Myopia Control

Are you myopic?  (pssst: That means that things up close aren’t as difficult to see as things far away.)

So what does that mean? Let’s take a look at a standard eye chart.

Snellen Visual Acuity Eye Chart











The proportions are different of course if you are looking at a real chart which should be positioned at 20 feet away.

For me, without my glasses/contacts I can’t see any of the letters on this chart. Even the big E you see at the top my eyes are so myopic I still can’t make out it. How did this happen? Genetics?

Blame the parents right!? Funny thing is that neither of them are even remotely close to how myopic I or my 3 siblings are. Well “sure, maybe it skipped a generation or something” you might say. But then I look at the rest of my relatives even from multiple generations ago none of them are nearly as myopic as I am.

Now that I’m an optometrist I’ve done quite a bit of research on this topic. The incidence of myopia is reaching epidemic levels. In countries in South East Asia, the vast majority of kids are myopic when they reach 19 years old. I’ve seen studies that have it at even 80-90%! Those are staggering numbers. It’s more appropriate to ask “who doesn’t need glasses” then to ask who does!

In the United States, the same story. Studies have shown a big boom of a 60% increase from the 1970s vs the early 2000s. I bet if they did the study again today in 2015 the numbers would be even higher! It is becoming epidemic. Genetics can’t be only to blame, it has to due with certain environmental stress factors. So what can we do about it for our children since it’s too late to stop myopia now that it is set in us older adults?

Start with the easy stuff. Go outside, play, exercise, stop texting your friends and just talk to them face to face. Studies have shown again and again that outdoor activities versus those children who spend their days inside glued to a book or video games are less likely to develop myopia.

Go see a good optometrist. When I say “good” optometrist I mean one that will take the time, quality time,  and discuss things you can do to control myopia in a growing child who’s vision is deteriorating. They should recommend visual hygiene, regular eye checkups, and myopia control interventions such as corneal reshaping, orthokeratology, or even atropine treatment.

It’s too late for me, but whenever I see a young kid with glasses. I cringe to think the ship by sail and it become too late to change their fate once they get older.

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ALS Ice Bucket Challenge

The ALS Ice Bucket Challenge is one of the smartest, most viral, charity methods to raise awareness and money I have ever seen. It really is a thing of genius. It’s chain mail meets social media meets feel good charitable cause all rolled into an event where people dump ice water on themselves in front of the cameras.


I love it! Basically you are challenged by a friend to dump ice water on your head or donate (or better yet, both!). Even if you decide not to donate a single penny, just the act of dumping water on your head and posting to facebook for all your friends to see is HUGE. You know how many marketing dollars are spent on that type of awareness? I bet just posting it to your facebook page would normally cost a marketing person thousands of dollars alone to get the same type of awareness.

I’m all for it. So far I believe they’ve already raised over $70 million dollars. Incredible.

My Life’s Greatest Achievements Are…

Other people’s achievements! Serious! Just received word today that a pre-optometry friend just got accepted into SCCO. Super stoked for her.

This has been a growing trend in my life. I remember 10+ years ago, my friend Eric was applying to colleges. He had okay grades, but a terrible SAT score and his personal statements were in tatters.

I gave him all my SAT books. We sat through and worked through some of the problems giving him trouble. I looked over his personal essays and restructured and cleaned some of them up but still keeping true to his original voice and unique personal story.

I’ll never forget that morning. It was probably 10am on a random Thursday. My roommates were slowly waking up – early for them and I got a phone call:

“Thanh, I got into UCLA!”

“What the heck?!!?! Really???”

“Yeah man!! I made it. Thanks to you man.”

I slammed the desk so hard my roommates thought a burglar was breaking into our 125 sq foot dorm room. I was ecstatic, I wanted to yell “we made it!!!” when in fact it was just Eric who had made it and that I had barely done anything.

I remember when I got into undergrad, optometry school, graduated from optometry school, started my first job, all these were important milestones and I was very happy. But when I look back, nothing compares to the sheer elation and un-fakeable truth that I feel the GREATEST accomplishments when I am somehow involved in the success of others.

True story!

The E-Myth Optometrist By Michael Gerber

Do you hear this from business owners? “I wish I could just work 9-5 and go home without thinking about the business like my workers.”

There is a great book out there written by Michael Gerber about running a successful small business. The first thing the book points out is a fatal flaw that most people enter small business doing.

