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

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

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

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

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

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

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

3 Key Takeaways

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

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

2. Beauty routines should be discussed, not dismissed.

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

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

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

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

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

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

Key Takeaways

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

Free Report from Conor Heaney

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

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