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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In this episode of The 20/20 Podcast, Harbir welcomes back Conor Heaney, founder of Optical Success Academy and owner of Jones & Co., a premium independent optometry and optical boutique in Manchester, UK. This conversation was so packed with value that it has been split into two parts. In Part 1, Harbir and Conor explore what it really takes to move an independent practice forward—not just by working harder, but by stepping back, gaining clarity, developing your team, and implementing changes consistently.

Harbir shares his own experience after spending the past year inside Optical Success Academy, including the practical changes that have made the biggest difference at Clarity Eyecare. From weekly team meetings and better phone conversations to creating a more intentional patient experience, this episode is full of real-world lessons for practice owners who want to improve their leadership, team culture, and patient journey.

Conor also breaks down the idea of “critical non-essentials”—the small details that may not seem directly related to optometry, but completely shape how patients feel about your practice. Whether it is the way a patient is greeted, how your space looks and feels, or something as simple as offering a drink, these moments can elevate the entire patient experience.

This episode is especially valuable for independent practice owners who feel busy, stretched, or stuck in the day-to-day. If you have ever felt like you are trying to “brute force” your way to growth, this conversation offers a more thoughtful path forward: better leadership, stronger implementation, more intentional team development, and a renewed focus on creating an experience patients remember.

Key Takeaways

Working harder is not always the answer.

Many practice owners get stuck trying to solve problems by doing more of the same. Conor explains why growth often requires pausing, reflecting, and making strategic choices instead of simply seeing more patients or putting out more fires.

Weekly team meetings can transform implementation.

Harbir shares how blocking dedicated time for team meetings became one of the most impactful changes in his practice. Those meetings created space to discuss challenges, celebrate wins, train the team, follow up on new systems, and keep important ideas from falling through the cracks.

The patient experience is shaped by more than clinical care.

Conor introduces the concept of “critical non-essentials”—the non-clinical details that strongly influence how patients perceive your practice. These may include the environment, music, hospitality, drinks, and the overall feeling patients have when they walk through the door.

Guest Info

Conor Heaney is an optometrist, practice owner, and founder of Optical Success Academy. He owns Jones & Co. in Manchester, UK, a premium independent optical boutique known for its elevated eyewear experience and strong focus on service, leadership, and practice differentiation.

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In this solo Eye2Eye episode, Dr. Harbir Sian reflects on the idea of detachment through a recent road trip experience that swung from an incredible high to an unexpected setback. After a spontaneous series of events led to seeing Lionel Messi score a hat trick at a World Cup match in Kansas City, the next day brought a very different turn: the truck broke down in Colby, Kansas, forcing everyone to adjust their plans.

The episode explores how detachment does not mean being emotionless or disconnected. Instead, it means enjoying the highs without assuming everything will keep going perfectly, and handling the lows without letting them ruin the bigger journey. Harbir connects this lesson to the Stoic concept of amor fati, or love of fate, encouraging listeners to accept what comes, adjust, and focus on the next right step.

3 Key Takeaways

1. Detachment helps us handle both highs and lows.

When things go amazingly well, it is easy to assume everything will continue that way. When things go wrong, it is easy to feel like the entire plan is ruined. Detachment gives us space from both reactions.

2. Life rarely follows the exact itinerary we create.

Even the most carefully planned trip, project, or life path can change unexpectedly. The goal is not to avoid disruption, but to stay calm enough to figure out the next right step.

3. Amor fati is about accepting the path, not resisting it.

Harbir reminds listeners that loving your fate means being grateful for the experience in front of you, even when it does not match the version you planned.

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In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Donna Mikulecky, Executive Director of Optometry Giving Sight, to discuss how the organization is helping build sustainable optometry services around the world. Donna explains that Optometry Giving Sight focuses on preventing vision impairment and blindness caused by uncorrected refractive error, with a mission that goes beyond short-term vision missions. Instead, the organization helps fund long-term infrastructure, including optometry schools, vision centres, and community-based programs that continue serving patients long after initial support is provided.

The conversation explores the real-world impact of access to eye care: children staying in school, adults being able to work, families becoming more independent, and local communities gaining employment opportunities through sustainable eye care systems. Donna also shares how optometrists, clinics, corporate partners, and patients can support Optometry Giving Sight through programs like the World Sight Day Challenge, Team OGS, patient rebate donations, and practice-based fundraising campaigns. The episode also addresses common questions around charitable giving, including where donations go, how grants are awarded, and how Optometry Giving Sight monitors the programs it funds.

3 Key Takeaways

1. Optometry Giving Sight focuses on sustainable eye care, not just temporary aid.

The organization supports long-term solutions such as optometry schools, vision centres, and local eye care programs that remain in communities and continue serving patients over time.