1. “Most small business owners are excellent technicians that one day decide they hate working for someone else and to start up their own business. These new business owners assume that because they are great at the technical work, that owning a business will come naturally. This is a fatal error. For the business to succeed, there needs to be equal attention to wearing the “manager” and “entrepreneur” hat as much as the technician hat.” (Gerber E Myth)

Thus most business owners spend their time like this:

70% technician – supplies output

20% manager- supplies order and system

10% entrepreneur – supplies the vision

Because the amateur business person does not devote enough time to properly manage and lead his or her business into the future, eventually even doing the technical work becomes frustrating.

The key solution the book provides is to:

Create a business from the start with the attitude as if you are building the prototype business in which to start a franchise or a turn-key operation which can be duplicated multiple times over again without you there. To achieve this your model must be foolproof where even the lowest skilled people can work and achieve great success due to the systems you have put in place. This makes it so that specialist with extraordinary skills really are not needed. In the optometry world, this is the Lenscrafters of our world. They open various locations in diverse areas and are extremely successful.
In order to create this you have to be religious about creating systems to treating problems. So when a patient complains about their glasses you have a system that is uniform to handle all scenarios. There is no “one-off” approach to dealing with a problem as it comes but rather everything is a system-based approach to preventing future problems from occurring. This plugs leaks as you go along versus bailing water constantly to stay afloat.
Also, your systems must be in writing. How to use the Auto-refractor, how to use the lensometer, glaucoma evaluations, all these things must be written down so that without you there your employee can always revert back to a standard operating procedure. How to schedule contact lenses exams, orders, glasses orders everything.

Innovation: You will want to be innovative and make changes, however, any change you make you must quantify the results and goals. From there you can build a database to track your progress and relentless try to improve the numbers.

After innovating and validating your new ideas with quantification you can streamline and improve orchestration.

Before you start your business you should answer the following questions:

1. What do you personally value most in life

2. What kind of life do you want to lead

3. What do you want your life to look like

4. Who do you wish to be

You should thus begin with the end in mind.

Organization Strategy:

Having an organization chart is very essential for people to understand what their role is and to be accountable for the task they are given. CEO is at the top, then a person for marketing, finance, and operations below. By creating this organization chart, it forces the business owner to have a blueprint in which to structure the business and grow from.

Each role should have a position title and roles in their contract. The results you want from each person and also how each result will be evaluated is the important task.

Because everything is outlined and all protocols and systems are put in writing, nearly anyone can walk in and work well given the right personality and work ethic. Prior skills and experience are less  important because everyone will have to be taught how business is done no matter how experienced they are.

For all employees they must know that:

1. They are the best and they need to ACT like it and be confident!

2. The customer must always feel as if they are right.

3. New skills and training will provide growth.

Goals need to be achievable so that anyone can achieve them when given the right training and systems. Think about Bill Belichick for the Patriots, it really doesn’t matter who the linemen are or the wide receivers, as long as you play your role and do everything Belichick asks you will succeed in his system (and generally make the playoffs!)

According to the book, most consumer buying decisions are made subconsciously and irrationally. So you have to understand your market better than the customer themselves. Know:

1. Demographics – you have to ask them questions about themselves in the health history forms. Create a profile of each customer, their lifestyle, family etc.

2. Psychographics: ask them their favorite color, word and shape preferences, and brands that they gravitate towards. Then craft your marketing messages based on this. For instance, Apple was targeting hip youngsters for their iPODS so they would have young people dancing. Also in their Mac vs PC commercials the PC was seen as old and nerdy vs the hip and cool Mac guy.

Create systems for everything: For instance for point of sales the keypoints are:

1. Scheduling an appointment

2. The eye examination

3. The solutions associated with eye examination. (glasses? contacts? surgery? VT? Orthok?)

For each of those benchmarks you need to create a script that has been fine-tuned with testing. Each script will have documented supporting material (handouts, pictures, demonstrations, videos etc).

All doctors and staff need to memorize a similar script and then deliver it in a nearly identical fashion (this reduces the “well the doctor recommended XYX and not what you said!”). So even if you have a doctor who is a VT or CL expert, they should describe the condition and come up with solutions that are nearly identical to another doctor within the practice – there should be similar practice philosophies.

When testing your marketing, you much measure how many appointments were made, how many people you contacted, and the amount of signups or success after each presentation.

As the business grows, it must enrich and grow the life of the owner. But remember to maintain your hierarchy and that everyone understands their role in your system. Once this is achieved, you can grant them high amounts of autonomy without micromanaging them.

Purchase the book here:

Why Doesn’t Your Staff Do What You Tell Them To?

