognizes a member with less than 10 years in the field and demonstrates outstanding leadership skills both within their profession and in their community.

• Optometry Industry Representative of the Year

| Ms. Paula Simonsen

The Optometry Industry Representative of the Year award honors a person who has provided exceptional services to our doctors.

• Optometric Assistant of the Year Award | Ms. Melina Malekzadeh

The Optometric Assistant of the Year honours a person who has provided exceptional service.

2022 OPTOFAIR

OPTOFAIR was a lively afternoon where conference delegates took the opportunity to connect with a variety of vendors and suppliers. A total of 55 organizations showcased at this year’s tradeshow, with some exhibitors providing raffle prizes for attendees to have a chance to win during OPTOFAIR.

Cocktail Reception & Annual Conference Gala

BCDO hosted the Annual Conference Gala on Saturday, May 14 at D6 Bar & Lounge at the JW Marriott Parq Vancouver. The spacious, modern space offered a great backdrop for conference attendees and industry partners to mix and mingle while enjoying exquisite food and beverages, with music provided by DJ A-Slam.

Friday Night Social

On Friday, May 13, Alcon hosted a social in conjunction with the Annual Conference weekend, in celebration of the launch of the new Precision 1 for astigmatism contact lens. This event was held at Rosewood Hotel Georgia and kicked off the weekend’s social activities.

BCDO looks forward to building upon the success of the 2022 Annual Conference as preparations are made for the 2023 Annual Conference. The 2023 Conference will be held on May 12 – 14 at the Hyatt Regency, and we look forward to seeing you there!

BCDO 2022 Public Education Campaign Phase

By BC Doctor of Optometry

Overview

Edelman’s 2022 Public Education campaign is focused on increasing awareness of Doctors of Optometry as primary health care providers for eye health. Our focus this year is to position them as a core part of British Columbians’ personal, primary healthcare team, especially for routine eye health and urgent eye issues.

To maximize the efficiency of the campaign

and budget, based on campaign results from 2021, we’ve worked with Edelman to launch a three-phase province-wide campaign spanning paid, owned and earned channels, to target two specific sub-categories: Adults 25-54 who had an interest in health and personal care, and parents with children aged 4-18, letting them know the following:

• Doctors of Optometry are primary eye care providers for urgent and routine eye care

• Protecting your vision through routine, annual visits must be a top priority

Considering the ongoing impact of COVID-19, the Ukraine War, inflation, and many other pressing issues in the news and media cycles, we decided to take a personable, sensible, and sensitive approach to our marketing and communication efforts. Our 2022 concept, “You’ve only got one pair of eyes” features the faces of people from diverse backgrounds, ethnicities, ages and genders in a personal and poignant manner.

Phase 1: Awareness through Paid, Search and Social

The Phase 1 campaign, which runs from May 9 to June 20, 2022, uses Google Search, Facebook & Instagram and programmatic ads, to drive awareness of both urgent and non-urgent eye

care among the target audience and to drive them to the Find a Doctor (FAD) page.

The Google search campaign was activated in May alongside the campaign, and will continue until the end of the year, employing an ‘always on’ approach so that BCDO’s website and content appears when people search for eye healthrelated terms. Organic social channels are also active throughout the year.

By including “call-to-action” language, Edelman focused intensely on the eyes, reminding audiences that they only have one pair of eyes and that when they need urgent eye care Doctors of Optometry must be their first call. This resulted in not only raising awareness but also leading BCDO’s audience to take action.

The campaign delivered over 7.4 million impressions while generating 11,637 link clicks to the BC Doctors of Optometry website. The paid amplification across social and programmatic channels drove strong awareness of campaign messaging, while the search complemented both campaigns by driving lower funnel results. Vancouver drove the highest volume of clicks, likely due to the population size.

For Search, BCDO had the highest search impression share of 27.88% among the top competitors, including Specsavers which was at 11.35%. The keyword "emergency eye care center" drove high Search intent traffic to the FAD page at a clickthrough rate CTR of 31.15% and it was found that urgent care and symptom messaging performed stronger on social and resonated best with an older demographic (A35+). Specsavers appeared to be bidding on BCDO brand keywords but BCDO's share stands at 93% for all types of paid search campaigns that are currently running.

Phase 2: An Integrated Campaign to Re-enforce the Message

Edelman utilized the most impactful findings from Phase 1 to guide digital campaign development for phases 2 and 3. With the findings from Phase 1 captured, Phase 2 of the campaign focuses on targeting an older audience who is more likely to click through to the website with potentially less influence from competitors/fast fashion while also sharing urgent care messaging honed to the unique benefits that BCDO can offer, and aligned to seasonal events to encourage routine adoption (ie booking annual eye care in the fall).

Phase 2, which runs from September 12 until October 24, will use Facebook, Instagram, Google search, and earned media as the primary campaign channels. The primary messaging for this stage of the campaign will focus on Urgent Care, reaching out to adults aged 25-54 years of age.

Paid ad & Google search: we will run social and programmatic paid ads simultaneously to expand reach and campaign efficiencies in order to push our messages to people who don’t necessarily follow BCDO or eye-care related topics, to drive awareness of routine eye health and the importance of comprehensive eye exams as well as introducing urgent care messaging to adults across British Columbia. The always-on paid search tactics will continue by targeting the high intent keywords to keep up with the impression share.

Survey: We will identify the unhealthy eye care habits of British Columbians and assess the level of awareness about visiting an optometrist for urgent eye issues.

Earned: We have worked with Edelman to launch an earned campaign to remind British Columbians who are struggling to see their GPs that optometrists can address their urgent eye symptoms quickly. So far, we have secured interviews with CBC, Omni TV, Fairchild TV and Fairchild Radio. In October, Edelman will leverage information from the 2022 research survey to launch another media relations campaign to highlight the survey results.

Organic social: we continue to create engaging and informative content on BCDO’s Facebook and Instagram channels using our content pillars. Three to four posts are scheduled per month, including one specifically focused on Children’s Eye Health. Utilizing and this year we will work with optometrists on Doctor-Generated Content. By doing so, we will integrate content created by BCDO to show useful information in an authentic way, establishing credibility with our followers and prospective followers.

Website refresh: we will enhance the format and content to make it more user friendly.

Phase 3 – A Personal Approach

The Phase 3 campaign, which runs from early October to mid-November, will transition to focus on Eye Health with an angle aimed toward children’s vision. Facebook and Instagram programming will continue with the introduction of Influencer Campaign, which will be a concept rooted in “You’ve only got one pair of eyes” by showing highlight reels of all of the beautiful moments they saw during their day.

We will continue to work with more members

from BCDO on integrated Doctor Generated Content (DGC) to show useful information in an authentic way, establishing credibility with our followers and prospective followers. This content should continue to be aligned with our existing content themes: Common eye issues, Eye health as self-care, Urgent care / support and Children’s eye health.

Doctors featured should reflect the diversity of doctors within the BCDO membership. All doctors should be given the opportunity to be featured through promotion through BCDO members channels, and it’s likely a direct invitation / request will garner strongest results. Tagging doctors or clinics will improve the performance of the video although is not required. We propose one-two DGC videos per month to assess performance and make ongoing optimizations.

Utilizing Instagram captions and stories’ link stickers, CTA viewers will be directed to the Find a Doctor tool where they will be encouraged to book an appointment with a Doctor of Optometry in their community. Edelman will continue to track how often the FAD tool is used; however, the main objective is always to drive website visits, measured through link clicks. Stay tuned!