2. The impact of vision care extends far beyond glasses.

Access to eye care can help children succeed in school, allow adults to work, support family independence, and create career opportunities for local eye care providers.

3. Every optometry practice can participate in giving back.

Whether through the World Sight Day Challenge, Team OGS, donating a portion of frame sales, encouraging patient rebate donations, or sharing OGS content online, practices can make giving part of their culture in a simple and meaningful way.

Learn more and contribute to Optometry Giving Sight at givingsight.org

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In this episode of The 20/20 Podcast, Dr. Harbir Sian speaks with Dr. Peter Rozanec, a Waterloo-trained optometrist, longtime Mississauga practitioner, and founder of the Canadian Optometry Group, Canada’s largest online community for optometrists.

Dr. Rozanec reflects on his 36-year career, from buying his first practice before graduation to becoming an early adopter of technology in optometry. He shares stories about the early days of the internet, building websites, purchasing LASIK-related domain names, launching an optometry podcast in 2009, and later creating COG as a national forum for Canadian ODs.

The conversation also explores the role of AI in optometry. Dr. Rozanec takes a balanced view, describing AI as a useful tool and “intelligence amplifier,” but not a replacement for optometrists. He emphasizes that clinicians still need strong foundational knowledge, critical thinking, and good judgment when using new technology.

The episode closes with advice for students and new grads: be confident, stay curious, keep reading, and remain grounded in science. Dr. Rozanec reminds listeners that optometry has always faced disruption, but the profession continues to adapt because people will always need people.

3 Key Takeaways

1. AI will likely support optometrists, not replace them.

Dr. Rozanec believes AI will become a useful supplement in optometry, especially for tasks like documentation, transcription, and information processing. However, he cautions that AI still requires human judgment, clinical knowledge, and context.

2. Technology is most powerful when it improves human connection.

From early internet tools to future AI scribes, Dr. Rozanec’s view is that technology should free optometrists to spend more time with patients — not create more administrative burden. The ideal technology works quietly in the background.

3. Community matters, especially during times of uncertainty.

The Canadian Optometry Group has become a trusted space for Canadian ODs to exchange ideas, ask questions, and support each other. Dr. Rozanec highlights how professional communities become especially valuable during periods of disruption, such as COVID, political challenges, and industry change.

Join the Canadian Optometry Group:

canadianoptometrygroup.com

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In this episode of The 20/20 Podcast, host Dr. Harbir Sian sits down live at the BCDO Conference with the one and only Dr. Richard Maharaj, widely known in Canadian optometry as the “Dry Eye Jedi.”

Dr. Maharaj is the Managing Partner of Optometry Services at Prism Eye Institute and one of the most respected voices in dry eye disease, ocular surface disease, chronic eye pain, and optometric research. But this conversation goes far beyond tear breakup time, MMP-9, meibography, and treatment algorithms.

Instead, Harbir and Richard explore the human side of clinical care: how we speak to patients, how we handle chronic pain, why patients often carry anxiety into the exam chair, and why clinicians need to pause before delivering information that may unintentionally create fear.

The episode dives deep into the biopsychosocial model of pain, the difference between pain and visible clinical signs, how to approach patients with symptoms that do not match what we see on the ocular surface, and why mental health support can be an important part of the care pathway.

Dr. Maharaj also shares emerging insights into the role of vitamin B, vitamin D, nutrition, corneal nerve health, oxidative stress, and ocular surface disease, including how B vitamins may support patients with chronic ocular pain and neurosensory symptoms.

This is a reflective, clinically rich, and deeply human conversation about dry eye, pain, gratitude, patient communication, and the responsibility optometrists have as trusted healthcare providers.

3 Key Takeaways

1. Chronic eye pain must be understood beyond the ocular surface

Dr. Maharaj explains that pain is not simply a direct reflection of visible tissue damage. In many patients, especially those with chronic ocular pain, the experience of pain is shaped by the brain, psychology, anatomy, and social context. Optometrists need to recognize that “normal-looking eyes” do not mean the patient’s symptoms are not real.

2. Patient communication can either calm or catastrophize

Patients often come into the exam room after consuming online information about dry eye, gland loss, or chronic disease. Dr. Maharaj encourages clinicians to avoid fear-based messaging and instead focus on measurable improvement, realistic timelines, reassurance, and clarity. Most patients improve, but they need to understand that progress is not always linear.

3. Nutrition may play a growing role in ocular surface disease

Dr. Maharaj discusses emerging research around vitamin B, particularly B12, in corneal nerve health, oxidative stress, and chronic pain. While topical treatments and procedures remain important, nutrition and supplementation may become an increasingly relevant part of dry eye and ocular surface management.

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