You know what is a strange occurrence? It’s when you turn to one of your staff members to do something, they nod their head and vow to do it, but then they are back to their old ways one day later. Why don’t they listen to you?

 Pattern Recognition vs. Reasoning System

I learned this important concept from an optometric consultant lecture, and that is, there are 2 systems of the brain- pattern recognition and the reasoning system.

Pattern recognition is our passive way of making decisions and involves less cognitive resources. It runs automatically, subconsciously, almost without thought so it’s easy for us to use. For instance, the posted speed limit is 45mph so I know that I can go 50mph without a problem. Of course if I got a ticket going 50mph I’d be pissed because my pattern recognition system told me that going 5 mph above the limit was A-OK because everyone does it yet I am technically breaking the law.

As an optometric example, what if every time your patient went to your office you made them wait 30 minutes? What would they do next time? What generally happens is that they might come 15 minutes late the next time because their pattern recognition system tells them that it is okay because even though they are technically 15 minutes late, you won’t see them on time anyways so they are within reason.

Unlike the previous scenario, our brain uses its reasoning system to make certain decisions – but unfortunately this system is very taxing to the brain. For a manager, an example of appealing to an employee’s reasoning system would be to tell them to remember to clock in when you see them forget. Or they forgot to call a patient to let them know their glasses haven’t arrived so you pull them aside and try to correct their behavior.

Perhaps you have a script about going over contact lens rebates you want your staff to employ when presenting fees to patients. They understand the training and how all the numbers work, but by the time the next patient comes guess what? They forget all the rebates and just quote the patient their total cost.

Why don’t they present the rebates that you trained them to do? They could, but remember it is very cognitively taxing to do so. It also takes repetition and multiple times to practice in order to embed a new skill or communication style. So as far as solutions go:

Recognize that the easiest way to influence behavior is nothing you say but rather what you do and how you act – this pertains to pattern recognition. Let’s say you get annoyed that you call a staff meeting at 10 o clock, but in actuality the meeting never starts until 10:15 because everyone slowly streams in and gets settled because they also know that the meeting will never truly start at 10:00. The next meeting, don’t wait for all staff members to be present, just start your meeting at 10:00 on the dot and begin discussing your agenda.

After a few meetings, without you saying anything, their pattern recognition system will tell them “meetings always start right on time” without you have to scream at everyone that meetings always start on the dot.

If you have to do something that requires their reasoning system, and thus more cognitive resources (and remember, we are all cognitive misers to an extent, we have limited cognition and are stingy in how we use it) then handle it with more care. Don’t expect a 15-30 minute training session to cement a new system or skill. Train it once, then twice, then a 3rd time and afterwards test them. People don’t do what you expect but what you inspect – so the saying goes.

How much have you failed recently?

I fail everyday and few things have helped me more than this.

If you’re an optometrist, you know what is best for your patients. You know overwearing and sleeping in Acuvue Oasys contact lenses for 1.5 months is not healthy. Your personally have AR coating on your lenses, and if you’re a high myope like me you’ve got Hi Index lenses as well.

My first year out, guess what happened when I had a patient in the chair and it was time to start talking materials or anything that costed money? Imperceptibly, my voice changed just slightly, I lost eye contact, I wavered a little. Why did I do this? Because I hadn’t practiced enough! Or I didn’t want to spend the time to chat about refractive surgery, orthoK, vision therapy, or talking to computer users about CVS or second pairs because I was a new OD falling behind schedule.

I avoided these things because I was afraid of failure. I was afraid to make recommendations to patients because many times they would say no. But guess what? Sometimes when a patient would truly and greatly benefit from one of these recommendations, if I had not practiced it then my delivery would be terrible.

In order to become more polished and decisive in your presentation, you have to fail a dozen or even hundreds of times first. But after you do it and habitually tweak your speech and test it on patients, you will become incredibly refined. Instead of failures, you will have more “yes!” and successes.

SuperCharge your practice with orthokeratology

Rarely can a conference change your entire mindset or way of thinking. We are all aware of pressures coming from all sides for our money for glasses or contact lenses. Medical insurances can be challenging to bill and are always trying to deny rightful claims.

Orthokeratology is an interesting part of optometry. It’s essentially “outside the system.” Vision plans don’t cover it, neither do medical. It can correct for vision and as another benefit also can reduce myopic progression in children. Fees can be very generous and rewarding for an OD. So why don’t more practices do it?

Because it takes a tremendous amount of work, an orchestrated fee presentation, and clinical expertise usually not well taught in school.

However, with an appropriate system in place, you can build a great portion orthokeratology practice. There is no better way to do this than to attend the OAA meetings in Chicago. On top of this, it is mandatory that you signup for the SuperCharge workshop with Dr. Despotidis. He hasn’t paid me to write this blog post, I am just a happy attendee!!

A clip of his workshop posted on YouTube.

Vision Therapy

Vision Therapy is a great part of optometry. A patient yesterday asked me how come more optometrist don’t do vision therapy and I had to think about it for a second before giving the answer. Ultimately I settled on:

1. Lack of interest in working with a pediatric population

2. Lack of training during school

3. Special interest in another specialty such as contact lenses, ocular disease, refractive surgery.

I did not say this to the patient but I think another large reason is because the ODs that I know question the effectiveness and impact vision therapy has on changing lives. You can read all the research you want that proves the efficacy of vision therapy (like the CITT study), but until you have witnessed it yourself you might not buy it. For many children, learning is a long process that can take months at a time. To see true improvement is impossible in the school clinic schedule where you might only see the same patient for 10 weeks before changing your schedule.


For me, I’ve followed the process and development of many young patients and have seen dramatic improvements in a private practice setting. These improvements are easy to see from an OD perspective such as:

Improved NPC, vergence ranges, accommodative amplitudes and facility, oculomotor etc. – to improved scores on standardized tests such as the TVPS.(1% at the initial testing, 90% after VT).

But the real meat of it is the patient response. I’ve had a mom with tears in her eye after graduating her child from vision therapy. I’ve gotten letters, cute finger paintings, and even a chicken feather from one of my kids who apparently raises chickens in thanks for changing their lives.

That’s all the justification I need, forget the rest.


1000 true fans in Optometry

My wife and I have been hooked on this show called “The Voice.” It’s one of those shows like American Idol where people try to become the next big music artist by:

1. singing really really well
2. having a personality where people say “hey! I like her/him!”

They sing their hearts out and try to impress watchers to vote for them. If no one likes them hopefully some hotshot producer gets a whiff and offers them a record deal.

Anyway, thinking about musicians got my thinking about an article I read. It said that to make a livable wage as a music artist you really only need 1000 true fans. These fans will drive 300 miles to hear you play, buy anything and everything you make because they just LOVE you. They’ll buy T-shirts with your quirky saying on them and facebook stalk you like no other.

Thank goodness optometrists are not musicians. Optometrist probably don’t need a 1000 raving fans but the point of this post is that you should have a nucleus of insanely loyal patients. These patients come on time, listen to your recommendations because they know you truly care for them, and recommend the heck of you.

In return you treat them like family, well, at least the good part of the family and not the crazy Uncle Steve who keeps asking for money. This is how you build a practice.

Optometric Communication

One of my favorite quotes is from Ralph Waldo Emerson:

“Who you are is speaking so loudly that I can’t hear what you’re saying.”

I love this saying because it goes back to how to make meaningful change in your life, to create lasting relationships, and to communicate more effectively. As long as I have created consistent principles in myself, then the day to day interactions and word choices pale in comparison to the internal roadmap I follow.

A book I am reading is called “7 Habits of Highly Effective People.” I am only 30% done with it but one of the driving points is that you cannot change another person without first changing yourself. I can’t tell my staff to treat people fairly, kindly, and with legendary customer service that you see at the successful businesses like Nordstrom, Disney, and Zappos and expect them to just turn a switch and start doing it.

If I want to make my optometric staff change, I myself have to become a shining unwavering example day in and day out the model I want them to become. This can’t happen overnight, but with time it will become infectious.


Today was a great day. Because for the first time as a doctor I diagnosed something that would never have been detected otherwise at this stage unless my patient had gotten an eye exam. 36 year old female came in just wanting new glasses. Routine as could be, but when I looked into the back of the eye I saw THIS (see below).



Holy swollen optic nerves batman! Along with VF loss. Referred the patient right away to get emergent MRI. The neurologist did the MRI immediately, which luckily came out negative. Patient is scheduled for a lumbar puncture next Friday and I am waiting for news.

The patient stopped by my clinic after seeing the neurologist and gave me one of the biggest hugs I’ve ever gotten because she thinks I might have saved her life. Maybe I did, and it was a great feeling!


Patient came by the office. Lumbar puncture revealed elevated CSF pressure. I asked the patient if she was taking an oral med now like Diamox and she was floored: saying “Dr. Mai, are you a neurologist on the side, that’s exactly what the neurologist put me on!”

Neurologist told her that she could have went blind if I didn’t catch it and so he was impressed by her optometrist!